A Patient Presenting with Diffuse Cutaneous Leishmaniasis (DCL) as a First Indicator of HIV Infection in India

Khandelwal, Kanika; Bumb, R A; Mehta, Rajesh Dutt; Kaushal, Himanshu; Lezama-Dávila, Claudio M.; Salotra, Poonam; Satoskar, Abhay R.

doi:10.4269/ajtmh.2011.10-0649

Cited by 23 publications

(18 citation statements)

References 9 publications

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“…DCL is a rare, but severe, form and is not limited to patients in South America. In patients with Leishmania tropica , L. major , or L. donovani infections in India and Africa, DCL or disseminated CL is also considered a clinical indicator of HIV co-infection [40, 41]. There is also a case report of DCL that developed in the context of the immune reconstitution inflammatory syndrome in a man with AIDS following initiation of antiretroviral therapy [18].…”

Section: Non-healing Human Diseases Associated With L Amazonensis Anmentioning

confidence: 99%

Immunopathogenesis of non-healing American cutaneous leishmaniasis and progressive visceral leishmaniasis

2012

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The outcomes of Leishmania infection are determined by host immune and nutrition status, parasite species, and co-infection with other pathogens. While subclinical infection and self-healing cutaneous leishmaniasis (CL) are common, uncontrolled parasite replication can lead to non-healing local lesions or visceral leishmaniasis (VL). It is known that infection control requires Th1-differentiation cytokines (IL-12, IL-18, and IL-27) and Th1 cell and macrophage activation. However, there is no generalized consensus for the mechanisms of host susceptibility. The recent studies on regulatory T cells and IL-17-producing cells help explain the effector T cell responses that occur independently of the known Th1/Th2 cell signaling pathways. This review focuses on the immunopathogenesis of non-healing American CL and progressive VL. We summarize recent evidence from human and animal studies that reveals the mechanisms of dysregulated, hyper-responses to Leishmania braziliensis, as well as the presence of disease-promoting or the absence of protective responses to Leishmania amazonensis and Leishmania donovani. We highlight immune-mediated parasite growth and immunopathogenesis, with an emphasis on the putative roles of IL-17 and its related cytokines as well as arginase. A better understanding of the quality and regulation of innate immunity and T cell responses triggered by Leishmania will aid in the rational control of pathology and the infection.

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Section: Non-healing Human Diseases Associated With L Amazonensis Anmentioning

confidence: 99%

Immunopathogenesis of non-healing American cutaneous leishmaniasis and progressive visceral leishmaniasis

2012

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“…1 Rarely, diffuse cutaneous leishmaniasis occurs, particularly in immunecompromised patients. 5 In India, cutaneous leishmaniasis is known to be endemic to the Thar Desert of Bikaner in Rajasthan State, which is located in northwestern India at an elevation of approximately 227 meters above mean sea level ( Figure 1). Bikaner is situated in the middle of the Thar Desert.…”

Section: Introductionmentioning

confidence: 99%

Clinco-Epidemiologic Study of Cutaneous Leishmaniasis in Bikaner, Rajasthan, India

Aara¹,

Khandelwal²,

Bumb³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Cutaneous leishmaniasis is endemic to the Thar Desert of Rajasthan, Bikaner, India. The present study describes clinico-epidemiologcial data of all cases of cutaneous leishmaniasis CL in this region during 2001-2011. A total of 1,379 patients with 2,730 lesions were reported during the study period. Ages of patients ranged from 3 months to 86 years, and there was a predominance of infections in males. Most patients were from urban areas and lower middle socioeconomic groups. Lesions were dry, ulcerated nodules or plaques of different sizes commonly over face and upper limb. Skin smears were positive for parasites in 958 (69.5%) patients, and the remaining 45.8% (193 of 421) patients were positive by skin biopsy. Histopathologic analysis of the skin showed mixed granulomas consisting of macrophages, lymphocytes, epitheloid, and plasma cells. Species identification was conducted for 45 randomly selected patients by polymerase chain reaction, the infective species was Leishmania tropica. Most patients were treated with intra-lesional injections of sodium stibogluconate.

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“…As demonstrated by the outbreaks documented in this report, with the lack of any medical intervention and the perennial presence of the major risk factors, CL is expected to persist in the study area. Apart from causing unsightly lesions, L. tropica is capable of more serious disease in synergy with other infections such as HIV, [21][22][23] for which the study area is at risk. Therefore, it cannot be ignored as a public health problem.…”

Section: Discussionmentioning

confidence: 99%

Identification ofLeishmania tropicafrom micro-foci of cutaneous leishmaniasis in the Kenyan Rift Valley

Odiwuor

Muia

Magiri

et al. 2012

Pathogens and Global Health

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We performed diagnosis and species identification of parasites in lesion samples from suspected cutaneous leishmaniasis patients in four villages, three of which are in a known Leishmania tropica endemic region in Kenya. Samples were analyzed both by microscopy and PCR for Leishmania, and typed by an assay using four ribosomal DNA-based species-identification PCRs. The lesions were demonstrated to be caused by L. tropica, which confirms the re-emergence of cutaneous leishmaniasis from this species after a period of reduced incidence in the endemic zone. Our report highlights the importance of an intervention and sustained Leishmania control program.

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A Patient Presenting with Diffuse Cutaneous Leishmaniasis (DCL) as a First Indicator of HIV Infection in India

Abstract: Figure 1. Papulo-nodular lesions on the upper ( A ) and lower extremities ( B ) in an HIV-infected patient suffering from DCL.

Cited by 23 publications

References 9 publications

Immunopathogenesis of non-healing American cutaneous leishmaniasis and progressive visceral leishmaniasis

Immunopathogenesis of non-healing American cutaneous leishmaniasis and progressive visceral leishmaniasis

Clinco-Epidemiologic Study of Cutaneous Leishmaniasis in Bikaner, Rajasthan, India

Identification ofLeishmania tropicafrom micro-foci of cutaneous leishmaniasis in the Kenyan Rift Valley

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