High levels of C-reactive protein in the peripheral blood during visceral leishmaniasis predict subsequent development of post kala-azar dermal leishmaniasis.

Post kala-azar dermal leishmaniasis (PKDL) is a known sequel to visceral leishmaniasis in India and East Africa, and in Sudan about 50% of the kala-azar patients develop PKDL. In this study we followed kala-azar patients from diagnosis and up to 2 years after initiation of treatment. During the first 6 months some developed PKDL (group 1), while some did not develop PKDL (group 2). We measured the plasma levels of C-reactive protein (CRP) at diagnosis of kala-azar (day 0), during treatment (day 15), after treatment (day 30) and later during the follow up period. At day 0, plasma CRP levels were higher in patients who later developed PKDL (group 1) than in patients who did not develop PKDL subsequently (group 2) (P = 0.008). At days 15 and 30, the CRP levels were comparable in the two groups, and lower than at day 0. We have previously shown that high plasma levels of IL 10 and in keratinocytes during visceral leishmaniasis predict subsequent development of PKDL. The method however requires expensive equipment and reagents. The results of the present study indicate that kala-azar patients, who have a high risk of developing PKDL after treatment can be identified by measuring plasma CRP.