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11/53. pentamidine isethionate as treatment and secondary prophylaxis for disseminated cutaneous leishmaniasis during hiv infection: case report.

    leishmaniasis is emerging as a common and serious opportunistic infection in hiv-infected patients in endemic areas (such as Mediterranean countries), and may occur with various clinical presentations, ranging from typical visceral forms to atypical cases, including cutaneous disease. Although pentavalent antimony compounds have been the mainstay of antileishmanial treatment for half a century, new drugs seem today reliable, including liposomal amphotericin b and pentamidine isethionate. However, the most effective therapy is still unknown. An hiv-infected i.v. drug abuser patient with a very uncommon disseminated cutaneous leishmaniasis, following an initial visceral disease, is described. Primary and recurrent visceral forms of protozoan infection have been treated with liposomal amphotericin b, while pentamidine isethionate was successfully employed as treatment for subsequent cutaneous relapse and as secondary prophylaxis.
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ranking = 1
keywords = leishmaniasis
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12/53. Visceral leishmaniasis with pericarditis in an hiv-infected patient.

    The clinical presentation of visceral leishmaniasis, or kala-azar, is variable but usually includes fever, severe cachexia, lymphadenopathy and hepatosplenomegaly. In immunocompromised patients the clinical course of the disease is even less specific and the diagnosis is often made by means of incidental detection of the parasites at atypical sites such as the gastrointestinal tract, peripheral blood, lungs and cerebrospinal fluid. We describe a case of pericardial leishmaniasis in an hiv-infected patient.
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ranking = 1.2
keywords = leishmaniasis
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13/53. Oral leishmaniasis in a hiv-positive patient. Report of a case involving the palate.

    leishmaniasis is a parasitic disease caused by a protozoon (Leishmania), with different clinical forms that are endemic in certain countries. The association of this disease in patients who are seropositive to human immunodeficiency virus (hiv) has recently been described. leishmaniasis can develop in any stage of hiv infection, although the clinical manifestations - and hence the diagnosis - tend to coincide with the periods of maximum immune depression. We present the case of a hiv-positive, ex-intravenous drug abuser (in stage B2 of the CDC, 1992) with concomitant hepatitis c infection who presented with palatinal pain and bleeding for the past 2 months. Exploration revealed a vegetating tumoration of the hard palate. hematoxylin-eosin and Giemsa staining of the biopsy confirmed the diagnosis of leishmaniasis. The definitive diagnosis was mucocutaneous leishmaniasis (MCL), for a bone marrow aspirate proved negative, and no further lesions could be established. The patient was treated with meglumine antimoniate (Glucantime), followed by improvement of the lesions.
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ranking = 1.2
keywords = leishmaniasis
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14/53. Post-kala-azar dermal leishmaniasis associated with AIDS.

    Post-kala-azar dermal leishmaniasis (PKDL) is rarely reported in south america. In spite of the fact that there are many reports about the association of visceral leishmaniasis and AIDS, PKDL is very uncommon in hiv-positive patients, and so far only four cases have been documented in the literature. We present another case with unusual clinicopathological aspects. The patient, a 28-year-old male, from Salvador, Bahia (an endemic area) presented with clinical manifestations of visceral leishmaniasis three years after the diagnosis of AIDS. During treatment for visceral leishmaniasis he developed disseminated miliary papules. Microscopically, the skin biopsy showed a "saw-tooth" pattern with a lichenoid mononuclear infiltrate simulating lichen planus. The histopathological diagnosis was achieved through the finding of amastigotes. The authors discuss the clinicopathological aspects of this case based on a review of the specific literature.
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ranking = 1.6
keywords = leishmaniasis
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15/53. Disseminated cutaneous leishmaniasis after visceral disease in a patient with AIDS.

    leishmaniasis is emerging as a common and serious opportunistic disease for patients with hiv infection. Almost all cases of hiv-Leishmania coinfection have been described in Mediterranean countries and they occur with various clinical presentations, ranging from typical visceral forms to asymptomatic or atypical cases, including cutaneous and mucocutaneous leishmaniasis. Pentavalent antimony compounds have been the mainstays of antileishmanial therapy for half a century and new lipid formulations of amphotericin b seem reliable, but the most effective treatment remains unknown. We describe a patient who was hiv infected and an intravenous drug user, with an unusual disseminated cutaneous leishmaniasis, after an initial visceral disease and after a 13-month maintenance treatment with liposomal amphotericin. The severe concurrent immunosuppression probably played an essential role in leading to this atypical cutaneous form, characterized by diffuse, nonulcerated, nonscabby maculopapular lesions.
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ranking = 1.2
keywords = leishmaniasis
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16/53. Two case reports of symptomatic visceral leishmaniasis in AIDS patients concomitant with immune reconstitution due to antiretroviral therapy.

    We report the first 2 cases of visceral leishmaniasis in AIDS patients, which ocurred a few d after initiating antiretroviral therapy. The report raises the question whether a rapid immune reconstitution may convert a latent visceral leishmaniasis into a symptomatic one.
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ranking = 1.2
keywords = leishmaniasis
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17/53. Nexus of infection with human immunodeficiency virus, pulmonary tuberculosis and visceral leishmaniasis: a case report from Bihar, india.

    A 37-year-old man was diagnosed as being infected with human immunodeficiency virus (hiv), tuberculosis (TB), tuberculoma of the brain, and visceral leishmaniasis (VL) at the Rajendra Memorial Institute of Medical Sciences in Bihar, india. He had taken anti-tuberculosis therapy (ATT) for two and a half months and had episodes of convulsions with loss of consciousness, tongue bites, and incontinence of urine. The results of a neurologic examination were normal except for a left plantar extensor. He was positive for both hiv-I (confirmed by Western blot) and VL (confirmed by splenic aspirate). Treatment was initiated with amphotericin b lipid complex, a four-drug regimen (rifampicin, isoniazid, ethambutol, and pyrazinamide) of ATT, highly active antiretroviral therapy, anti-convulsants, and other supportive therapies. A repeat computed tomography scan of the brain showed the disappearance of the lesion followed by gliosis. After six months, he was also cured of VL. The triad of infections (hiv, VL, and TB) is a real threat in Bihar as an emerging combination of diseases of public health importance. Keeping these facts in mind, efforts to develop simple and cost effective diagnostic techniques coupled with affordable therapeutic facilities are urgently needed in developing countries.
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ranking = 1
keywords = leishmaniasis
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18/53. Tegumentary leishmaniasis as a manifestation of immune reconstitution inflammatory syndrome in 2 patients with AIDS.

    Immune reconstitution inflammatory syndromes (IRISs) have been reported in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS) since the introduction of highly active antiretroviral therapy (HAART). This syndrome is characterized by clinical manifestations of opportunistic infections when signs of immune reconstitution are observed during therapy. We report on leishmaniasis, suggestive of HAART-induced iris, in 2 patients with AIDS. After beginning HAART, 1 patient presented with disseminated, tegumentary lesions, whereas the other patient's preexisting lesions worsened and became more extensive; however, at the same time, their CD4( ) T cell counts were recovering and their virus loads were decreasing significantly. The lesions healed with anti-Leishmania therapy.
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ranking = 1
keywords = leishmaniasis
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19/53. Post-kala-azar dermal leishmaniasis due to leishmania infantum in a human immunodeficiency virus type 1-infected patient.

    We report the first case of post-kala-azar dermal leishmaniasis due to leishmania infantum in a human immunodeficiency virus type 1-infected patient in australia. Molecular characterization of the isolate was performed using PCR restriction fragment length polymorphism targeting both repetitive sequences from Leishmania nuclear dna and repetitive kinetoplast dna minicircles for species differentiation.
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ranking = 1
keywords = leishmaniasis
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20/53. Atypical disseminated leishmaniasis resembling post-kala-azar dermal leishmaniasis in an hiv-infected patient.

    Post-kala-azar dermal leishmaniasis (PKDL) is very uncommon among hiv-positive patients, and very few cases have so far been documented. A case of atypical disseminated leishmaniasis resembling PKDL in an hiv-positive patient successfully treated with N-methylglucamine antimoniate is reported. The polymerase chain reaction performed on the skin lesions was positive for leishmania infantum.
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ranking = 2
keywords = leishmaniasis
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