Enhanced Case Detection and Improved Diagnosis of PKDL in a Kala-azar-Endemic Area of Bangladesh

PKDL is a skin disorder which usually develops in 10–20% and about 60% of patients with visceral leishmaniasis (VL) after treatment respectively in the Indian subcontinent and Sudan. However, cases among people without prior VL have also been reported. Except skin lesion, PKDL patients are healthy and usually do not feel sick. However, persistence of a few PKDL cases is sufficient to initiate a new epidemic of anthroponotic VL. Thus, identifying and treating people with PKDL is a key strategy for the elimination of kala-azar. Diagnosis of PKDL relies upon clinical criteria and a serological test which is not specific for PKDL. The use of the existing laboratory diagnostic tools for confirmation of PKDL among PKDL suspects is unknown. In the Indian subcontinent, PKDL is not self-limited and needs to be treated with sodium stibogluconate injections for 4–6 months. No data are available relating to treatment compliance by patients, particularly in Bangladesh. The results of the present study showed that trained village volunteers were useful for identifying PKDL suspects, and diagnostic confirmation improved with the use of PCR. However, patients' adherence to prescribed treatment was poor