Post‐kala‐azar dermal leishmaniasis – an overview

International Journal of Dermatology - Tập 49 Số 8 - Trang 921-931 - 2010
Sudipto Ganguly1, Nilay Kanti Das2, Joyashree Nath Barbhuiya3, Mitali Chatterjee4
1Johns Hopkins Sidney Kimmel Comprehensive Cancer Research Center, Room 284, Bunting and Blaustein Research Building, 1650, Orleans Baltimore, MD 21205, USA
2Department of Dermatology, Medical College Calcutta
3Department of Dermatology, School of Tropical Medicine, Kolkata, West Bengal, India
4Department of Pharmacology, Institute of Post Graduate Medical Education and Research

Tóm tắt

SummaryPost‐kala‐azar dermal leishmaniasis (PKDL) is a dermal sequela of visceral leishmaniasis (VL), reported mainly from two regions – Sudan in eastern Africa and the Indian subcontinent, with incidences of 50–60% and 5–10%, respectively. Importantly, patients with PKDL are considered as reservoirs of VL, linking its eradication to effective control of PKDL. The etiopathogenesis of PKDL is presumably due to an immunological assault on latent dermal parasites. Immunological markers include IL‐10, whose expression in skin and plasma of Sudanese patients with VL predicted onset of PKDL. Cell‐mediated immune responses, notably restoration of IFN‐γ production by antigen‐stimulated lymphocytes are well documented in Sudanese PKDL, but remain ambiguous in the Indian form; recently, antigen‐specific IL‐10‐producing CD8+ lymphocytes have been implicated in pathogenesis. In Indian PKDL, upregulation of intralesional IFN‐γ and TNF‐α is counterbalanced by IL‐10 and TGF‐β together with downregulated IFN‐γ R1. Although IL‐10 curtails excessive IFN‐γ‐mediated reactivity and ensures parasite survival, its cellular source remains to be confirmed, with infiltrating regulatory T cells (Tregs) being a likely candidate. Future functional investigations on Tregs and their interaction with lesional effector lymphocytes would be indispensable for development of immunomodulatory therapies against Leishmania infection.

Từ khóa


Tài liệu tham khảo

10.1016/S1473-3099(03)00517-6

Brahmachari UN, 1922, A new form of cutaneous leishmaniasis‐dermal leishmanoid, Indian Med. Gaz., 57, 125

Sen Gupta PC, 1947, History of Kala‐azar in India, Indian Med. Gaz., 82, 283

10.1111/j.1365-4362.1995.tb03584.x

Baghestani S, 1998, Post‐kala‐azar dermal leishmaniasis, Eur. J. Dermatol., 8, 277

10.4269/ajtmh.1991.44.536

10.3201/eid1303.060242

10.1016/S0035-9203(03)90061-7

Sharma NL, 2005, Localized cutaneous leishmaniasis due to Leishmania donovani and Leishmania tropica: Preliminary findings of the study of 161 new cases from a new endemic focus in Himachal Pradesh (India), Am J Trop Med Hyg, 72, 819, 10.4269/ajtmh.2005.72.819

Croft S, 2008, PKDL – a drug related phenomenon?, Indian J Med Res, 128, 10

10.1111/j.1365-2133.2007.08157.x

10.1086/505079

Mandal S, 2009, High‐throughput screening of amastigotes of Leishmania donovani clinical isolates against drugs using a colorimetric β‐lactamase assay, Indian J Exp Biol, 47, 475

10.1017/S0031182007003150

10.1093/jac/dkl494

Thakur CP, 2008, Impact of amphotericin‐B in the treatment of kala‐azar on the incidence of PKDL in Bihar, India, Indian J Med Res, 128, 38

10.4049/jimmunol.179.8.5592

10.4269/ajtmh.2009.80.336

10.1080/00034989760707

10.1128/JCM.43.3.1269-1277.2005

10.1086/588387

10.1111/j.1365-3156.2007.01854.x

Salotra P, 2006, Challenges in the diagnosis of post kala‐azar dermal leishmaniasis, Indian J Med Res, 123, 295

10.1016/0952-7915(93)90033-O

10.1002/(SICI)1096-9896(199912)189:4<615::AID-PATH466>3.0.CO;2-Z

10.1046/j.1365-2249.1998.00468.x

10.1046/j.1365-2249.2000.01163.x

Haldar JP, 1983, Cell‐mediated immune response in Indian kala‐azar and post‐kala‐azar dermal leishmaniasis, Infect Immun, 42, 702, 10.1128/iai.42.2.702-707.1983

10.1080/00034983.1988.11812205

10.4269/ajtmh.1997.56.522

10.1186/1471-2334-5-113

10.1016/j.clim.2006.01.017

10.1111/j.1365-3083.1995.tb03527.x

10.1111/j.1365-4632.2004.01579.x

10.1086/506624

10.1111/j.1365-2249.2008.03761.x

10.1038/jid.2009.393

10.1016/j.pt.2004.04.003

10.1038/nri2189

10.1111/j.0105-2896.2006.00415.x

10.1084/jem.20052056

10.1086/502980

10.1086/596508

Gazzinelli RT, 1992, IL‐10 inhibits parasite killing and nitrogen oxide production by IFN‐γ‐activated macrophages, J Immunol, 148, 1792, 10.4049/jimmunol.148.6.1792

Carvalho EM, 1994, Restoration of IFN‐γ production and lymphocyte proliferation in visceral leishmaniasis, J Immunol, 152, 5949, 10.4049/jimmunol.152.12.5949

10.1084/jem.20041470

10.1038/ni0901-816

10.1038/nature01152

10.1084/jem.20061141

10.1016/j.pt.2005.11.010

10.1179/136485905X514127

10.1128/AAC.36.8.1630

10.1016/0190-9622(93)70275-X

10.1086/519690

10.1016/j.trstmh.2005.09.015

10.1111/j.1365-2230.2007.02547.x

10.1016/j.trstmh.2007.08.006

Thông tin
Thông tin xuất bản

International Journal of Dermatology

Tập 49 Số 8

921-931

Thông tin tác giả