1/17. Visceral leishmaniasis: an opportunistic infection in haematological malignancy.Visceral leishmaniasis is a rare but potentially life threatening opportunistic protozoan infection in immunocompromised patients. The clinical manifestations in these patients are unusual and the diagnosis is difficult. They need prolonged treatment and are liable to have relapses. Here we report three patients with haematological malignancy (one with acute lymphoblastic leukaemia, one with chronic myeloid leukaemia, and one with myelodysplastic syndrome) complicated with visceral leishmaniasis. The clinical presentation, diagnosis, and outcome are discussed.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/17. coinfection of visceral leishmaniasis and Mycobacterium in a patient with acquired immunodeficiency syndrome.We report a case of coinfection of visceral leishmaniasis and mycobacterium avium-intracellulare in the same lesions in the small bowel and bone marrow of a 33-year-old man with acquired immunodeficiency syndrome who complained of abdominal pain and chronic diarrhea. The duodenal mucosa and bone marrow biopsy specimens showed numerous foamy macrophages packed with two forms of microorganisms that were identified histologically and ultrastructurally as Leishmania and Mycobacterium species. Visceral leishmaniasis is rarely suspected in patients residing in nonendemic countries including the united states. It should be included in the differential diagnosis for opportunistic infection in patients with acquired immunodeficiency syndrome. An appropriate travel history is important. To our knowledge, this is the first reported case showing coinfection of visceral leishmaniasis and mycobacterium avium-intracelluulare in the same lesion in a patient with acquired immunodeficiency syndrome.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
3/17. Liposomal amphotericin b as first line and secondary prophylactic treatment for visceral leishmaniasis in a patient infected with hiv.Visceral leishmaniasis has emerged in both endemic and non-endemic areas as an opportunistic infection in hiv-positive subjects. At risk for infection are hiv-positive intravenous drug abusers with a low CD4 T cell count and a high hiv viral load. In these patients, who are not always symptomatic, leishmaniasis is probably due to endogenous reactivation and often presents in an atypical fashion. death results from uncontrolled bleeding or bacterial infections. The clinical and biological spectrum of this disease suggests that it should be included among the diagnostic criteria for AIDS. Visceral leishmaniasis responds poorly to therapy and, when responsive, the relapse rate is high. Treatment protocols and criteria to document cure after treatment have not been definitely established. Lastly, there is no effective immuno- or chemo-prophylaxis against this protozoan. We report the case of an hiv-infected patient affected by visceral leishmaniasis who was successfully treated with liposomal amphotericin b given both as first line and as secondary prophylactic therapy. The patient has remained disease-free for 26 months after his first remission whereas, to our knowledge, almost all immunocompromised patients relapse within 12 months.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
4/17. Visceral leishmaniasis in human immunodeficiency virus (hiv)-infected and non-hiv-infected patients. A comparative study.Visceral leishmaniasis is an endemic infection in Mediterranean countries, where it has become a frequent complication of acquired immunodeficiency syndrome (AIDS). The incidence of visceral leishmaniasis is increasing in spain due to human immunodeficiency virus (hiv)-related cases, but some aspects of its epidemiology, clinical features, and management remain unknown. In addition, no comparative clinical studies about the disease in hiv-infected and non-hiv-infected patients have been reported. During a 24-year period, 120 cases of visceral leishmaniasis were diagnosed at our institution and 80 (66%) were associated with hiv infection. The mean age at diagnosis was higher in hiv-infected that in non-hiv-infected patients (33.2 versus 23.2 yr; p = 0.002), but the male/female ratio was similar in both groups. The main risk factor for hiv infection was intravenous drug abuse (78.7%). The clinical presentation of leishmaniasis was similar in both groups, but hiv-infected patients had a lower frequency of splenomegaly than hiv-negative individuals (80.8% versus 97.4%; p = 0.02). hiv-infected patients had a greater frequency and degree of leukopenia, lymphocytopenia, and thrombocytopenia. Most of them were profoundly immunosuppressed (mean CD4 lymphocyte count, 90 cells/mm3) at the time of diagnosis of leishmaniasis, and 53.7% had AIDS. The sensitivity of serologic studies for Leishmania was significantly lower in hiv-infected than in non-hiv-infected patients (50% versus 80%; p < 0.001), but the diagnostic yield of bone marrow aspirate (67.1% versus 79.4%) and bone marrow culture (62.9% versus 66.6%) was similar in both groups. After initial treatment, the response rate was significantly lower in hiv-infected than in non-hiv-infected individuals (54.8% versus 89.7%; p = 0.001). The relapse rate was 46.2% and 7.5%, respectively (p < 0.001). Secondary prophylaxis with antimonial compounds or amphotericin b seems to be useful in preventing relapses in hiv-infected patients. The mortality rate was higher (53.7% versus 7.5%; p < 0.001) and the median survival time shorter (25 versus > 160 mo; p < 0.001) in AIDS patients than in hiv-negative individuals. Although leishmaniasis could contribute to death in a significant number of hiv-infected patients, it was the main cause of death in only a few of them. The CD4 lymphocyte count and the use of highly active antiretroviral therapy and secondary prophylaxis for leishmaniasis were the most significant prognostic factors for survival in AIDS patients. Visceral leishmaniasis behaves as an opportunistic infection in hiv-infected individuals and should be considered as an AIDS-defining disease.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
5/17. Visceral leishmaniasis in two cases of leukemia.Two cases of visceral leishmaniasis (VL), one in a 51-year-old man with accelerated-phase chronic myeloid leukemia and another in a 35-year-old woman with acute myeloblastic leukemia, are reported. Incidental finding of Leishman-Donovan (LD) bodies in patients with leukemia highlights VL as a potent opportunistic infection in immunosuppressed patients.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
6/17. leishmaniasis: a rare cause of unexplained fever in a renal graft recipient.We report a case of visceral leishmaniasis in a 38-year-old renal transplant recipient living in an endemic country. Antimonial derivatives induced a rapid remission. A review of the literature disclosed 8 cases of this association with a fatal fulminant outcome in 5 cases. We suggest that the specific immunosuppression used in renal transplant patients might facilitate the development of a dormant infection and in these patients the misleading presentation may delay the diagnosis. Moreover special caution with treatment of leishmaniasis must be taken in renal transplant because of possible interactions between antimony compounds and ciclosporin metabolites. In renal transplant patients living in endemic countries, visceral leishmaniasis should be kept in mind as a potential cause of unexplained long-standing fever and considered as an opportunistic infection.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
7/17. Visceral leishmaniasis infection in a rheumatoid arthritis patient treated with infliximab.Anti-TNFalpha strategies can result in significant clinical benefits in rheumatoid arthritis (RA), but with an increased rate of opportunistic infections. Visceral leishmaniasis (VL) is a severe disease that can develop in immunocompromised hosts, principally in hiv patients. VL in RA patients treated with TNFalpha antagonists is an extremely rare event, and only one case has been described. Here we report a case of VL, occurring after 9 infusions of infliximab in association with azathioprine, in a patient who developed blood cytopenia, fluctuant fever, and splenomegaly.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
8/17. Disseminated visceral leishmaniasis (kala azar) in acquired immunodeficiency syndrome (AIDS).The case of an AIDS patient with visceral leishmaniasis diagnosed by bone marrow and liver biopsy is reported. Despite the infrequent association between hiv infection and leishmaniasis pathologists and clinicians alike should be alerted to the possibility of leishmaniasis occurring as yet another opportunistic infection in the setting of hiv-induced immunodeficiency.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
9/17. Visceral leishmaniasis as an opportunistic infection in the acquired immunodeficiency syndrome.We describe the case of a woman aged 34 years infected with the human immunodeficiency virus and whose illness was complicated by visceral leishmaniasis that ultimately led to her death.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
10/17. histoplasmosis capsulati and duboisii in europe: the impact of the hiv pandemic, travel and immigration.The present report describes a fatal case of imported AIDS-related disseminated histoplasmosis capsulati infection associated with multiple coexisting infections, diagnosed with cultural recovery of histoplasma capsulatum var. capsulatum with a commercial radiometric Mycobacterium medium. The epidemiological and clinical features of histoplasmosis capsulati and duboisii in europe are reviewed by examining also 69 documented cases of histoplasma capsulatum var. capsulatum infection (25 in AIDS patients) and 17 cases of histoplasma capsulatum var. duboisii infection (3 in hiv-infected patients), described since 1980. This draws special attention to the role played during recent years by the emergence of the hiv pandemic and the progressive intensification of travel and immigration as risk factors for this disease in our continent. AIDS patients, who are prone to multiple concurrent opportunistic infections which may share clinical and laboratory features with each other and with other hiv-associated diseases, represent the most relevant current group at risk for severe disseminated histoplasmosis, which may come to medical attention far from their place of origin.- - - - - - - - - - ranking = 0.25keywords = opportunistic infection (Clic here for more details about this article) |
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