Reactivation of Cutaneous Leishmaniasis after Renal Transplantation: A Case Report

Mortazavi, Hossein; Salehi, Mona; Kamyab, Kambiz

doi:10.1155/2014/251423

Cited by 9 publications

(14 citation statements)

References 13 publications

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“…There are numerous causes of immunosuppression in human patients, for example HIV infection, cancer, immunosuppressive treatments and transplantation. The association between immunosuppression and atypical cutaneous manifestations of leishmaniasis was systematically reviewed in a previous study ( Meireles et al, 2017 ) and described as case reports by several authors ( Gontijo et al, 2002 ; Tuon et al, 2007 , 2014 ; Mortazavi et al, 2014 ; Souza et al, 2017 ; among others). In a case of a kidney transplant patient infected with L. braziliensis , a concurrent cutaneous, visceral and ocular leishmaniasis was observed ( Gontijo et al, 2002 ).…”

Section: The Host Point Of Viewmentioning

confidence: 99%

The Binomial Parasite-Host Immunity in the Healing Process and in Reactivation of Human Tegumentary Leishmaniasis

2018

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Leishmaniasis is a vector-borne infectious disease caused by different species of protozoa from the Leishmania genus. Classically, the disease can be classified into two main clinical forms: Visceral (VL) and Tegumentary (TL) leishmaniasis. TL is a skin/mucosal granulomatous disease that manifests mainly as cutaneous localized or disseminated ulcers, papules diffusely distributed, mucosal lesions or atypical lesions. Once the etiology of the infection is confirmed, treatment can take place, and different drugs can be administered. It has already been shown that, even when the scar is clinically evident, inflammation is still present in the native tissue, and the decrease of the inflammatory process occurs slowly during the 1st years after clinical healing. The maintenance of residual parasites in the scar tissue is also well documented. Therefore, it is no longer a surprise that, under some circumstances, therapeutic failure and/or lesion reactivation occurs. All over the years, an impressive amount of data on relapses, treatment resistance and lesion reactivation after healing has been collected, and several factors have been pointed out as having a role in the process. Different factors such as Leishmania species, parasite variability, Leishmania RNA virus 1, parasite load, parasite persistence, age, nutritional status, gender, co-morbidities, co-infection, pregnancy, immunosuppression, lesion duration, number and localization of lesions, drug metabolism, irregular treatment and individual host cellular immune response were described and discussed in the present review. Unfortunately, despite this amount of information, a conclusive understanding remains under construction. In addition, multifactorial influence cannot be discarded. In this context, knowing why leishmaniasis has been difficult to treat and control can help the development of new approaches, such as drugs and immunotherapy in order to improve healing maintenance. In this sense, we would like to highlight some of the findings that may influence the course of Leishmania infection and the therapeutic response, with an emphasis on TL.

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Section: The Host Point Of Viewmentioning

confidence: 99%

The Binomial Parasite-Host Immunity in the Healing Process and in Reactivation of Human Tegumentary Leishmaniasis

2018

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“…In a report from Iran, several weeks after immunosuppression (cyclosporine and prednisolone) for a renal transplant, two previously untreated lesions became large and cauliflowerlike. 5 A report from Brazil described reactivation 1 year after transplant while on tacrolimus, mycophenolate, and prednisolone. 6 Another report from Brazil describes reactivation of cutaneous leishmaniasis after 2 years in the context of corticosteroid treatment for rheumatoid arthritis.…”

Section: Discussionmentioning

confidence: 99%

Case Reports: Late Emergence of Cutaneous Leishmaniasis in an Immunocompromised Patient in a Non-Endemic Setting

New

Rogers

2019

The American Journal of Tropical Medicine and Hygiene

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“…The treatment of CL (CL, MCL, and PKDL) for SOT and HSCT patients is not standardized. In general, treatment decisions must be made on an individual basis, and active drugs include amphotericin B, PAs, fluconazole, miltefosine, pentamidine, and paromomycin [15,54,62,[83][84][85][86][87][88]. Topical treatment (cryotherapy, thermotherapy, intralesional antimonials) or surgical excision has been advocated in cases involving a limited number of small lesions.…”

Section: Managementmentioning

confidence: 99%

Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management

Clemente¹,

Mourão²

2020

Emerging Transplant Infections

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Leishmaniasis is a rare disease in both solid-organ and hematopoietic stem cell transplantation. Additionally, the frequency of disease is likely related to the leishmaniasis prevalence in the general population. Although cutaneous leishmaniasis (CL) presentation is more prevalent than that of visceral leishmaniasis (VL) in the general population, the opposite occurs in transplant patients. The current available knowledge is based on small series, case reports, or extrapolations from studies conducted in the general population or in immunocompromised subjects. Therefore, recommendations for disease management are based on the opinion of experts. Leishmania transmission through organ grafts has not been conclusively demonstrated, and there are relatively low rates of transfusion-transmitted leishmaniasis (TTL). To date, compulsory screening for VL in organ donors and the deferral criteria have still not been established. In the context of transplant recipients, diagnosis and management remain a challenge. Delayed diagnosis frequently occurs because of low clinical suspicion and atypical disease presentation. Liposomal amphotericin is the drug of choice and the most commonly used therapy. However, patient profile, Leishmania species, disease extent, drug availability or toxicity, presence of concomitant infections, and especially response can influence this choice. Immunosuppression dose reduction is often recommended, but such decisions must be taken on an individual basis. The main challenges include donor screening and organ deferral, duration of therapy, secondary prophylaxis, and follow-up.

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Reactivation of Cutaneous Leishmaniasis after Renal Transplantation: A Case Report

Cited by 9 publications

References 13 publications

The Binomial Parasite-Host Immunity in the Healing Process and in Reactivation of Human Tegumentary Leishmaniasis

The Binomial Parasite-Host Immunity in the Healing Process and in Reactivation of Human Tegumentary Leishmaniasis

Case Reports: Late Emergence of Cutaneous Leishmaniasis in an Immunocompromised Patient in a Non-Endemic Setting

Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management

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