Pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral leishmaniasis in an adult HIV negative patient

Abstract

This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having HIV infection, based on risk factor analyses, but was subsequently shown to be HIV negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for Mycobacterium tuberculosis and Pneumocystis carinii, and stool tests were positive for Strongyloides stercoralis and Schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the HIV tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his HIV ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as HIV infection. The occurrence of opportunistic infections in severely ill patients without HIV must always be considered and alternate causes of immunosuppression sought

Indoleamine 2,3‐dioxygenase (IDO) induced by Leishmania infection of human dendritic cells

“…However, he was later found to be infected with L. infantum chagasi as a comorbidity. Treatment with antimony‐based compounds led to the patient making a full recovery, with clearance of all other pathogens after the L. i. chagasi ‐induced immunosuppression was alleviated (52). No study has provided a definitive mechanism for this noted Leishmania ‐induced immunosuppression, although the interaction of CTLA‐4 with B7 (53) has been implicated.…”

Co-infection of tuberculosis and parasitic diseases in humans: a systematic review

“…Of those, leishmaniasis, hydatid disease and malaria were reported to coexist more freuequently with TB in the human body. In addition to co-infection of TB and a single parasitic disease, there was also co-infection of TB and multiple parasitic diseases, such as co-infection of pneumocystis carinii pneumonia, visceral leishmaniasis and PTB, co-infection of toxoplasmosis, toxocariasis and TB, and co-infection of strongyloidiasis, giardiasis and TB [9,20,28]. …”

Adaptações crônicas sobre a função pulmonar em indivíduos infectados pela leishmaniose visceral

“…Em humanos, relatos de casos descrevem que dentre as principais alterações em pacientes com envolvimento pulmonar estão a pneumonite intersticial (19,20) e o derrame pleural (21,22). Outros sintomas comumente encontrados são a tosse seca e, eventualmente, dispneia (23), inflamação generalizada da árvore brônquica (24), além da pneumocitys carini (25). Outro aspecto importante que tem sido verificado é a relação de coinfecção HIV/LV (26), com relatos de aparecimento de nódulo pulmonar solitário (19), como, também, infiltrações pulmonares (27) e adenoma bronquioalveoloar (28).…”