Autochthonous Visceral Leishmaniasis in a Human Immunodeficiency Virus (HIV)-Infected Patient: The First in Thailand and Review of the Literature

Abstract

Abstract. We report a case of visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected 37-year-old Thai fisherman who presented with nephritonephrotic syndrome, fever, anemia, and thrombocytopenia. Bone marrow biopsy revealed many amastigotes within macrophages. Kidney biopsy showed membranoproliferative glomerulonephritis. Polymerase chain reaction (PCR) and nucleotide sequence analysis of the internal transcribed spacer 1 of the small subunit ribosomal RNA gene in blood and kidney biopsy specimens showed Leishmania species previously described in a Thai patient with visceral leishmaniasis. Only four autochthonous cases of leishmaniasis have been reported in Thailand since 1996. To the best of our knowledge, this is the first report of autochthonous visceral leishmaniasis in an HIV-infected Thai. With an increasing number of patients with autochthonous leishmaniasis in association with the presence of potential vector, it remains to be determined whether this vector-borne disease will become an emerging infectious disease in Thailand.Leishmaniasis is a vector-borne infection caused by an obligate intracellular protozoon, Leishmania sp., which is transmitted by phlebotomine sandflies.1-3 It occurs worldwide in tropical and subtropical regions including the Middle East, India, China, Africa, and southern and central America. Thailand is not a known endemic area for leishmaniasis. Most imported cases were reported between 1960 and 1986 in Thai workers returning from the Middle East. 4,5 The first reported indigenous patient with leishmaniasis was a 3-year-old girl living at Suratthani Province of southern Thailand in 1996.6 Several autochthonous cases with leishmaniasis were recently seen in northern, central, and southern Thailand.7-9 Interestingly, these patients were from provinces where a potential sandfly vector has never been reported. [10][11][12] We describe the first report of visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected patient and review all previous reports of autochthonous cases of leishmaniasis in Thailand. CASE REPORTA 37-year-old Thai fisherman with known HIV infection presented with progressive leg edema, ascites, and low-grade fever of 8 weeks duration. Seven weeks prior to admission (PTA), he was hospitalized at Chantaburi Provincial Hospital with a diagnosis of nephritonephrotic syndrome (hypertension, edema, heavy proteinuria, microscopic hematuria, azotemia, hypoalbuminemia, and hypercholesterolemia). He was treated with prednisolone 50 mg/day. Two weeks PTA, he had not improved and developed thrombocytopenia (platelet count of 85,000/µL) and anemia (hematocrit decreased from 29% to 23.4%). Bone marrow aspiration and biopsy were performed and revealed decreased cellularity and many "yeast-like" organisms 1-2 µM in size. Fungal cultures of both specimens did not grow any fungi. He was then transferred to King Chulalonkorn Memorial Hospital in Bangkok for further evaluation. The patient was born at Chantaburi, eastern Thailand. He had never been outside...

Leishmaniasis in Thailand: A Review of Causative Agents and Situations

“…The phylogenetic tree showed that the L. martiniquensis reference sequence was grouped with the same taxa that have been identified as L. siamensis suggesting that most isolates would belong to L. martiniquensis. Figure 2 includes the Leishmania sequences obtained from sandflies and black rats in the study of animal reservoirs and potential vectors of L. siamensis by Chusri and others (JQ866907, JQ866906) 25 and sequences belong to L. siamensis lineage PG previously isolated from Thai patients (GQ226034, GQ293226, JQ001751, and JQ001752), 10,18,19 horses (JQ617283, GQ281278, GQ281279, GQ281280, and GQ281281), 16,21 and cows (GQ281282). 17 However, the L. siamensis lineage TR, ∥The sequences of accession number JQ001752 and KF227887 to KF227892 were obtained from the specimens collected from the same source but different site of specimen collection.…”

“…Phang-nga, 15 4. Chanthaburi, 18 15 The map of Thailand shows sporadic cases of CL and VL reported in six southern, one central, one eastern, and four northern provinces. Table 3 shows the characteristics of published leishmaniasis cases in Thailand from 1999 to 2016.…”

“…E-mail: sleelayoova@gmail.com As shown in Table 2, all L. siamensis published papers from 2008 to 2016 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] were reviewed and the species of Leishmania were confirmed using nucleotide sequences of the SSU-rRNA, ITS1 region of SSU-rRNA, and hsp70 genes from GenBank database and were compared with the nucleotide sequences of each gene using axenic cul- those reported in horses and cow. 16,17,21 Only one published paper by Bualert and others in 2012 identified L. siamensis infection.…”

Detection of Leishmania siamensis DNA in Saliva by Polymerase Chain Reaction

“…[5][6][7] In comparisons of microscopic examination, culture, and PCR in detecting Leishmania parasites, PCR has shown to have a significantly higher sensitivity than culture and microscopic examination (97%, 78%, and 76% [8][9][10] sensitivity, respectively). New cases of leishmaniasis caused by L. siamensis, a novel species of Leishmania, have been documented in patients in Thailand [11][12][13][14][15][16][17] and Myanmar (unpublished data). The infection was described in immunocompromised patients, mostly persons infected with human immunodeficiency virus (HIV).…”

“…The infection was described in immunocompromised patients, mostly persons infected with human immunodeficiency virus (HIV). [11][12][13][14][15][16][17] Clinical presentations of these patients have included visceral, [11][12][13] diffuse cutaneous, 15 and overlapping diffuse cutaneous and visceral forms. 14 With low prevalence of leishmaniasis in Thailand and Myanmar, screening tests for leishmaniasis such as enzymelinked immunosorbent assay, direct agglutination test, and recombinant protein K39 dipstick test are not readily available.…”