Visceral leishmaniasis due to Leishmania infantumwith renal involvement in HIV-infected patients

Abstract

BackgroundWe describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings.Cases presentationFour HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete recovery of renal function after anti-parasitic treatment. Main clinical presentations were nephrotic or nephritic syndrome and/or acute renal failure secondary to membranoproliferative type III glomerulonephritis or acute interstitial nephritis. Clinical outcome was poor, probably as a consequence of insufficient immuno-virological control of the HIV infection.ConclusionsOur findings suggest that the main histological findings in case of renal involvement due to Leishmania infantum infection in HIV-infected patients are type III MPGN and acute interstitial nephritis, with a histological specificity similar to that observed in canine leishmaniasis. Poor immune status in HIV-infected patients, altering the capacity for parasite clearance, and prolonged course of chronic active VL in this population may lead to the development of specific renal lesions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0561-9) contains supplementary material, which is available to authorized users.

Characterization of Leishmania (L.) infantum chagasi in visceral leishmaniasis associated with hiv co-infection in Northeastern Brazil

“…The increasing number of visceral leishmaniasis/HIV coinfection cases in Brazil is worrying, in view of the inherent risk of developing VL when HIV is present 14 - 16 . Additionally, the cumulative immunosuppression accelerates the clinical progression of both infections 17 . In the present study, the female patient presented classical clinical and epidemiological features of VL infection.…”

Canine leishmaniosis and kidney disease: Q&A for an overall management in clinical practice

“…Type III MPGN, amyloidosis and acute interstitial nephritis with intralesional parasites are the most common pathological findings in affected people (Vassallo et al . 2014, Enriquez et al . 2015).…”

“…However, tubular necrosis is also described and thought to be secondary to the inflammation and/or ischemia due to small vessel obliteration by Leishmania parasites (Vassallo et al . 2014).…”

“…Visceral leishmaniosis in humans frequently affects immune-deficient patients, e.g. those infected with the human immunodeficiency virus or organ transplant recipients (Clementi et al 2011, Vassallo et al 2014, Enriquez et al 2015, El Jeri et al 2017. Visceral leishmaniosis is also reported in association with other renal diseases such as those occurring as part of systemic lupus erythematous, sicca syndrome and diabetes (El Jeri et al 2017).…”

“…Visceral leishmaniosis is also reported in association with other renal diseases such as those occurring as part of systemic lupus erythematous, sicca syndrome and diabetes (El Jeri et al 2017). Type III MPGN, amyloidosis and acute interstitial nephritis with intralesional parasites are the most common pathological findings in affected people (Vassallo et al 2014, Enriquez et al 2015. However, tubular necrosis is also described and thought to be secondary to the inflammation and/or ischemia due to small vessel obliteration by Leishmania parasites (Vassallo et al 2014).…”