Microscopy and polymerase chain reaction detection of Leishmania chagasi in the pleural and ascitic fluid of a patient with AIDS: Case report and review of diagnosis and therapy of visceral leishmaniasis

Does Leishmaniasis disease alter the parenchyma and protein expression in salivary glands?

Leishmaniasis is considered a serious public health problem in several regions in Brazil and worldwide. This research aimed to perform a histopathological and proteomic study of parotid, submandibular and sublingual glands of BALB/c mice infected by Leishmania (L) infantum chagasi using histological, immunohistochemical and epifluorescence techniques. Twelve isogenic BALB/c male mice, around six- to eight-weeks old, were separated into two groups: the animals of the control group were injected with 0.15 ml of NaCl, while those in the experimental group were inoculated with 5 × 10(6) amastigote forms of Leishmania (L) infantum chagasi by the ip route. After 50 days, animals were euthanized and major salivary glands were collected to perform histological, immunohistochemical and epifluorescence techniques using anti-Caspase-2, anti-Ki-67 and anti-β-catenin antibodies, respectively. The histological and morphometric evaluation showed clusters of mononuclear inflammatory cells and a higher area and perimeter of the parotid gland. However, none of the salivary glands had morphophysiological impairment. There was no immunoreactivity to the anti-caspase-2 antibody and Ki67 expression in acinar and ductal cells in both groups. According to the immunofluorescence staining, the β-catenin antibodies did not show nuclear expression, suggesting no uncontrolled proliferation. The data obtained in this study showed population and morphological stability of major salivary glands after 50 days post-infection by Leishmania (L) infantum chagasi.

Visceral leishmaniasis with pleural effusion in an immunocompetent patient

Visceral leishmaniasis (VL) is usually characterized by splenomegaly, pallor and fever. Pleural effusion is an uncommon feature of this disease, which is encountered in immunocompromised patients. Here, we report a case of VL with pleural effusion in an immunocompetent patient. Pulmonary symptoms in VL are usually related to bacterial lung infection, vagal nerve compression by splenomegaly, and hypoalbuminaemia with mild pulmonary edema. Our patient presented with cough and chest pain. The clinical features of this case were baffling since they mimicked that of pulmonary tuberculosis. This case report emphasizes the need to recognize the diverse nature of presentation of this curable yet fatal infectious disease.

Immunodiagnosis of CNS parasitic infections

The nature of many parasitic infections of the central nervous system (CNS) requires immunodiagnosis to confirm presumptive diagnoses. The CNS is the primary site of parasite infection for some parasitic organisms and for others, neurological infection occurs only in immunocompromised hosts. Still other parasites cause ectopic infections of the CNS and occur very rarely. This review concentrates on laboratory diagnosis of diseases that are caused by parasites with a primary predilection for the CNS. Emphasis is placed on laboratory diagnostic methods that are used and suitable for clinical diagnosis, rather than a comprehensive review of all the experimental methods that have been reported in the literature. Immunodiagnosis is not appropriate for the diagnosis of all parasitic infections of the CNS; in those cases, alternative diagnostic methods are presented, but not discussed in detail. In some instances potential new antigens or methods are presented, particularly if adoption of these methods is expected in the near future.

Importance of nonenteric protozoan infections in immunocompromised people

There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.

L. (L.) chagasi in AIDS and visceral leishmaniasis (kala-azar) co-infection

Concomitant skin lesions in visceral leishmaniasis (VL) or kala-azar are rare, being more common the description of post-kala-azar dermal leishmaniasis occurring post treatment of kala-azar. Skin lesions caused by Leishmania donovani are frequently seen in the aids-VL co-infection. In Brazil cutaneous or mucosal forms of tegumentary leishmaniasis concomitant with aids are more commonly registered. Here we present a case of aids-VL co-infection, with unusual cutaneous and digestive compromising attributed to L. (L.) chagasi, with special attention to ecthymatous aspect of the lesion, allied to the absence of parasite on the histological skin biopsy.