title: Post kala-azar dermal leishmaniasis: an unresolved mystery.
abstract: Post kala-azar dermal leishmaniasis (PKDL), a cutaneous sequela of visceral leishmaniasis (VL), develops in some patients alongside but more commonly after apparent cure from VL. In view of the pivotal role of PKDL patients in the transmission of VL, here we review clinical, epidemiological, parasitological, and immunological perspectives of this disease, focusing on five hypotheses to explain the development of PKDL: (i) the role of antimonial drugs; (ii) UV-induced skin damage; (iii) reinfection; (iv) organ specific failure of memory T cell responses; and (v) genetic susceptibility of the host. This review will enable researchers and clinicians to explore the unresolved mystery of PKDL and provide a framework for future application of 'omic' approaches for the control and eventual elimination of VL.
authors.affiliation: Department of Pharmacology, Institute of Postgraduate Medical Education and Research, 244 B, Acharya JC Bose Road, Kolkata 700 020, India.
authors.forename: Debanjan
authors.initials: D
authors.lastname: Mukhopadhyay
authors.affiliation: Centre for Immunology and Infection, Hull York Medical School and Department of Biology, University of York, Wentworth Way, York, YO10 5DD, UK.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Dalton
authors.affiliation: Centre for Immunology and Infection, Hull York Medical School and Department of Biology, University of York, Wentworth Way, York, YO10 5DD, UK. Electronic address: paul.kaye@york.ac.uk.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kaye
authors.affiliation: Department of Pharmacology, Institute of Postgraduate Medical Education and Research, 244 B, Acharya JC Bose Road, Kolkata 700 020, India. Electronic address: ilatim@vsnl.net.
authors.forename: Mitali
authors.initials: M
authors.lastname: Chatterjee
mesh_terms: D000965:Antimony / Q000494:pharmacology; D000981:Antiprotozoal Agents / Q000009:adverse effects / Q000627:therapeutic use; D020022:Genetic Predisposition to Disease; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000469:parasitology*; D013601:T-Lymphocytes / Q000276:immunology; D014466:Ultraviolet Rays
chemical_list: D000981:Antiprotozoal Agents; D000965:Antimony
keywords: UV light; antimony; post kala-azar dermal leishmaniasis (PKDL); regulatory T cells; vitamin D