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1/4. A patient with intestinal amoebiasis and cutaneous amoebic ulcer.

    This paper reports a patient with intestinal amoebiasis in concomitant with amoebic ulcer in the thigh. The ulcer was suspected to be carcinoma, complicated cutaneous leishmaniasis or due to free-living amoebae. The diagnosis was confirmed by the pathological and parasitological demonstration of haematophagous trophozoites of E. histolytica. The patient was successfully treated with metronidazole.
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ranking = 1
keywords = leishmaniasis
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2/4. Unusual duodenal presentation of leishmaniasis.

    This case report describes an atypical case of duodenal leishmaniasis in an elderly patient not infected with human immunodeficiency virus. Investigation of this 84 year old woman with a constitutional syndrome and dysphagia revealed anaemia of chronic disorder, a high erythrocyte sedimentation rate, and polyclonal hypergammaglobulinaemia. Abdominal ultrasonography revealed thickening of the stomach wall, which was seen to be inflamed during gastroscopy. Duodenal histology revealed numerous leishmania amastigotes within macrophages. This was confirmed by bone marrow biopsy and leishmania serology. This case report stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, but also in elderly immunocompetent patients.
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ranking = 6
keywords = leishmaniasis
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3/4. 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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ranking = 6
keywords = leishmaniasis
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4/4. 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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ranking = 6
keywords = leishmaniasis
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