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Bruscas Izu C, Lázaro Sánchez A, Alonso Alonso ML, Álvarez Alegret R. Cutaneous Leishmaniasis: A Case Study in the Context of Treatment with Adalimumab. REUMATOLOGIA CLINICA 2021; 17:304-305. [PMID: 32571735 DOI: 10.1016/j.reuma.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Carlos Bruscas Izu
- Servicio de Reumatología, Hospital General de la Defensa, Zaragoza, España.
| | - Amaya Lázaro Sánchez
- Servicio de Otorrinolaringología, Hospital General de la Defensa, Zaragoza, España
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Moreno Martínez MJ, Moreno Ramos MJ, Sánchez Pedreño P. Cutaneous leishmaniasis: An opportunistic infection. REUMATOLOGIA CLINICA 2017; 13:181-182. [PMID: 27642092 DOI: 10.1016/j.reuma.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 06/06/2023]
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Çakar M, Çinar M, Yilmaz S, Sayin S, Özgür G, Pay S. A case of leishmaniasis with a lupus-like presentation. Semin Arthritis Rheum 2015; 45:e3-4. [PMID: 25953712 DOI: 10.1016/j.semarthrit.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Mustafa Çakar
- Department of Rheumatology, Gulhane Medical Faculty, Gen Tevfik Sağlam Caddesi, Etlik-Ankara 06100, Turkey.
| | - Muhammet Çinar
- Department of Rheumatology, Gulhane Medical Faculty, Gen Tevfik Sağlam Caddesi, Etlik-Ankara 06100, Turkey
| | - Sedat Yilmaz
- Department of Rheumatology, Gulhane Medical Faculty, Gen Tevfik Sağlam Caddesi, Etlik-Ankara 06100, Turkey
| | - Selim Sayin
- Department of Hematology, Gulhane Medical Faculty, Etlik-Ankara, Turkey
| | - Gökhan Özgür
- Department of Hematology, Gulhane Medical Faculty, Etlik-Ankara, Turkey
| | - Salih Pay
- Department of Rheumatology, Gulhane Medical Faculty, Gen Tevfik Sağlam Caddesi, Etlik-Ankara 06100, Turkey
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Guedes-Barbosa LS, Pereira da Costa I, Fernandes V, Henrique da Mota LM, de Menezes I, Aaron Scheinberg M. Leishmaniasis during anti-tumor necrosis factor therapy: report of 4 cases and review of the literature (additional 28 cases). Semin Arthritis Rheum 2013; 43:152-7. [PMID: 23777708 DOI: 10.1016/j.semarthrit.2013.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 01/30/2013] [Accepted: 01/31/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the development of 4 new cases of leishmaniasis in patients receiving anti-tumor necrosis factor-α (anti-TNF) agents and review the pertinent literature. METHODS Chart review of the 4 cases and MEDLINE search for additional reported cases. RESULTS All reported cases, including ours, came from endemic areas. The infection was detected on an average of 23.5 months after the initiation of anti-TNF therapy. The majority of cases had the classical clinical presentation. The biological therapy was suspended in 21 cases. The results were successful for leishmaniasis therapy in all cases. In 10 cases it was possible to reintroduce anti-TNF agents. On follow-up it was observed that there was an infection relapse in 3 cases. CONCLUSIONS The present study shows that leishmaniasis, in its several clinical forms, should be included in the differential diagnosis of possible infections involving patients under use of aTNF therapy. Endemic disease under geographic expansion, easy international displacement and intense human migratory flows certainly represents a risk of this infection in an increasing universe of people which includes the immunosuppressed patients. Cutaneous lesions, prolonged fever, splenomegaly, and pancytopenias, the main clinical-laboratory findings of leishmaniasis, can also be present in autoimmune rheumatic disease, thus leading to delayed diagnosis and treatment of the parasitic disease. The diagnosis depends basically on a high suspicion index, being confirmed with the identification of the protozoan. The classic treatment of the infection when instituted is associated with complete recovery. It is important to point out that all cases reported so far had either originated from or been recently in regions regarded as endemic of leishmaniasis.
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Cenderello G, Pasa A, Dusi A, Dentone C, Toscanini F, Bobbio N, Bondi E, Del Bono V, Izzo M, Riccio G, Anselmo M, Giacchino R, Marazzi MG, Pagano G, Cassola G, Viscoli C, Ferrea G, De Maria A. Varied spectrum of clinical presentation and mortality in a prospective registry of visceral leishmaniasis in a low endemicity area of Northern Italy. BMC Infect Dis 2013; 13:248. [PMID: 23718708 PMCID: PMC3674923 DOI: 10.1186/1471-2334-13-248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 05/22/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls. METHODS Demographic data, clinical, laboratory features and therapeutic findings were recorded in patients identified by a regional VL disease registry from January 2007 to December 2010. RESULTS A total of 55 patients (36 adults mean age 48.7 years, 19 children median age 37.5 months) were observed presenting with 65 episodes. All childen were immunocompetent, whereas adults affected by VL included both immunocompetent (n°17) and immunesuppressed (n°19) patients. The clinical presentation was homogeneous in children with predominance of fever and hepato-splenomegaly. A wider spectrum of clinical presentations was observed in immunocompromised adults. Bone marrow detection of intracellular parasites (Giemsa staining) and serology (IFAT) were the most frequently used diagnostic tools. In addition, detection of urinary antigen was used in adult patients with good specificity (90%). Liposomal amphotericin B was the most frequently prescribed first line drug (98.2% of cases) with 100% clinical cure. VL relapses (n°10) represented a crucial finding: they occurred only in adult patients, mainly in immunocompromised patients (40% of HIV, 22% of non-HIV immunocompromised patients, 5,9% of immunocompetent patients). Furthermore, three deaths with VL were reported, all occurring in relapsing immunocompromised patients accounting for a still high overall mortality in this group (15.8%). CONCLUSIONS The wide spectrum of clinical presentation in immunesuppresed patients and high recurrence rates still represent a clinical challenge accounting for high mortality. Early clinical identification and satisfactory treatment performance with liposomal amphotericin B are confirmed in areas with low-level endemicity and good clinical standards. VL needs continuing attention in endemic areas where increasing numbers of immunocompromised patients at risk are dwelling.
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Affiliation(s)
| | - Ambra Pasa
- S.C. Oncologia Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Andrea Dusi
- SSD Microbiologia ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | - Chiara Dentone
- SC. Malattie Infettive, ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | | | - Nicoletta Bobbio
- S.C. Malattie Infettive Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Elisabetta Bondi
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Valerio Del Bono
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Manuela Izzo
- SC Malattie infettive Ospedale Santa Maria della Misericordia Albenga ASL-2, Albenga (SV), Italy
| | - Giovanni Riccio
- SC Malattie infettive Ospedale Santa Maria della Misericordia Albenga ASL-2, Albenga (SV), Italy
| | - Marco Anselmo
- SC Malattie Infettive Ospedale San Paolo ASL2, Savona, Italy
| | - Raffaella Giacchino
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Maria Grazia Marazzi
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Gabriella Pagano
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Giovanni Cassola
- S.C. Malattie Infettive Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Giuseppe Ferrea
- SC. Malattie Infettive, ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | - Andrea De Maria
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
- S.S.Infettivologia, IRCCS AOU San Martino-IST Genova, Genova, Italy
- A.D.M, University of Genova, Largo R.Benzi 10, Genova, 16132, Italy
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Berry CE, Tsai J, Tierney A, Pickles R. Visceral leishmaniasis in a patient taking adalimumab for rheumatoid arthritis. Med J Aust 2013; 198:331-3. [DOI: 10.5694/mja12.11003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 12/10/2012] [Indexed: 11/17/2022]
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Visceral leishmaniasis: host-parasite interactions and clinical presentation in the immunocompetent and in the immunocompromised host. Int J Infect Dis 2013; 17:e572-6. [PMID: 23380419 DOI: 10.1016/j.ijid.2012.12.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 12/05/2012] [Accepted: 12/21/2012] [Indexed: 01/06/2023] Open
Abstract
Visceral leishmaniases are vector-borne parasitic diseases caused by protozoa belonging to the genus Leishmania. The heterogeneity of clinical manifestations and epidemiological characteristics of the disease reflect the complex interplay between the infecting Leishmania species and the genetic and immunologic characteristics of the infected host. The clinical presentation of visceral leishmaniasis depends strictly on the immunocompetency of the host and ranges from asymptomatic to severe forms. Conditions of depression of the immune system, such as HIV infection or immunosuppressive treatments, impair the capability of the immune response to resolve the infection and allow reactivation and relapses of the disease.
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Leishmaniasis: new insights from an old and neglected disease. Eur J Clin Microbiol Infect Dis 2011; 31:109-18. [PMID: 21533874 DOI: 10.1007/s10096-011-1276-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/12/2011] [Indexed: 02/06/2023]
Abstract
Leishmaniases are a clinically heterogeneous group of diseases caused by protozoa of the genus Leishmania. There is growing evidence that the true incidence of the disease is underestimated, especially in hyperendemic regions. Moreover, climate changes together with the increasing movement of humans and animals raise concerns about the possible introduction of Leishmania infection in previously spared areas. The disease is emerging in immunocompromised patients undergoing bone marrow or solid organ transplantation or treatment with biologic drugs. Furthermore, the deployment of military troops and travel to endemic areas are associated with the observation of a growing number of patients with cutaneous disease. Improvement in diagnostic methods, both in the field and in specialized laboratories, has been obtained through the implementation of molecular amplification methods and using the rK39 antigen as the substrate. Finally, new therapeutic approaches are gaining attention, such as the use of miltefosine for cutaneous leishmaniasis and paromomycin for visceral leishmaniasis, as well as the use of various antileishmanial drugs in combination.
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