Leishmania major Cutaneous Leishmaniasis in HIV-Positive Patients Does Not Spread to Extralesional Sites

Healed Lesions of Human Cutaneous Leishmaniasis Caused By Leishmania major Do Not Shelter Persistent Residual Parasites

“…Hence, they may either represent a de novo cutaneous leishmaniasis caused by L. major inoculated by a sand fly bite to a HIV patient or alternatively indicate the reactivation by the HIV induced immunosuppression of residual dormant parasites that persisted in the scar of a previous healed HCL due to L. major . The distinction between the two possibilities in the context of HIV infection remains an open question ( Guiguemde et al., 2003 ; Foulet et al., 2006 ; Ngouateu et al., 2015 ).…”

The Relationship between Leishmaniasis and AIDS: the Second 10 Years

“…However, the relationship is not necessarily linear. Among six African HIV-positive patients with cutaneous L. major infection seen in an outpatient clinic in France between 1997 and 2002, five had DCL and none showed parasite dissemination beyond the lesion, despite a high viral load and very low CD4 levels in the peripheral blood (Ͻ10 cells/l) (99). In DCL, where the tendency for a Th2 response is already established, synergy could emerge early with severe negative consequences for the course of leishmaniasis.…”

“…Leishmania major was reported to cause DCL in a child with AIDS (104), in four coinfected patients with CD4 levels below 10/l, with no visceralization and no relapse after successful treatment (99), and in a severely immunocompromised patient in Burkina Faso, who failed to respond to treatment courses of amphotericin B deoxycholate (AMB), sodium stibogluconate, and liposomal AMB (L-AMB) but responded to miltefosine (234). A longitudinal study in the same country reported clinical polymorphism and a variable treatment response for 32 CL-HIV patients followed over a period of 16 months, with some patients presenting with more than one clinical form (173).…”

“…The incubation period does not seem to be affected by HIV status (99). The impact of HAART has not been studied.…”

Detection and Identification ofLeishmaniaSpecies from Clinical Specimens by Using a Real-Time PCR Assay and Sequencing of the CytochromebGene

“…Although the clinical presentation of cutaneous leishmaniasis is influenced by the infecting species (13,22), on an individual basis, the clinical presentation is not specific enough to allow a reliable species determination (1,7,13,32). Identification of the species can also help predict the risk of dissemination in immunocompromised patients (10,11). Thus, species identification is important to determine the clinical prognosis and to select the most appropriate therapeutic regimen to be administered to each individual.…”