title: Post-Kala-Azar Dermal Leishmaniasis: A Paradigm of Paradoxical Immune Reconstitution Syndrome in Non-HIV/AIDS Patients.
abstract: Visceral leishmaniasis (VL) is a parasitic disease characterized by immune suppression. Successful treatment is usually followed by immune reconstitution and a dermatosis called post-Kala-azar dermal leishmaniasis (PKDL). Recently, PKDL was described as one of the immune reconstitution syndromes (IRISs) in HIV/VL patients on HAART. This study aimed to present PKDL as a typical example of paradoxical IRIS in non-HIV/AIDS individuals. Published and new data on the pathogenesis and healing of PKDL was reviewed and presented. The data suggested that PKDL is a typical example of paradoxical IRIS, being a new disease entity that follows VL successful treatment and immune recovery. PKDL lesions are immune inflammatory in nature with granuloma, adequate response to immunochemotherapy, and an ensuing hypersensitivity reaction, the leishmanin skin test (LST). The data also suggested that the cytokine patterns of PKDL pathogenesis and healing are probably as follows: an active disease state dominated by IL-10 followed by spontaneous/treatment-induced IL-12 priming, IL-2 stimulation, and INF- γ production. INF- γ -activated macrophages eliminate the Leishmania parasites/antigen to be followed by LST conversion and healing. In conclusion, PKDL is a typical example of paradoxical IRIS in non-HIV/AIDS individuals with anti-inflammatory cytokine patterns that are superseded by treatment-induced proinflammatory cytokines and lesions healing.
authors: The Leishmaniasis Research Group, Sudan ; Institute of Endemic Diseases, University of Khartoum, P.O. Box 45235, 11111 Khartoum, Sudan ; The Central Laboratory, Ministry of Science & Communications, 7099 Khartoum, Sudan.
authors: Eltahir Awad Gasim
authors: EA
authors: Khalil
authors: Selma Abdelmoneim
authors: SA
authors: Khidir
authors: Ahmed Mudawi
authors: AM
authors: Musa
authors: Brema Younis
authors: BY
authors: Musa
authors: Mona Elfaki Eltahir
authors: ME
authors: Elfaki
authors: Abdelgadir Mohamed Yousif
authors: AM
authors: Elkadaru
authors: Edward
authors: E
authors: Zijlstra
authors: Ahmed Mohamed
authors: AM
authors: El-Hassan
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