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1/28. 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.
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keywords = leishmaniasis
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2/28. Visceral leishmaniasis masquerading as tuberculosis in a patient with AIDS.

    We report a case of visceral leishmaniasis presenting as significant lymphadenopathy in a patient with acquired immune deficiency syndrome. The lymphadenopathy was initially suspected to be tubercular in nature on pathological examination. This report highlights the increasing incidence of acquired immune deficiency syndrome and Leishmania co-infection in india, and the importance of demonstrating tubercle bacilli on culture before suggesting a diagnosis of tuberculosis.
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ranking = 0.71428571428571
keywords = leishmaniasis
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3/28. pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral leishmaniasis in an adult hiv negative patient.

    This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having hiv infection, based on risk factor analyses, but was subsequently shown to be hiv negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for mycobacterium tuberculosis and pneumocystis carinii, and stool tests were positive for strongyloides stercoralis and schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the hiv tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his hiv ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as hiv infection. The occurrence of opportunistic infections in severely ill patients without hiv must always be considered and alternate causes of immunosuppression sought.
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ranking = 0.71428571428571
keywords = leishmaniasis
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4/28. 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 = 1.1428571428571
keywords = leishmaniasis
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5/28. Disseminated American muco-cutaneous leishmaniasis caused by leishmania braziliensis braziliensis in a patient with AIDS: a case report.

    The authors report a case of culture-proven disseminated American muco-cutaneous leishmaniasis caused by leishmania braziliensis braziliensis in an hiv positive patient. Lesions began in the oropharynx and nasal mucosa eventually spreading to much of the skin surface. The response to a short course of glucantime therapy was good.
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ranking = 0.71428571428571
keywords = leishmaniasis
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6/28. 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 = 1.1428571428571
keywords = leishmaniasis
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7/28. Cellular and humoral immune responses of a patient with American cutaneous leishmaniasis and AIDS.

    The lymphocyte responsiveness to leishmanial antigens and its influence on the course of cutaneous leishmaniasis was studied in a patient with AIDS-associated American cutaneous leishmaniasis caused by leishmania braziliensis. The patient had cutaneous disseminated erythematous papules or nodules and mucosal lesions as well as moniliasis and weight loss. The patient had a poor delayed-type hypersensitivity to leishmanial antigens, showing 3 mm of induration. The cellular immune responses were studied in vitro by lymphocyte proliferative assays induced by leishmanial antigens and concanavalin a. The T cell phenotypes were analysed by flow cytometry. The peripheral blood mononuclear cells before proliferation showed an inversion of the CD4/CD8 ratio (0.28:1). The lymphoproliferative responses to antigen and mitogen were very low (indices < 2.5). The blast-like cell phenotypes after antigen stimulation in culture were: CD3 44.8%, CD4 7.53% and CD8 17.45%. In AIDS patients the decrease in the pool of CD4 cells, and consequent diminution of the CD4/CD8 ratio, produced by hiv infection provokes a generalized immune depression. The patient's disseminated clinical picture was probably related to the inability of his T cell-mediated immune responses to control the spread of Leishmania infection.
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ranking = 0.85714285714286
keywords = leishmaniasis
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8/28. 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 = 0.85714285714286
keywords = leishmaniasis
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9/28. Visceral leishmaniasis and hiv co-infection: a rare case of pulmonary and oral localization.

    Visceral leishmaniasis (VL) has increased as a complicating infection in subjects with human immunodeficiency virus (hiv) in countries bordering the Mediterranean sea. The clinical course as well as organ involvement of VL are often atypical in hiv positive subjects. In this study a case of VL with pulmonary and oral mucose localisation in a patient with acquired immune deficiency syndrome (AIDS), is reported. These findings, together with the presence of the parasite in the peripheral blood smear, confirm that in hiv positive patients the impaired immune system allows the spreading and the atypical localisation of the Leishmania amastigotes more easily than in immuno-competent individuals. In endemic areas and in hiv positive subjects a systemic and careful parasitological follow-up is necessary to ensure that any clinical form of leishmaniasis is not overlooked.
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ranking = 0.85714285714286
keywords = leishmaniasis
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10/28. Successful treatment of cutaneous leishmaniasis with lipid formulations of amphotericin b in two immunocompromised patients.

    Pentavalent antimonial drugs are habitually the first choice for treating leishmaniasis, although they possess well-known toxicity and may present some therapeutic failure. Lipid formulations of amphotericin b (LFAB) have been increasingly used for treating several types of leishmaniasis. However, the administration of such lipid formulations specifically to patients with cutaneous leishmaniasis (CL) is still rare, including immunocompromised patients to whom standard treatments are more frequently contraindicated. We describe here two cases of immunocompromised patients with CL, one of them with AIDS, representing the first case of AIDS and CL co-infection treated with LFAB described in the literature. The patient achieved therapeutic success with a total 1.500 mg dose of amphotericin b colloidal dispersion. The other had diabetes mellitus as well as kidney failure and was under dialysis, having obtained the healing of lesion with a total dose of 600 mg of liposomal amphotericin b. Thus, the authors suggest that LFAB can represent a safe, efficient and less toxic therapeutic alternative to pentavalent antimonials, as well as to the so-called second line drugs, pentamidine and amphotericin b deoxycholate.
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ranking = 1
keywords = leishmaniasis
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