Since PKDL does not cause significant morbidity, at least initially, but the affected patients continue to act as a reservoir of the disease, active case detection is required to identify cases early to control the disease transmission in the community. The differential diagnosis depends on the pattern of manifestations, but lepromatous leprosy is the closest mimicker. Recognition of spectrum of mucocutaneous changes helps physicians in early initiation of treatment and in reducing disease transmission in the community. Atypical morphology and presentations are not uncommon, especially in endemic areas, which include photosensitivity, verrucous, hypertrophic, xanthomatous, and ulcerative lesions. The disease usually manifests as a variable combination of hypopigmented patches, erythematous succulent papulo-plaques, and nodular lesions on the face and upper body and sometimes extending on the extremities, genitalia, and tongue. Stay in a fairly open but camouflaged space to ease your mobility.Post kala-azar dermal leishmaniasis (PKDL) is a mucocutaneous disease usually seen in apparently cured, inadequately treated or untreated cases of visceral leishmaniasis and is endemic to many parts of India, Nepal, Bangladesh, and eastern Africa (Sudan, Ethiopia, Kenya). If trapped in a small space, the ability to counteract or escape is dramatically reduced as the Hunters shower it with attacks. The Meteor Goliath has some flaws, too.Use your mobility to quickly escape bad situations, and set up strong initiations to fights. The Meteor Goliath jumps further and traverses longer, and is tankier to boot. If you can keep constant pressure on multiple targets, the medic/support will not be able to keep up and the whole team will buckle. Fighting with the Meteor Goliath is less about focusing down individual targets and more about spreading the love. Rewards for perks that are already at level 3 are replaced with a 200 keys reward. This leap is longer and lighter than the Goliath, but has a slightly higher cooldown. Unlike the rest of its abilities, basic attacks do not light enemies on fire. Versus incapacitated hunters: 112 damage.Meteor Goliath's charge travels for longer and applies a standard flame DoT. The Goliath charges forward in a straight line, a powerful attack that allows the Goliath to rush forward and close the gap between itself and its target, damaging and knocking aside all in its path.
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