Post-Kala-Azar Dermal Leishmaniasis in an HIV-1–Infected Woman: Recovery after Amphotericin B Following Failure of Oral Miltefosine

Guffanti, Monica; Gaiera, Giovanni; Bossolasco, Simona; Ceserani, Norberto; Ratti, Deborah; Cinque, Paola; Salmaso, F.; Gianotti, Nicola; Lazzarin, Adriano

doi:10.4269/ajtmh.2008.79.715

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…A total of 10 cases of PKDL were reported in association with IRIS. 7,13,15,17,19,22 –26 Post–kala-azar dermal leishmaniasis was diagnosed between 1 and 111 months after the onset of HAART. In only 1 patient, the previous diagnosis of VL was unconfirmed.…”

Section: Methodsmentioning

confidence: 99%

“…The most frequent clinical presentation was VL (19 cases), [7][8][9]12,20,26 followed by PKDL (10 cases). 7,13,15,17,19,[22][23][24][25][26] In 2 cases, VL and PKDL were diagnosed simultaneously. 7,26 Tegumentary leishmaniasis was reported in 5 cases 10,11,14,16 , and MCL was reported in 2 of the 5 cases, 14 while diffuse cutaneous leishmaniasis (DCL) was reported in 2 others.…”

Section: Literature Reviewmentioning

confidence: 99%

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Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients

Badaró

Gonçalves

Gois

et al. 2014

J Int Assoc Provid AIDS Care

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Introduction After the onset of highly active antiretroviral therapy (HAART), some HIV-infected patients present a severe inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary and visceral leishmaniasis have been described in association with IRIS. Methods A systematic literature review of IRIS in association with leishmaniasis identified 34 reported cases. Results and Discussion The majority of these occurred in males 4 months following the onset of HAART. The mean CD4 count before HAART was 94 ± 77 cells/mm3, increasing to 5 times the initial value between the onset of HAART and IRIS presentation. Visceral leishmaniasis and post–kala-azar dermal leishmaniasis were the most commonly reported clinical manifestations, followed by tegumentary leishmaniasis and uveitis. Conclusions Commonly found characteristics included cutaneous involvement, regardless of Leishmania species; appearance of lesions unrelated to time of probable Leishmania infection; rapid recovery of CD4 count following HAART; and rapid progression.

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Section: Methodsmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients

Badaró

Gonçalves

Gois

et al. 2014

J Int Assoc Provid AIDS Care

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“…A case on antiretroviral therapy was cured with 100 mg/d given for 28 d 15 . On the contrary, another HIV‐positive case who did not respond to miltefosine was cured with amphotericin B 16 …”

Section: Discussionmentioning

confidence: 99%

Oral miltefosine in post‐kala‐azar dermal leishmaniasis – experience in three cases

Khandpur¹,

Chaturvedi²,

Kumar³

et al. 2010

Int J Dermatology

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“…Clinical manifestations in co-infected patients with PKDL may differ ( Table 2 ). Most patients have florid disease with various descriptions including macules, (painful) papulo-erythematous eruption, disseminated miliary papules, nodules and plaques, or a mixed picture; in most, parasites were easily demonstrated [43] – [47] , [49] , [53] – [56] . The classical distribution and spread from the face to other parts of the body is not always found.…”

Section: Classical Pkdl and Other Dermal Lesions Following Hiv Co-infmentioning

confidence: 99%

“…It is therefore conceivable that antileishmanial therapy and antiretroviral therapy both contribute to this phenomenon ( Figure 3 ). PKDL has been reported to occur as a likely IRD in various cases reports [43] – [47] , [53] , [54] , [56] , [123] ; in some, this was documented in the context of an increasing CD4 cell count as well as decreasing IL-10 and production of interferon-γ [45] , [123] . Sometimes the relationship was not so clear and the lesions occurred after years on ART [46] , [47] ; in others, VL occurred while on successful ART and PKDL occurred after antileishmanial therapy, while ART continued [48] , [49] .…”

Section: Immune Reconstitution Diseasementioning

confidence: 99%

PKDL and Other Dermal Lesions in HIV Co-infected Patients with Leishmaniasis: Review of Clinical Presentation in Relation to Immune Responses

Zijlstra¹

2014

PLoS Negl Trop Dis

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BackgroundCo-infection of leishmaniasis and HIV is increasingly reported. The clinical presentation of leishmaniasis is determined by the host immune response to the parasite; as a consequence, this presentation will be influenced by HIV-induced immunosuppression. As leishmaniasis commonly affects the skin, increasing immunosuppression changes the clinical presentation, such as in post-kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL); dermal lesions are also commonly reported in visceral leishmaniasis (VL) and HIV co-infection.MethodsWe reviewed the literature with regard to dermal manifestations in leishmaniasis and HIV co-infection, in three clinical syndromes, according to the primary presentation: PKDL, VL, or CL.ResultsA wide variety of descriptions of dermal leishmaniasis in HIV co-infection has been reported. Lesions are commonly described as florid, symmetrical, non-ulcerating, nodular lesions with atypical distribution and numerous parasites. Pre-existing, unrelated dermal lesions may become parasitized. Parasites lose their tropism and no longer exclusively cause VL or CL. PKDL in HIV co-infected patients is more common and more severe and is not restricted to Leishmania donovani. In VL, dermal lesions occur in up to 18% of patients and may present as (severe) localized cutaneous leishmaniasis, disseminated cutaneous leishmaniasis (DL) or diffuse cutaneous leishmaniasis (DCL); there may be an overlap with para-kala-azar dermal leishmaniasis. In CL, dissemination in the skin may occur resembling DL or DCL; subsequent spread to the viscera may follow. Mucosal lesions are commonly found in VL or CL and HIV co-infection. Classical mucocutaneous leishmaniasis is more severe. Immune reconstitution disease (IRD) is uncommon in HIV co-infected patients with leishmaniasis on antiretroviral treatment (ART).ConclusionWith increasing immunosuppression, the clinical syndromes of CL, VL, and PKDL become more severe and may overlap. These syndromes may be best described as VL with disseminated cutaneous lesions (before, during, or after VL) and disseminated cutaneous leishmaniasis with or without visceralization.

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Post-Kala-Azar Dermal Leishmaniasis in an HIV-1–Infected Woman: Recovery after Amphotericin B Following Failure of Oral Miltefosine

Cited by 8 publications

References 15 publications

Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients

Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients

Oral miltefosine in post‐kala‐azar dermal leishmaniasis – experience in three cases

PKDL and Other Dermal Lesions in HIV Co-infected Patients with Leishmaniasis: Review of Clinical Presentation in Relation to Immune Responses

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