Visceral leishmaniasis with cutaneous lesions in a patient infected with human immunodeficiency virus

Ara,; Maillo,; Peón,; Clavel,; Cuesta, José A.; Grasa,; Carapeto,

doi:10.1046/j.1365-2133.1998.02326.x

Cited by 34 publications

(34 citation statements)

References 19 publications

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“…In Ethiopia, severe PKDL was more common in HIV-positive (27.3%) than in HIV-negative (13.3%) VL patients at a 6-month follow-up (216). Case reports of VL-HIVcoinfected patients have described cutaneous lesions that precede (159), accompany (18,44,64,105), and follow (50, 56) VL after treatment. It is unclear whether these are forms of PKDL or parasitized skin lesions formed during the course of VL.…”

Section: Pkdl and Hiv Coinfectionmentioning

confidence: 99%

The Relationship between Leishmaniasis and AIDS: the Second 10 Years

et al. 2008

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SUMMARY To date, most Leishmania and human immunodeficiency virus (HIV) coinfection cases reported to WHO come from Southern Europe. Up to the year 2001, nearly 2,000 cases of coinfection were identified, of which 90% were from Spain, Italy, France, and Portugal. However, these figures are misleading because they do not account for the large proportion of cases in many African and Asian countries that are missed due to a lack of diagnostic facilities and poor reporting systems. Most cases of coinfection in the Americas are reported in Brazil, where the incidence of leishmaniasis has spread in recent years due to overlap with major areas of HIV transmission. In some areas of Africa, the number of coinfection cases has increased dramatically due to social phenomena such as mass migration and wars. In northwest Ethiopia, up to 30% of all visceral leishmaniasis patients are also infected with HIV. In Asia, coinfections are increasingly being reported in India, which also has the highest global burden of leishmaniasis and a high rate of resistance to antimonial drugs. Based on the previous experience of 20 years of coinfection in Europe, this review focuses on the management of Leishmania-HIV-coinfected patients in low-income countries where leishmaniasis is endemic.

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Section: Pkdl and Hiv Coinfectionmentioning

confidence: 99%

The Relationship between Leishmaniasis and AIDS: the Second 10 Years

et al. 2008

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“…We report a severely immunocompromised patient with cutaneous lesions that appeared after a long time of visceral disease. Because Leishmania parasites could be observed in blood smears of patients co-infected with VL and HIV 2,8 we hypothesized that cutaneous lesions in our patient were the result of hematogenic dissemination of visceral disease. Such a hypothesis was strengthened by histologic appearance of cutaneous lesions; Leishmania parasites were observed in deep dermis under normal-appearing epidermis and papillarymedial dermis ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…6 Leishmaniasis in immunocompromised patients appears in advanced stages of HIV infection and shows CD4 + T cell counts less than 200 cells/mm 3 in most patients. 7 Cutaneous lesions in a persons coinfected with VL and HIV may occur by dissemination after an external infection 2,8 or reactivation after a latent infection. We report a severely immunocompromised patient with cutaneous lesions that appeared after a long time of visceral disease.…”

Section: Introductionmentioning

confidence: 99%

“…These features include several relapses after appropriate therapy, atypical parasite locations, and skin involvement. 2 Cutaneous lesions may occur before or after visceral infection and show a considerably variable dermatologic aspect that includes macules, 3 papules, 4 nodules, 5 or ulcers. 6 Leishmaniasis in immunocompromised patients appears in advanced stages of HIV infection and shows CD4 + T cell counts less than 200 cells/mm 3 in most patients.…”

Section: Introductionmentioning

confidence: 99%

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Atypical Lesions as a Sign of Cutaneous Dissemination of Visceral Leishmaniasis in a Human Immunodeficiency Virus–Positive Patient Simultaneously Infected by Two Viscerotropic Leishmania Species

Santos-Oliveira

Da‐Cruz²,

Pires³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Leishmaniasis is considered an emerging opportunistic disease in human immunodeficiency virus (HIV)–infected patients who have considerably variable clinical presentation. We report a patient with visceral leishmaniasis who had unexpected clinical aspects (atypical cutaneous lesions appearing after long-term evidence of visceral parasites). The patient had hepatoesplenomegaly in the absence of fever, but was otherwise generally healthy. The HIV viral load was low despite severe immunossupression (low lymphocyte proliferation and low level of interferon-γ, concomitant with a high lymphocyte activation status). Surprisingly, two Leishmania strains were isolated from his bone marrow (typical L. infantum sequence MON-1, type A) and skin (L. donovani MON-2 sequence); this second strain had not been previously identified in Brazil. The association of visceral leishmaniasis and HIV/acquired immunodeficiency syndrome is a largely unknown disease, particularly in areas in which leishmaniasis is not endemic. Such atypical cases indicate that this disease can be undiagnosed in clinical settings.

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“…Cutaneous localization is rarely described in AIDS and usually represents the primary site of infection, with a low number of lesions; however, a diffuse skin localization secondary to visceral dissemination of the protozoas is exceedingly uncommon. [3][4][5] A case of atypical disseminated cutaneous leishmaniasis after visceral disease, despite continued suppressive treatment with liposomal amphotericin B, is reported in a patient with a recent AIDS diagnosis.…”

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confidence: 99%