Tegumentary Leishmaniasis as the Cause of Immune Reconstitution Inflammatory Syndrome in a Patient Co-infected with Human Immunodeficiency Virus and Leishmania guyanensis

Chrusciak‐Talhari, Anette; Ribeiro‐Rodrigues, Rodrigo; Talhari, Carolina; Silva, Roberto Moreira; Ferreira, L.A.F.M.; Botileiro, Simone Ferreira de Castro; Santos, Lucilaide Oliveira; Dietze, Reynaldo; Talhari, Sinésio

doi:10.4269/ajtmh.2009.09-0077

Cited by 25 publications

(21 citation statements)

References 16 publications

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“…The main endemic regions are the Indian subcontinent, the Mediterranean area, Central and South America and south Sudan/ Ethiopia. The most important species causing VL in the Mediterranean area is L. infantum [4,5].…”

Section: Case Discussionmentioning

confidence: 99%

Development of visceral leishmaniasis in an HIV+ patient upon immune reconstitution following the initiation of antiretroviral therapy

et al. 2015

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Visceral leishmaniasis (VL) is a common opportunistic infection in HIV-positive patients from endemic countries but occurs rarely following antiretroviral treatment. This case demonstrates that patients who develop VL upon immune reconstitution may not be diagnosed initially by standard laboratory assays for the diagnosis of VL and underlines the necessity to repeat serologic and molecular biologic testing for VL in cases of fever of unknown origin in patients from or with travel history to endemic countries.

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Section: Case Discussionmentioning

confidence: 99%

Development of visceral leishmaniasis in an HIV+ patient upon immune reconstitution following the initiation of antiretroviral therapy

et al. 2015

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“…Patients with suppressed immune systems: ATL infection is emerging as a result of immunosuppression, and HIV is the most common cause 62,[75][76][77][78][79][80][81][82][83][84][85][86][87][88] . Bone marrow or solid organ transplantation [89][90][91][92][93][94][95] and therapy with immunosuppressive or biologic drugs [96][97][98] also have been associated with the appearance of ATL.…”

Section: Resultsmentioning

confidence: 99%

“…syndrome: the association between ATL and HIV-AIDS has increasingly been described in many regions of the world 99 together with immune reconstitution infl ammatory syndrome presentation 82,84,85,100 .…”

Section: Human Immunodefi Ciency Virus/acquired Immunodefi Ciencymentioning

confidence: 99%

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

Silva

Galvão

Gomes

et al. 2013

Rev. Soc. Bras. Med. Trop.

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Revista da Sociedade Brasileira de Medicina Tropical 46(6):669-677, Nov-Dec, 2013http://dx.doi. org/10.1590/0037-8682-0104-2013 Address to: Dr a Juliana Saboia Fontenele e Silva. Lab. ABSTRACT We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fi ll in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.

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“…Recently, the first case of IRIS associated with Leishmania guyanensis was described. 12 We report the case of a patient with AIDS and disseminated cutaneous histoplasmosis who developed a clinical picture suggestive of IRIS while taking HAART irregularly.…”

Section: Case Reportmentioning

confidence: 99%

Síndrome de restauração imune associada à histoplasmose

Passos

Talhari

Santos

et al. 2011

An. Bras. Dermatol.

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Abstract:A 27-year-old HIV-positive male patient with disseminated cutaneous histoplasmosis was treated with both HAART and amphotericin B (total accumulated dose of 0.5g). Amphotericin B was later replaced with itraconazole (200mg/day). Two months after therapy had been started and the cutaneous lesions had healed, the patient interrupted both treatments voluntarily and his health deteriorated. HAART was then re-introduced and CD4+ cell count increased sharply at the same time as lymph node histoplasmosis was diagnosed. This paradoxical response ? the relapse of histoplasmosis and concomitant increase in CD4+ cell count and undetectable viral load after resumption of HAART ? suggests that this was a case of immune reconstitution inflammatory syndrome (IRIS). Keywords: Histoplasma; Histoplasmosis; Polymerase chain reaction Resumo: Paciente masculino, 27 anos, portador de HIV, com quadro de histoplasmose cutânea disseminada. Terapia antirretroviral oral e anfotericina B por via EV (dose total acumulada 0,5g) foram introduzidas, verificando-se rápida cicatrização das lesões após duas semanas. A anfotericina B foi substituí-da por itraconazol (200mg/dia). O paciente interrompeu voluntariamente os tratamentos. A terapia antirretroviral foi reintroduzida, havendo aumento da contagem de células T CD4-positivas (No restante do texto, a autora usa o símbolo "+" (T CD4+) ao invés da palavra "positiva". O que fazer neste caso? Seguimos o padrão do restante do texto ou acatamos essa opção da autora no resumo?!). Neste momento, diagnosticou-se histoplasmose ganglionar. O aumento da contagem de células T CD4-positivas (de novo aqui), associado à redução da carga viral a níveis inferiores ao limite de detecção após a reintrodução da terapia antirretroviral, sugere que essa piora clínica paradoxal seja uma síndrome de restauração imune. Palavras-chave: Histoplasma; Histoplasmose; Reação em cadeia da polimerase

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Tegumentary Leishmaniasis as the Cause of Immune Reconstitution Inflammatory Syndrome in a Patient Co-infected with Human Immunodeficiency Virus and Leishmania guyanensis

Cited by 25 publications

References 16 publications

Development of visceral leishmaniasis in an HIV+ patient upon immune reconstitution following the initiation of antiretroviral therapy

Development of visceral leishmaniasis in an HIV+ patient upon immune reconstitution following the initiation of antiretroviral therapy

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

Síndrome de restauração imune associada à histoplasmose

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