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Berrezouga L, Kooli I, Belgacem S, Marrakchi W, Ben Hamouda S, Toumi A, Babba H, Zakhama A, Chakroun M. Mucosal leishmaniasis of the lips and cheeks: a first concomitant presentation of visceral and mucosal leishmaniasis in a patient living with HIV/AIDS in Monastir, Tunisia. AIDS Res Ther 2024; 21:73. [PMID: 39443962 DOI: 10.1186/s12981-024-00660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 09/27/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is the most severe and fatal disease if left untreated. In people living with HIV/AIDS (PLHA), VL is considered an emerging opportunistic infection. The aim of this manuscript was to report a first case in Tunisia of a concomitant presentation of visceral and oral leishmaniasis in a patient LHA. A systematic review of the literature was performed according to PRISMA guidelines, as well. CASE PRESENTATION The patient, a 43-year-old heterosexual man, treated for HIV/AIDS was referred for macrocheilitis of the upper and lower lips. A noticeable nodular and painless swelling extending to the cheeks' mucosa was noted. The patient's poor oral hygiene was evident due to the presence of multiple dental caries. Histological analysis of the biopsied lower lip sample revealed the presence of numerous Leishmania amastigotes. The diagnosis of VL was clinically confirmed by the presence of a mild splenomegaly and pancytopenia and biologically by the identification of the parasite using PCR Lei and the species L. infantum involved using RFLP-PCR and culture. The treatment consisted of an intravenous administration of liposomal Amphotericin B (Ambisome®, 40 mg/kg/weight) for a period of 6 weeks. A favorable outcome was noted after one year with the resolution of clinical symptoms and a negative Leishmania blood PCR test. After 2 years, the patient remained asymptomatic but showed a positive Leishmania blood PCR test. Dolutegravir® was introduced in the patient's ART regimen. CONCLUSIONS To the best of our knowledge, this is the first case report in Tunisia of atypical VL diagnosed through an uncommon oral location in an HIV/AIDS co-infected patient . Since VL is a severe and potentially fatal disease, it is essential for dentists to perform a thorough clinical examination and adopt a multidisciplinary approach in order to ensure an early diagnosis and an effective treatment outcome.
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Affiliation(s)
- Latifa Berrezouga
- Department of Microbiology and Immunology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia.
- Department of Endodontics, Dental Clinic, University of Monastir, Monastir, Tunisia.
- Laboratory of Medical and Molecular Parasitology and Mycology LR12ES09, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.
| | - Ikbel Kooli
- Department of Infectious Diseases, F. Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Sameh Belgacem
- Laboratory of Medical and Molecular Parasitology and Mycology LR12ES09, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Department of Microbiology, F. Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Wafa Marrakchi
- Department of Infectious Diseases, F. Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Seifeddine Ben Hamouda
- Department of Department of Pathology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Adnene Toumi
- Department of Infectious Diseases, F. Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Hamouda Babba
- Laboratory of Medical and Molecular Parasitology and Mycology LR12ES09, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Department of Microbiology, F. Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Abdelfattah Zakhama
- Department of Department of Pathology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Mohamed Chakroun
- Department of Infectious Diseases, F. Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
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Ostad M, Shirian S, Pishro F, Abbasi T, Ai A, Azimi F. Control of Cutaneous Leishmaniasis Using Geographic Information Systems from 2010 to 2014 in Khuzestan Province, Iran. PLoS One 2016; 11:e0159546. [PMID: 27467509 PMCID: PMC4965128 DOI: 10.1371/journal.pone.0159546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/04/2016] [Indexed: 12/21/2022] Open
Abstract
Background Cutaneous leishmanisis (CL) is found worldwide and is considered to be endemic in 88 countries such as Iran. Geographic information system (GIS) is a method that can create, archive, analyze traditional map and place data of the disease distribution. The aim of this study was to produce distributional maps of CL over five years and evaluate the role of GIS in control of CL in Khuzestan province where an endemic area of CL in Iran is. Methods CL epidemiological data on the District and village levels for the period 2010–2013 were provided as census by health surveillance system in all counties and in control diseases center (CDC) of Khuzestan province. After collection of CL data, the collected data of CL from 2010 to 2013 were analyzed using GIS. The collected data of CL from 2010 to 2013 was analyzed using GIS. The endemic areas of CL during 2010–2013 were recognized using GIS maps and the control programs of CL were done in these regions based on epidemiological situation and the stratification of risk areas. Results During the study period, there were 4672 recorded cases of clinical cases of CL by Khuzestan Health Center. Data of GIS referring to CL patients showed that center and eastern districts of Khuzestan had a significant number of cases. In 2014 that control program was done, ten distinct of Khuzestan Province didn’t show any cases of the disease. Conclusion In conclusion, analyses of data distributed in the geographic spaces are increasingly appreciated in leishmaniasis control management. GIS tools promoted greater efficiency in making decisions and planning activities in the control of vector born disease such as leishmaniasis.
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Affiliation(s)
- Mojdeh Ostad
- Department of Geography, Ahvaz Islamic Azad University, Ahvaz, Iran
| | - Sadegh Shirian
- Department of Pathology, School of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
- Shiraz Molecular Pathology Research Center, Dr Daneshbod Lab, Shiraz, Iran
- * E-mail: (SS); (FA)
| | - Fatemeh Pishro
- Department of Geography, Ahvaz Islamic Azad University, Ahvaz, Iran
| | - Tahereh Abbasi
- Shiraz Molecular Pathology Research Center, Dr Daneshbod Lab, Shiraz, Iran
- Department of Water Resource Engineering, Shiraz Islamic Azad University, Shiraz, Iran
| | - Armin Ai
- Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Azimi
- Department of Geography, Ahvaz Islamic Azad University, Ahvaz, Iran
- * E-mail: (SS); (FA)
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PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses. PLoS Negl Trop Dis 2014; 8:e3258. [PMID: 25412435 PMCID: PMC4238984 DOI: 10.1371/journal.pntd.0003258] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Co-infection of leishmaniasis and HIV is increasingly reported. The clinical presentation of leishmaniasis is determined by the host immune response to the parasite; as a consequence, this presentation will be influenced by HIV-induced immunosuppression. As leishmaniasis commonly affects the skin, increasing immunosuppression changes the clinical presentation, such as in post-kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL); dermal lesions are also commonly reported in visceral leishmaniasis (VL) and HIV co-infection. Methods We reviewed the literature with regard to dermal manifestations in leishmaniasis and HIV co-infection, in three clinical syndromes, according to the primary presentation: PKDL, VL, or CL. Results A wide variety of descriptions of dermal leishmaniasis in HIV co-infection has been reported. Lesions are commonly described as florid, symmetrical, non-ulcerating, nodular lesions with atypical distribution and numerous parasites. Pre-existing, unrelated dermal lesions may become parasitized. Parasites lose their tropism and no longer exclusively cause VL or CL. PKDL in HIV co-infected patients is more common and more severe and is not restricted to Leishmania donovani. In VL, dermal lesions occur in up to 18% of patients and may present as (severe) localized cutaneous leishmaniasis, disseminated cutaneous leishmaniasis (DL) or diffuse cutaneous leishmaniasis (DCL); there may be an overlap with para-kala-azar dermal leishmaniasis. In CL, dissemination in the skin may occur resembling DL or DCL; subsequent spread to the viscera may follow. Mucosal lesions are commonly found in VL or CL and HIV co-infection. Classical mucocutaneous leishmaniasis is more severe. Immune reconstitution disease (IRD) is uncommon in HIV co-infected patients with leishmaniasis on antiretroviral treatment (ART). Conclusion With increasing immunosuppression, the clinical syndromes of CL, VL, and PKDL become more severe and may overlap. These syndromes may be best described as VL with disseminated cutaneous lesions (before, during, or after VL) and disseminated cutaneous leishmaniasis with or without visceralization.
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Crovetto-Martínez R, Aguirre-Urizar JM, Orte-Aldea C, Araluce-Iturbe I, Whyte-Orozco J, Crovetto-De la Torre MA. Mucocutaneous leishmaniasis must be included in the differential diagnosis of midline destructive disease: two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e20-6. [PMID: 25442251 DOI: 10.1016/j.oooo.2014.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/18/2014] [Accepted: 09/09/2014] [Indexed: 01/05/2023]
Abstract
Midline destructive lesions have multiple possible etiologies, which can be grouped into neoplastic, infectious, or vasculitis-associated. The purpose of these case reports and literature review was to highlight the need to include mucocutaneous leishmaniasis in the diagnosis of midfacial lesions in any patient who has lived in Leishmania-endemic areas because this entity meets all of the clinical criteria to be considered a form of midline destructive lesion. We present two cases of mucocutaneous leishmaniasis that occurred in a Bolivian male immigrant and a European male traveler to Panama, in whom lesions were misdiagnosed as different midline destructive lesions with different causes (Wegener, vasculitis, and natural killer or T-cell lymphoma [NKTL]). The conclusion of our work is that all patients with midline destructive lesions should undergo histologic and molecular studies to be evaluated for mucosal leishmaniasis, particularly patients whose clinical history suggests this possibility. In cases of uvular involvement, biopsy of this region might be a possible alternative to nasal biopsy.
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Affiliation(s)
- R Crovetto-Martínez
- Department of Stomatology II, University of the Basque Country / EHU, Spain.
| | - J M Aguirre-Urizar
- Department of Stomatology II, University of the Basque Country / EHU, Spain
| | - C Orte-Aldea
- Department of Otorhinolaryngology, Miguel Servet Hospital, Zaragoza, Spain
| | - I Araluce-Iturbe
- Department of Otorhinolaryngology, Basurto University Hospital (UPV/EHU), Bilbao, Vizcaya, Spain
| | - J Whyte-Orozco
- Department of Anatomy and Histology, University of Zaragoza, Spain
| | - M A Crovetto-De la Torre
- Department of Otorhinolaryngology, Basurto University Hospital (UPV/EHU), Bilbao, Vizcaya, Spain
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Lingual Leishmaniasis Presenting to Maxillofacial Surgery in UK with Successful Treatment with Miltefosine. Case Rep Med 2013; 2013:975131. [PMID: 24194765 PMCID: PMC3806221 DOI: 10.1155/2013/975131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/24/2013] [Indexed: 10/29/2022] Open
Abstract
Leishmaniasis is a disease that is caused by protozoa of the genus Leishmania, which is prevalent in tropical and subtropical areas. Clinical forms of leishmaniasis are particularly diverse representing a complex of diseases. We present a case of lingual Leishmaniasis in an immunocompetent man. The lesions were caused by Leishmania donovani/infantum species. The patient responded excellently to miltefosine treatment, with no reactivation during followup. To the authors' knowledge, it is the first such case of successful miltefosine treatment in this unusual variant of leishmaniasis occurring on the tongue.
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Daneshbod Y, Oryan A, Davarmanesh M, Shirian S, Negahban S, Aledavood A, Davarpanah MA, Soleimanpoor H, Daneshbod K. Clinical, histopathologic, and cytologic diagnosis of mucosal leishmaniasis and literature review. Arch Pathol Lab Med 2011; 135:478-82. [PMID: 21466365 DOI: 10.5858/2010-0069-oa.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Mucosal leishmaniasis (ML) is a rare disease in the world, even in endemic areas such as Iran. Clinical, histologic, or cytologic assessment may help in the diagnosis of ML. OBJECTIVE To describe clinical, histologic, and cytologic findings in ML. DESIGN Review of our files showed 11 patients diagnosed with ML, of whom 7 patients had oral lesions, 1 of whom was a known patient with oral leishmaniasis with recurrence of oral lesions; 2 had laryngeal lesions; and 3 had nasal lesions. One case of laryngeal leishmaniasis was a recurrence of prior oral lesions. Cytologic smears were prepared by scraping the lesions with a scalpel or cytobrush. Histology on the biopsies was done for 7 patients. In 2 patients with nasal lesions, exfoliative cytology was made by washing the nasal cavity. Smears were both air dried and fixed in alcohol and stained. RESULTS Cytologic findings showed free Leishman-Donovan bodies, intrahistiocytic Leishman-Donovan bodies, atypical organisms, granuloma, acute and chronic inflammatory cells, histiocytes, multinucleated giant cells, mast cells, binucleated histiocytes (Reed-Sternberg-like cells), and plasma cells. In 6 of the patients, biopsy was inconclusive and in subsequent cytology the organism was detected. In 3 cases, findings from clinical and cytologic examinations were suggestive for leishmaniasis; however, with response to treatment, the diagnosis was confirmed. In 5 patients a malignant tumor was suspected because of clinical or histologic findings, but cytology helped to diagnose leishmaniasis. CONCLUSIONS Clinically or histologically, ML can be mistaken for benign and malignant lesions. Scraping or exfoliative cytology is an easy, reliable, and cost-effective method for diagnosing ML. Thus, clinical, histologic, and cytologic features together may help in ML diagnosis.
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Affiliation(s)
- Yahya Daneshbod
- Department of Cytopathology, Dr Daneshbod Pathology Laboratory, Shiraz, Iran.
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Mazumder SA, Pandey S, Brewer SC, Baselski VS, Weina PJ, Land MA, Fleckenstein JM. Lingual leishmaniasis complicating visceral disease. J Travel Med 2010; 17:212-4. [PMID: 20536896 DOI: 10.1111/j.1708-8305.2010.00403.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leishmania species are obligate intracellular parasites transmitted by various types of female sand flies. The clinical syndrome that results depends on a number of factors including the Leishmania species and immune response of the host. Here, we report successful treatment of lingual leishmaniasis complicating visceral disease in an immunocompetent patient.
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Affiliation(s)
- Shirin A Mazumder
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
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Awale M, Kumar V, Saravanan P, Mohan CG. Homology modeling and atomic level binding study of Leishmania MAPK with inhibitors. J Mol Model 2009; 16:475-88. [PMID: 19649663 DOI: 10.1007/s00894-009-0565-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 07/08/2009] [Indexed: 12/11/2022]
Abstract
The current therapy for leishmaniasis is not sufficient and it has two severe drawbacks, host-toxicity and drug resistance. The substantial knowledge of parasite biology is not yet translating into novel drugs for leishmaniasis. Based on this observation, a 3D structural model of Leishmania mitogen-activated protein kinase (MAPK) homologue has been developed, for the first time, by homology modeling and molecular dynamics simulation techniques. The model provided clear insight in its structure features, i.e. ATP binding pocket, phosphorylation lip, and common docking site. Sequence-structure homology recognition identified Leishmania CRK3 (LCRK3) as a distant member of the MAPK superfamily. Multiple sequence alignment and 3D structure model provided the putative ATP binding pocket of Leishmania with respect to human ERK2 and LCRK3. This analysis was helpful in identifying the binding sites and molecular function of the Leishmania specific MAPK homologue. Molecular docking study was performed on this 3D structural model, using different classes of competitive ATP inhibitors of LCRK3, to check whether they exhibit affinity and could be identified as Leishmania MAPK specific inhibitors. It is well known that MAP kinases are extracellular signal regulated kinases ERK1 and ERK2, which are components of the Ras-MAPK signal transduction pathway which is complexed with HDAC4 protein, and their inhibition is of significant therapeutic interest in cancer biology. In order to understand the mechanism of action, docking of indirubin class of molecules to the active site of histone deacetylase 4 (HDAC4) protein is performed, and the binding affinity of the protein-ligand interaction was computed. The new structural insights obtained from this study are all consistent with the available experimental data, suggesting that the homology model of the Leishmania MAPK and its ligand interaction modes are reasonable. Further the comparative molecular electrostatic potential and cavity depth analysis of Leishmania MAPK and human ERK2 suggested several important differences in its ATP binding pocket. Such differences could be exploited in the future for designing Leishmania specific MAPK inhibitors.
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Affiliation(s)
- Mahendra Awale
- National Institute of Pharmaceutical Education and Research, Nagar, Punjab, India
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Palmeiro MR, Rosalino CMV, Quintella LP, Morgado FN, da Costa Martins AC, Moreira J, de Oliveira Schubach A, Conceição-Silva F. Gingival leishmaniasis in an HIV-negative patient. ACTA ACUST UNITED AC 2007; 104:e12-6. [DOI: 10.1016/j.tripleo.2007.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 06/13/2007] [Accepted: 07/06/2007] [Indexed: 01/19/2023]
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Motta ACF, Lopes MA, Ito FA, Carlos-Bregni R, de Almeida OP, Roselino AM. Oral leishmaniasis: a clinicopathological study of 11 cases. Oral Dis 2007; 13:335-40. [PMID: 17448219 DOI: 10.1111/j.1601-0825.2006.01296.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leishmaniasis is a parasitic disease with diverse clinical manifestations, and considered a public health problem in endemic countries such as Brazil. Mucosal lesions usually involve the upper respiratory tract, with a predilection for nose and larynx. Oral involvement is unusual and in most cases it becomes evident after several years of resolution of the original cutaneous lesions. Oral lesions classically appear as mucosal ulcerations, mainly in the hard or soft palate. This report describes the clinicopathological data of 11 cases of mucocutaneous leishmaniasis with oral manifestations. Two cases of Leishmania (Viannia) braziliensis and one case of Leishmania (Leishmania) amazonensis were confirmed by polymerase chain reaction-restriction fragment length polymorphism or DNA sequencing in mucosal samples.
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Affiliation(s)
- A C F Motta
- Division of Dermatology, Department of Medical Clinics, Faculty of Medicine of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
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de Lima Pereira SA, dos Santos VM, Rodrigues DBR, da Cunha Castro EC, dos Reis MA, de Paula Antunes Teixeira V. Quantitative analysis of fibrosis and mast cells in the tongue of chronic chagasic patients: autopsy study. Med Mal Infect 2007; 37:229-33. [PMID: 17346914 DOI: 10.1016/j.medmal.2006.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 11/27/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Recently, an orally transmitted outbreak of Chagas disease was reported in Santa Catarina, Brazil, after ingestion of sugar cane juice (garapa). This disease is caused by Trypanosoma cruzi, a parasite that stimulates the development of chronic inflammatory response, characterized by fibrous connective tissue neoformation (fibrosis). As the density of tissue mast cells (MC) may be an index of fibroblast proliferation and development of local fibrosis, the purpose of this autopsy study was to quantify the fibrosis rate and the number of MC in the tongues of chronic chagasic (CC) patients, compared with a non-chagasic (NC) control group. METHODOLOGY Twenty-four evaluations, with a quantitative assessment of fibrosis percentage and MC density were performed. RESULTS The percentage of fibrosis in the tongue was higher among CC than in the control group. In the CC group, a positive and significant correlation was found when the fibrosis rate was compared with the MC density. CONCLUSIONS These morphometric findings suggest that tongue biopsy may be useful to study specific changes associated with Chagas disease. They also suggest that the systematic analysis of oral cavity, including tongue histopathology changes, could be useful in forensic pathology of the orally acquired chronic Chagas disease.
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Puig L, Pradinaud R. Leishmania and HIV co-infection: dermatological manifestations. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2004; 97 Suppl 1:107-14. [PMID: 14678638 DOI: 10.1179/000349803225002589] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Leishmania species can cause a wide spectrum of cutaneous disease in HIV-positive patients: asymptomatic, localized cutaneous, mucosal, muco-cutaneous, diffuse cutaneous or post-kala-azar leishmaniasis. In such cases, which are usually severely immunocompromised, the leishmanial parasites reach the skin of the human host by dissemination after either a new infection (resulting from the bite of infected sandfly or, probably, the sharing of contaminated syringes by intravenous-drug users) or the re-activation of a latent infection. Recent experience and past observations on the dermatology of leishmaniasis in those with Leishmania/HIV co-infection are reviewed here.
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Affiliation(s)
- L Puig
- Departamento de Dermatología, Hospital de la Santa Creu I Sant Pau, Avenida de Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
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Olivier M, Badaró R, Medrano FJ, Moreno J. The pathogenesis of Leishmania/HIV co-infection: cellular and immunological mechanisms. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2004; 97 Suppl 1:79-98. [PMID: 14678636 DOI: 10.1179/000349803225002561] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The intracellular protozoan parasites of the genus Leishmania have been recognized as opportunistic pathogens in immunosuppressed individuals, including those infected with human immunodeficiency virus type-1 (HIV-1). Leishmaniasis and AIDS overlap in several sub-tropical and tropical regions around the world, including the Mediterranean area. In 1994, 3%-7% of HIV-1-infected individuals in southern Europe developed visceral leishmaniasis. In humans, interestingly, both HIV-1 and Leishmania interact with, invade, and multiply within cells of myeloid or lymphoid origin. The combined modulation of Leishmania - and HIV-1-related pathogenesis in the co-infected cases is therefore probably a realistic goal. In the light of the recent demonstration that L. donovani can up-regulate HIV-1 replication, both in monocytoid and lymphoid cells in vitro and in co-infected individuals, it is clear from the epidemiological data available that Leishmania can probably act as a powerful co-factor in the pathogenesis of HIV-1 infection. In those who are co-infected, complex mechanisms involving cytokine secretion and cellular-signalling events play pivotal roles in the Leishmania-mediated activation and pathogenesis of HIV-1. An overview of the recent findings concerning this Leishmania/HIV-1 interaction is presented here.
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Affiliation(s)
- M Olivier
- Faculty of Medicine, McGill University, Lyman Duff Medical Building, 3775 University Street, Montreal, Québec, H3A 2B4, Canada
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Expresión cutánea atípica de leishmaniasis visceral en la infección por VIH. ACTAS DERMO-SIFILIOGRAFICAS 2004. [DOI: 10.1016/s0001-7310(04)76811-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bosch RJ, Rodrigo AB, Sánchez P, de Gálvez MV, Herrera E. Presence of Leishmania organisms in specific and non-specific skin lesions in HIV-infected individuals with visceral leishmaniasis. Int J Dermatol 2002; 41:670-5. [PMID: 12390190 DOI: 10.1046/j.1365-4362.2002.01610.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leishmania coinfection is frequently seen in human immunodeficiency virus (HIV)-infected patients in endemic areas, and from time to time the protozoan is detected in cutaneous biopsies. OBJECTIVE To establish the characteristics and possible ethiologic role of the presence of Leishmania in these lesions. METHODS We studied 12 cutaneous biopsies with Leishmania organisms from nine HIV-infected patients (seven men and two women) with visceral leishmaniasis, diagnosed by bone marrow examination, seen over a period of 9 years. RESULTS Based on clinical characteristics, evolution and response to anti-leishmanial treatment, cutaneous alterations were found to be related to the presence of the protozoan in six cases, whereas in the other six cases it was not considered responsible for the dermatological lesions (dermatofibroma, and lesions of psoriasis, Reiter's syndrome, bacillary angiomatosis, cryptococcosis and oral aphthae). Of note was the high prevalence of specific mucocutaneous manifestations, usually accompanied by intense pruritus, great variability, and a tendency to relapse after treatment stopped. On two occasions, detection of the protozoa in skin biopsies led to the diagnosis of a previously unsuspected visceral leishmaniasis. CONCLUSIONS Cutaneous detection of Leishmania is frequent in HIV-infected individuals with visceral leishmaniasis. Sometimes Leishmania is associated with changes attributable to other dermatological processes, and its presence does not imply a causative role. A clear relationship between the systemic process and the therapeutic response is necessary to demonstrate an ethiologic role.
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Affiliation(s)
- Ricardo J Bosch
- Department of Dermatology, University Hospital, School of Medicine, Malaga, Spain.
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Sacristán O, Porcel JM, Panadés MJ, Rubio M. [A 34-year-old man with lingual tumor. Lingual leishmaniasis in a patient with HIV infection]. Rev Clin Esp 2001; 201:103-5. [PMID: 11345598 DOI: 10.1016/s0014-2565(01)71379-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- O Sacristán
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida
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