Mediterranean leishmaniasis in HIV-infected patients: Epidemiological, clinical, and diagnostic features of 22 cases

Abstract

Twenty-two Italian HIV-infected patients developed leishmaniasis, clinically manifested as visceral (13 cases), cutaneous (2 cases) and disseminated disease (7 cases). Twenty were males and two females (mean age: 32.8 years) with a mean CD4+ cell count of 46.8/microliter at diagnosis; risk factors were intravenous drug use (17 patients) and sexual behaviour (two bisexual, two homosexual, one heterosexual). All but one patient lived or travelled in hypoendemic Italian regions and other Mediterranean countries. Apart from the two patients with cutaneous leishmaniasis, the clinico-pathological and biological spectrum of the infection was often atypical, especially in patients with disseminated disease. The diagnosis was routinely made by direct recovery of parasites in biological specimens, mainly in bone marrow aspirate, whereas serology was negative or borderline in most of the patients. Among 17 in vitro isolates, Leishmania infantum was the only species involved with previously undescribed isoenzyme patterns in two cases. Treatment with antimonials and other drugs showed only temporary clinical improvement in some patients. Relapses were the rule. Leishmaniasis confirms itself as an opportunistic infection in HIV-positive persons. Secondary chemoprophylaxis should be considered in cases of relapsing disease.

Disseminated cutaneous leishmaniasis after visceral disease in a patient with AIDS

“…1,2 Leishmaniasis is emerging as a common and serious opportunistic infection for patients with HIV disease in endemic areas (such as Southern Europe). 1,3,4 Although classic microbiologic methods and pentavalent antimony compounds have been pivotal for half a century for leishmaniasis diagnosis and treatment, respectively, new molecular-based approaches and the lipid formulations of amphotericin B have been successfully tested, and seem reliable in the setting of this protozoan disease. 1 In patients with HIV infection, visceral leishmaniasis occurs with various clinical presentations, ranging from typical forms to asymptomatic or atypical cases.…”

Vaccination with Plasmid DNA Encoding TSA/LmSTI1 Leishmanial Fusion Proteins Confers Protection againstLeishmania majorInfection in Susceptible BALB/c Mice

“…In addition, approximately 1.5 to 2 million new cases are believed to occur annually. Moreover, Leishmania-human immunodeficiency virus coinfection is emerging as an extremely serious new disease, particularly in Southern Europe and South America (1,9,34,41). These alarming figures are believed to be due primarily to the lack of both an efficacious vaccine and safe and efficient methods to control the various vectors that transmit the diseases.…”

Disseminated Leishmaniasis: Clinical, immunological, and therapeutic aspects

“…The presence of DL cases in HIV carriers or immunosuppressed patients is reported in association with other Leishmania species [Agostini et al, 1998;Schraner et al, 2005;Lindoso et al, 2009]. We found no evidence for any type of immunosuppression in DL patients from the L. braziliensis endemic area of Corte de Pedra.…”

“…It has also been observed in other regions of Brazil and South America [Galvão et al, 1993;Ogawa et al, 2006;Calvopina et al, 2005]. DL has also been reported in the Old World [Alborzi et al, 2008]; some cases are associated with immunosuppression [Agostini et al, 1998;Schraner et al, 2005;Lindoso et al, 2009]. DL can be caused by several species of Leishmania, like L. amazonensis [Carvalho et al, 1994], L. guyanensis [Couppié et al, 2004], and L. panamensis [Calvopina et al, 2005], but the main causative agent in the New World is L. braziliensis [Turetz et al, 2002].…”