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

Details in treatment regimen and other can be seen at Minutes of the Working Group on HIV-KA in India -Click Here