Leishmaniasis is a neglected tropical disease affecting the world’s poorest populations in over 90 countries, of which visceral leishmaniasis (VL)/kala-azar is the most fatal. Post kala-azar dermal leishmaniasis (PKDL) is a chronic dermal sequela that occurs in patients who have undergone treatment for VL caused by Leishmania donovani. The geographical distribution of PKDL involves East Africa, where it presents as papular or nodular lesions, and South Asia, where it presents with widespread polymorphic and macular lesions. Patients with PKDL represent an important but largely neglected reservoir of infection that perpetuates anthroponotic Leishmania transmission and can jeopardize the VL elimination program in the Indian subcontinent. Therefore, although not life-threatening, it becomes imperative to diagnose and treat PKDL cases as a part of the elimination program, which, in turn, requires the availability of robust data regarding the immunopathology of dermal lesions. However, in the absence of an animal model, understanding the immunological basis of PKDL is critical for developing effective treatment regimens, but the information remains limited. A complex interplay between dendritic cells, neutrophils, macrophages, T cells, B cells, and associated cytokines plays a significant role in disease pathogenesis. Furthermore, recent findings have indicated differential immune responses between the two clinical forms of PKDL, which may impact on the disease pathogenicity and response to chemotherapy. Collectively, this review highlights the role of immune dysregulation in South Asian PKDL, which have allowed parasite persistence, leading to disease progression. Interventions via targeted immunomodulatory therapies aiming to restore effective immune responses could provide promising therapeutic strategies for management of PKDL.
BT - Annals of Medical Science & Research DO - 10.4103/amsr.amsr_48_24 IS - Suppl 1 LA - eng M3 - Research Article N2 -Leishmaniasis is a neglected tropical disease affecting the world’s poorest populations in over 90 countries, of which visceral leishmaniasis (VL)/kala-azar is the most fatal. Post kala-azar dermal leishmaniasis (PKDL) is a chronic dermal sequela that occurs in patients who have undergone treatment for VL caused by Leishmania donovani. The geographical distribution of PKDL involves East Africa, where it presents as papular or nodular lesions, and South Asia, where it presents with widespread polymorphic and macular lesions. Patients with PKDL represent an important but largely neglected reservoir of infection that perpetuates anthroponotic Leishmania transmission and can jeopardize the VL elimination program in the Indian subcontinent. Therefore, although not life-threatening, it becomes imperative to diagnose and treat PKDL cases as a part of the elimination program, which, in turn, requires the availability of robust data regarding the immunopathology of dermal lesions. However, in the absence of an animal model, understanding the immunological basis of PKDL is critical for developing effective treatment regimens, but the information remains limited. A complex interplay between dendritic cells, neutrophils, macrophages, T cells, B cells, and associated cytokines plays a significant role in disease pathogenesis. Furthermore, recent findings have indicated differential immune responses between the two clinical forms of PKDL, which may impact on the disease pathogenicity and response to chemotherapy. Collectively, this review highlights the role of immune dysregulation in South Asian PKDL, which have allowed parasite persistence, leading to disease progression. Interventions via targeted immunomodulatory therapies aiming to restore effective immune responses could provide promising therapeutic strategies for management of PKDL.
PB - Ovid Technologies (Wolters Kluwer Health) PY - 2025 EP - 9 T2 - Annals of Medical Science & Research TI - Mapping the immune landscape in South Asian post kala-azar dermal leishmaniasis UR - https://journals.lww.com/amsr/fulltext/2025/06001/mapping_the_immune_landscape_in_south_asian_post.11.aspx VL - 4 SN - 2949-785X, 2949-7868 ER -