Post-Kala-Azar Dermal Leishmaniasis: A Paradigm of Paradoxical Immune Reconstitution Syndrome in Non-HIV/AIDS Patients

• Published in: Journal of Tropical Medicine
• Main Authors: Eltahir Awad Gasim Khalil, Selma Abdelmoneim Khidir, Ahmed Mudawi Musa, Brema Younis Musa, Mona Elfaki Eltahir Elfaki, Abdelgadir Mohamed Yousif Elkadaru, Edward Zijlstra, Ahmed Mohamed El-Hassan
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2013
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Arctic; Azar
• Online Access: https://doi.org/10.1155/2013/275253; https://doaj.org/article/5ad55b45ccd84f27a7461d03bbb35490

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is a typical example of paradoxical IRIS in non-HIV/AIDS individuals with anti-inflammatory cytokine patterns that are superseded by treatment-induced proinflammatory cytokines and lesions healing.