Visceral leishmaniasis in immunosuppressed Caucasian patient

Immunity to visceral leishmaniasis: implications for immunotherapy

Visceral leishmaniasis, caused by Leishmania donovani, L. infantum (syn. Leishmania chagasi), is a globally widespread disease with a burden of about 400,000 new infections reported annually. It is the most dangerous form of human leishmaniasis in terms of mortality and morbidity and is spreading to several nonendemic areas because of migration, global traveling and military conflicts. The emergence of Leishmania-HIV co-infection and increased prevalence of drug-resistant strains have worsened the impact of the disease. The traditional low-cost drugs are often toxic with several adverse effects, highlighting the need for development of new therapeutic and prophylactic strategies. Therefore, a detailed understanding of mechanisms of protective immunity is extremely important in order to develop new therapeutics in the form of vaccines or immunotherapies. This review gives an overview of visceral leishmaniasis, with particular emphasis on the innate and adaptive immune responses, vaccine and vaccination strategies and their potentials for immunotherapy against the disease.

Multiple nodular lesions in spleen associated with visceral leishmaniasis: a case report of MRI-findings

The spleen is one of the most commonly involved organs of visceral leishmaniasis (VL). However, there were few reports about imaging findings of splenic leishmaniasis, especially regarding MRI findings. This case report describes a 45 years old male patient from Zhejiang province of southeastern China, who was admitted for persistent fever of unknown origin, with splenomegaly and multiple hypodense/low echo nodules on CT/ultrasonography (USG) studies. MRI showed multiple nodules with concentric rings in the spleen on T2-weighted imaging (T2WI), with no obvious diffusion restriction on diffusion weighted imaging (DWI), and gradual ring-like enhancement after intravenous administration of contrast medium. So MRI suggested necrotic granulomatous lesion. By reviewing the clinical history and following positive serological leishmania antibody test, the patient was finally confirmed a recent infection with VL. The patient received antimony gluconate therapy intravenously. At 4 months follow-up, the contrast-enhanced abdominal MRI showed that the size of the spleen was returned to normal and the splenic lesions were completely resolved except for reduced infarction compared with the previous MRI. This is the first case which was performed MRI examination completely. Meanwhile, it is the second case which MRI findings were reported. As for the characteristics of MRI in this case, there are several features, which are helpful for giving the diagnosis and differential diagnosis of VL.