Leishmaniasis or aids?

Loma, A de la; Alvar, Jorge; Galiano, E.Martinez; Blázquez, Julio César; Muñoz, Alejandro; Nájera, Rafael

doi:10.1016/0035-9203(85)90400-6

Cited by 54 publications

(9 citation statements)

References 4 publications

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“…In fact, clinical manifestations of VL caused by L. infantum and L. donovani in HIV-infected patients are not significantly different from those in non-HIVinfected patients 1,6,7,8 . Classical features commonly present are fever, weight loss, hepatosplenomegaly, and pancytopenia.…”

Section: Discussionmentioning

confidence: 86%

“…Since the mid-1980's, when the first case of Leishmania/HIV coinfection was reported, the incidence of coinfection has steadily increased and, at the end of the 90s, it had been reported in 35 countries 1,2 . The majority of the cases in South America are reported in Brazil, where there is a large endemic area for VL with a strong trend to urbanization.…”

Section: Article/artigomentioning

confidence: 99%

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Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

Souza

Biscione

Greco

et al. 2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.

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Section: Discussionmentioning

confidence: 86%

Section: Article/artigomentioning

confidence: 99%

Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

Souza

Biscione

Greco

et al. 2012

Rev. Soc. Bras. Med. Trop.

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“…The first American Leishmania -HIV-coinfected patient was reported in Brazil [8] 5 years after the first world report in 1985 in southern Europe [9]. Since then, many other coinfected cases have been reported in other Latin American countries (Table 1).…”

Section: Epidemiologymentioning

confidence: 98%

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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“…described the first case of leishmaniasis and HIV coinfection. 4 Since then, many other coinfection cases have been reported, most of them in Spain. 5 It is estimated that 1·5–9% of patients with AIDS in south‐western Europe will acquire kala‐azar.…”

Section: Discussionmentioning

confidence: 99%

Kaposi’s sarcoma‐like lesions and other nodules as cutaneous involvement in AIDS‐related visceral leishmaniasis

González‐Beato¹,

Moyano²,

Sánchez³

et al. 2000

British Journal of Dermatology

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A 40-year-old human immunodeficiency virus (HIV)-positive man had three relapses of visceral leishmaniasis (VL). In the third he developed nodular skin lesions of three types, some reminiscent of Kaposi's sarcoma. Biopsy of each type disclosed abundant dermal macrophages with a huge number of intracellular and extracellular Leishman-Donovan bodies. Rapid improvement of lesions was achieved after antiparasitic treatment. AIDS leads to atypical forms of leishmaniasis. Leishmania has been detected both in normal and pathological skin of these patients due to dissemination during VL. It is suspected that a considerable proportion of the population may be infected in endemic areas, Leishmania being opportunistic in immunosuppressed individuals. It is important to recognize the range of lesions that may occur in patients with HIV and VL, many of which are non-specific and may cause diagnostic difficulty.

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Leishmaniasis or aids?

Cited by 54 publications

References 4 publications

Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

Visceral Leishmaniasis and HIV Coinfection in Latin America

Kaposi’s sarcoma‐like lesions and other nodules as cutaneous involvement in AIDS‐related visceral leishmaniasis

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