Kala-azar is a slow progressing indigenous disease caused by a protozoan parasite of genus Leishmania
In India Leishmania donovani is the only parasite causing this disease
The parasite primarily infects reticuloendothelial system and may be found in abundance in bone marrow, spleen and liver.
Post Kala-azar Dermal Leishmaniasis (PKDL) is a condition when Leishmania donovani invades skin cells, resides and develops there and manifests as dermal leisions. Some of the kala-azar cases manifests PKDL after a few years of treatment. Recently it is believed that PKDL may appear without passing through visceral stage. However, adequate data is yet to be generated on course of PKDL manifestation

What are Signs & Symptoms of Kala-Azar?

Recurrent fever intermittent or remittent with often double rise
loss of appetite, pallor and weight loss with progressive emaciation
weakness
Splenomegaly – spleen enlarges rapidly to massive enlargement, usually soft and nontender
Liver – enlargement not to the extent of spleen, soft, smooth surface, sharp edge
Lymphadenopathy – not very common in India
Skin – dry, thin and scaly and hair may be lost. Light coloured persons show grayish discolouration of the skin of hands, feet, abdomen and face which gives the Indian name Kala-azar meaning “Black fever”
Anaemia – develops rapidly

Anaemia with emaciation and gross splenomegaly produces a typical appearance of the patients

What is Post Kala-Azar Dermal Leishmaniasis (PKDL)?

Post Kala-azar Dermal Leishmaniasis is a condition in which Leishmania donovani parasites are found in skin. PKDL develops in some of the Indian kala-azar patients usually 1-2 years or more following recovery of Kala-azar; less commonly without suffering from Kala-azar

What are Signs & Symptoms of PKDL?

Types of morphological lesions:

Early hypopigmented macules similar to macular lesions of Lepromatous Leprosy but normally less than 1 cm. Usually occur on face but can affect any part of the body.
Later (after a variable period of months or years) diffuse nodular lesions on those macules
Erythematous butterfly rash which may be aggravated by exposure to Sunlight; an early sign of PKDL
Erythematous papules and nodules which usually occur on face, especially the chin.
Lesions progressive over many years , seldom heal spontaneously

Rare manifestations of PKDL include:

Multiple lesions coalesce to form larger plaque type lesions
Verrucous lesions (hands and feet)
Papillomatous lesions (on muzzle area of face, nose, chin, and lips)
Hypertrophic lesions (eyelids, nose and lips)
Xanthematous rash (orange plaque on axillary fold, cubital fossae, inner thighs, outer canthus of the eye and perioral)
Pityriasis rosea like lesions

HIV and Kala-azar co-infection

Visceral leishmaniasis (VL) has emerged as an opportunistic infection in HIV and other immunosuppressed patients
More than 1000 cases of HIV and VL are reported from 25 countries. However, in India yet not a serious problem
VL may be first Opportunistic Infection in asymptomatic HIV-I infected person
Also occurs in advanced stage of AIDS
All co-infected patients are not symptomatic
Diagnosis may be altered because symptoms may be of short duration; fever and spleen may not be marked; Leishmania antibodies may be undetectable.
However peripheral blood smears of buffycoat and blood culture may yield good results
Response to treatment is poor; drug side effects may be more and relapses may be common