Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.

<h4>Objectives</h4>To support the Bangladesh National Kala-azar Elimination Programme (NKEP), we investigated the feasibility of using trained village volunteers for detecting post-kala-azar dermal leishmaniasis (PKDL) cases, using polymerase chain reaction (PCR) for confirmation of diag...

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Autores principales:	Dinesh Mondal, Kamrul Nahar Nasrin, M Mamun Huda, Mamun Kabir, Mohammad Shakhawat Hossain, Axel Kroeger, Tania Thomas, Rashidul Haque
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/dcd701a0cf4d45d79f850b5761eb79e0
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spelling	oai:doaj.org-article:dcd701a0cf4d45d79f850b5761eb79e02021-11-18T09:13:47ZEnhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.1935-27271935-273510.1371/journal.pntd.0000832https://doaj.org/article/dcd701a0cf4d45d79f850b5761eb79e02010-10-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20957193/pdf/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Objectives</h4>To support the Bangladesh National Kala-azar Elimination Programme (NKEP), we investigated the feasibility of using trained village volunteers for detecting post-kala-azar dermal leishmaniasis (PKDL) cases, using polymerase chain reaction (PCR) for confirmation of diagnosis and treatment compliance by PKDL patients in Kanthal union of Trishal sub-district, Mymensingh, Bangladesh.<h4>Methods</h4>In this cross-sectional study, Field Research Assistants (FRAs) conducted census in the study area, and the research team trained village volunteers on how to look for PKDL suspects. The trained village volunteers (TVVs) visited each household in the study area for PKDL suspects and referred the suspected PKDL cases to the study clinic. The suspected cases underwent physical examinations by a qualified doctor and rK39 strip testing by the FRAs and, if positive, slit skin examination (SSE), culture, and PCR of skin specimens and peripheral buffy coat were done. Those with evidence of Leishmania donovani (LD) were referred for treatment. All the cases were followed for one year.<h4>Results</h4>The total population of the study area was 29,226 from 6,566 households. The TVVs referred 52 PKDL suspects. Probable PKDL was diagnosed in 18 of the 52 PKDL suspect cases, and PKDL was confirmed in 9 of the 18 probable PKDL cases. The prevalence of probable PKDL was 6.2 per 10,000 people in the study area. Thirteen PKDL suspects self-reported from outside the study area, and probable and confirmed PKDL was diagnosed in 10 of the 13 suspects and in 5 of 10 probable PKDL cases respectively. All probable PKDL cases had hypopigmented macules. The median time for PKDL development was 36 months (IQR, 24-48). Evidence of the LD parasite was documented by SSE and PCR in 3.6% and 64.3% of the cases, respectively. PCR positivity was associated with gender and severity of disease. Those who were untreated had an increased risk (odds ratio = 3.33, 95%CI 1.29-8.59) of having persistent skin lesions compared to those who were treated. Patients' treatment-seeking behavior and treatment compliance were poor.<h4>Conclusion</h4>Improved detection of PKDL cases by TVVs is feasible and useful. The NKEP should promote PCR for the diagnosis of PKDL and should find ways for improving treatment compliance by patients.Dinesh MondalKamrul Nahar NasrinM Mamun HudaMamun KabirMohammad Shakhawat HossainAxel KroegerTania ThomasRashidul HaquePublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 4, Iss 10 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Dinesh Mondal Kamrul Nahar Nasrin M Mamun Huda Mamun Kabir Mohammad Shakhawat Hossain Axel Kroeger Tania Thomas Rashidul Haque Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.
description	<h4>Objectives</h4>To support the Bangladesh National Kala-azar Elimination Programme (NKEP), we investigated the feasibility of using trained village volunteers for detecting post-kala-azar dermal leishmaniasis (PKDL) cases, using polymerase chain reaction (PCR) for confirmation of diagnosis and treatment compliance by PKDL patients in Kanthal union of Trishal sub-district, Mymensingh, Bangladesh.<h4>Methods</h4>In this cross-sectional study, Field Research Assistants (FRAs) conducted census in the study area, and the research team trained village volunteers on how to look for PKDL suspects. The trained village volunteers (TVVs) visited each household in the study area for PKDL suspects and referred the suspected PKDL cases to the study clinic. The suspected cases underwent physical examinations by a qualified doctor and rK39 strip testing by the FRAs and, if positive, slit skin examination (SSE), culture, and PCR of skin specimens and peripheral buffy coat were done. Those with evidence of Leishmania donovani (LD) were referred for treatment. All the cases were followed for one year.<h4>Results</h4>The total population of the study area was 29,226 from 6,566 households. The TVVs referred 52 PKDL suspects. Probable PKDL was diagnosed in 18 of the 52 PKDL suspect cases, and PKDL was confirmed in 9 of the 18 probable PKDL cases. The prevalence of probable PKDL was 6.2 per 10,000 people in the study area. Thirteen PKDL suspects self-reported from outside the study area, and probable and confirmed PKDL was diagnosed in 10 of the 13 suspects and in 5 of 10 probable PKDL cases respectively. All probable PKDL cases had hypopigmented macules. The median time for PKDL development was 36 months (IQR, 24-48). Evidence of the LD parasite was documented by SSE and PCR in 3.6% and 64.3% of the cases, respectively. PCR positivity was associated with gender and severity of disease. Those who were untreated had an increased risk (odds ratio = 3.33, 95%CI 1.29-8.59) of having persistent skin lesions compared to those who were treated. Patients' treatment-seeking behavior and treatment compliance were poor.<h4>Conclusion</h4>Improved detection of PKDL cases by TVVs is feasible and useful. The NKEP should promote PCR for the diagnosis of PKDL and should find ways for improving treatment compliance by patients.
format	article
author	Dinesh Mondal Kamrul Nahar Nasrin M Mamun Huda Mamun Kabir Mohammad Shakhawat Hossain Axel Kroeger Tania Thomas Rashidul Haque
author_facet	Dinesh Mondal Kamrul Nahar Nasrin M Mamun Huda Mamun Kabir Mohammad Shakhawat Hossain Axel Kroeger Tania Thomas Rashidul Haque
author_sort	Dinesh Mondal
title	Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.
title_short	Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.
title_full	Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.
title_fullStr	Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.
title_full_unstemmed	Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.
title_sort	enhanced case detection and improved diagnosis of pkdl in a kala-azar-endemic area of bangladesh.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/dcd701a0cf4d45d79f850b5761eb79e0
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Enhanced case detection and improved diagnosis of PKDL in a Kala-azar-endemic area of Bangladesh.

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