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Dondi A, Manieri E, Gambuti G, Varani S, Campoli C, Zama D, Pierantoni L, Baldazzi M, Prete A, Attard L, Lanari M, Melchionda F. A 10-Year Retrospective Study on Pediatric Visceral Leishmaniasis in a European Endemic Area: Diagnostic and Short-Course Therapeutic Strategies. Healthcare (Basel) 2023; 12:23. [PMID: 38200929 PMCID: PMC10779246 DOI: 10.3390/healthcare12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a potentially fatal disease, with an increasing occurrence in northern Italy, affecting children and both immunocompetent and immunocompromised adults. METHODS This retrospective study conducted at the St. Orsola University Hospital of Bologna, Italy, evaluates the characteristics of 16 children (with a median age of 14.3 months) who were hospitalized between 2013 and 2022 for VL. RESULTS Seventy-five percent of patients presented with a triad of fever, cytopenia, and splenomegaly. An abdominal ultrasound examination revealed splenomegaly and hypoechoic spleen abnormalities in 93.8% and 73.3% of cases, respectively. Five VL cases were complicated by secondary hemophagocytic lymphohistiocytosis. Eleven patients were treated with a single 10 mg/kg dose of Liposomal Amphotericin B (L-AmB), while five received two doses (total of 20 mg/kg); one of the former groups experienced a recurrence. The fever generally decreased 48 h after the first L-AmB dose, and hemoglobin levels normalized within a month. The splenomegaly resolved in approximately 4.5 months. CONCLUSIONS Pediatricians should consider VL in children with fever of an unknown origin, anemia, cytopenia, and splenomegaly. In our experience, abdominal ultrasounds and molecular tests on peripheral blood contributed to diagnosis without the need for bone marrow aspiration. The short-course therapy with two 10 mg/kg doses of L-AmB is safe and effective.
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Affiliation(s)
- Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.); (L.P.); (M.L.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Elisa Manieri
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (E.M.)
| | - Giacomo Gambuti
- Specialty School of Paediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (E.M.)
| | - Stefania Varani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
- Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Caterina Campoli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.C.); (L.A.)
| | - Daniele Zama
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.); (L.P.); (M.L.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.); (L.P.); (M.L.)
| | - Michelangelo Baldazzi
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Arcangelo Prete
- Pediatric Oncology and Hematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna S. Orsola Hospital, 40138 Bologna, Italy; (A.P.); (F.M.)
| | - Luciano Attard
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.C.); (L.A.)
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.); (L.P.); (M.L.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Fraia Melchionda
- Pediatric Oncology and Hematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna S. Orsola Hospital, 40138 Bologna, Italy; (A.P.); (F.M.)
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Colomba C, Boncori G, Albano C, Garbo V, Bagarello S, Condemi A, Giordano S, Cascio A. Mucosal Relapse of Visceral Leishmaniasis in a Child with SARS-CoV-2 Infection. Pathogens 2023; 12:1127. [PMID: 37764934 PMCID: PMC10536868 DOI: 10.3390/pathogens12091127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Leishmaniasis is a vector-borne disease caused by protozoan parasites of the genus Leishmania and is transmitted through the bite of infected female sandflies. In the Mediterranean region, visceral leishmaniasis is caused by Leishmania. infantum, and it is usually responsible for symptoms such as fever, pancytopenia and enlargement of the liver and spleen. Relapse is rare in immunocompetent patients as much as the mucous involvement. We present a rare case of mucosal relapse of visceral leishmaniasis in a child with SARS-CoV-2 infection and perform an extensive review of the literature about leishmaniasis relapses in children. Atypical mucosal involvement during Leishmaniasis relapse is an eventuality in pediatric patients. Clinical follow-up and periodic PCR tests must be considered essential for the early recognition and treatment of an eventual relapse.
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Affiliation(s)
- Claudia Colomba
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy; (C.C.); (G.B.); (V.G.); (S.B.); (A.C.); (A.C.)
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy;
| | - Giovanni Boncori
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy; (C.C.); (G.B.); (V.G.); (S.B.); (A.C.); (A.C.)
| | - Chiara Albano
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy; (C.C.); (G.B.); (V.G.); (S.B.); (A.C.); (A.C.)
| | - Valeria Garbo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy; (C.C.); (G.B.); (V.G.); (S.B.); (A.C.); (A.C.)
| | - Sara Bagarello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy; (C.C.); (G.B.); (V.G.); (S.B.); (A.C.); (A.C.)
| | - Anna Condemi
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy; (C.C.); (G.B.); (V.G.); (S.B.); (A.C.); (A.C.)
| | - Salvatore Giordano
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy;
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy; (C.C.); (G.B.); (V.G.); (S.B.); (A.C.); (A.C.)
- Infectious and Tropical Diseases Unit, AOU Policlinico “P. Giaccone”, 90100 Palermo, Italy
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Colomba C, Guccione C, Rubino R, Scalisi M, Condemi A, Bagarello S, Giordano S, Cascio A. Third Case of Visceral Leishmaniasis in COVID-19: Mini Review Article. Pathogens 2022; 11:pathogens11080913. [PMID: 36015034 PMCID: PMC9412552 DOI: 10.3390/pathogens11080913] [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: 07/03/2022] [Revised: 07/29/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In the currently ongoing coronavirus pandemic, coinfections with unrelated life-threatening febrile conditions may pose a particular challenge to clinicians. Leishmaniasis is a zoonosis that may present general symptoms, including fever, malaise, and arthralgia, rendering it indistinguishable from COVID-19. Methods: In this paper, we aim to draw attention to this issue and analyze the clinical characteristics of the coinfection SARS-CoV-2/Leishmania through a systematic review of the literature. We were motivated by the observation of the first case of visceral leishmaniasis and COVID-19 in a paediatric patient. Conclusion: Our case is a reminder for healthcare providers to consider the diagnosis of visceral leishmaniasis in patients presenting with febrile syndrome in endemic regions during the COVID-19 pandemic.
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Affiliation(s)
- Claudia Colomba
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Cristoforo Guccione
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Raffaella Rubino
- Infectious and Tropical Diseases Unit, AOU Policlinico “P-Giaccone”, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-0916554015
| | - Michela Scalisi
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Anna Condemi
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Sara Bagarello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Salvatore Giordano
- Division of Paediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico, 90134 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Infectious and Tropical Diseases Unit, AOU Policlinico “P-Giaccone”, 90127 Palermo, Italy
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López Marcos M, Ruiz Sáez B, Vílchez Pérez JS, Moreno Pérez D, Carazo Gallego B, Falcón Neyra L, Goycochea Valdivia WA, Obando Santaella I, Lucena Soto JM, Díaz Martos J, Santos Pérez JL, Rodríguez Benjumea M, Angulo González de Lara R, Sánchez Codez MI, Peromingo Matute E, Cruz Cañete M, Calviño Molinero J, Hurtado Mingo Á, Lendínez Molinos F, Medina Claros AF, Muñoz Vilches MJ, Neth O, Olbrich P. Distinct Laboratory and Clinical Features of Secondary Hemophagocytic Lymphohistiocytosis in Pediatric Visceral Leishmaniasis: A Retrospective Analysis of 127 Children in Andalusia, Spain (2004-2019). Pediatr Infect Dis J 2021; 40:525-530. [PMID: 33538542 DOI: 10.1097/inf.0000000000003086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) is an endemic in Southern Europe. However, details regarding disease burden, clinical presentations, laboratory markers, management and outcome in children are scarce. METHODS Medical records of children (<14 years) admitted with VL to 10 pediatric units in Andalusia (2004-2019) were retrospectively reviewed. VL diagnosis was based on clinical presentation, serology, microscopy and molecular methods. Diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH) was established using the hemophagocytic lymphohistiocytosis-2004 criteria. RESULTS A total of 127 patients were identified. Median age was 14.5 months; the main clinical presentations were fever and splenomegaly (95.3% each). Cytopenias were the most common laboratory abnormalities. Diagnostics as well as treatment regimens varied over time and the participating centers. Liposomal amphotericin B was prescribed in 97.6%; relapses as well as adverse events were rarely observed (3.1% each). Thirty-seven patients, diagnosed with sHLH required longer hospital admission (P = 0.001), an increased number of platelet (P < 0.006) and red blood cell (P = 0.0001) transfusions and pediatric intensive care unit admission (P = 0.007). Monocytopenia (P = 0.011) and high C-reactive protein levels (P = 0.031), variables not included in the hemophagocytic lymphohistiocytosis-2004 criteria, were associated with sHLH. One patient deceased in the context of the Leishmania infection. CONCLUSIONS We report data on the largest pediatric VL cohort from Europe, commonly associated with sHLH. Raised C-reactive protein levels and monocytopenia appear to be associated with sHLH. The latter may help to identify these patients and to guide decisions regarding need of additional supportive clinical care and immunomodulatory therapies. The observed high rate of heterogeneity in terms of diagnosis and management warrants the establishment of appropriate guidelines.
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Affiliation(s)
- María López Marcos
- From the Unidad de Pediatría, Sección de Infectología, Reumatología e Inmunología Pediátrica, Hospital Infantil Virgen del Rocío, Instituto de Biomedicina de Sevilla, RITIP, Sevilla, Spain
| | - Beatriz Ruiz Sáez
- Unidad de Pediatría, Sección de Infectología Pediátrica, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - David Moreno Pérez
- Unidad de Pediatría, Sección de Infectología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Begoña Carazo Gallego
- Unidad de Pediatría, Sección de Infectología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Lola Falcón Neyra
- From the Unidad de Pediatría, Sección de Infectología, Reumatología e Inmunología Pediátrica, Hospital Infantil Virgen del Rocío, Instituto de Biomedicina de Sevilla, RITIP, Sevilla, Spain
| | - Walter Alfredo Goycochea Valdivia
- From the Unidad de Pediatría, Sección de Infectología, Reumatología e Inmunología Pediátrica, Hospital Infantil Virgen del Rocío, Instituto de Biomedicina de Sevilla, RITIP, Sevilla, Spain
| | - Ignacio Obando Santaella
- From the Unidad de Pediatría, Sección de Infectología, Reumatología e Inmunología Pediátrica, Hospital Infantil Virgen del Rocío, Instituto de Biomedicina de Sevilla, RITIP, Sevilla, Spain
- Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - José Manuel Lucena Soto
- Departamento de Inmunología, Sección de Inmunodeficiencias, Hospital Virgen del Rocío, Sevilla, Spain
| | - Julio Díaz Martos
- From the Unidad de Pediatría, Sección de Infectología, Reumatología e Inmunología Pediátrica, Hospital Infantil Virgen del Rocío, Instituto de Biomedicina de Sevilla, RITIP, Sevilla, Spain
- Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
| | | | | | | | - Mª Isabel Sánchez Codez
- Unidad de Pediatría, Sección de Infectología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Estrella Peromingo Matute
- Unidad de Pediatría, Sección de Infectología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Marta Cruz Cañete
- Hospital de Montilla, Agencia Sanitaria Alto Guadalquivir, Córdoba, Spain
| | - Jennifer Calviño Molinero
- Unidad de Pediatría, Sección de Infectología Pediátrica, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ángela Hurtado Mingo
- Unidad de Urgencias Pediátricas, Hospital Infantil Virgen del Rocío, Sevilla, Spain
- Grupo Hispalense de Pediatría SL, Sevilla, Spain
| | | | | | - Mª José Muñoz Vilches
- Unidad de Pediatría, Sección de Infectología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Olaf Neth
- From the Unidad de Pediatría, Sección de Infectología, Reumatología e Inmunología Pediátrica, Hospital Infantil Virgen del Rocío, Instituto de Biomedicina de Sevilla, RITIP, Sevilla, Spain
| | - Peter Olbrich
- From the Unidad de Pediatría, Sección de Infectología, Reumatología e Inmunología Pediátrica, Hospital Infantil Virgen del Rocío, Instituto de Biomedicina de Sevilla, RITIP, Sevilla, Spain
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Serbate Borges Portela Á, Margotto Bertollo C, da Silva Praxedes MF, Silva Brasileiro SA, Moreira Reis AM, Parreiras Martins MA. Adverse reactions to meglumine antimoniate in Brazilian inpatients with visceral leishmaniases: A case series. J Clin Pharm Ther 2019; 45:573-576. [PMID: 31793023 DOI: 10.1111/jcpt.13089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Adverse drug reactions (ADR) related to the treatment of visceral leishmaniasis (VL) can cause severe clinical complications. We report a case series of ADR in hospitalized VL patients on meglumine antimoniate (MA). CASE DESCRIPTION Seven cases of patients taking MA had at least one objective evidence for suspected ADR, including electrocardiographic, laboratory or clinical alteration. WHAT IS NEW AND CONCLUSION Meglumine antimoniate is highly toxic. Adherence to treatment guidelines is important. Pharmacists working in multidisciplinary teams may contribute to early detection and management of MA therapy-related ADR.
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Affiliation(s)
| | | | - Marcus Fernando da Silva Praxedes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
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van Griensven J, Diro E. Visceral Leishmaniasis: Recent Advances in Diagnostics and Treatment Regimens. Infect Dis Clin North Am 2019; 33:79-99. [PMID: 30712769 DOI: 10.1016/j.idc.2018.10.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diagnostic advances in visceral leishmaniasis include the development of the rK39 and rK28 rapid diagnostic test. The direct agglutination test is also increasingly used, as well as conventional and real-time polymerase chain reaction, which also performs well on peripheral blood. The choice of treatment for visceral leishmaniasis depends on the geographic region where the infection is acquired. Liposomal amphotericin B is generally found to be safe and effective in most endemic regions of the world; antimonials still remain to be the most effective in eastern Africa despite its high toxicity. Combination therapy is increasingly explored. Immunosuppressed patients require adapted diagnostic and therapeutic strategies.
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Affiliation(s)
- Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp 2000, Belgium.
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Post Office Box 196, Gondar, Ethiopia
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Chakravarty J, Sundar S. Current and emerging medications for the treatment of leishmaniasis. Expert Opin Pharmacother 2019; 20:1251-1265. [DOI: 10.1080/14656566.2019.1609940] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Abstract
Treatment of Visceral Leishmaniasis (VL), a neglected tropical disease, is very challenging with few treatment options. Long duration of treatment and drug toxicity further limit the target of achieving VL elimination. Chemotherapy remains the treatment of choice. Single dose of liposomal amphotericin B (LAmB) and multidrug therapy (LAmB + miltefosine, LAmB + paromomycin (PM), or miltefosine + PM) are recommended treatment regimen for treatment of VL in Indian sub-continent. Combination therapy of pentavalent antimonials (Sbv) and PM in East Africa and LAmB in the Mediterranean region/South America remains the treatment of choice. Various drugs having anti-leishmania properties are in preclinical phase and need further development. An effective treatment and secondary prophylaxis of HIV-VL co-infection should be developed to decrease treatment failure and drug resistance.
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
| | - Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
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Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6481028. [PMID: 27999807 PMCID: PMC5141564 DOI: 10.1155/2016/6481028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/24/2016] [Indexed: 11/17/2022]
Abstract
Background. Visceral leishmaniasis (VL) caused by Leishmania infantum is endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy) between 2012 and 2015. Methods. Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital. Results. Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50%) and all the isolates were identified as L. infantum by ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6–131 days). All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%. Conclusions. VL due to L. infantum could determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.
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Cutaneous and visceral leishmaniasis during anti-TNFα therapy. Wien Med Wochenschr 2016; 167:78-82. [DOI: 10.1007/s10354-016-0527-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
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Sundar S, Singh A. Recent developments and future prospects in the treatment of visceral leishmaniasis. Ther Adv Infect Dis 2016; 3:98-109. [PMID: 27536354 DOI: 10.1177/2049936116646063] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Limited therapeutic options in visceral leishmaniasis (VL) make the treatment of this neglected disease very challenging. In addition to this, long treatment duration and toxic adverse effects make it even more difficult. With no effective vaccine available to date, treatment of VL is based only on chemotherapy. In the Indian subcontinent, a single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin [PM], or miltefosine + PM) are the treatments of choice for VL. In East Africa, however, combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice, and in the Mediterranean region and South America, L-AmB is the recommended drug. Fexinidazole and PA-824 are new promising drugs which have shown encouraging results in preclinical studies.
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005 India
| | - Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Guarneri C, Tchernev G, Bevelacqua V, Lotti T, Nunnari G. The unwelcome trio: HIV plus cutaneous and visceral leishmaniasis. Dermatol Ther 2015; 29:88-91. [PMID: 26555699 DOI: 10.1111/dth.12303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Leishmania/Human Immunodeficiency Virus (HIV) coinfection has emerged as an extremely serious and increasingly frequent health problem in the last decades. Considering the insidious and not typical clinical picture in presence of immunosuppressive conditions, the increasing number of people travelling in endemic zones, the ability to survive, within both human and vector bodies, of the parasite, clinicians and dermatologists as the first line should be aware of these kind of "pathologic alliances," to avoid delayed diagnosis and treatment. In this setting, the occurrence of cutaneous lesions can, paradoxically, aid the physician in recognition and approaching the correct staging and management of the two (or three) diseases. Treatment of these unwelcome synergies is a challenge: apart from the recommended anti-retroviral protocols, different anti-leishmanial drugs have been widely used, according with the standard guidelines for visceral leishmaniasis (VL), with no successful treatment regimen still been established.
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Affiliation(s)
- C Guarneri
- Department of Clinical Experimental Medicine, Unit of Dermatology, University of Messina, Messina, Italy
| | - G Tchernev
- Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, University Hospital Lozenetz, Koziak Street 1, 1407, Sofia, Bulgaria
| | - V Bevelacqua
- Unit of Dermatology at A.O.R.N.A.S. "G. Garibaldi" and Department of General Pathology at the University of Catania, Piazza Santa Maria del Gesù, 95125, Catania, Italy
| | - T Lotti
- University of Rome "G. Marconi", Rome, Italy
| | - G Nunnari
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases at the University of Catania, Catania, Italy.,Department of Microbiology and Immunology, Jefferson Medical College at the Thomas Jefferson University, Philadelphia
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A case of visceral leishmaniasis and pulmonary tuberculosis in a post-partum woman. Int J Infect Dis 2015; 33:5-6. [DOI: 10.1016/j.ijid.2014.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/23/2022] Open
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Gallina V, Binazzi R, Golemi A, Farsad M, Weiss G, Wiedermann CJ. Imported visceral leishmaniasis - unexpected bone marrow diagnosis in a patient with fever, pancytopenia, and splenomegaly. AMERICAN JOURNAL OF BLOOD RESEARCH 2014; 4:101-105. [PMID: 25755910 PMCID: PMC4348797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 06/04/2023]
Abstract
Leishmaniasis is spreading from mediterranean countries to the north of Europe. The Alps are not an endemic region and there are only few reports of sporadic cases. We report the case of a 72 year old male who presented after a syncope with fever, cough and a sacral skin rash. Clinical examination revealed splenomegaly, elevated liver enzymes and pancytopenia; differential diagnosis included myeloproliferative or lymphoproliferative disorders, infections and auto-immune conditions that cause enlargement of the spleen and liver diseases, however, all tests were negative. In (18)FDG PET computerized tomography, pathological and diffuse uptake in the spleen was seen, with mild and homogeneous FDG uptake in the bone marrow and normal tracer uptake elsewhere in the body. Bone marrow aspiration revealed the presence of numerous intra- and extracellular Leishmania amastigotes. Travel history indicated that he had been in Sardinia for a 7-day vacation several months ago. The patient promptly responded to treatment with liposomal amphotericin B. Imported visceral leishmaniasis is likely to be seen more frequently in non-endemic regions and fever, pancytopenia and splenomegaly are diagnostic clues, whereas diagnostic confirmation may be done by detection of Leishmania spp. amastigotes in the bone marrow.
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Affiliation(s)
- Valentina Gallina
- Department of Internal Medicine, Central Hospital of Bolzano/BozenBolzano/Bozen (BZ), Italy
| | - Raffaella Binazzi
- Department of Infectious Disease, Central Hospital of Bolzano/BozenBolzano/Bozen (BZ), Italy
| | - Arber Golemi
- Department of Nuclear Medicine, Central Hospital of Bolzano/BozenBolzano/Bozen (BZ), Italy
| | - Mohsen Farsad
- Department of Nuclear Medicine, Central Hospital of Bolzano/BozenBolzano/Bozen (BZ), Italy
| | - Günter Weiss
- Department of Internal Medicine VI, Medical University of InnsbruckInnsbruck (Tyrol), Austria
| | - Christian J Wiedermann
- Department of Internal Medicine, Central Hospital of Bolzano/BozenBolzano/Bozen (BZ), Italy
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Abstract
INTRODUCTION Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis. The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic. AREAS COVERED A literature search on treatment of leishmaniasis was done on PubMed. Single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin (PM), or miltefosine + PM) are the treatment of choice for VL in the Indian subcontinent. A 17-day combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice for East African VL. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen for VL in the Mediterranean region and South America. Treatment of CL should be decided by the severity of clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. EXPERT OPINION There is an urgent need to implement a single-dose L-AmB or combination therapy in the Indian subcontinent. Shorter and more acceptable regimens are needed for the treatment of post - kala-azar dermal leishmaniasis. Combination therapy with newer drugs needs to be tested in Africa. Due to the toxicity of systemic therapy, a trend toward local treatment for New World CL is preferred in patients without risk of mucosal disease.
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Affiliation(s)
- Shyam Sundar
- Banaras Hindu University, Institute of Medical Sciences, Department of Medicine , Varanasi , India +91 542 2369632 ;
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