L. (L.) chagasi in aids and visceral leishmaniasis (kala-azar) co-infection

Roselino, Ana Maria Ferreira; Chociay, Maria Fernanda; Costa, R. S.; Machado, Alcyone Artioli; Figueiredo, José Fernando de Castro

doi:10.1590/s0036-46652008000400012

Cited by 9 publications

(12 citation statements)

References 20 publications

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“…A similar phenomenon was described in VL, most likely as a consequence of intestinal infection by Leishmania [29], [49]–[52]. The consequent translocation of bacterial components, such as lipopolysaccharides (LPS), may contribute to an enhancement of cellular activation by stimulating the innate and adaptive immune systems [53], creating an inflammatory environment that results in the increased proliferation and activation of T cells and causing a loss in systemic immune function [54], [55].…”

Section: Immunopathogenesismentioning

confidence: 73%

“…In fact, atypical clinical cases have been reported in Latin America, including the involvement of the gastrointestinal tract (duodenum and pancreas) and kidney [52], [58], [59]. However, based on the 356 cases reported so far (Table 1), the major clinical presentation of VL-HIV-coinfected patients in the Americas is quite similar to that observed for VL in non-HIV-infected patients and in Mediterranean coinfected patients.…”

Section: Clinical Aspectsmentioning

confidence: 80%

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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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Section: Immunopathogenesismentioning

confidence: 73%

Section: Clinical Aspectsmentioning

confidence: 80%

Visceral Leishmaniasis and HIV Coinfection in Latin America

et al. 2014

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“…Cytopenias are frequent during the course of HIV infection and may result from several mechanisms 24 . In addition, is important to be alert for possible situations of co-infection where manifestations of VL are atypically presented 28 .…”

Section: Discussionmentioning

confidence: 99%

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

Cavalcanti

Medeiros

Lopes

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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HIV/AIDS-associated visceral leishmaniasis may display the characteristics of an aggressive disease or without specific symptoms at all, thus making diagnosis difficult. The present study describes the results of diagnostic tests applied to a series of suspected VL cases in HIV-infected/AIDS patients admitted in referral hospitals in Pernambuco, Brazil. From a total of 14 eligible patients with cytopenias and/or fever of an unknown etiology, and indication of bone marrow aspirate, 10 patients were selected for inclusion in the study. Diagnosis was confirmed by the following examinations: Leishmania detection in bone marrow aspirate, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. Five out of the ten patients were diagnosed with co-infection. A positive direct agglutination test was recorded for all five co-infected patients, the Leishmania detection and latex agglutination tests were positive in four patients, the rK39 dipstick test in three, the indirect immunofluorescence in two and a positive polymerase chain reaction was recorded for one patient. This series of cases was the first to be conducted in Brazil using this set of tests in order to detect co-infection. However, no consensus has thus far been reached regarding the most appropriate examination for the screening and monitoring of this group of patients.

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“…B o t h c l i n i c a l e n t i t i e s p o t e n t i a t e e a c h other, boosting symptom development and their complications; the most frequently observed clinical manifestations are fever and splenomegaly (10), although there have been seldom reports of atypical cutaneous lesions caused by L. infantum (L. chagasi) (11). Brazil reported 209 cases of Leishmania/ HIV coinfection in 2013, accounting for 6.4% of the total cases of visceral leishmaniasis (8).…”

Section: Epidemiology Of Leishmaniasis In Latin Americamentioning

confidence: 99%

Leishmaniasis visceral en América Latina y perspectivas terapéuticas

Yasnot

2017

Rev MVZ Córdoba

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In Latin America, visceral leishmaniasis is caused by Leishmania infantum. In this geographical area, main vectors associated with transmission are Lutzomyia longipalpis and Lutzomyia evansi, with dogs being incriminated as the main reservoir involved in transmission of the disease. This pathology primarily affects children between 0 -5 years, a highly susceptible population where socio-economic, environmental and nutritional factors affects the pathological outcome and increase the likelihood of vector-human contact. According to the World Health Organization (WHO) recommended treatment for Visceral Leishmaniasis is liposomal amphotericin B, a drug with a limited and variable availability between countries depending on market prices, which leaves pentavalent antimonial as the most widely used treatment despite the associated toxic effects. In the Americas, evidence on the efficacy of single-dose (monotherapy) and combination therapies as options for treating these parasites is required. Disease, drug therapy, Leishmania infantum, Lutzomyia, vector (Source: MeSH). Keywords: RESUMENLa Leishmaniasis visceral es una enfermedad causada en América Latina por Leishmania infantum, en esta área geográfica los principales vectores asociados a la transmisión son Lutzomyia longipalpis y Lutzomyia evansi, siendo el perro uno de los principales reservorios incriminados en su transmisión. Es una patología que afecta principalmente a la población infantil entre los 0 a 5 años, donde los factores socioeconómicos, ambientales y nutricionales son determinantes en el contacto con el insecto vector y el desenlace patológico. Según la Organización Mundial de la Salud el tratamiento recomendando para esta patología es la Anfotericina B liposomal, sin embargo, la disponibilidad del medicamento por el costo varía entre los diferentes países, dejando antimoniales pentavalentes como opción más utilizada, pese a los efectos tóxicos asociados. En el continente americano se requiere evidencia de la eficacia de monoterapias de una solo dosis y terapias combinadas, como opciones para el tratamiento de estas parasitosis. INTRODUCCIÓNLa Leishmaniasis visceral (LV) es una parasitosis causada por un protozoo flagelado del género Leishmania, en América Latina la especie responsable de esta forma clínica es Leishmania infantum, su ciclo de transmisión involucra un insecto vector perteneciente al género Lutzomyia, y animales reservorios, como el perro que se destaca por su papel en el ciclo de transmisión doméstica (1).El proceso infeccioso inicia cuando una hembra hematófaga del genero Lutzomyia se alimenta de sangre del hospedador liberando de sus glándulas salivares promastigotes metacíclicos, los cuales son fagocitados principalmente por macrófagos locales, al interior se transforman en amastigotes que se reproducen intracelularmente. Tras la ruptura del macrófago los amastigotes son liberados con la capacidad de infectar nuevas células, posteriormente migran al hígado, medula ósea y bazo (2) alterando la arquitectura esplénica y produc...

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L. (L.) chagasi in aids and visceral leishmaniasis (kala-azar) co-infection

Cited by 9 publications

References 20 publications

Visceral Leishmaniasis and HIV Coinfection in Latin America

Visceral Leishmaniasis and HIV Coinfection in Latin America

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil

Leishmaniasis visceral en América Latina y perspectivas terapéuticas

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