1/25. Mixed cryoglobulinemia secondary to visceral leishmaniasis.We describe a case of type II mixed cryoglobulinemia, with monoclonal IgMkappa rheumatoid factor, associated with visceral leishmaniasis caused by leishmania infantum. Involvement of Leishmania antigen(s) in the formation of cryoprecipitable immune complexes was suggested by the fact that cryoglobulinemic vasculitis subsided after antiparasite therapy and that anti-Leishmania antibodies, as well as rheumatoid factor, were enriched in the cryoprecipitate. We observed 2 additional patients with visceral leishmaniasis and cryoglobulinemic vasculitis. All 3 patients had seemingly contracted leishmaniasis in italy, were hepatitis c virus negative, and were initially diagnosed as having autoimmune disorders. These findings indicate that Leishmania can be an etiologic agent of type II mixed cryoglobulinemia. This parasitosis should be taken into consideration in the differential diagnosis of vasculitides in endemic areas.- - - - - - - - - - ranking = 1keywords = infantum (Clic here for more details about this article) |
2/25. Visceral leishmaniasis in costa rica: first case report.We describe a 15-month-old eutrophic immunocompetent male who presented with fever, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Leishmania amastigotes were identified in spleen and bone marrow specimens. In addition, tissue culture, animal inoculation, and isoenzyme analysis identified the parasite as leishmania donovani infantum or leishmania donovani chagasi. The infant was successfully treated with an antimonial drug. These findings represent the first case of visceral leishmaniasis reported in costa rica.- - - - - - - - - - ranking = 1keywords = infantum (Clic here for more details about this article) |
3/25. Congenital transmission of visceral leishmaniasis (Kala Azar) from an asymptomatic mother to her child.In this article, we report the case of a 16-month-old German boy who was admitted to the Children's Hospital of Stuttgart with a 4-week history of intermittent fever, decreased appetite, weakness, fatigue, and difficulty sleeping. He was healthy at birth and remained so for the first 15 months of his life. On admission, physical examination showed enlarged cervical, axillary, and inguinal lymph nodes, as well as hepatosplenomegaly. Laboratory data revealed pancytopenia, elevated liver function tests, and hypergammaglobulinemia. blood, stool, and urine culture results were negative. Viral infections and rheumatologic and autoimmune disorders were ruled out, but a positive titer for Leishmania antibodies was noted. In a liver and bone marrow biopsy, the amastigote form of the parasite could not be seen in cells. The promastigote form of Leishmania was found and the diagnosis of visceral leishmaniasis was made by combining the cultures of both the liver and the bone marrow biopsy material in 5 mL 0.9% saline on brain heart infusion agar, supplemented with defibrinated rabbit blood and incubated at 25 to 26 degrees C for 5 days. The parasite was identified by Southern blot analysis as leishmania infantum. Specific therapy with the antimonial compound sodium stibogluconate with a dose of 20 mg/kg body weight was begun immediately. Within 4 days, the patient became afebrile. The side effects of treatment, including erosive gastritis, cholelithiasis, worsening hepatosplenomegaly, elevation of liver enzymes, pancreatitis, and electrocardiogram abnormalities, necessitated the discontinuation of treatment after 17 days. On discharge 4 weeks later, the patient was stabilized and afebrile with a normal spleen, normal complete blood count, normal gammaglobulins, and decreasing antibody titers to Leishmania. During the next 24 months, the patient experienced intermittent episodes of abdominal pain, decreased appetite, recurrent arthralgia, and myalgia. But at his last examination in January 1998, he was well; all symptoms mentioned above had disappeared. Because the child had never left germany, nonvector transmission was suspected and household contacts were examined. His mother was the only one who had a positive antibody titer against leishmania donovani complex. She had traveled several times to endemic Mediterranean areas (portugal, malta, and Corse) before giving birth to the boy. But she had never been symptomatic for visceral leishmaniasis. Her bone marrow, spleen, and liver biopsy results were within normal limits. culture results and polymerase chain reaction of this material were negative. A montenegro skin test result was positive, indicating a previous infection with Leishmania. Western blot analysis showed specific recognition by maternal antibodies of antigens of Leishmania cultured from the boy's tissue. Visceral leishmaniasis is endemic to several tropical and subtropical countries, but also to the mediterranean region. It is transmitted by the sand fly (phlebotomus, Lutzomyia). Occasional nonvector transmissions also have been reported through blood transfusions, sexual intercourse, organ transplants, excrements of dogs, and sporadically outside endemic areas. Only 8 cases of congenital acquired disease have been described before 1995, when our case occurred. In our patient, additional evaluation showed that the asymptomatic mother must have had a subclinical infection with Leishmania that was reactivated by pregnancy, and then congenitally transmitted to the child. Visceral leishmaniasis has to be considered in children with fever, pancytopenia, and splenomegaly, even if the child has not been to an endemic area and even if there is no evidence of the disease in his environment, because leishmaniasis can be transmitted congenitally from an asymptomatic mother to her child.- - - - - - - - - - ranking = 1keywords = infantum (Clic here for more details about this article) |
4/25. Post-kala-azar dermal leishmaniasis during highly active antiretroviral therapy in an AIDS patient infected with leishmania infantum.We report a case of post-kala-azar dermal leishmaniasis (PKDL) in a woman with AIDS which occurred 13 months after a diagnosis of visceral leishmaniasis concomitantly with immunological recovery induced by highly active retroviral therapy. Cytokine pattern at the time of visceral leishmaniasis and PKDL diagnosis was studied and pathogenic implications were discussed.- - - - - - - - - - ranking = 4keywords = infantum (Clic here for more details about this article) |
5/25. Pediatric visceral leishmaniasis in austria: diagnostic difficulties in a non-endemic region.Visceral leishmaniasis is usually fatal if left untreated. In europe it is mainly caused by leishmania infantum which is endemic in the whole mediterranean region. While visceral leishmaniasis classically affects children, adults increasingly suffer infections in regions which are known to be endemic for HIV. Nowadays up to 70% of the patients with visceral leishmaniasis in southern europe are HIV-infected adults. The diagnosis is known to be especially difficult to establish in this group of patients because of a frequently atypical clinical presentation, but even in non-HIV-infected patients visceral leishmaniasis often represents a diagnostic challenge particularly when the patient is living in a non-endemic region. We report on four children with visceral leishmaniasis diagnosed at St. Anna Children's Hospital, Vienna, in the last decade. Diagnostic difficulties arose (1) from inexperience with this rare disease, (2) from a long incubation period (6 to 8 months) and (3) from a travel history apparently unsuspicious for the contraction of what is considered a 'tropical' disease. In one case, specific problems resulted (4) from clinical appearance and laboratory data mimicking hemophagocytic lymphohistiocytosis. Consequently even in regions where leishmaniasis is not endemic, diagnostic efforts should be undertaken to rule out this disease especially in patients with the presumptive diagnosis of hemophagocytic lymphohistiocytosis.- - - - - - - - - - ranking = 1keywords = infantum (Clic here for more details about this article) |
6/25. Localized lymphadenopathy due to leishmanial infection.A 25-year-old female patient presented with an isolated cervical lymph node enlargement several months after having returned from spain and latin america. She had no other signs or symptoms of disease. leishmania infantum/chagasi was identified as the causative agent. With extended travel activities localized lymph node enlargement due to leishmanial infection should be included in the differential diagnosis of lymphadenopathy of unknown origin.- - - - - - - - - - ranking = 1keywords = infantum (Clic here for more details about this article) |
7/25. Acute renal failure as initial presentation of visceral leishmaniasis in an hiv-1-infected patient.We report the case of an HIV-infected patient who presented with acute renal failure due to visceral leishmaniasis (VL). Although renal failure is the leading cause of death in dogs, the natural reservoir of leishmania infantum, renal involvement is usually absent in human VL. However, L. infantum can be considered a cause of renal failure in HIV-infected patients.- - - - - - - - - - ranking = 2keywords = infantum (Clic here for more details about this article) |
8/25. epiglottis involvement in a visceral leishmaniasis.The visceral form of leishmaniasis caused by leishmania infantum is frequently observed in Mediterranean countries, however otorhinolaryngeal involvement has only rarely been reported in the literature. We report here the case of a 23-year-old cameroon man, resident in france since 1991, and presenting with recurrent epistaxis and an epiglottis tumoral lesion. The visceral form of leishmaniasis with hepatosplenomegaly and pancytopenia was diagnosed. culture of the epiglottal lesion revealed L. infantum. Serological test for human immunodeficiency virus was negative and the patient was not on immunosuppressive drugs. Dramatic improvement was observed with antimony.- - - - - - - - - - ranking = 2keywords = infantum (Clic here for more details about this article) |
9/25. Co-infection by Leishmania amazonensis and L. infantum/L. chagasi in a case of diffuse cutaneous leishmaniasis in bolivia.We present the first report of a co-infection by Leishmania amazonensis and L. infantum/L. chagasi isolated in 1993 from a patient with diffuse cutaneous leishmaniasis (DCL), living in the sub-Andean region of bolivia. This is the third reported case of DCL in bolivia, but the first one with isoenzymatic identification of the aetiological agents involved and the first one giving evidence for a mixed infection by 2 Leishmania parasites in the same lesion.- - - - - - - - - - ranking = 5keywords = infantum (Clic here for more details about this article) |
10/25. leishmaniasis diagnosed from bronchoalveolar lavage.A 51-year-old renal transplant patient, whose spleen had been removed 11 years ago, was admitted to hospital for elective surgery, which was cancelled as she developed spiking fever and nonproductive cough and her general condition deteriorated. After 2 weeks, leishmaniasis was unexpectedly diagnosed from a bronchoalveolar lavage specimen, which had been subjected to parasitological examination under the suspicion of pneumocystosis. Isoenzyme typing identified the parasite as leishmania infantum. The patient had visited Malaga, spain, twice a year, the last trip taking place 1 month before admission. Specific treatment was followed by rapid recovery without relapse during 1.5 years. splenectomy and immunosuppressive medication obscured the clinical suspicion of leishmaniasis. The case is a reminder of the interstitial pneumonitis in leishmaniasis and emphasizes the value of broad-spectrum methods detecting a variety of parasites.- - - - - - - - - - ranking = 1keywords = infantum (Clic here for more details about this article) |
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