“…Autopsy was performed to confirm the mucosal involvement by Leishmania . A real-time Leishmania -specific PCR [8] performed on the nasal biopsy was positive (cycle threshold value 23,87) and molecular HSP70-typing identified L. infantum as etiological agent [9]. Fig.…”
BackgroundLeishmaniasis is a protozoan disease caused by parasites of the genus Leishmania, transmitted to humans by sandflies. The diagnosis of leishmaniasis is often challenging as it mimics many other infectious or malignant diseases. The disease can present in three ways: cutaneous, mucocutaneous, or visceral leishmaniasis, which rarely occur together or consecutively.Case presentationThe patient was a 52 years old immunosuppressed Belgian woman with a long history of severe rheumatoid arthritis. She underwent bone marrow biopsy to explore thrombocytopenia. Diagnosis of visceral leishmaniasis was made by identification of Leishman Donovan (LD) bodies in macrophages. Treatment with liposomal amphotericin B was successful. She later developed cutaneous leishmaniasis treated with amphotericin B lipid complex. She next presented with relapsing cutaneous lesions followed by rapidly progressing lymphadenopathies. Biopsy confirmed the diagnosis of leishmaniasis. Treatments by miltefosine, amphotericin B, N-methyl-glucamine antimoniate were subsequently initiated. She later presented a recurrent bone marrow involvement treated with intramuscular paromomycin and miltefosine. She died two years later from leukemia. At the time of death, she presented with a mucosal destruction of the nose. A Leishmania-specific PCR (Polymerase Chain Reaction) identified L. infantum as etiological agent.ConclusionsClinicians should be aware of the potential concomitant or sequential involvement of multiple anatomic localizations of Leishmania in immunosuppressed patients.
“…Autopsy was performed to confirm the mucosal involvement by Leishmania . A real-time Leishmania -specific PCR [8] performed on the nasal biopsy was positive (cycle threshold value 23,87) and molecular HSP70-typing identified L. infantum as etiological agent [9]. Fig.…”
BackgroundLeishmaniasis is a protozoan disease caused by parasites of the genus Leishmania, transmitted to humans by sandflies. The diagnosis of leishmaniasis is often challenging as it mimics many other infectious or malignant diseases. The disease can present in three ways: cutaneous, mucocutaneous, or visceral leishmaniasis, which rarely occur together or consecutively.Case presentationThe patient was a 52 years old immunosuppressed Belgian woman with a long history of severe rheumatoid arthritis. She underwent bone marrow biopsy to explore thrombocytopenia. Diagnosis of visceral leishmaniasis was made by identification of Leishman Donovan (LD) bodies in macrophages. Treatment with liposomal amphotericin B was successful. She later developed cutaneous leishmaniasis treated with amphotericin B lipid complex. She next presented with relapsing cutaneous lesions followed by rapidly progressing lymphadenopathies. Biopsy confirmed the diagnosis of leishmaniasis. Treatments by miltefosine, amphotericin B, N-methyl-glucamine antimoniate were subsequently initiated. She later presented a recurrent bone marrow involvement treated with intramuscular paromomycin and miltefosine. She died two years later from leukemia. At the time of death, she presented with a mucosal destruction of the nose. A Leishmania-specific PCR (Polymerase Chain Reaction) identified L. infantum as etiological agent.ConclusionsClinicians should be aware of the potential concomitant or sequential involvement of multiple anatomic localizations of Leishmania in immunosuppressed patients.
“…Importantly, iris nodules containing leishmania parasites may be visible. [ 42 ] The rate of visual loss may be gradual[ 44 ] or extremely rapid,[ 49 ] requiring prompt diagnosis and referral to an ophthalmology service. Only one article reports the case of a unilateral posterior uveitis with no inflammatory response in the retina, vitreous or anterior chamber.…”
Section: Resultsmentioning
confidence: 99%
“…[ 38 48 ] It is therefore crucial to obtain samples from the eye itself. Successful methods include corneal scrapings,[ 49 ] aqueous/vitreous aspirate PCR[ 38 48 51 ] and Giemsa staining of iris nodule biopsies. [ 42 ]…”
Section: Resultsmentioning
confidence: 99%
“…Sub-conjunctival steroids may be a useful adjunct to prevent inflammation following intracameral amphotericin B injections. [ 38 49 ] In all cases, steroid monotherapy never brought about any significant therapeutic response and these should always be coupled to a systemic antileishmanial agent. [ 41 48 49 ] Considering the variability in terms of response to therapy, it is essential to be prepared to add or substitute antileishmanials based on the response.…”
Section: Resultsmentioning
confidence: 99%
“…[ 38 49 ] In all cases, steroid monotherapy never brought about any significant therapeutic response and these should always be coupled to a systemic antileishmanial agent. [ 41 48 49 ] Considering the variability in terms of response to therapy, it is essential to be prepared to add or substitute antileishmanials based on the response. [ 51 52 ] Animal experimental models have shown that the penetration of amphotericin B into the aqueous and vitreous is dependent on the presence of ocular inflammation.…”
The incidence of leishmaniasis is reported to be up to 1 million per year. To date, there has been no comprehensive review describing the diversity of clinical presentations of ocular leishmaniasis (OL) and its treatment. This systematic review aims to address this knowledge gap and provide a summary of the clinical presentation, natural course, and treatment options for OL. Our study identified a total of 57 published articles as describing cases of OL involving: adnexa (
n
= 26), orbit (
n
= 1), retina (
n
= 7), uvea (
n
= 18) and cornea (
n
= 6). Though well described and easily treated, palpebral leishmaniasis is often misdiagnosed and may lead to chronic issues if untreated. The retinal manifestations of Leishmaniasis consist of self-resolving hemorrhages secondary to thrombocytopenia. Two main uveitis etiologies have been identified: uveitis in the context of active Leishmanial infection (associated with immunosuppression) and uveitis occurring as an immune reconstitution syndrome. Corneal involvement in most geographic areas generally follows an aggressive course, most often ending in corneal perforation if left untreated. In the Americas, a chronic indolent interstitial keratitis may also occur. Topical steroids are of little use in keratitis (systemic antileishmanials being the cornerstone of treatment). However, these are essential in cases of uveitis, with or without concomitant systemic antileishmanial therapy. In conclusion, though ocular involvement in Leishmaniasis is rare, severe sight-threatening consequences follow if left untreated. Early diagnosis, enthusiastic follow-up and aggressive treatment are essential for good outcomes.
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