Isolation of a Protozoan Parasite Genetically Related to the Insect Trypanosomatid Herpetomonas samuelpessoai from a Human Immunodeficiency Virus-Positive Patient

Abstract

Severely immunocompromised human immunodeficiency virus (HIV) patients can develop various opportunistic infections due to bacteria, viruses, fungi, or protozoa. Here we report the first isolation of a flagellated protozoan genetically closely related to Herpetomonas samuelpessoai, which is usually a parasite of insects, from the blood of an HIV-infected patient. CASE REPORTIn November 2003, a 42-year-old man living in the south of France with no history of recent travel outside France was admitted to Montpellier University Hospital with a fever (38.9°C) and left-side continual frontal headache that had persisted for 15 days. The patient was working as a florist, was homosexual, and had no history of drug abuse. He had been human immunodeficiency virus (HIV)-positive since 1991 and had experienced multiple antiretroviral therapy failures. His CD4 cell count had been below 20 cells/mm 3 for 7 years. He had presented with several opportunistic infections, such as anal condyloma, herpes zoster, and multiple episodes of oral candidiasis. At the time of admission, he was treated with abacavir, lamivudine, ritonavir, amprenavir, and cotrimoxazole.Upon admission, physical examination was normal. No neurological signs or primary infection site was noted. Cerebral tomodensitometry showed no abnormality. Laboratory findings revealed a moderate inflammatory syndrome (C-reactive protein, 18.8 mg/liter) and pancytopenia: anemia (hemoglobin, 10.7 g/dl), neutropenia (white blood cell count, 0.9 ϫ 10 3 /mm 3 with 65% neutrophils, 19% lymphocytes, 11% monocytes, and 3% eosinophils), and thrombocytopenia (83 ϫ 10 3 / mm 3 ). A bone marrow biopsy performed on day four after admission showed a regenerative process. Taking into account the fever and pancytopenia, bacterial, viral, fungal, and parasitological investigations (Toxoplasma detection by PCR) were performed on the sputum, blood, cerebrospinal fluid, and bone marrow. Results of all of these investigations were negative. Because leishmaniasis is endemic in the south of France, a blood sample was inoculated on Novy-MacNeal-Nicolle (NNN) medium, a specific blood-enriched culture medium (6), at 27°C and checked weekly for the presence of Leishmania parasites. Four weeks after seeding, a flagellated protozoan was isolated, and the Giemsa-stained preparations from this culture showed a cell body mean size of 10 m by 2.5 m and a flagellum mean size around 12 m. The kinetoplast was generally located close to the nucleus in a para-or promastigote position. The global morphology of the cells was clearly different from that of the Leishmania promastigotes (Fig. 1).Therefore, molecular identification was performed based on nucleotide sequence analysis of 5S and 18S ribosomal DNA regions. Amplification of the 5S region was performed using the previously described primer pair 5S-L and 5S-R, whereas amplification of the 18S region was performed using two primers designed for this study, SSUeuglenD (5Ј-GCGTGCGGTT TAATTTGACT-3Ј) and SSUeuglenR (5Ј-GGACGTAATCG GCACAGTTT-3Ј) (12). PCR product...

SOLiD™ Sequencing of Genomes of Clinical Isolates of Leishmania donovani from India Confirm Leptomonas Co-Infection and Raise Some Key Questions

“…Monoxenous trypanosomatids can be pathogenic for human beings. Similar cases have also been reported [35], [36] where in HIV infected patients, Leptomonas parasites were detected with symptoms sometimes resembling those of visceral or cutaneous leishmaniasis. The present article also sustains the possibility of lower trypanosomatids infecting humans exists and should be considered by attending physicians.…”

Detection of Leptomonas sp. parasites in clinical isolates of Kala-azar patients from India

“…in Texas (McGhee and Cosgrove, 1980), Herpetomonas samuelpessoai in the south of France (Morio et al, 2008), Leptomonas pulexsimulantis in Brazil (Pacheco et al, 1998), or a yet unidentified trypanosomatid in Spain (Jimenez et al, 1996). Also in other mammals similar observations were described, e.g.…”

Probing into the diversity of trypanosomatid flagellates parasitizing insect hosts in South-West China reveals both endemism and global dispersal

“…Despite their virtual omnipresence, especially in some host groups such as Heteroptera and Diptera, insect trypanosomatids remained largely neglected, and until the 1990s only sporadic descriptions, typically based on the ''one host -one parasite" paradigm, were available (Podlipaev, 2001). This has to some extent changed after it was recognized that even monoxenous trypanosomatids have a potential to occasionally infect humans, in particular immunocompromised individuals (Morio et al, 2008;Barreto-deSouza et al, 2008).…”