by Goyal V, Das VNR, Singh SN, Singh RS, Pandey K, Verma N, Hightower A, Rijal S, Das P, Alvar J, Bern C, Alves F. PLOS Neglected Tropical Diseases 2020;14(7): e0008429. doi: 10.1371/journal.pntd.0008429
Summary: Visceral leishmaniasis is thought to be maintained between epidemics as post-kala-azar dermal leishmaniasis (PKDL). Since patients are not systemically ill and PKDL is difficult to cure, they seldom seek treatment, making PKDL a likely major obstacle to elimination. The authors followed-up a cohort of more than 1700 patients treated with three different drug regimens in Bihar, India to determine how different visceral leishmaniasis treatment regimens affect the risk of subsequent PKDL. They found that patients treated with miltefosine-paromomycin had a lower risk of relapse but higher PKDL incidence, while liposomal amphotericin B treated patients had the reverse pattern. To sustain the gains already made, active surveillance for PKDL and relapse, timely treatment, and new visceral leishmaniasis treatment regimens that avoid future PKDL are needed.