Duodenal leishmaniasis diagnosed by biopsy in two HIV-positive patients

Alonso, María José; Muñz, E.; Picazo, A.; Abad, Mónica Viñarás; Gómez, Francisco Javier Torres; M, Roldán; Laguna, Fernando Ballester; Paz, J.I.; López-Bravo, A.

doi:10.1016/s0344-0338(97)80092-1

Cited by 19 publications

(9 citation statements)

References 13 publications

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“…The main difference is time; while these are acute diseases, VL develops over a protracted course and possibly because of this, patients do not present with acute hemodynamic changes. L. chagasi is an intracellular parasite restricted to the macrophage lineage, dendritic cells, neutrophils, eosinophils and fibroblasts 21 , no parasitism of hepatocytes, pneumocytes, glomerular or tubular cells or epithelial or glandular intestinal cells occurs 17,18,22,23 , and no toxins are released by Leishmania. Therefore, the absence of parasite actions or products that would harm the host cells or tissues is one more indication that the systemic pathogenicity of VL is dependent on the host response.…”

Section: Discussionmentioning

confidence: 99%

Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

Costa

Werneck

Costa

et al. 2010

Rev. Soc. Bras. Med. Trop.

120

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Introduction: The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. Methods: Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. Results: Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count), while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load). Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. Conclusions: The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome. Keywords: Visceral leishmaniasis. Kala-azar. Severe inflammatory response syndrome. AIDS. Bleeding. RESUMO Introdução: O objetivo do estudo foi identificar os principais fatores de risco para morte na leishmaniose visceral do Novo Mundo e estabelecer um substrato patogênico baseado nos achados clínicos coerente para doença grave. Métodos: Em um estudo caso-controle, foram estudados 76 pacientes internados que faleceram e 320 pacientes internados tratados com sucesso. Resultados: Infecção bacteriana e sangramento foram eventos que levaram à morte, mutuamente exclusivos. Cinco fatores de risco foram únicos para morte por infecção bacteriana (desnutrição, estertores pulmonares, anemia grave, neutropenia absoluta grave e número de leucócitos aumentados), enquanto outros seis foram exclusivos para morte por sangramento (icterícia, neutropenia relativa grave, trombocitopenia grave, lesão hepática, insuficiência renal, maior carga de parasitas na medula óssea). Entre os pacientes tratados com sucesso, as principais síndromes de leishmaniose visceral foram infecções bacterianas, sangramento, anemia grave, diarreia, dispneia, edema, icterícia e carga de parasitas na medula óssea. Conclusões: Os dados apoiam a ideia de que as infecções bacterianas são secundárias a imunoparalisia. O amplo envolvimento de órgãos e sistemas é de forma plausível devido a elevada produção de citocinas pró-inflamatórias, cujas ações se encaixam com a leishmaniose visceral. As síndromes e os mediadores causais são típicos da síndrome de resposta inflamatória sistêmica, desenrolando-se lentamente. Palavras-chaves: Leishmaniose visceral. Calazar. Síndrome da resposta inflamatória sistêmica. AIDS. Sangramento.

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Section: Discussionmentioning

confidence: 99%

Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

Costa

Werneck

Costa

et al. 2010

Rev. Soc. Bras. Med. Trop.

120

View full text Add to dashboard Cite

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“…We should have performed biopsies as esophago-gastro-duodenoscopy endoscopy showed gastroduodenal normal mucosa; previous studies stressed that 45% of biopsies taken in "apparently normal mucosa" at endoscopy in HIV-infected patients with digestive tract symptoms revealed leishmaniasis infection [12,16]. Interestingly, in both cases marked splenomegaly, hypergammaglobulinemia and serum antileishmania antibodies were absent.…”

Section: Discussionmentioning

confidence: 95%

“…Additionally, if at the beginning there was no fever and only moderate splenomegaly, VL should have been considered since the gastrointestinal location is relatively common in HIV-positive individuals [11]. However, in 90% of patients with acquired immunodeficiency syndrome, the location is duodenal and causes dysphagia, diarrhea, or abdominal pain [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

The Role of F-18 FDG PET in the Diagnosis of Visceral Leishmaniasis: Two Case Reports

Chianura¹,

Ferrari²,

Popescu³

et al. 2014

JCR

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Abstract:Visceral leishmaniasis (VL) is endemic in Mediterranean countries. Among immunosuppressed patients, the disease can manifest with atypical clinical features. An unusual clinical manifestation of the disease is fever of unknown origin (FUO). F-18 fluorodeoxyglucose positron emission tomography-computed tomography (F-18 FDG PET) may be useful for detecting inflammatory foci by observing increased metabolism in activated granulocytes and macrophages. We report two cases of PET/CT total body imaging showing a diffuse increase of reticuloendothelial metabolic activity in the spleen and vertebral bodies in two patients diagnosed with VL by direct detection of amastigotes in bone marrow biopsy.

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“…The intestinal symptoms may be the first manifestation of VL or appear as a relapse (Laguna et al, 1994;Sebastian et al, 1997). Co-infection with HIV appears to increase the risk of intestinal involvement in VL (Datry et al, 1990;Michiels et al, 1992;Jablonowski et al, 1994;Laguna et al, 1994;Bechade et al, 1996;Alonso et al, 1997;Hamour et al, 1998;Velasco et al, 1998;Hofman et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Visceral leishmaniasis with duodenal involvement: three immunocompetent cases from southern Iran

Geramizadeh

Fakhar

Motazedian

2006

Annals of Tropical Medicine & Parasitology

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Duodenal leishmaniasis diagnosed by biopsy in two HIV-positive patients

Cited by 19 publications

References 13 publications

Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

The Role of F-18 FDG PET in the Diagnosis of Visceral Leishmaniasis: Two Case Reports

Visceral leishmaniasis with duodenal involvement: three immunocompetent cases from southern Iran

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