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

Schleenvoigt, Benjamin T.; Ignatius, Ralf; Baier, Michael; Schneider, Thomas; Weber, Maja; Hagel, Stefan; Forstner, Christina; Pletz, Mathias W.

doi:10.1007/s15010-015-0813-7

Cited by 3 publications

(5 citation statements)

References 17 publications

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“…Here, we included also visceral leishmaniasis [ 5 ]. Visceral leishmaniasis (VL) is a common opportunistic infection in HIV-positive patients from endemic countries but occurs rarely following antiretroviral treatment [ 13 ]. It is a vector-borne infection that is transmitted to humans through the bite of an infected sandfly which usually becomes infected from blood of infected animals in particular dogs.…”

Section: Discussionmentioning

confidence: 99%

Visceral Leishmaniasis and Herpes Zoster as a Component of Syndrome of Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient

Muco

Karruli

Hoxha

et al. 2022

Case Reports in Infectious Diseases

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Immune reconstitution syndrome (IRIS) is a state of unusual hyperinflammatory response against latent infections which occurs after CD4 cell count improvement and as a consequence of immune response once highly active antiretroviral therapy for HIV is introduced. Leishmania parasites and varicella zoster virus (VZV) may be a manifestation of IRIS, but few data exist in literature in particular regarding Leishmania parasites. Case Presentation. A 47-year-old man was admitted to our hospital with fever. He was diagnosed with HIV infection and was a late presenter according to CD4+ count of 98 cells/mm3/9.5% and baseline illness (chronic diarrhea, weight loss, and oral candidiasis). The patient started highly active antiretroviral therapy (abacavir plus lamivudine plus efavirenz). Clinical symptoms improved and CD4+ increased to 22%, 374 cells/mm3. After 88 days, he presented with a 17-day history of high fever, sweat, fatigue, further weight loss, and lethargy. According to clinical image findings and hematochemical parameters, the patient was diagnosed with visceral leishmaniasis. He improved under treatment with liposomal amphotericin B. He presented again, 105 days after with disseminated herpes zoster infection. CD4+ count was 28.5%, 455 cell/mm3. The patient started treatment with acyclovir for 10 days. Four weeks later, he had no skin elements. At present, the patient continues HAART and is under regular monitoring. Conclusions. Early diagnosis of IRIS-associated diseases and treatment were fundamental in the patient’s prognosis. Our patient presented with two different components of IRIS in two different time frames, confirming IRIS to be a broad-spectrum disease, heterogeneous and unique for each patient. A close monitoring during ART initiation, in particular in late presenters, is important in preventing IRIS. In case of IRIS development, a detailed investigation of rare associated diseases not only common ones is of great importance for the management and the prognosis of these patients.

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Section: Discussionmentioning

confidence: 99%

Visceral Leishmaniasis and Herpes Zoster as a Component of Syndrome of Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient

Muco

Karruli

Hoxha

et al. 2022

Case Reports in Infectious Diseases

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“…Outside the European region, cases were diagnosed in Australia (n = 10, [28,36,45,57,64,211,251]), Kenya (n = 16, [16]), Kuwait (n = 36, [19]), Saudi Arabia (n = 35, [259]) and the USA (n = 8, [21,43,49,51,55,60,215]). The predominance of cases from the Mediterranean region likely reflects more intensive travel to southern Europe, especially in people from countries where most cases were diagnosed such as France (n = 107, [6,18,61,68]), the UK (n = 80, [22,38,50,52,58,201,204,207,210,214,219,252,253,261]) and Germany (n = 68, [8,20,25,27,33,35,37,40,44,46,47,53,56,…”

Section: Visceral Leishmaniasismentioning

confidence: 99%

“…Relapse or treatment failure occurred in 14% of the cases where treatment was known (n = 35) in 12% of patients initially treated with LAmB and 19% of patients initially treated with antimonials. Retreatments (n = 19, [21,32,35,44,47,51,55,58,66,252,260,261] often consisted of additional single or multiple courses of the same treatment strategy (53%, [44,47,51,55,58,66,260,261]) and rarely consisted in combined therapy [35]. Seventy-seven percent of the failures/relapses occurred in immunosuppressed patients [32,35,47,55,58,66,252,257,260,261].…”

Section: Visceral Leishmaniasismentioning

confidence: 99%

“…Retreatments (n = 19, [21,32,35,44,47,51,55,58,66,252,260,261] often consisted of additional single or multiple courses of the same treatment strategy (53%, [44,47,51,55,58,66,260,261]) and rarely consisted in combined therapy [35]. Seventy-seven percent of the failures/relapses occurred in immunosuppressed patients [32,35,47,55,58,66,252,257,260,261]. Patients medically immunosuppressed by chemical or biological drugs or presenting immunodeficiencies (such as HIV infection/AIDS) are prone to VL relapses [295,296]; therefore, close monitoring until a sustained immune reconstitution has occurred is advisable [297].…”

Section: Visceral Leishmaniasismentioning

confidence: 99%

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Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review

Rocha¹,

Pereira

Maia³

2022

Pathogens

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Leishmaniases are human and animal parasitic diseases transmitted by phlebotomine sand flies. Globalization is an important driver of the burden and in the current dynamics of these diseases. A systematic review of articles published between 2000 and 2021 was conducted using the PubMed search engine to identify the epidemiology and clinical management of imported human leishmaniases as a fundamental step to better manage individual cases and traveler and migrant health from a global perspective. A total of 275 articles were selected, representing 10,341 human imported cases. Identified drivers of changing patterns in epidemiology include conflict and war, as well as host factors, such as immunosuppression, natural and iatrogenic. Leishmania species diversity associated with different clinical presentations implies diagnostic and treatment strategies often complex to select and apply, especially in non-endemic settings. Thus, diagnostic and management algorithms for medical clinical decision support are proposed. Increased surveillance of non-endemic cases, whether in vulnerable populations such as refugees/migrants and immunocompromised individuals or travelers, could improve individual health and mitigate the public health risk of introducing Leishmania species into new areas.

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“…Although VL seems to be rare in the context of IRIS, it must be considered as a cause of sudden fever of unknown origin following the initiation of antiretroviral treatment in HIV patients from (or with travel history to) endemic areas. 71 …”

Section: Iris and Leishmaniasismentioning

confidence: 99%

Leishmaniasis–HIV coinfection: current challenges

Lindoso¹,

Cunha²,

Queiroz³

et al. 2016

HIV

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Leishmaniasis – human immunodeficiency virus (HIV) coinfection can manifest itself as tegumentary or visceral leishmaniasis. Almost 35 countries have reported autochthonous coinfections. Visceral leishmaniasis is more frequently described. However, usual and unusual manifestations of tegumentary leishmaniasis have been reported mainly in the Americas, but the real prevalence of Leishmania infection in HIV-infected patients is not clear. Regarding the clinical manifestations, there are some reports showing unusual manifestations in visceral leishmaniasis and tegumentary leishmaniasis in HIV-infected patients; yet, the usual manifestations are more frequent. Leishmaniasis diagnosis relies on clinical methods, but serological tests are used to diagnose visceral leishmaniasis despite them having a low sensitivity to tegumentary leishmaniasis. The search for the parasite is used to diagnose both visceral leishmaniasis and tegumentary leishmaniasis. Nevertheless, in HIV-infected patients, the sensitivity of serology is very low. Drugs available to treat leishmaniasis are more restricted and cause severe side effects. Furthermore, in HIV-infected patients, these side effects are more prominent and relapses and lethality are more recurrent. In this article, we discuss the current challenges of tegumentary leishmaniasis and visceral leishmaniasis–HIV infection, focusing mainly on the clinical manifestations, diagnosis, and treatment of leishmaniasis.

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

Cited by 3 publications

References 17 publications

Visceral Leishmaniasis and Herpes Zoster as a Component of Syndrome of Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient

Visceral Leishmaniasis and Herpes Zoster as a Component of Syndrome of Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient

Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review

Leishmaniasis–HIV coinfection: current challenges

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

Cited by 3 publications

References 17 publications

Visceral Leishmaniasis and Herpes Zoster as a Component of Syndrome of Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient

Visceral Leishmaniasis and Herpes Zoster as a Component of Syndrome of Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient

Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review

Leishmaniasis&ndash;HIV coinfection: current challenges

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Leishmaniasis–HIV coinfection: current challenges