Microscopy and Polymerase Chain Reaction Detection of Leishmania chagasi in the Pleural and Ascitic Fluid of a Patient with AIDS: Case Report and Review of Diagnosis and Therapy of Visceral Leishmaniasis

Abstract

Atypical visceral leishmaniasis is increasingly reported in immunocompromised patients, including patients with AIDS. A case of visceral leishmaniasis in an HIV-infected Brazilian patient with pulmonary and peritoneal involvement is reported. Histological evaluation of pleural fluid and ascites aspirate revealed macrophages with intracellular Leishmania. Polymerase chain reaction analysis was positive for Leishmania in the pleural and ascitic fluid with use of primers specific for Leishmania chagasi. In addition to classical methods for diagnosing leishmaniasis, such as microscopy and culture, polymerase chain reaction detection and identification of Leishmania species in pleural effusions and ascites are important diagnostic tools that should be considered by clinicians evaluating HIV-infected patients from endemic areas of visceral leishmaniasis. The authors review the clinical manifestations, diagnostic and therapeutic aspects of visceral leishmaniasis in immunocompetent and HIV-infected patients.

The first documentation of the immune response to cutaneous leishmaniasis caused by Leishmania donovani in Sri Lanka.

“…Their diagnosis was based on microscopy of slit skin smears (SSS) obtained from skin lesions and/or clinical criteria. A detailed description of each lesion, including the number, type (papulo-nodular, ulcerative, plaque types), size (expressed in mm 2 , great axis x small axis), duration and presence of inflammation, were documented. The cytokine patterns in the 9 biopsies were compared with 4 skin biopsy samples obtained from apparently healthy volunteers.…”

“…2 Two of the 4 lesions had inflammatory signs and 2 out of 4 were plaque like lesions. Two lesions out of the 9 CL lesions were ulcerative type, and they both tested positive for IFN-γ.…”

“…1 In leishmaniasis, multiple and complex interactions resulting from the invasiveness of the parasite, tropism and pathogenicity and the genetically determined immune status of the host contribute to the ultimate clinical manifestations of the disease. 2,3 Even among patients with cutaneous leishmaniasis (CL), the clinical presentation may show a spectrum, from single small lesions to large, multiple, disfiguring lesions that may be resistant to treatment. In Sri Lanka, the predominant form of the disease is cutaneous leishmaniasis caused by the parasite Leishmania donovani of the zymodeme MON-37.…”

Importance of Nonenteric Protozoan Infections in Immunocompromised People

“…Visceral leishmaniasis, resulting from the replication of amastigotes within mononuclear phagocytes of the liver, spleen, and bone marrow, usually results in fever, severe cachexia, hepatosplenomegaly, and pancytopenia (170,264,408). The symptoms of VL usually develop after an incubation period of weeks to years (264), and the disease is invariably fatal if left untreated.…”

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

“…Another atypical VL compromising was related in aids patient, when Leishmania chagasi was detected by PCR in the pleural and ascitic fluid 7 .…”