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Abstract
HIV infection alters the skin microbiome and predisposes to a wide range of cutaneous infections, from atypical presentations of common skin infections to severe disseminated infections involving the skin that are AIDS-defining illnesses. Bacterial infection of the skin, most commonly caused by Staphylococcus aureus, occurs frequently and can result in bacteremia. Nontuberculous mycobacterial infections that are usually localized to the skin may disseminate, and guidance on the treatment of these infections is limited. Herpes simplex can be severe, and less common presentations such as herpetic sycosis and herpes vegetans have been reported. Severe herpes zoster, including disseminated infection, requires intravenous antiviral treatment. Viral warts can be particularly difficult to treat, and in atypical or treatment-resistant cases a biopsy should be considered. Superficial candidosis occurs very commonly in people living with HIV, and antifungal resistance is an increasing problem in non-albicans Candida species. Systemic infections carry a poor prognosis. In tropical settings the endemic mycoses including histoplasmosis are a problem for people living with HIV, and opportunistic infections can affect those with advanced HIV in all parts of the world. Most cutaneous infections can develop or worsen as a result of immune reconstitution in the weeks to months after starting antiretroviral therapy. Direct microscopic examination of clinical material can facilitate rapid diagnosis and treatment initiation, although culture is important to provide microbiological confirmation and guide treatment.
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Affiliation(s)
- David J Chandler
- Dermatology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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2
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Monachesi CF, Gomes-Silva A, Carvalho-Costa FA. Factors associated with mucosal involvement in tegumentary leishmaniasis: a nation-based study using surveillance data from Brazil. Rev Inst Med Trop Sao Paulo 2023; 65:e47. [PMID: 37703118 PMCID: PMC10495114 DOI: 10.1590/s1678-9946202365047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/19/2023] [Indexed: 09/15/2023] Open
Abstract
This study aimed to assess the factors associated with mucosal leishmaniasis (ML) within the scope of tegumentary leishmaniasis (TL) cases reported in Brazil. Surveillance data were assessed, and comparisons were made between ML and cutaneous leishmaniasis (CL) cases. Additionally, ML incidence rates for municipalities were depicted through a geographic information system. From 2007 to 2017, 235,489 TL cases were reported, of which 235,232 were classified as follows: 14,204 (6%) were ML cases and 221,028 (94%) were CL cases. Multivariate analysis showed that the proportion of ML cases reached 16.8% among individuals >75 years (adjusted OR = 2.77; 95% CI = 2.41-3.19; p < 0.001), and ML was also more frequent among males (aOR = 1.28; 95% CI = 1.20-1.38; p < 0.001), HIV-positive patients (aOR = 2.15; 95% CI = 1.80-2.56; p < 0.001), patients residing in urban areas (aOR = 1.52; 95% CI = 1.43-1.62; p < 0.001), and imported cases (with respect to county) when compared to autochthonous cases (aOR = 1.84; 95% CI = 1.71-1.98; p < 0.001). A lower proportion of positive results in direct parasitological examinations was observed in ML cases (32.6% vs. 60.8%; p < 0.001). The leishmanin skin test results were more often positive in ML cases (41.7% vs. 25.9%; p < 0.001). In ML, compatible changes in histopathology were more frequent (14.6% vs. 3.9%; p < 0.001). A greater proportion of ML cases were treated with amphotericin B (6.9% vs. 0.9%; p < 0.001). The case-fatality rate was higher in ML (0.6% vs. 0.1%; p < 0.001). A higher incidence of ML was observed in a geographical band extending across the Amazon region from the southern Para State to the Acre State. ML exhibited varying frequencies within specific populations. The definition of predictable factors predisposing Leishmania-infected subjects to develop ML is important for defining strategies to mitigate the mucosal damage caused by leishmaniasis.
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Affiliation(s)
- Clarisse Fonseca Monachesi
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Epidemiologia e Sistemática Molecular, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriano Gomes-Silva
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, Rio de Janeiro, Brazil
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipe Anibal Carvalho-Costa
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Epidemiologia e Sistemática Molecular, Rio de Janeiro, Rio de Janeiro, Brazil
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3
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Maksoud S, El Hokayem J. The cytokine/chemokine response in Leishmania/HIV infection and co-infection. Heliyon 2023; 9:e15055. [PMID: 37082641 PMCID: PMC10112040 DOI: 10.1016/j.heliyon.2023.e15055] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023] Open
Abstract
HIV infection progressively weakens the immune system by infecting and destroying cells involved in host defense. Viral infection symptoms are generated and aggravated as immunosuppression progresses, triggered by the presence of opportunistic infections: among these is leishmaniasis, a disease caused by the intracellular parasite Leishmania. The incidence of this co-infection is growing progressively due to the geographic distribution overlap. Both pathogens infect monocytes/macrophages and dendritic cells, although they can also modulate the activity of other cells without co-infecting, such as T and B lymphocytes. Leishmania/HIV co-infection could be described as a system comprising modulations of cell surface molecule expression, production of soluble factors, and intracellular death activities, leading ultimately to the potentiation of infectivity, replication, and spread of both pathogens. This review describes the cytokine/chemokine response in Leishmania/HIV infection and co-infection, discussing how these molecules modulate the course of the disease and analyzing the therapeutic potential of targeting this network.
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4
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Yaich S, Abid H, Toumi S, Fendri B, Chaker H, Agrebi I, Dammak N, Masmoudi M, Masmoudi A, Turki H, Kammoun K, Hmida MB. Leishmaniose cutanée après transplantation rénale : à propos de 7 cas et revue de la littérature. Nephrol Ther 2022; 18:506-511. [DOI: 10.1016/j.nephro.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
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5
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Maksoud S, Ortega JT, Hidalgo M, Rangel HR. Leishmania donovani and HIV co-infection in vitro: Identification and characterization of main molecular players. Acta Trop 2022; 228:106248. [PMID: 34822851 DOI: 10.1016/j.actatropica.2021.106248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Abstract
The incidence of Leishmania/HIV co-infection is growing and few studies detail the cellular processes and macromolecules participating in co-infection. Thus, the goal of this study was to partially describe the Leishmania/HIV co-infection events by measuring molecular and functional parameters associated with both pathogens in vitro. MT-4 cells (human T-lymphocytes), primary monocytes, and peripheral blood mononuclear cells were exposed to HIV and/or Leishmania donovani. The cytopathic effects generated by the pathogens were observed through microscopy. Viral replication was assessed by monitoring p24 protein levels and parasitic proliferation/infectivity was determined using Giemsa staining. Changes in molecular markers were evaluated by ELISA and fluorescence assays. Our results showed that our system reassembles the main parameters previously described for Leishmania/HIV co-infection in patients in terms of potentiation of parasitic and viral replication/infectivity, amplification of syncytia induction, and alterations of cell viability. In addition, an amplification in NF-κB activation, changes in CXCR4/CCR5 surface expression, and a Th1→Th2 variation in cytokine/chemokine secretion were demonstrated. Altogether, this study could contribute to gain a deep understanding of the molecular events associated with Leishmania/HIV co-infection.
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Affiliation(s)
- S Maksoud
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
| | - J T Ortega
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
| | - M Hidalgo
- Laboratorio de Inmunoparasitología, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
| | - H R Rangel
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
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6
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Araújo CF, Oliveira IBN, Silva MVT, Pereira LIDA, Pinto SA, Silveira MB, Dorta ML, Fonseca SG, Gomes RS, Ribeiro-Dias F. New world Leishmania spp. infection in people living with HIV: Concerns about relapses and secondary prophylaxis. Acta Trop 2021; 224:106146. [PMID: 34562423 DOI: 10.1016/j.actatropica.2021.106146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Coinfection with the human immunodeficiency virus (HIV) and Leishmania impairs immune responses, increases treatment failure and relapse rates in patients with American tegumentary leishmaniasis (ATL), as well as visceral leishmaniasis (VL). There is insufficient data on the treatment, relapse, and secondary prophylaxis in patients coinfected with HIV/Leishmania in Brazil. This study investigated patients with HIV/ATL and HIV/VL to describe the outcome of leishmaniasis in patients assisted at a referral hospital of Brazilian midwestern region. Patients with HIV/ATL (n = 21) mainly presented cutaneous diseases (76.2%) with an overall relapse rate of 28.57% after treatment, whereas HIV/VL (n = 28) patients accounted for 17.5% of the cases. The counts of CD4+ T cells and CD8+ T cells and the CD4+/CD8+ cell ratios at diagnosis or relapses were not significantly different between relapsing and non-relapsing patients. Patients with HIV/ATL or HIV/VL showed high levels of activation markers in CD4+ and CD8+ T cells. The regular use of highly active antiretroviral therapy (HAART) and viral load at the time of diagnosis did not influence the relapse rates. Relapses occurred in 36.4% (4/11) of the patients with HIV/VL receiving secondary prophylaxis and in 5.9% (1/17) of the patients who did not receive secondary prophylaxis (p = 0.06). These data are relevant for the therapeutic management of the patients coinfected with HIV/Leishmania.
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7
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Carvalho AM, Guimarães LH, Costa R, Saldanha MG, Prates I, Carvalho LP, Arruda S, Carvalho EM. Impaired Th1 Response Is Associated With Therapeutic Failure in Patients With Cutaneous Leishmaniasis Caused by Leishmania braziliensis. J Infect Dis 2021; 223:527-535. [PMID: 32620011 DOI: 10.1093/infdis/jiaa374] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/01/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Leishmania skin test (LST) evaluates the delayed type hypersensitivity to Leishmania antigens (LA) and has been used for diagnosis of cutaneous leishmaniasis (CL). In CL patients LST is usually positive but a small percentage have negative LST. The aim of this study was to determine the clinical and immunologic features and response to antimony therapy in LST-negative CL patients. METHODS We compare the clinical presentation, response to therapy, and immune response of CL patients with negative vs positive LST. RESULTS The clinical presentation was similar in both groups but LST-negative patients had a lower cure rate. In the lesions, LST-negative patients displayed less inflammation and necrosis, and higher frequency of CD8+ T cells. Mononuclear cells from LST-negative patients had a poor T helper 1 cell (Th1) response but levels of interleukin-1β (IL-1β), IL-6, IL-17, granzyme B, and metalloproteinase-9 (MMP-9) were similar to the LST-positive group upon stimulation with LA. Leishmania internalization and killing by macrophages were similar in both groups. Cure of disease was associated with restoration of Th1 response. CONCLUSIONS In LST-negative patients, impaired Th1 response is associated with therapeutic failure. Increased frequency of CD8+ T cells and high production of inflammatory cytokines, granzyme B, and MMP-9 contributes to immunopathology.
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Affiliation(s)
- Augusto M Carvalho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luiz H Guimarães
- Universidade Federal do Sul da Bahia, Teixeira de Freitas, Brazil
| | - Rúbia Costa
- Instituto Nacional de Ciência e Tecnologia me Doenças Tropicais, Salvador, Bahia, Brazil
| | - Maíra G Saldanha
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Iana Prates
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Lucas P Carvalho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Instituto Nacional de Ciência e Tecnologia me Doenças Tropicais, Salvador, Bahia, Brazil
| | - Sérgio Arruda
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Instituto Nacional de Ciência e Tecnologia me Doenças Tropicais, Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Instituto Nacional de Ciência e Tecnologia me Doenças Tropicais, Salvador, Bahia, Brazil
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8
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Lago T, Carvalho LP, Nascimento M, Guimarães LH, Lago J, Castellucci L, Carvalho AM, Lago A, Carvalho EM. Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis Caused by Leishmania braziliensis. Clin Infect Dis 2021; 73:1020-1026. [PMID: 33725723 DOI: 10.1093/cid/ciab236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. METHODS A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days. RESULTS Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (P < .05). CONCLUSIONS Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.
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Affiliation(s)
- Tainã Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Lucas P Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
| | - Mauricio Nascimento
- Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
| | - Luiz H Guimarães
- Federal University of Southern Bahia, Teixeira de Freitas, Brazil
| | - Jamile Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Léa Castellucci
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | | | - Alex Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
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9
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Reis LC, Lindoso JAL, Celeste BJ, Braz LMA, Ramos-Sanchez EM, Yamashiro-Kanashiro EH, Goto H, Oyafuso LKM. Unusual manifestation of genital cutaneous leishmaniasis in an immunocompetent patient from São Paulo, Brazil: A case report. Rev Soc Bras Med Trop 2021; 54:e0514-2020. [PMID: 33759920 PMCID: PMC8008857 DOI: 10.1590/0037-8682-0514-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022] Open
Abstract
A 31-year-old male patient developed an ulcer on the glans penis that evolved for three months without healing. We diagnosed it as leishmaniasis using polymerase chain reaction. No immunosuppression or associated diseases were observed. The patient was treated with meglumine antimoniate that cured the lesion in a month post-treatment. Here, we report this case of cutaneous leishmaniasis lesion at the unusual location of glans penis in an immunocompetent individual. The lesion likely developed due to the bite of a vector, highlighting the need for considering cutaneous leishmaniasis among differential diagnosis of sexually transmitted diseases in areas endemic for leishmaniasis.
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Affiliation(s)
- Luiza Campos Reis
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - José Angelo Lauletta Lindoso
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil.,Secretaria de Saúde do Estado de São Paulo, Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, SP, Brasil
| | - Beatriz Julieta Celeste
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Lucia Maria Almeida Braz
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Milton Ramos-Sanchez
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil.,Universidad Nacional Toribio Rodriguez de Mendoza de Amazonas, Facultad de Ciencias de La Salud, Departamento de Salud Publica, Chachapoyas, Peru
| | | | - Hiro Goto
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Preventiva, São Paulo, SP, Brasil
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10
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Souza MDD, Falqueto A, Morais GLD, Salomão ADS, Pereira FD. Challenges in diagnosis of genital ulcers: a genital leishmaniasis case series. Rev Soc Bras Med Trop 2021; 54:e0772-2020. [PMID: 33759929 PMCID: PMC8008918 DOI: 10.1590/0037-8682-0772-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
Leishmaniasis is a tropical infectious disease caused by Leishmania spp. protozoa and is transmitted by insects from the Phlebotominae subfamily. It can manifest as cutaneous leishmaniasis, a painless ulcer that can develop into a more serious systemic affliction as the protozoa spreads lymphatically or hematogenously, depending on the host's immunity. In this case series, the authors present a rare form of genital mucocutaneous leishmaniasis, with consideration of epidemiologic characteristics, clinical presentation, differential diagnosis, and treatments offered.
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Affiliation(s)
- Marina Dias de Souza
- Universidade Federal do Espírito Santo, Departamento de Doenças Infecciosas, Vitória, ES, Brasil
| | - Aloísio Falqueto
- Universidade Federal do Espírito Santo, Departamento de Doenças Infecciosas, Vitória, ES, Brasil
| | - Gabriela Lopes de Morais
- Universidade Federal do Espírito Santo, Departamento de Doenças Infecciosas, Vitória, ES, Brasil
| | - Amanda da Silva Salomão
- Universidade Federal do Espírito Santo, Departamento de Doenças Infecciosas, Vitória, ES, Brasil
| | - Fernanda Daher Pereira
- Universidade Federal do Espírito Santo, Departamento de Doenças Infecciosas, Vitória, ES, Brasil
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11
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Kassardjian AA, Yim KM, Rabi S, Liang TZ, Kim GH, Ochoa MT, Sattah MV, Ahronowitz IZ. Diffuse cutaneous leishmaniasis and HIV co-infection: A case report and review of the literature. J Cutan Pathol 2021; 48:802-806. [PMID: 33611800 DOI: 10.1111/cup.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ari A Kassardjian
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Kaitlyn M Yim
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Sina Rabi
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Tom Z Liang
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Gene H Kim
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Maria T Ochoa
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Martin V Sattah
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Iris Z Ahronowitz
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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12
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Reimão JQ, Coser EM, Lee MR, Coelho AC. Laboratory Diagnosis of Cutaneous and Visceral Leishmaniasis: Current and Future Methods. Microorganisms 2020; 8:E1632. [PMID: 33105784 PMCID: PMC7690623 DOI: 10.3390/microorganisms8111632] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023] Open
Abstract
Leishmaniasis is a neglected tropical disease with two main clinical forms: cutaneous and visceral leishmaniasis. Diagnosis of leishmaniasis is still a challenge, concerning the detection and correct identification of the species of the parasite, mainly in endemic areas where the absence of appropriate resources is still a problem. Most accessible methods for diagnosis, particularly in these areas, do not include the identification of each one of more than 20 species responsible for the disease. Here, we summarize the main methods used for the detection and identification of leishmaniasis that can be performed by demonstration of the parasite in biological samples from the patient through microscopic examination, by in vitro culture or animal inoculation; by molecular methods through the detection of parasite DNA; or by immunological methods through the detection of parasite antigens that may be present in urine or through the detection of specific antibodies against the parasite. Potential new methods that can be applied for laboratory diagnosis of leishmaniasis are also discussed.
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Affiliation(s)
- Juliana Quero Reimão
- Departamento de Morfologia e Patologia Básica, Faculdade de Medicina de Jundiaí, Jundiaí 13202-550, Brazil; (J.Q.R.); (M.R.L.)
| | - Elizabeth Magiolo Coser
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-862, Brazil;
| | - Monica Ran Lee
- Departamento de Morfologia e Patologia Básica, Faculdade de Medicina de Jundiaí, Jundiaí 13202-550, Brazil; (J.Q.R.); (M.R.L.)
| | - Adriano Cappellazzo Coelho
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-862, Brazil;
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13
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Lyra MR, da Silva AB, Valete-Rosalino CM, Pimentel MIF. Clinical and epidemiological aspects of American cutaneous leishmaniasis with genital involvement. An Bras Dermatol 2020; 95:641-644. [PMID: 32768199 PMCID: PMC7562992 DOI: 10.1016/j.abd.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/08/2019] [Indexed: 10/27/2022] Open
Abstract
Genital lesions are an unusual presentation of American cutaneous leishmaniasis. Conditions such as disseminated cutaneous leishmaniasis and HIV infection may be associated with genital involvement. The authors present five cases of American cutaneous leishmaniasis with genital lesions and discuss the clinical and epidemiological aspects observed in this case series.
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Affiliation(s)
- Marcelo Rosandiski Lyra
- Laboratory for Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | | | - Cláudia Maria Valete-Rosalino
- Laboratory for Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratory for Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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14
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Abstract
Cutaneous leishmaniasis is a parasitic infection caused by a flagellated parasite belonging to the genus Leishmania. In most cases, it is a zoonotic disease transmitted via a bite by bloodsucking sand-flies of the genus Phlebotomus. The disease reservoirs consist of wild or semi-domesticated animals, generally rodents or dogs. The disease itself is distributed extensively worldwide in the Americas, Asia, Europe and Africa. Epidemiology is affected by environmental, migratory and climatic factors. Identification of the different types of leishmaniasis is based chiefly on the biochemical characteristics (isoenzymes) on which their classification is based. The offending parasites are dimorphic intracellular organisms within the phagosome of the host's immune cells, and a single-cell flagellated protozoan with a kinetoplast contained in the gut of the vector and in culture. Three major clinical forms are seen: cutaneous leishmaniasis, mucosal leishmaniasis and visceral leishmaniasis. The clinical presentation depends on factors associated with the virulence of the parasite, with individual immune response and with the site of lesions. Although each type of leishmaniasis may have its own specific cutaneous signs and endemic regions, the most common presentations are crusted, ulcerated nodules and plaques. The natural history of leishmaniasis must also be considered when formulating therapeutic strategies. Cutaneous leishmaniasis resolves spontaneously within between one month and six years. While numerous therapeutic options have been considered in recent decades, very few have shown proven efficacy and safety. Antimony compounds administered either directly to the lesion or parenterally remain the standard treatment and their toxicity calls for vigilance and monitoring of therapy.
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Affiliation(s)
- M Mokni
- Faculté de médecine de Tunis, université Al Manar 2, service de dermatologie, hôpital La Rabta, rue Jabbari-Bab Saadoun, 1007 Tunis, Tunisie.
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Visceral and Cutaneous Leishmaniasis Recommendations for Solid Organ Transplant Recipients and Donors. Transplantation 2018; 102:S8-S15. [PMID: 29381573 DOI: 10.1097/tp.0000000000002018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Best I, Privat-Maldonado A, Cruz M, Zimic M, Bras-Gonçalves R, Lemesre JL, Arévalo J. IFN-γ Response Is Associated to Time Exposure Among Asymptomatic Immune Responders That Visited American Tegumentary Leishmaniasis Endemic Areas in Peru. Front Cell Infect Microbiol 2018; 8:289. [PMID: 30186774 PMCID: PMC6111704 DOI: 10.3389/fcimb.2018.00289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Clinical manifestations of American Tegumentary Leishmaniasis (ATL) include cutaneous (CL) and mucous forms (ML); however, there are asymptomatic individuals who despite being infected do not present any clinical manifestations. This study characterized the cell-mediated immunity of travelers who lived in the Andean highlands of Cusco, free of leishmaniasis transmission, which eventually visited leishmaniasis endemic in the Amazonian basin and returned home without any clinical signs of the disease. Their immune response was compared with CL and ML patients who acquired the disease during their stage in the same region. Fifty-four human subjects from the highlands of Cusco (Peru), who have visited an endemic area, were enrolled: 28 of them did not show any symptoms, 12 showed CL and 14 showed ML. Ten healthy subjects from a non-endemic area (HS) were included as controls. T-cell proliferation was evaluated using peripheral blood mononuclear cells (PBMC) stimulated for 5 days with a total soluble leishmanial antigen (TSLA) of L. (V.) braziliensis. Th1/Th2/Th17 cytokines were also quantified in the supernatants by a flow cytometry multiplex assay. T-cell proliferation was expressed as stimulation index (SI) and the cut off was fixed at SI >2.47. Fifteen out of 28 subjects did not show any signs of disease (54%); subjects with an SI above the cut off. They were defined as asymptomatic immune responders (AIR). CL and ML patients presented a higher SI than HS and AIR. Among the latter group, the exposure time to Leishmania was clearly associated with the IFN-γ response. Increased levels of this cytokine were observed in individuals who remained <90 days in an endemic area of leishmaniasis. Our results evidenced two sub-populations among asymptomatic individuals, one AIR who did not develop clinical disease manifestations when they were exposed to Leishmania in endemic areas. Exposure time to Leishmania in the wild was associated with the IFN-γ response.
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Affiliation(s)
- Ivan Best
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angela Privat-Maldonado
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Cruz
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mirko Zimic
- Laboratorios de Investigación y Desarrollo, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rachel Bras-Gonçalves
- Institut de Recherche pour le Développement (IRD), UMR177-INTERTRYP, Montpellier, France
| | - Jean-Loup Lemesre
- Institut de Recherche pour le Développement (IRD), UMR177-INTERTRYP, Montpellier, France
| | - Jorge Arévalo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratorios de Investigación y Desarrollo, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
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Conceição-Silva F, Leite-Silva J, Morgado FN. The Binomial Parasite-Host Immunity in the Healing Process and in Reactivation of Human Tegumentary Leishmaniasis. Front Microbiol 2018; 9:1308. [PMID: 29971054 PMCID: PMC6018218 DOI: 10.3389/fmicb.2018.01308] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/29/2018] [Indexed: 01/09/2023] Open
Abstract
Leishmaniasis is a vector-borne infectious disease caused by different species of protozoa from the Leishmania genus. Classically, the disease can be classified into two main clinical forms: Visceral (VL) and Tegumentary (TL) leishmaniasis. TL is a skin/mucosal granulomatous disease that manifests mainly as cutaneous localized or disseminated ulcers, papules diffusely distributed, mucosal lesions or atypical lesions. Once the etiology of the infection is confirmed, treatment can take place, and different drugs can be administered. It has already been shown that, even when the scar is clinically evident, inflammation is still present in the native tissue, and the decrease of the inflammatory process occurs slowly during the 1st years after clinical healing. The maintenance of residual parasites in the scar tissue is also well documented. Therefore, it is no longer a surprise that, under some circumstances, therapeutic failure and/or lesion reactivation occurs. All over the years, an impressive amount of data on relapses, treatment resistance and lesion reactivation after healing has been collected, and several factors have been pointed out as having a role in the process. Different factors such as Leishmania species, parasite variability, Leishmania RNA virus 1, parasite load, parasite persistence, age, nutritional status, gender, co-morbidities, co-infection, pregnancy, immunosuppression, lesion duration, number and localization of lesions, drug metabolism, irregular treatment and individual host cellular immune response were described and discussed in the present review. Unfortunately, despite this amount of information, a conclusive understanding remains under construction. In addition, multifactorial influence cannot be discarded. In this context, knowing why leishmaniasis has been difficult to treat and control can help the development of new approaches, such as drugs and immunotherapy in order to improve healing maintenance. In this sense, we would like to highlight some of the findings that may influence the course of Leishmania infection and the therapeutic response, with an emphasis on TL.
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Affiliation(s)
- Fatima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Brazil
| | - Jessica Leite-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Brazil
| | - Fernanda N. Morgado
- Laboratory of Leishmaniasis Research, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Brazil
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Calvopina M, Aguirre C, Cevallos W, Castillo A, Abbasi I, Warburg A. Coinfection of Leishmania guyanensis and Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome: Report of a Case of Disseminated Cutaneous Leishmaniasis in Ecuador. Am J Trop Med Hyg 2017; 96:1151-1154. [PMID: 28193741 DOI: 10.4269/ajtmh.16-0431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractReported herein is the first case of Leishmania-human immunodeficiency virus (HIV) coinfection in Ecuador. In Ecuador, HIV infections overlap endemic areas of leishmaniasis. Immunosuppression is a well-established risk factor for developing severe disease. This is a severe case of a 32-year-old man presenting with disseminated pleomorphic ulcers, papules, and cutaneous plaque-like lesions over his whole body. Numerous amastigotes were observed in both skin scrapings and biopsies. The sequence of the cytochrome b gene confirmed the presence of Leishmania guyanensis. The patient was treated but failed to respond to meglumine antimoniate and amphotericin B. Six months later, the patient died due to bacterial septic shock.
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Affiliation(s)
- Manuel Calvopina
- Carrera de Medicina, Universidad De Las Americas (UDLA), Quito, Ecuador
| | - Cristina Aguirre
- Servicio de Medicina Interna, Hospital Eugenio Espejo, Quito, Ecuador
| | - William Cevallos
- Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Alberto Castillo
- Servicio de Medicina Interna, Hospital Eugenio Espejo, Quito, Ecuador
| | - Ibrahim Abbasi
- The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alon Warburg
- The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University of Jerusalem, Jerusalem, Israel.,PROMETEO, Secretaría Nacional de Educación Superior, Ciencia, Tecnología e Innovación (SENESCYT), Ecuador
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Use of Recombinant Antigens for Sensitive Serodiagnosis of American Tegumentary Leishmaniasis Caused by Different Leishmania Species. J Clin Microbiol 2016; 55:495-503. [PMID: 27927927 PMCID: PMC5277519 DOI: 10.1128/jcm.01904-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022] Open
Abstract
American tegumentary leishmaniasis (ATL) (also known as cutaneous leishmaniasis [CL]) is caused by various species of protozoa of the genus Leishmania. The diagnosis is achieved on a clinical, epidemiological, and pathological basis, supported by positive parasitological exams and demonstration of leishmanin delayed-type hypersensitivity. Serological assays are not routinely used in the diagnosis because many are considered to have low sensitivity and the particular Leishmania species causing the disease can lead to variable performance. In the present study, we generated recombinant versions of two highly conserved Leishmania proteins, Leishmania (Viannia) braziliensis-derived Lb8E and Lb6H, and evaluated both in enzyme-linked immunosorbent assays (ELISA). Recombinant Lb6H (rLb6H) had better performance and reacted with 100.0% of the ATL and 89.4% of the VL samples. These reactions with rLb6H were highly specific (98.5%) when compared against those for samples from healthy control individuals. We then assessed rLb6H against sera from ATL patients infected with different species of Leishmania prevalent in Brazil [Leishmania (Leishmania) amazonensis, L. (Viannia) braziliensis, and L. (V.) guyanensis] and samples from patients with other infectious diseases. In analyses of 500 sera, ELISA using rLb6H detected all 219 ATL samples (sensitivity of 100.0%) with an overall specificity of 93.9% (considering healthy individuals and other infectious diseases patients). Only a minority of samples from Chagas disease patients possessed antibodies against rLb6H, and all of these responses were low (with a highest reactivity index of 2.2). Taken together, our data support further evaluation of rLb6H and the potential for its routine use in the serological diagnosis of ATL.
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Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
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Lindoso JAL, Cunha MA, Queiroz IT, Moreira CHV. Leishmaniasis-HIV coinfection: current challenges. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2016; 8:147-156. [PMID: 27785103 PMCID: PMC5063600 DOI: 10.2147/hiv.s93789] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Leishmaniasis – human immunodeficiency virus (HIV) coinfection can manifest itself as tegumentary or visceral leishmaniasis. Almost 35 countries have reported autochthonous coinfections. Visceral leishmaniasis is more frequently described. However, usual and unusual manifestations of tegumentary leishmaniasis have been reported mainly in the Americas, but the real prevalence of Leishmania infection in HIV-infected patients is not clear. Regarding the clinical manifestations, there are some reports showing unusual manifestations in visceral leishmaniasis and tegumentary leishmaniasis in HIV-infected patients; yet, the usual manifestations are more frequent. Leishmaniasis diagnosis relies on clinical methods, but serological tests are used to diagnose visceral leishmaniasis despite them having a low sensitivity to tegumentary leishmaniasis. The search for the parasite is used to diagnose both visceral leishmaniasis and tegumentary leishmaniasis. Nevertheless, in HIV-infected patients, the sensitivity of serology is very low. Drugs available to treat leishmaniasis are more restricted and cause severe side effects. Furthermore, in HIV-infected patients, these side effects are more prominent and relapses and lethality are more recurrent. In this article, we discuss the current challenges of tegumentary leishmaniasis and visceral leishmaniasis–HIV infection, focusing mainly on the clinical manifestations, diagnosis, and treatment of leishmaniasis.
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Affiliation(s)
- José Angelo Lauletta Lindoso
- Laboratory of Soroepidemiology (LIM HC-FMUSP), São Paulo University, São Paulo; Instituto de Infectologia Emilio Ribas-SES, São Paulo
| | - Mirella Alves Cunha
- Department of Infectious Disease, Faculty of Medicine, São Paulo University, São Paulo
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Parmentier L, Cusini A, Müller N, Zangger H, Hartley MA, Desponds C, Castiglioni P, Dubach P, Ronet C, Beverley SM, Fasel N. Severe Cutaneous Leishmaniasis in a Human Immunodeficiency Virus Patient Coinfected with Leishmania braziliensis and Its Endosymbiotic Virus. Am J Trop Med Hyg 2016; 94:840-843. [PMID: 26834198 PMCID: PMC4824227 DOI: 10.4269/ajtmh.15-0803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022] Open
Abstract
Leishmania parasites cause a broad range of disease, with cutaneous afflictions being, by far, the most prevalent. Variations in disease severity and symptomatic spectrum are mostly associated to parasite species. One risk factor for the severity and emergence of leishmaniasis is immunosuppression, usually arising by coinfection of the patient with human immunodeficiency virus (HIV). Interestingly, several species of Leishmania have been shown to bear an endogenous cytoplasmic dsRNA virus (LRV) of the Totiviridae family, and recently we correlated the presence of LRV1 within Leishmania parasites to an exacerbation murine leishmaniasis and with an elevated frequency of drug treatment failures in humans. This raises the possibility of further exacerbation of leishmaniasis in the presence of both viruses, and here we report a case of cutaneous leishmaniasis caused by Leishmania braziliensis bearing LRV1 with aggressive pathogenesis in an HIV patient. LRV1 was isolated and partially sequenced from skin and nasal lesions. Genetic identity of both sequences reinforced the assumption that nasal parasites originate from primary skin lesions. Surprisingly, combined antiretroviral therapy did not impact the devolution of Leishmania infection. The Leishmania infection was successfully treated through administration of liposomal amphotericin B.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nicolas Fasel
- *Address correspondence to Nicolas Fasel, Department of Biochemistry, University of Lausanne, Ch. des Boveresses 155, Epalinges, Lausanne, Switzerland 1066. E-mail:
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Gois L, Badaró R, Schooley R, Grassi MFR. Immune response to Leishmania antigens in an AIDS patient with mucocutaneous leishmaniasis as a manifestation of immune reconstitution inflammatory syndrome (IRIS): a case report. BMC Infect Dis 2015; 15:38. [PMID: 25645330 PMCID: PMC4323250 DOI: 10.1186/s12879-015-0774-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/20/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND After the onset of HAART, some HIV-infected individuals under treatment present a exacerbated inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary leishmaniasis have been described in association with IRIS. Moreover, the immunopathogenesis of IRIS in association with Leishmania is unclear. CASE PRESENTATION The present study reports on a 29-year-old HIV-infected individual who developed mucocutaneous leishmaniasis associated with immune reconstitution inflammatory syndrome (IRIS) five months following highly active antiretroviral therapy (HAART). Severe lesions resulted in the partial destruction of the nasal septum, with improvement observed 15 days after treatment with Amphotericin B and corticosteroids. The immune response of this patient was evaluated before and after the lesions healed. IRIS was diagnosed in association with high levels of TNF-α and IL-6. Decreased production of IFN-γ and a low IFN-γ/IL-10 ratio were also observed in response to Leishmania antigens. After receiving anti-leishmanial treatment, the individual's specific Th1 immune response was restored. CONCLUSION The results suggest that the production of inflammatory cytokines by unstimulated T-lymphocytes could contribute to occurrence of leishmaniasis associated with IRIS.
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Affiliation(s)
- Luana Gois
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil.
| | - Roberto Badaró
- Hospital Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Robert Schooley
- Department of Medicine, University of California, San Diego, USA.
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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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Badaró R, Gonçalves LO, Gois LL, Maia ZPG, Benson C, Grassi MFR. Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients: A Literature Review. J Int Assoc Provid AIDS Care 2014; 14:402-7. [PMID: 25331225 DOI: 10.1177/2325957414555225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION After the onset of highly active antiretroviral therapy (HAART), some HIV-infected patients present a severe inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary and visceral leishmaniasis have been described in association with IRIS. METHODS A systematic literature review of IRIS in association with leishmaniasis identified 34 reported cases. RESULTS AND DISCUSSION The majority of these occurred in males 4 months following the onset of HAART. The mean CD4 count before HAART was 94 ± 77 cells/mm³ increasing to 5 times the initial value between the onset of HAART and IRIS presentation. Visceral leishmaniasis and post-kala-azar dermal leishmaniasis were the most commonly reported clinical manifestations, followed by tegumentary leishmaniasis and uveitis. CONCLUSIONS Commonly found characteristics included cutaneous involvement, regardless of Leishmania species; appearance of lesions unrelated to time of probable Leishmania infection; rapid recovery of CD4 count following HAART; and rapid progression.
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Affiliation(s)
- Roberto Badaró
- Universidade Federal da Bahia, Complexo Hospitalar Prof Edgard Santos, Unidade docente de Infectologia, Salvador, BA, Brazil
| | - Larissa O Gonçalves
- Universidade Federal da Bahia, Complexo Hospitalar Prof Edgard Santos, Unidade docente de Infectologia, Salvador, BA, Brazil
| | - Luana L Gois
- Fundação Oswaldo Cruz, Centro de Pesquisa Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brazil Escola Bahiana de Medicina e Saúde Pública, Faculdade de Medicina, Salvador, BA, Brazil
| | - Zuinara Pereira Gusmão Maia
- Universidade Federal da Bahia, Complexo Hospitalar Prof Edgard Santos, Unidade docente de Infectologia, Salvador, BA, Brazil
| | - Constance Benson
- University of California San Diego, Division of Infectious Diseases, La Jolla, CA, USA
| | - Maria Fernanda Rios Grassi
- Fundação Oswaldo Cruz, Centro de Pesquisa Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brazil Escola Bahiana de Medicina e Saúde Pública, Faculdade de Medicina, Salvador, BA, Brazil
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van Griensven J, Carrillo E, López-Vélez R, Lynen L, Moreno J. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect 2014; 20:286-99. [DOI: 10.1111/1469-0691.12556] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Satow MM, Yamashiro-Kanashiro EH, Rocha MC, Oyafuso LK, Soler RC, Cotrim PC, Lindoso JAL. Applicability of kDNA-PCR for routine diagnosis of American tegumentary leishmaniasis in a tertiary reference hospital. Rev Inst Med Trop Sao Paulo 2014; 55:393-9. [PMID: 24213191 PMCID: PMC4105086 DOI: 10.1590/s0036-46652013000600004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 06/13/2013] [Indexed: 11/21/2022] Open
Abstract
SUMMARY This study evaluated the applicability of kDNA-PCR as a prospective
routine diagnosis method for American tegumentary leishmaniasis (ATL) in patients
from the Instituto de Infectologia Emílio Ribas (IIER), a reference center for
infectious diseases in São Paulo - SP, Brazil. The kDNA-PCR method detected
Leishmania DNA in 87.5% (112/128) of the clinically suspected
ATL patients, while the traditional methods demonstrated the following percentages
of positivity: 62.8% (49/78) for the Montenegro skin test, 61.8% (47/76) for
direct investigation, and 19.3% (22/114) for in vitro culture.
The molecular method was able to confirm the disease in samples considered
negative or inconclusive by traditional laboratory methods, contributing to the
final clinical diagnosis and therapy of ATL in this hospital. Thus, we strongly
recommend the inclusion of kDNA-PCR amplification as an alternative diagnostic
method for ATL, suggesting a new algorithm routine to be followed to help the
diagnosis and treatment of ATL in IIER.
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Affiliation(s)
- Marcela M Satow
- Instituto de Medicina Tropical de São Paulo, São PauloSP, Brazil, , , , , , , , , ,
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Mucocutaneous leishmaniasis as presentation of HIV infection in Sardinia, insular Italy. Parasitol Int 2014; 63:35-6. [DOI: 10.1016/j.parint.2013.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 11/23/2022]
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Goto H, Lindoso JAL. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther 2014; 8:419-33. [DOI: 10.1586/eri.10.19] [Citation(s) in RCA: 287] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Leishmaniases are emerging as an important disease in human immunodeficiency virus (HIV)-infected persons living in several sub-tropical and tropical regions around the world, including the Mediterranean. The HIV/AIDS pandemic is spreading at an alarming rate in Africa and the Indian subcontinent, areas with very high prevalence of leishmaniases. The spread of HIV into rural areas and the concomitant spread of leishmaniases to suburban/urban areas have helped maintain the occurrence of Leishmania/HIV co-infection in many parts of the world. The number of cases of Leishmania/HIV co-infection is expected to rise owing to the overlapping geographical distribution of the two infections. In Southwestern Europe, there is also an increasing incidence of Leishmania/HIV co-infection (particularly visceral leishmaniasis) in such countries as France, Italy, Spain and Portugal. Studies suggest that in humans, very complex mechanisms involving dysregulation of host immune responses contribute to Leishmania-mediated immune activation and pathogenesis of HIV. In addition, both HIV-1 and Leishmania infect and multiply within cells of myeloid or lymphoid origin, thereby presenting a perfect recipe for reciprocal modulation of Leishmania and HIV-1-related disease pathogenesis. Importantly, because recovery from leishmaniases is associated with long-term persistence of parasites at the primary infection sites and their draining lymph nodes, there is very real possibility that HIV-mediated immunosuppression (due to CD4(+) T cell depletion) could lead to reactivation of latent infections (reactivation leishmaniasis) in immunocompromised patients. Here, we present an overview of the immunopathogenesis of Leishmania/HIV co-infection and the implications of this interaction on Leishmania and HIV disease outcome.
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Affiliation(s)
- Ifeoma Okwor
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Silva JSFE, Galvao TF, Pereira MG, Silva MT. Treatment of American tegumentary leishmaniasis in special populations: a summary of evidence. Rev Soc Bras Med Trop 2013; 46:669-77. [DOI: 10.1590/0037-8682-0104-2013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/31/2013] [Indexed: 01/16/2023] Open
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Gois LL, Mehta S, Rodrigues MZA, Schooley RT, Badaró R, Grassi MFR. Decreased memory T-cell response and function in human immunodeficiency virus-infected patients with tegumentary leishmaniasis. Mem Inst Oswaldo Cruz 2013; 109:9-14. [PMID: 24141962 DOI: 10.1590/0074-0276130174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/18/2013] [Indexed: 02/08/2023] Open
Abstract
The effects of human immunodeficiency virus (HIV) on the immune response in patients with cutaneous leishmaniasis have not yet been fully delineated. This study quantified and evaluated the function of memory T-cell subsets in response to soluble Leishmania antigens (SLA) from patients coinfected with HIV and Leishmania with tegumentary leishmaniasis (TL). Eight TL/HIV coinfected subjects and 10 HIV seronegative subjects with TL were evaluated. The proliferative response of CD4+and CD8+T-cells and naïve, central memory (CM) and effector memory (EM) CD4+T-cells in response to SLA were quantified using flow cytometry. The median cell division indices for CD4+and CD8+T-cells of coinfected patients in response to SLA were significantly lower than those in patients with Leishmania monoinfection (p < 0.05). The proportions of CM and EM CD4+T-cells in response to SLA were similar between the coinfected patients and patients with Leishmania monoinfection. However, the median CM and EM CD4+T-cell counts from coinfected patients were significantly lower (p < 0.05). The reduction in the lymphoproliferative response to Leishmania antigens coincides with the decrease in the absolute numbers of both EM and CM CD4+T-cells in response to Leishmania antigens in patients coinfected with HIV/Leishmania.
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Affiliation(s)
| | - Sanjay Mehta
- Centro de Pesquisa Gonçalo Moniz, Fiocruz, SalvadorBA, Brasil
| | | | | | - Roberto Badaró
- Centro de Pesquisa Gonçalo Moniz, Fiocruz, SalvadorBA, Brasil
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Demarchi IG, Silveira TG, Ferreira IC, Lonardoni MV. Effect of HIV protease inhibitors on New World Leishmania. Parasitol Int 2012; 61:538-44. [DOI: 10.1016/j.parint.2012.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 04/23/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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de Oliveira FS, Valete-Rosalino CM, Schubach ADO, Madeira MDF, Pacheco RDS. Genetic polymorphism in Leishmania (Viannia) braziliensis detected in mucosal leishmaniasis of HIV-infected and non-HIV-infected patients. Trans R Soc Trop Med Hyg 2012; 106:683-7. [PMID: 22954800 DOI: 10.1016/j.trstmh.2012.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022] Open
Abstract
The genetic polymorphism of Leishmania (Viannia) braziliensis detected in cases of mucosal leishmaniasis (ML) from HIV-infected and non HIV-infected patients was evaluated. Nine samples from three HIV-infected patients and five samples from five non HIV-infected patients were analysed by polymerase chain reaction (PCR), low-stringency single-specific primer PCR (LSSP-PCR) and phenetic analysis. The presence of L. (V.) braziliensis DNA was detected in all samples by specific PCR assay. The intraspecific polymorphism of the variable region of L. (V.) braziliensis kDNA minicircles was investigated by LSSP-PCR. Phenetic analysis grouped the genetic profiles into two distinct clusters, which discriminated between samples obtained from HIV-infected and non HIV-infected patients. In two HIV-infected patients, identical genetic profiles were detected in lesions biopsied at different times after the treatment of the initial lesion. Interestingly, genetically divergent profiles were detected in the cutaneous and mucosal lesions of the same HIV-infected patient collected at the same time. This is the first work comparing genetic polymorphism of L. (V.) braziliensis in cases of mucosal leishmaniasis from HIV-infected and non HIV-infected patients.
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Affiliation(s)
- Fernanda Santos de Oliveira
- Laboratório de Sistemática Bioquímica, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, CEP 21040-360, Brazil.
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Lindoso JAL, Costa JML, Queiroz IT, Goto H. Review of the current treatments for leishmaniases. Res Rep Trop Med 2012; 3:69-77. [PMID: 30890869 DOI: 10.2147/rrtm.s24764] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Leishmaniases are vector-borne zoonotic diseases that are prevalent in tropical and subtropical areas in the world, with two million new cases occurring yearly. Visceral and tegumentary forms of leishmaniasis are known. The latter form may present as localized cutaneous or mucosal forms, disseminated, diffuse forms, or leishmaniasis recidiva cutis. Visceral leishmaniasis is caused by parasites of the species Leishmania (Leishmania) donovani and L. (L.) infantum, and tegumentary leishmaniasis is caused by 15 other species, with distinct distributions in the Old and New World. The varied clinical manifestations, the multitude of Leishmania species, and the increasing incidence of HIV coinfection make the diagnosis and treatment of leishmaniases complex. Since there are no solid data relating clinical manifestations, treatment outcomes and Leishmania species the decision regarding the best therapeutic option is almost entirely based on clinical manifestations. Because most of the literature is focused on leishmaniasis in the Old World, in this review we present data on the treatment of New World leishmaniasis in more detail. Ranked therapeutic options, clinical trials, and also observations, even with a restricted number of subjects, on treatment outcome of visceral and different forms of tegumentary leishmaniasis, are presented. Treatment for leishmaniasis in HIV-coinfected patients is addressed as well. Some of these data strongly suggest that the differences in the outcome of the treatment are related to the Leishmania species. Therefore, although it is not possible at most points of care to identify the species causing the infection - a process that requires a well equipped laboratory - the infecting species should be identified whenever possible. More recent approaches, such as the use of immunomodulators and immunotherapy, and the lines for development of new candidate drugs are mentioned.
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Affiliation(s)
| | | | - Igor Thiago Queiroz
- Departament of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Sao Paulo, Brazil
| | - Hiro Goto
- Instituto de Medicina Tropical de São Paulo, and Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Sao Paulo, Brazil,
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Goto H, Lauletta Lindoso JA. Cutaneous and Mucocutaneous Leishmaniasis. Infect Dis Clin North Am 2012; 26:293-307. [DOI: 10.1016/j.idc.2012.03.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Castellano LR, Llaguno M, Silva MV, Machado JR, Correia D, Silva-Vergara ML, Rodrigues V. Immunophenotyping of circulating T cells in a mucosal leishmaniasis patient coinfected with HIV. Rev Soc Bras Med Trop 2012; 44:520-1. [PMID: 21860904 DOI: 10.1590/s0037-86822011000400025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/01/2011] [Indexed: 11/21/2022] Open
Abstract
HIV coinfection modifies the clinical course of leishmaniasis by promoting a Th2 pattern of cytokine production. However, little information is available regarding the lymphocytic response in untreated coinfected patients. This work presents the immunophenotyping of Leishmania-stimulated T cells from a treatment-naÏve HIV+ patient with ML. Leishmania braziliensis antigens induced CD69 expression on CD3+CD4+ and CD3+CD8+ cells. It also increased IL-4 intracellular staining on CD3+CD4+GATA3- population and decreased the percentage of CD3+CD4+IL-17+ cells. This suggests that modulations in the IL-4R/STAT6 pathway and the Th17 population may serve as parasitic evasion mechanisms in HIV/ML. Further studies are required to confirm these results.
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Affiliation(s)
- Lúcio Roberto Castellano
- Laboratório de Imunologia, Departamento de Ciências Biológicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil.
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Bañuls AL, Bastien P, Pomares C, Arevalo J, Fisa R, Hide M. Clinical pleiomorphism in human leishmaniases, with special mention of asymptomatic infection. Clin Microbiol Infect 2012; 17:1451-61. [PMID: 21933304 DOI: 10.1111/j.1469-0691.2011.03640.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review gives an update of current knowledge on the clinical pleiomorphism of Leishmania, with a special emphasis on the case of asymptomatic carriage. The first part describes the numerous unusual expressions of the disease that occur besides the classic (visceral, cutaneous, and mucocutaneous) forms of leishmaniases. The second part deals with progress in the understanding of disease outcome in humans, and the possible future approaches to improve our knowledge in the field. The third part highlights the role of the too often neglected asymptomatic carrier compartment. This group could be key to understanding infraspecific differences in virulence and pathogenicity of the parasite, as well as identifying the genetic determinants involved in the expression of the disease.
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Affiliation(s)
- A L Bañuls
- UMR MIVEGEC (IRD 224-CNRS 5290-Université Montpellier, France.
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Development of cutaneous leishmaniasis after leishmania skin test. Case Rep Med 2011; 2011:631079. [PMID: 22162702 PMCID: PMC3227237 DOI: 10.1155/2011/631079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/01/2011] [Accepted: 09/01/2011] [Indexed: 11/17/2022] Open
Abstract
Thirty-year-old female with a previous history of a cutaneous ulcer suspicious of leishmaniasis 20 years ago presented with a new complaint of a depressed papular lesion 8 × 7 mm in the right lower extremity. The lesion was of 10-day duration. Because early cutaneous leishmaniasis (CL) lesions may have a non-ulcerated appearance, a Leishmania skin test (LST) was performed on the forearm with a strong positive result (38 × 32 mm). After 8 days, the lesion in the leg, which was diagnosed as folliculitis, completely healed. However, a typical CL ulcer (26 × 24 mm) developed at the LST site. Histopathology of the new lesion did not identifiy parasites, but the findings were consistent with a diagnosis of CL. Further analysis identified amastigotes by immunohistochemical stain. Mononuclear cells harvested from the patient were stimulated with Leishmania antigen and showed high levels of production of both tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ): 2,943 pg/mL and 2,313 pg/mL, respectively. After 40 days of treatment with antimony and pentoxifylline, the ulcer resolved. The development of CL at the LST site suggests a strong Th1 immune response, and it is an in vivo documentation of the role of the host immune response in the pathology of CL. It teaches us that LST should be cautiously, if at all, used in patients with self-healing CL ulcers.
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Guerra JAO, Coelho LIRC, Pereira FR, Siqueira AM, Ribeiro RL, Almeida TML, Lacerda MVG, Barbosa MDGV, Talhari S. American tegumentary leishmaniasis and HIV-AIDS association in a tertiary care center in the Brazilian Amazon. Am J Trop Med Hyg 2011; 85:524-7. [PMID: 21896816 DOI: 10.4269/ajtmh.2011.11-0075] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
American tegumentary leishmaniasis (ATL) and human immunodeficiency virus (HIV) are both common infectious diseases in the Brazilian Amazon with overlapping expansion areas, which leads to the occurrence of Leishmania/HIV coinfection. Most ATL/HIV-acquired immunodeficiency syndrome (AIDS) association cases have been reported from areas where Leishmania (Viannia) braziliensis is the main pathogen; this finding is in contrast with the Amazon region, where L. (V.) guyanensis is the most implicated agent, implying distinct clinical and therapeutic aspects. We describe 15 cases of ATL/HIV coinfection treated in a tertiary care center in the Brazilian Amazon between 1999 and 2008. Thirteen patients presented with diverse clinical manifestations of cutaneous leishmaniasis, and four of them had disseminated forms; two patients presented with mucosal leishmaniasis (ML). Seven patients required more than one course of treatment. The particularities of ATL/HIV-AIDS association in L. (V.) guyanensis-endemic areas require efforts for an increased understanding of its burden and subsequent improvements in case management.
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Affiliation(s)
- Jorge Augusto O Guerra
- Gerência de Leishmaniose, Gerência de DST e AIDS, Gerência de Malária, Gerência de Entomologia e Gerência de Dermatologia Tropical, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
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41
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Rosa MEA, Machado PRL. Disseminated Leishmaniasis: Clinical, immunological, and therapeutic aspects. Drug Dev Res 2011. [DOI: 10.1002/ddr.20450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Th1/Th2 cytokine profile in patients coinfected with HIV and Leishmania in Brazil. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1765-9. [PMID: 21832098 DOI: 10.1128/cvi.00076-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To evaluate the effects of HIV on immune responses in cutaneous leishmaniasis (CL), we quantified cytokine levels from plasma and stimulated peripheral blood mononuclear cells (PBMCs) from individuals infected with HIV and/or CL. Gamma interferon (IFN-γ) and interleukin 13 (IL-13) levels and the ratio of IFN-γ to IL-10 produced in response to stimulation with soluble Leishmania antigens were significantly lower in HIV-Leishmania-coinfected patients than in CL-monoinfected patients.
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AbdullGaffar B, Abdull Gaffar B, Almualla A. An unidentified ulcer on the dorsum of the hand. Cutaneous leishmaniasis. Int J Dermatol 2011; 50:667-9. [PMID: 21595658 DOI: 10.1111/j.1365-4632.2010.04747.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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44
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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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Santos-Oliveira JR, Giacoia-Gripp CBW, Alexandrino de Oliveira P, Amato VS, Lindoso JÂL, Goto H, Oliveira-Neto MP, Mattos MS, Grinsztejn B, Morgado MG, Da-Cruz AM. High levels of T lymphocyte activation in Leishmania-HIV-1 co-infected individuals despite low HIV viral load. BMC Infect Dis 2010; 10:358. [PMID: 21171992 PMCID: PMC3022832 DOI: 10.1186/1471-2334-10-358] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 12/20/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Concomitant infections may influence HIV progression by causing chronic activation leading to decline in T-cell function. In the Americas, visceral (AVL) and tegumentary leishmaniasis (ATL) have emerged as important opportunistic infections in HIV-AIDS patients and both of those diseases have been implicated as potentially important co-factors in disease progression. We investigated whether leishmaniasis increases lymphocyte activation in HIV-1 co-infected patients. This might contribute to impaired cellular immune function. METHODS To address this issue we analyzed CD4+ T absolute counts and the proportion of CD8+ T cells expressing CD38 in Leishmania/HIV co-infected patients that recovered after anti-leishmanial therapy. RESULTS We found that, despite clinical remission of leishmaniasis, AVL co-infected patients presented a more severe immunossupression as suggested by CD4+ T cell counts under 200 cells/mm3, differing from ATL/HIV-AIDS cases that tends to show higher lymphocytes levels (over 350 cells/mm3). Furthermore, five out of nine, AVL/HIV-AIDS presented low CD4+ T cell counts in spite of low or undetectable viral load. Expression of CD38 on CD8+ T lymphocytes was significantly higher in AVL or ATL/HIV-AIDS cases compared to HIV/AIDS patients without leishmaniasis or healthy subjects. CONCLUSIONS Leishmania infection can increase the degree of immune system activation in individuals concomitantly infected with HIV. In addition, AVL/HIV-AIDS patients can present low CD4+ T cell counts and higher proportion of activated T lymphocytes even when HIV viral load is suppressed under HAART. This fact can cause a misinterpretation of these laboratorial markers in co-infected patients.
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Affiliation(s)
- Joanna R Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz -FIOCRUZ. Av. Brasil 4365. Rio de Janeiro, CEP 21040-360, Brazil
| | - Carmem BW Giacoia-Gripp
- Laboratório de Aids e Imunologia Molecular; Instituto Oswaldo Cruz - FIOCRUZ, Av. Brasil 4365. Rio de Janeiro, CEP 21040-360, Brazil
| | - Priscilla Alexandrino de Oliveira
- Hospital-Dia Profa. Esterina Corsini, Hospital Universitário, Universidade Federal de Mato Grosso do Sul (UFMS). Mato Grosso do Sul, CEP 79070-900, Brazil
| | - Valdir S Amato
- Serviço de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. CEP 05403-010, São Paulo, Brazil
| | - Jose Ângelo L Lindoso
- Instituto de Medicina Tropical de São Paulo - Universidade de São Paulo, São Paulo, CEP 05403-010, Brazil
| | - Hiro Goto
- Instituto de Medicina Tropical de São Paulo - Universidade de São Paulo, São Paulo, CEP 05403-010, Brazil
| | - Manoel P Oliveira-Neto
- Instituto de Pesquisa Clínica Evandro Chagas, IPEC - FIOCRUZ, Av. Brasil 4365. Rio de Janeiro, CEP 21040-360, Brazil
| | - Marise S Mattos
- Instituto de Pesquisa Clínica Evandro Chagas, IPEC - FIOCRUZ, Av. Brasil 4365. Rio de Janeiro, CEP 21040-360, Brazil
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas, IPEC - FIOCRUZ, Av. Brasil 4365. Rio de Janeiro, CEP 21040-360, Brazil
| | - Mariza G Morgado
- Laboratório de Aids e Imunologia Molecular; Instituto Oswaldo Cruz - FIOCRUZ, Av. Brasil 4365. Rio de Janeiro, CEP 21040-360, Brazil
| | - Alda M Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz -FIOCRUZ. Av. Brasil 4365. Rio de Janeiro, CEP 21040-360, Brazil
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Abstract
A 43-year-old Brazilian female presented in 2001 with nasal stuffiness and sinusitis. A biopsy was consistent with limited Wegener's granulomatosis although antineutrophil cytoplasmic antibodies were negative. Her nasal inflammation progressed despite trials of prednisone, methotrexate, and azathioprine. A septal perforation developed and a repeat biopsy showed granulomatous inflammation. In 2006 the patient was referred to Division of Rheumatology, University of California, Los Angeles. The nose was grossly erythematous and a magnetic resonance imaging revealed nasal destruction and sinusitis. Palatine biopsies showed chronic inflammation. Cyclophosphamide at 150 mg/d resulted in markedly improved mucocutaneous lesions. The patient developed a leg and arm rash in 2007. A skin biopsy was positive for Leishmania braziliensis. The cyclophosphamide was discontinued and amphotericin B was initiated with transient benefit. Remission was achieved with pentavalent antimony. Despite multiple nasopharyngeal biopsies, for a 6-year span, mucocutaneous leishmaniasis masqueraded as Wegener's granulomatosis. Cyclophosphamide not only resulted in clinical improvement, due to reduced inflammatory response, but also allowed widespread cutaneous dissemination.
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47
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Carneiro FP, De Magalhães AV, De Jesus Abreu Almeida Couto M, Bocca AL, Muniz-Junqueira MI, Ribeiro Sampaio RN. Foxp3 expression in lesions of the different clinical forms of American tegumentary leishmaniasis. Parasite Immunol 2009; 31:646-51. [PMID: 19751477 DOI: 10.1111/j.1365-3024.2009.01148.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As the diversity in clinical presentation of American tegumentary leishmaniasis (ATL) is determined mainly by the immune response of host, our aim was to evaluate the in situ expression of Foxp3 [marker of regulatory T (Treg) cell] in lesions of the different clinical forms of ATL. Foxp3(+) cells were observed in 39.5% (32/81) of the samples and the number of positive cells was low in all the clinical forms. Even presenting a significantly lower number of CD4(+) T cells, diffuse cutaneous leishmaniasis (DCL) showed a higher expression of Foxp3 when compared with localized cutaneous leishmaniasis (LCL) and mucocutaneous leishmaniasis (MCL). In LCL and MCL, the number of Foxp3(+) cells correlated positively with the number of apoptotic cells (active caspase-3(+) cells). A positive correlation was also observed between the expression of active caspase-3 and FasL in these clinical forms. Our data suggest that increased number of Treg cells may be associated to the hyporesponsiveness observed in DCL and also indicate that the apoptosis may be a possible mechanism of action of Foxp3(+) Treg cell in LCL and MCL. However, further studies are required to better understand the mechanism of action of Treg cell.
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Affiliation(s)
- F P Carneiro
- Department of Pathology, University of Brasília, Brasília, Brazil.
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48
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Lindoso JAL, Lindoso AAB. Neglected tropical diseases in Brazil. Rev Inst Med Trop Sao Paulo 2009; 51:247-53. [DOI: 10.1590/s0036-46652009000500003] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 09/02/2009] [Indexed: 11/21/2022] Open
Abstract
Poverty is intrinsically related to the incidence of Neglected Tropical Diseases (NTDs). The main countries that have the lowest human development indices (HDI) and the highest burdens of NTDs are located in tropical and subtropical regions of the world. Among these countries is Brazil, which is ranked 70th in HDI. Nine out of the ten NTDs established by the World Health Organization (WHO) are present in Brazil. Leishmaniasis, tuberculosis, dengue fever and leprosy are present over almost the entire Brazilian territory. More than 90% of malaria cases occur in the Northern region of the country, and lymphatic filariasis and onchocerciasis occur in outbreaks in a particular region. The North and Northeast regions of Brazil have the lowest HDIs and the highest rates of NTDs. These diseases are considered neglected because there is not important investment in projects for the development of new drugs and vaccines and existing programs to control these diseases are not sufficient. Another problem related to NTDs is co-infection with HIV, which favors the occurrence of severe clinical manifestations and therapeutic failure. In this article, we describe the status of the main NTDs currently occurring in Brazil and relate them to the HDI and poverty.
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Affiliation(s)
| | - Ana Angélica B.P. Lindoso
- Instituto de Infectologia Emílio Ribas, Brasil; Pontifícia Universidade Católica de São Paulo, Brasl; SES, Brasil
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