Post-kala-azar dermal leishmaniasis associated with AIDS

Bittencourt, Achiléa Candida Lisboa; Silva, Nancy; Straatmann, Andréa; Nunes, Victor Luiz Correia; Follador, Ivonise; Badaró, Roberto

doi:10.1590/s1413-86702003000300009

Cited by 29 publications

(27 citation statements)

References 12 publications

(6 reference statements)

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“…16,17 Frequently, cutaneous lesions in HIV-infected patients are associated with visceral leishmaniasis resembling postkala-azar dermal leishmaniasis. 18,19 As the clinical manifestations of tegumentary leishmaniasis in HIV-infected patients are likely to be dependent on immunological status, and as the presence of severe immunosuppression may modify the clinical characteristics of the disease, hindering the diagnosis of tegumentary leishmaniasis by physicians, we investigated tegumentary leishmaniasis in HIV-infected patients, focusing on clinical manifestations, diagnosis, immunological status and outcome. These patients were from institutions that concentrate a considerable proportion of HIV patients from São Paulo city, São Paulo state, considered one of the most prevalent region for HIV in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Unusual manifestations of tegumentary leishmaniasis in AIDS patients from the New World

Lindoso

Barbosa

Vergara

et al. 2009

British Journal of Dermatology

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Section: Discussionmentioning

confidence: 99%

Unusual manifestations of tegumentary leishmaniasis in AIDS patients from the New World

Lindoso

Barbosa

Vergara

et al. 2009

British Journal of Dermatology

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“…The incidence of leishmania/human immunodeficiency virus coinfection is increasing, and PKDL has been reported in patients infected with human immunodeficiency virus. [23][24][25] Although not standardised universally or used widely, PCR appears to be the most sensitive and specific assay for the diagnosis of PKDL, according to studies conducted in India and the Sudan. 14 15 Several DNA targets have been described for leishmania, such as ribosomal RNA genes, kinetoplast DNA, miniexon derived genes, and genomic repeats.…”

Section: Discussionmentioning

confidence: 99%

Parasite detection in patients with post kala-azar dermal leishmaniasis in India: a comparison between molecular and immunological methods

Salotra

Sreenivas²,

Beena³

et al. 2003

Journal of Clinical Pathology

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Aims: To evaluate the sensitivity and specificity of serological, immunohistochemical, and molecular methods in the diagnosis of post kala-azar dermal leishmaniasis (PKDL). Methods: Twenty five patients with confirmed PKDL and 25 controls were included in the study. G2D10, a monoclonal antibody against Leishmania, was used for the immunohistochemical (IHC) staining of lesion sections to visualise anti-Leishmania donovani antibodies. The diagnostic usefulness of IHC was compared with enzyme linked immunosorbent assay (ELISA) with a recombinant (rk39) antigen, and a species specific polymerase chain reaction (PCR) assay, amplifying a kinetoplast minicircle DNA sequence. Results: IHC detected 22 of 25 PKDL cases, giving a sensitivity of 88%. The diagnostic sensitivity of both the ELISA and PCR tests was higher (96%). All of the 25 controls examined were negative in PCR, indicating 100% specificity of the test, whereas ELISA showed 96% specificity. Conclusions: IHC with G2D10 significantly enhances the sensitivity of detection of PKDL over routine haematoxylin and eosin staining. ELISA with a recombinant antigen is an economical and practical assay. PCR is the most sensitive and specific diagnostic method for PKDL. The tests described would facilitate the recognition of patients with PKDL, enabling timely treatment, which would contribute greatly to the control of kala-azar.

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“…Two patients presented cutaneous lesions, characterized as PKDL-like, after a successful treatment for VL. One patient presented confluent, miliary papules on the face, thorax, and limbs, and the other presented non-pruritic and erythematous maculopapular lesions on the face and thorax [64], [65]. In two other patients [46], [66], the cutaneous lesion was concomitant to visceral involvement (erythematous papules and plaques).…”

Section: Clinical Aspectsmentioning

confidence: 95%

Visceral Leishmaniasis and HIV Coinfection in Latin America

et al. 2014

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Visceral leishmaniasis (VL) is an endemic zoonotic disease in Latin America caused by Leishmania (Leishmania) infantum, which is transmitted by sand flies from the genus Lutzomyia. VL occurs in 12 countries of Latin America, with 96% of cases reported in Brazil. Recently, an increase in VL, primarily affecting children and young adults, has been observed in urban areas of Latin America. The area in which this spread of VL is occurring overlaps regions with individuals living with HIV, the number of whom is estimated to be 1.4 million people by the World Health Organization. This overlap is suggested to be a leading cause of the increased number of reported VL-HIV coinfections. The clinical progression of HIV and L. infantum infections are both highly dependent on the specific immune response of an individual. Furthermore, the impact on the immune system caused by either pathogen and by VL-HIV coinfection can contribute to an accelerated progression of the diseases. Clinical presentation of VL in HIV positive patients is similar to patients without HIV, with symptoms characterized by fever, splenomegaly, and hepatomegaly, but diarrhea appears to be more common in coinfected patients. In addition, VL relapses are higher in coinfected patients, affecting 10% to 56.5% of cases and with a lethality ranging from 8.7% to 23.5% in Latin America, depending on the study. With regards to the diagnosis of VL, parasitological tests of bone marrow aspirates have proven to be the most sensitive test in HIV-infected patients. Serologic tests have demonstrated a variable sensitivity according to the method and antigens used, with the standard tests used for diagnosing VL in Latin America displaying lower sensitivity. For this review, few articles were identified that related to VL-HIV coinfections and originated from Latin America, highlighting the need for improving research within the regions most greatly affected. We strongly support the formation of a Latin American network for coinfections of Leishmania and HIV to improve the consistency of research on the current situation of VL-HIV coinfections. Such a network would improve the collection of vital data and samples for better understanding of the clinical manifestations and immunopathogenic aspects of VL in immunosuppressed patients. Ultimately, a concerted effort would improve trials for new diagnostic methodologies and therapeutics, which could accelerate the implementation of more specific and effective diagnosis as well as public policies for treatments to reduce the impact of VL-HIV coinfections on the Latin American population.

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Post-kala-azar dermal leishmaniasis associated with AIDS

Cited by 29 publications

References 12 publications

Unusual manifestations of tegumentary leishmaniasis in AIDS patients from the New World

Unusual manifestations of tegumentary leishmaniasis in AIDS patients from the New World

Parasite detection in patients with post kala-azar dermal leishmaniasis in India: a comparison between molecular and immunological methods

Visceral Leishmaniasis and HIV Coinfection in Latin America

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