Abstract:
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Visceral leishmaniasis (VL) is a parasitic disease characterized by immune suppression. Successful treatment is usually followed by
immune reconstitution and a dermatosis called post-Kala-azar dermal leishmaniasis (PKDL). Recently, PKDL was described as one
of the immune reconstitution syndromes (IRISs) in HIV/VL patients on HAART. This study aimed to present PKDL as a typical
example of paradoxical IRIS in non-HIV/AIDS individuals. Published and new data on the pathogenesis and healing of PKDL
was reviewed and presented. The data suggested that PKDL is a typical example of paradoxical IRIS, being a new disease entity that
followsVL successful treatment andimmune recovery.PKDL lesions areimmune inflammatory in nature with granuloma, adequate
response toimmunochemotherapy, and an ensuing hypersensitivity reaction, the leishmanin skin test (LST).Thedata also suggested
that the cytokine patterns of PKDL pathogenesis and healing are probably as follows: an active disease state dominated by IL-10
followed by spontaneous/treatment-induced IL-12 priming, IL-2 stimulation, and INF-𝛾 production. INF-𝛾-activated macrophages
eliminate the Leishmania parasites/antigen to be followed by LST conversion and healing. In conclusion, PKDL is a typical example
of paradoxical IRIS in non-HIV/AIDS individuals with anti-inflammatory cytokine patterns that are superseded by treatmentinduced
proinflammatory cytokines and lesions healing. |