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Types of morphological lesions:


    • Early hypopigmented macules similar to macular lesions of Lepromatous Leprosy but normally less than 1 cm. Usually occur on face but can affect any part of the body.
    • Later (after a variable period of months or years) diffuse nodular lesions on those macules
    • Erythematous butterfly rash which may be aggravated by exposure to Sunlight; an early sign of PKDL
    • Erythematous papules and nodules which usually occur on face, especially the chin.
    • Lesions progressive over many years , seldom heal spontaneously

Rare manifestations of PKDL include:

  • Multiple lesions coalesce to form larger plaque type lesions
  • Verrucous lesions (hands and feet)
  • Papillomatous lesions (on muzzle area of face, nose, chin, and lips)
  • Hypertrophic lesions (eyelids, nose and lips)
  • Xanthematous rash (orange plaque on axillary fold, cubital fossae, inner thighs, outer canthus of the eye and perioral)
  • Pityriasis rosea like lesions

HIV and Kala-azar co-infection

  • Visceral leishmaniasis (VL) has emerged as an opportunistic infection in HIV and other immunosuppressed patients
  • More than 1000 cases of HIV and VL are reported from 25 countries. However, in India yet not a serious problem
  • VL may be first Opportunistic Infection in asymptomatic HIV-I infected person
  • Also occurs in advanced stage of AIDS
  • All co-infected patients are not symptomatic
  • Diagnosis may be altered because symptoms may be of short duration; fever and spleen may not be marked; Leishmania antibodies may be undetectable.
  • However peripheral blood smears of buffycoat and blood culture may yield good results
  • Response to treatment is poor; drug side effects may be more and relapses may be common

Details in treatment regimen and other can be seen at Minutes of the Working Group on HIV-KA in India -Click Here