RECURRENCE OF KALA-AZAR AFTER PKDL - ROLE OF COFACTORS

Recurrence of kala-azar after post kala-azar dermal leishmaniasis (PKD L) has remained uncommon. We report here two patients with recurrence of kala-azar (KA) after development of PKDL. In one case the second at tack of KA was preceded by repeated attacks of malaria and tuberculosi s, and in the other the recurrence of KA followed an attack of measles . While measles has earlier been suggested as co-factor in inducing tr ansformation from sub-clinical to clinical kala-azar, malaria was demo nstrated to enhance the virulence and invasiveness of Leishmania in an experimental model as well as under natural condition. We propose tha t in our cases, measles and repeated attacks of malaria or tuberculosi s led to immunosuppression and recurrence of visceral leishmaniasis (V L).