Severe post-kala-azar dermal leishmaniasis successfully treated with miltefosine in an Ethiopian HIV patient

Abongomera, Charles; Battaglioli, Tullia; Adera, Cherinet; Ritmeijer, Koert

doi:10.1016/j.ijid.2019.02.012

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…The majority of patients were men (86.1%), with a median age of 35.5 years (IQR 29.5–42). Group 1 ([6,10–25], cases 1 and 3) included 20 patients (55.6%), group 2 ([23,26–36], case 2) included 16 patients (44.4%). Patients from group 1 originated mostly from Europe, whereas patients from group 2 were mostly from Central or South America, East Africa and India.…”

Section: Resultsmentioning

confidence: 99%

“…Notably, few cases are from the areas of highest prevalence of PKDL which impacts the external validity of our study. Moreover, some cases of PKDL were diagnosed clinically with no parasitic confirmation on skin biopsy ( [13,18,23,25] and case 3), which exposes to a risk of misdiagnosis. Finally, missing data were frequent, notably regarding the control of HIV infection under ART which would have been interesting to assess.…”

Section: Discussionmentioning

confidence: 99%

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Immune recovery-related patterns of post kala-azar dermal and ocular leishmaniasis in people living with HIV

Rousset

Zenou

Saunier³

et al. 2022

Aids

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Objective:Post kala-azar dermal leishmaniasis (PKDL) is a rare complication of visceral leishmaniasis. We aimed at reporting PKDL cases in people living with HIV (PLHIV) and compare their characteristics based on whether PKDL occurred in the context of immune recovery under antiretroviral therapy (ART) or not.Design:National survey and literature review.Methods:We called for observations in France in October 2020 and performed a literature review from PubMed (Medline) and Web of Science up to December 2020. Two groups of patients were defined based on whether PKDL occurred in the context of immune recovery under ART (group 1) or not (group 2), and compared.Results:Three PLHIV with PKDL identified in France in the last decade were described and added to 33 cases from the literature. Compared with group 2 (16/36, 44.4%), patients from group 1 (20/36, 55.6%) originated more frequently from Europe (12/20, 60% vs. 2/16, 12.5%; P = 0.0038), had higher median blood CD4+ cell counts (221/μl vs. 61/μl; P = 0.0005) and increase under ART (122/μl, interquartile range 73–243 vs. 33/μl, interquartile range 0–53; P = 0.0044), had less frequently concomitant visceral leishmaniasis (3/20, 15% vs. 8/12, 66.7%; P = 0.006), and a trend to more frequent ocular involvement (7/20, 35% vs. 1/16, 6.25%; P = 0.0531).Conclusion:In PLHIV, PKDL occurs after a cured episode of visceral leishmaniasis as part of an immune restoration disease under ART, or concomitant to a visceral leishmaniasis relapse in a context of AIDS. For the latter, the denomination ‘disseminated cutaneous lesions associated with visceral leishmaniasis’ seems more accurate than PKDL.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Immune recovery-related patterns of post kala-azar dermal and ocular leishmaniasis in people living with HIV

Rousset

Zenou

Saunier³

et al. 2022

Aids

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“…While the use of oral miltefosine tablets to treat CL and VL is approved for South America, it is not yet widely available in East Africa with the first study conducted in Ethiopia for CL and for VL in Kenya showing promise [16][17][18]. PKDL is often treated with sodium stibogluconate in East Africa, while the use of miltefosine has been reported elsewhere [19]. Nevertheless, treatment for the leishmaniases can be prohibitively expensive, and providers often rely on the donation of supplies and medications to care for their patients [8].…”

Section: Introductionmentioning

confidence: 99%

The leishmaniases in Kenya: A scoping review

Grifferty,

Shirley,

O’Brien

et al. 2023

PLoS Negl Trop Dis

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Background The leishmaniases are a group of four vector-borne neglected tropical diseases caused by 20 species of protozoan parasites of the genus Leishmania and transmitted through a bite of infected female phlebotomine sandflies. Endemic in over 100 countries, the four types of leishmaniasis–visceral leishmaniasis (VL) (known as kala-azar), cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and post-kala-azar dermal leishmaniasis (PKDL)–put 1.6 billion people at risk. In Kenya, the extent of leishmaniasis research has not yet been systematically described. This knowledge is instrumental in identifying existing research gaps and designing appropriate interventions for diagnosis, treatment, and elimination. Methodology/Principal findings This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to determine the state of leishmaniases research in Kenya and identify research gaps. We searched seven online databases to identify articles published until January 2022 covering VL, CL, MCL, and/or PKDL in Kenya. A total of 7,486 articles were found, of which 479 underwent full-text screening, and 269 met our eligibility criteria. Most articles covered VL only (n = 141, 52%), were published between 1980 and 1994 (n = 108, 39%), and focused on the theme of “vectors” (n = 92, 34%). The most prevalent study types were “epidemiological research” (n = 88, 33%) tied with “clinical research” (n = 88, 33%), then “basic science research” (n = 49, 18%) and “secondary research” (n = 44, 16%). Conclusion/Significance While some studies still provide useful guidance today, most leishmaniasis research in Kenya needs to be updated and focused on prevention, co-infections, health systems/policy, and general topics, as these themes combined comprised less than 4% of published articles. Our findings also indicate minimal research on MCL (n = 1, <1%) and PKDL (n = 2, 1%). We urge researchers to renew and expand their focus on these neglected diseases in Kenya.

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“…PKDL is more frequent and more severe in HIV co-infection (Abongomera et al, 2019); skin lesions may precede, accompany, or follow VL in HIV co-infection, some of which may be referred to as PKDL (Zijlstra, 2014). As the pathophysiology is completely different, this category will not be discussed.…”

Section: Introductionmentioning

confidence: 99%

Biomarkers in Post-kala-azar Dermal Leishmaniasis

Zijlstra¹

2019

Front. Cell. Infect. Microbiol.

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Post-kala-azar dermal leishmaniasis (PKDL) follows visceral leishmaniasis (VL, kala-azar) in 10-60% of cases. It is characterized by an asymptomatic skin rash, usually starting in the face and consisting of macules, papules, or nodules. Diagnosis is difficult in the field and is often made clinically. There is an extensive differential diagnosis, and parasitological confirmation is preferred particularly when drug treatment is considered. The response to treatment is difficult to assess as this may be slow and lesions take long to heal, thus possibly exposing patients unnecessarily to prolonged drug treatment. Biomarkers are needed; these may be parasitological (from microscopy, PCR), serological (from blood, or from the lesion), immunological (from blood, tissue), pathological (from cytology in a smear, histology in a biopsy), repeated clinical assessment (grading, photography), or combinations. In this paper, we will review evidence for currently used biomarkers and discuss promising developments.

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Severe post-kala-azar dermal leishmaniasis successfully treated with miltefosine in an Ethiopian HIV patient

Cited by 7 publications

References 13 publications

Immune recovery-related patterns of post kala-azar dermal and ocular leishmaniasis in people living with HIV

Immune recovery-related patterns of post kala-azar dermal and ocular leishmaniasis in people living with HIV

The leishmaniases in Kenya: A scoping review

Biomarkers in Post-kala-azar Dermal Leishmaniasis

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