Special conditions


©WHO/Old Fangak, South Sudan, 2011

Visceral leishmaniasis can cause overwhelming and protracted epidemics, with high case–fatality rates. Epidemics occur frequently in regions which are difficult to access, particularly in east Africa and occasionally in south America . The areas that have been affected by major epidemics recently include Libo Kemkem, Ethiopia (2005–06), Wajir, Kenya (2008), and Jonglei and Upper Nile, Southern Sudan (2009-2012).
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Leishmania–HIV coinfection

Leishmania–HIV coinfection had been reported from 35 endemic countries. Coinfection with HIV intensifies the burden of visceral and cutaneous leishmaniasis by causing severe forms that are more difficult to manage.
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Post-kala-azar dermal leishmaniasis (PKDL)

PKDL is a skin sequela of visceral leishmaniasis that appears as macular, papular or nodular rash usually on face, upper arms, trunks and other parts of the body.

It occurs mainly in East Africa and on the Indian subcontinent, where up to 50% and 5-10% of patients with kala-azar, respectively, could develop the condition. It usually appears 6 months to 1 or more years after kala-azar has apparently been cured. But it can occur earlier. People with PKDL are considered to be a potential source of kala-azar infection.