{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:41:16Z","timestamp":1790808076952,"version":"4.1.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,10,24]],"date-time":"2018-10-24T00:00:00Z","timestamp":1540339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Spanish Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>On the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection reservoir.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted xenodiagnosis on 47 PKDL patients and 15 VL patients using laboratory-reared Phlebotomus argentipes. In direct xenodiagnosis, flies were allowed to feed on the patient\u2019s skin for 15 minutes. For indirect xenodiagnosis, flies were fed through a membrane on the patient\u2019s blood. Five days later, blood-fed flies were dissected and examined by microscopy and\/or polymerase chain reaction (PCR). A 3-mm skin snip biopsy (PKDL) or venous blood (VL) was processed by quantitative PCR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-seven PKDL patients (57.4%) had positive results by direct and\/or indirect xenodiagnosis. Direct was significantly more sensitive than indirect xenodiagnosis (55.3% vs 6.4%, P &lt; .0001). Those with positive xenodiagnosis had median skin parasite loads &gt;1 log10 unit higher than those with negative results (2.88 vs 1.66, P &lt; .0001). In a multivariable model, parasite load, nodular lesions, and positive skin microscopy were significantly associated with positive xenodiagnosis. Blood parasite load was the strongest predictor for VL. Compared to VL, nodular PKDL was more likely and macular PKDL less likely to result in positive xenodiagnosis, but neither difference reached statistical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nodular and macular PKDL, and VL, can be infectious to sand flies. Active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciy891","type":"journal-article","created":{"date-parts":[[2018,10,15]],"date-time":"2018-10-15T07:18:05Z","timestamp":1539587885000},"page":"251-258","source":"Crossref","is-referenced-by-count":127,"title":["Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies"],"prefix":"10.1093","volume":"69","author":[{"given":"Dinesh","family":"Mondal","sequence":"first","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caryn","family":"Bern","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California\u2013San Francisco School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debashis","family":"Ghosh","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masud","family":"Rashid","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Molina","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Centre for Leishmaniasis, Laboratory of Medical Entomology, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajashree","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh, 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