ENDEMIC KALA-AZAR IN EASTERN SUDAN - POST-KALA-AZAR DERMAL LEISHMANIASIS

In a longitudinal study between 1991 and 1993 in an endemic area in ea stern Sudan, 85 cases of kala-azar (visceral leishmaniasis) were diagn osed, of whom 48 (56%) developed post-kala-azar dermal leishmaniasis ( PKDL). Another four cases of PKDL had no clinical history of kala-azar . In children, PKDL was more frequent in the very young; seven of nine kala-azar cases (78%) in the group 0-1 years of age and 13 of 16 (81% ) in the group 2-3 years of age developed PKDL. On the average, PKDL o ccurred 56 days (mean; range 0-180) after the end of treatment of kala -azar. To assess the severity of PKDL, a classification was developed using three grades of severity based on differences in density and dis tribution of lesions. In young children, PKDL was more severe. Incompl ete treatment of kala-azar may be important in the pathogenesis of PKD L. Thirty-one patients were followed-up for at least six months; of th ese, 20 were not treated (17 healed, two improved, and in one, the con dition was unchanged), three healed after incomplete treatment with so dium stibogluconate, and eight were cured after treatment but two requ ired two courses. Considerable morbidity was caused by PKDL and should be taken into consideration in the management and follow-up of kala-a zar patients. The high incidence of PKDL may have important implicatio ns in transmission.