Dyarrheal Syndrome in a Patient Co-Infected withLeishmania infantumandSchistosoma mansoni

Abstract

This case report describes an atypical clinical presentation of visceral leishmaniasis affecting the digestive tract and causing malabsorption syndrome in a patient without recognized immunosuppressive condition. After appropriate treatment for the classical visceral form of the disease, diarrhea persisted as the main symptom and massive infection by Leishmania was detected by histopathology analysis of the duodenal mucosa. Schistosoma mansoni coinfection was also confirmed and treated without impact on diarrhea. New course of amphotericin B finally led to complete improvement of diarrhea. Atypical visceral leishmaniasis involving the gastrointestinal tract is well recognized in HIV coinfection but very rare in immunocompetent patients. The factors determining the control or evolution of the Leishmania infection have not been completely identified. This case stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, and raises the possible influence of chronic infection by S. mansoni reducing the immune response to Leishmania.

In Vitro and In Vivo Anti-Schistosomal Activity of the Alkylphospholipid Analog Edelfosine

“…The likely involvement of different mechanisms of action for the schistomicidal activities of praziquantel and edelfosine might suggest that the combination of these two drugs could promote a synergistic action and/or minimize the possibility of drug resistance, as has been proposed for the combined use of praziquantel and artemisinin derivatives or mefloquine [70] , [71] . Taking together the results herein reported as well as our previous studies showing the leishmanicidal activity of edelfosine, it might be envisaged that this drug could be of special interest in the treatment of patients that are co-infected with both Leishmania and Schistosoma parasites [29] , [30] , [72] – [74] .…”

“…Miltefosine has also been shown to exert activity against leishmaniasis and schistosomiasis [27] , [28] . Both Leishmania and Schistosoma parasites share geographic areas in tropical and subtropical countries [29] , [30] . Here we have investigated the putative anti-schistosomal properties of edelfosine, as compared to other APLs, by in vitro and in vivo approaches, using an experimental mouse model of S. mansoni infection.…”

Implications of co-infection ofLeptomonasin visceral leishmaniasis in India

“…Leishmania (VL/PKDL)-HIV co-infection is known (Shah et al 2010; Diro et al 2014; Singh, 2014). Several cases of Leishmania co-infection with malaria, chagas, schistosomiasis and tuberculosis were also reported (Griemberg et al 2006; Rathnayake et al 2010; Gil et al 2011; Cota et al 2012; van den Bogaart et al 2013; Vega Benedetti et al 2013). Domestic cats and a dog showing co-infection with Leishmania spp.…”

A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract

“… Biopsy specimen of the duodenum of a patient diagnosed with Visceral Leishmaniasis demonstrates extensive infiltration with Leishmania bodies. (Images obtained with permission from Cota et al [ 84 ]). …”