Cases reported "HIV Seropositivity"

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1/7. Successful miltefosine treatment of post-kala-azar dermal leishmaniasis occurring during antiretroviral therapy.

    The first two patients to be treated with miltefosine for post-kala-azar dermal leishmaniasis (PKDL) are reported. One was a 26-year-old Ethiopian man who had been treated with sodium stibogluconate, for relapsing visceral leishmaniasis (VL), four times between August 2002 and March 2004. In January 2004 this patient was found to be seropositive for hiv and began antiretroviral treatment with stavudine, lamivudine and nevirapine. Five months later he developed clinical PKDL, with extensive cutaneous, conjunctival and oral mucosal involvement. The second patient was a 42-year-old Ethiopian man who was treated for relapsing VL in November 2003. He too was subsequently found to be seropositive for hiv and was treated with stavudine, lamivudine and nevirapine from May 2004. He developed a nodular rash of PKDL over his face and upper body 2 weeks after starting the antiretroviral therapy. Treatment of both patients with oral miltefosine, at 100 mg/day for 28 days, led to the complete regression of their PKDL lesions. When checked 3-6 months after the end of the miltesofine treatment, neither patient showed any signs of VL, PKDL or other hiv-associated disease.
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keywords = leishmaniasis
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2/7. An unusual gastrointestinal presentation of leishmaniasis.

    While visceral leishmaniasis (VL) generally occurs in immunocompetent subjects in endemic areas, it has been increasingly recognised as an important opportunistic infection in the immunocompromised including those infected with the human immunodeficiency virus. We report an unusual presentation of visceral leishmaniasis in a patient with the acquired immunodeficiency syndrome (AIDS) with disease which appeared to be limited to the gastrointestinal tract.
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keywords = leishmaniasis
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3/7. Atypical cutaneous histological features of visceral leishmaniasis in acquired immunodeficiency syndrome.

    Cutaneous lesions in Mediterranean visceral leishmaniasis (VL) are very unusual, except for the presence of Leishmania organisms in cutaneous Kaposi's sarcoma in patients with acquired immunodeficiency syndrome (AIDS). We have identified two unusual cutaneous histological features of VL in three patients with AIDS not described previously; two had "silent leishmaniasis," and in the third, Leishmania organisms were present in sweat ducts, suggesting transepithelial elimination through eccrine sweat glands and/or eccrine epithelial tropism.
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keywords = leishmaniasis
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4/7. leishmaniasis presenting as a dermatomyositis-like eruption in AIDS.

    Three patients are described with leishmaniasis and AIDS, with cutaneous lesions mimicking dermatomyositis. Leishmania organisms were observed in great numbers in the dermis of lesional skin biopsy specimens. They were also present inside keratinocytes in all layers of the epidermis in one patient. skin cultures from all patients and bone marrow culture in patients 1 and 3 revealed leishmania infantum. Leishmania organisms were also found in nonlesional skin. The absence of proximal symmetric muscle weakness, elevated muscle enzymes, myopathic electromyograms, or characteristic histopathologic and immunologic features of dermatomyositis, and the rapid and complete clearance or marked improvement of the cutaneous lesions after treatment for leishmaniasis, make us consider true dermatomyositis unlikely. We suggest that leishmaniasis be included in the list of diseases capable of inducing a dermatomyositis-like eruption.
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5/7. Digestive leishmaniasis in acquired immunodeficiency syndrome: a light and electron microscopic study of two cases.

    An increased incidence of visceral leishmaniasis in patients infected with the human immunodeficiency virus (hiv) is observed in areas in which both infectious diseases are endemic. Intensive worldwide traveling has also resulted recently in an increasing number of leishmanial and hiv coinfections in nonendemic areas. We describe the clinical, light microscopic, and ultrastructural features of two cases of imported, hiv-related, visceral leishmaniasis involving the alimentary tract, including the esophagus, the stomach, the duodenum, the ileum, the colon, and the rectum. We also discuss the differentiation of leishmanial infections from other hiv-related gastrointestinal opportunistic infections.
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keywords = leishmaniasis
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6/7. Duodenal leishmaniasis diagnosed by biopsy in two hiv-positive patients.

    We describe two cases of duodenal leishmaniasis in patients with human immunodeficiency virus (hiv) infection, diagnosed by light and electron microscopy. The patients presented nonspecific signs and symptoms, blood cultures were sterile, and serological tests for Leishmania spp. were negative. endoscopy showed normal-appearing mucosa in one patient and possible peptic duodenitis in the other patient. In these patients, the parasite was only detected in a duodenal biopsy specimen. In view of the unusual location of the parasite and the fact that the diagnostic and dissemination of the disease was established by means of conventional biopsy, this is not a routine procedure for the diagnosis of leishmaniasis because the classic procedures require the demonstration of antibodies and visualization in bone marrow, lymph nodes, liver and/or spleen aspirates. We decided to report these two cases to call attention to the possible finding of Leishmania amastigotes in biopsies from intestinal mucosa in hiv infected patients.
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keywords = leishmaniasis
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7/7. Oral mucosal leishmaniasis as a presenting feature of hiv infection and its management.

    leishmaniasis is a chronic parasitic protozoal disease transmitted by sandfly vectors and is endemic in some regions of south america, asia, africa and Mediterranean countries. This case report describes a British patient who presented with oral mucosal leishmaniasis and in whom it was also the first sign of hiv disease. We believe it is the first reported case of isolated oral mucosal leishmaniasis as a presenting feature of otherwise unknown hiv infection.
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keywords = leishmaniasis
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