Recurrent leishmaniasis in kidney transplant recipients: report of 2 cases and systematic review of the literature

Abstract

The characteristics of 8 episodes of leishmaniasis with atypical manifestations in 2 Italian kidney transplant recipients are analyzed and contextualized among those of 52 other episodes of leishmaniasis observed in 19 transplant recipients found through a systematic review of the international literature. In all the patients, the initial episode was visceral leishmaniasis, which was associated with mucocutaneous involvement in 2 cases. With the exception of 1 case of post kala-azar dermal leishmaniasis, 2 episodes of Leishmania endophthalmitis, and 3 episodes of mucocutaneous leishmaniasis, all the recurrences were characterized by visceral involvement. The potential role of polymerase chain reaction in monitoring the infection, the importance of a long follow-up, the potential benefit of chemoprophylaxis, and the therapeutic challenges are discussed.

Intestinal microsporidiosis in renal transplant recipients: Prevalence, predictors of occurrence and genetic characterization

“…[18] However, these infections have rarely been reported in RT recipients. [19][20][21] Though, the frequency of microsporidia is less in RT recipients, this cannot be overlooked as microsporidia causes high morbidity and mortality. [3] Also, in the current study, microsporidiosis was diagnosed within mean duration of 4.3 ± 2.5 years (4 months to 9 years) after transplantation which is in concordance with earlier published reports.…”

Leishmaniasis in rheumatology, haematology and oncology: epidemiological, immunological and clinical aspects and caveats: Figure 1

“…The latter can result, for example, from HIV infections, antitumour and immune-ablative chemotherapies or immunosuppressive treatments with glucocorticoids, azathioprine, methotrexate, cyclophosphamide, the calcineurin inhibitors ciclosporin and tacrolimus, the mTOR inhibitors rapamycin (sirolimus) and everolimus, or with biological agents directed against TNF (anti-TNF-antibodies, soluble TNF receptor) or T cell costimulatory molecules. Consequently, immunosuppressed patients with AIDS,11 93 organ transplantations,2 94 haematopoietic malignancies (eg, leukaemia, lymphomas, Hodgkin's disease), autoimmune diseases (eg, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, polyarteritis nodosa, Wegener's granulomatosis, Behçet's disease, myasthenia gravis), chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis) or allergic disorders (eg, asthma, atopic dermatitis) have all been shown to develop severe CL, VL or systemic leishmaniasis, either after primary infection or as a result of reactivation of persistent parasites 95–107. CL, mucosal leishmaniasis or VL can also develop in HIV-infected patients as a manifestation of an immune reconstitution inflammatory syndrome following highly active antiretroviral therapy 108…”

Treatment of American tegumentary leishmaniasis in special populations: a summary of evidence

“…The excretion of amphotericin B, pentamidine isethionate and miltefosine in breast milk is [93][94][95][96][97][98]103,[107][108][109][110][111][112][113][114] (Table 3).…”

“…In transplant recipients, CL and ML are rare and usually there is a time interval between transplantation and disease manifestation 106 . Reviews of organ transplant recipients with leishmaniasis show that the majority of patients have undergone renal transplantation, and most cases are identifi ed as visceral-type disease 93,[107][108][109] .…”