Leishmaniasis

Copeland, Nathanial K.; Aronson, Naomi

doi:10.1097/qco.0000000000000194

Cited by 103 publications

(36 citation statements)

References 35 publications

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“…Subsequently, several major clinical guidelines have been published, but they were not targeted toward clinical management in North America [13]. In the USA, there is a dichotomous dilemma with the diagnosis and care of patients with leishmaniasis.…”

Section: Discussionmentioning

confidence: 99%

Addressing a clinical challenge: guidelines for the diagnosis and treatment of leishmaniasis

Aronson

2017

BMC Med

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Leishmaniasis is a chronic intracellular parasitic infection that travelers, immigrants, deployed military personnel, and refugees from endemic global areas acquire from the bite of infected sand flies and carry with them, including to non-endemic countries where leishmaniasis may be an unfamiliar illness to medical providers. This commentary discusses the first clinical practice guidelines produced by the Infectious Diseases Society of America and American Society of Tropical Medicine and Hygiene for the diagnosis and management of leishmaniasis, targeted for clinicians in North America.

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Section: Discussionmentioning

confidence: 99%

Addressing a clinical challenge: guidelines for the diagnosis and treatment of leishmaniasis

Aronson

2017

BMC Med

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“…For patients similar to ours a combination treatment could be an alternative, although there is currently not enough international data to judge the value of this approach [11]. However, studies in India have demonstrated excellent efficacy of short combination therapy and according to expert opinion, combination therapy will probably become the standard of VL treatment in the future which will allow to shorten treatment regimens, thus reducing treatment related toxicity, as well as preventing emergence of drug resistance [12].…”

Section: Discussionmentioning

confidence: 99%

A severe case of visceral leishmaniasis and liposomal amphotericin B treatment failure in an immunosuppressed patient 15 years after exposure

et al. 2017

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BackgroundVisceral leishmaniasis (VL) is a protozoan disease, which is responsible for 200.000–400.000 yearly infections worldwide. If left untreated, the fatality rate can be as high as 100% within 2 years. 90% of cases occur in just six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. It is thus a disease rarely seen by physicians in Europe or North America. We report on the fatal case of VL in an 80-year-old immunosuppressed patient who presented with a latency of over 15 years after having visited an endemic region. This is the first report showing such extreme latency of VL in a European traveller. This case is furthermore unusual because it suggests primary treatment failure to liposomal amphotericin B.Case presentationAn 80-year-old man who was on immunosuppressive treatment due to a non-specific inflammatory disease of the liver and kidney presented to our hospital with recurrent fever, fatigue and bloody diarrhoea. Histopathological analysis from a colon biopsy showed intracellular amastigotes. The diagnosis of VL was confirmed by polymerase-chain-reaction (PCR) of the colon biopsy. PCR was also performed in plasma, a bronchopulmonary lavage, a lymph node, liver and bone marrow biopsy and proved L. donovani as causative species. The disseminated infection was unresponsive to treatment with liposomal amphotericin B as recommended in immunosuppressed individuals despite stopping immunosuppressive treatment.ConclusionImported cases of VL to non-endemic regions are increasing due to extensive international travel and migration. Furthermore, the increase of elderly patients and immunosuppressed individuals, secondary to HIV, post-transplant and chemotherapeutic agents, has resulted in an increase of VL also in endemic regions of Europe. It is thus important for physicians to be able to recognize the infection. This case also demonstrates treatment failure to amphotericin B, which was only a known problem in patients with HIV until now. The knowledge of this as a possible complication is important for specialists treating the disease.

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“…[6] Coinfection leads to increased treatment failure, relapse, drug toxicity, and mortality. [7] In HIV-infected patients, cutaneous dissemination is common in visceral leishmaniasis. [2] Furthermore, atypical lesions and relapses of the disease are common in these patients.…”

Section: Discussionmentioning

confidence: 99%

Unusual presentation of mucocutaneous leishmaniasis in HIV-infected patient

Bains

Vedant

Gupta³

et al. 2016

Indian J Sex Transm Dis

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Leishmaniasis is caused by protozoan parasite of genus leishmania. Visceral leishmaniasis, diffuse cutaneous leishmaniasis, and atypical forms of cutaneous leishmaniasis are common in HIV-infected patients. Our patient presented with an obstructive mass in nasal cavity and was diagnosed as a case of mucocutaneous leishmaniasis. Spontaneous healing of lesions in HIV-infected patients is rare rather they are unresponsive to treatment and have frequent relapses, especially in patients with low CD4 count. However, in our patient, the lesion improved significantly after 2 months of highly active antiretroviral therapy and co-trimoxazole prophylaxis.

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Leishmaniasis

Abstract: Leishmaniasis remains a neglected tropical disease, with a need for additional clinical trials with better design and reported endpoints to lead evidence-based treatment recommendations--especially in cutaneous leishmaniasis and leishmaniasis in the immunocompromised host.

Cited by 103 publications

References 35 publications

Addressing a clinical challenge: guidelines for the diagnosis and treatment of leishmaniasis

Addressing a clinical challenge: guidelines for the diagnosis and treatment of leishmaniasis

A severe case of visceral leishmaniasis and liposomal amphotericin B treatment failure in an immunosuppressed patient 15 years after exposure

Unusual presentation of mucocutaneous leishmaniasis in HIV-infected patient

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