Post kala-azar dermal leishmaniasis burden in high visceral leishmaniasis endemic upazilas in Bangladesh

Abstract

Abstract Background Post kala-azar Dermal Leishmaniasis (PKDL) threatens the success of the Visceral Leishmaniasis (VL) elimination initiative as PKDL patients are inter-epidemic reservoirs of the Leishmania donovani infection in the Indian sub-continent and do not actively seek medical care. Therefore, active case detection (ACD) and management of PKDL cases are vital for preventing an eventual outbreak of VL and sustaining the success of the VL elimination program. We aimed to investigate the burden of PKDL in the highly VL-endemic upazilas in Bangladesh, including an active search for PKDL in leprosy-negative skin lesion cases. We also characterized PKDL cases and investigated their health-seeking behavior and perceived level of stigma. Methods This was a cross-sectional survey among people living in the VL-endemic villages of the five most VL-endemic upazilas. VL experts trained medical officers in Upazila Health Complexes (UHCs) and leprosy hospitals in PKDL diagnosis and treatment. The frontline public health workers conducted house-to-house surveys for PKDL suspects and referred them to the responsible centers [UHC and Surja Kanta Kala-azar Research Centre (SKKRC)] after the training. PKDL patients were diagnosed and treated following National Kala-azar Case management guidelines. Data management and analysis were done with the Epi Info version 7 and IBM SPSS Statistics 25. Results Of 472,435 individuals screened, 4022 had VL in the past (0.85%). This survey found 82 PKDL suspects among 4022 cases of past VL, and 62 PKDL were confirmed. The overall PKDL burden was 1.3 in 10,000 people but varied across study areas. The predominance of the male sex and the macular form of PKDL were observed. 39 PKDL patients perceived stigma of different levels. Active screening for PKDL among 137 leprosy-negative PKDL suspects in leprosy hospitals yielded 10 (7.3%) PKDL cases. Only 27 of 62 (43.5%) had received treatment for PKDL. Treatment interruption was common due to the unavailability of medicines and side effects of treatment. Conclusions Tedious house-to-house surveys for active PKDL search should be complemented with ACD for PKDL through all leprosy hospitals countrywide, as its yield is impressive. Better planning for ensuring medicines for treating PKDL cases is urgently required.