Diffuse cutaneous leishmaniasis with oral involvement in a patient of Northern Mexico.

Diffuse cutaneous leishmaniasis is a rare chronic infectious disease, associated with Leishmania mexicana and L. amazonensis, presenting as multiple non-ulcerative painless nodules, with a tendency to relapse soon after treatment. We report a case of a 56-year-old Mexican woman exhibiting nodular lesions, plaques, crusts and scars involving the whole body. A solitary nodule was present at the junction between hard and soft palates. Diffuse cutaneous leishmaniasis is a disfiguring disease resulting in severe scarring if untreated.

Case Report: First Coinfection Report of Mixed Leishmania infantum/Leishmania major and Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome: Report of a Case of Disseminated Cutaneous Leishmaniasis in Iran.

Visceral leishmaniasis, a neglected tropical disease, is the third most common opportunistic disease in immunosuppressed patients, such as those affected by the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome. Although the reports have been characterized as Leishmania/HIV coinfections, the occurrence of a mixed infection by two Leishmania species in HIV-positive patients is rare. Here, we present an atypical case of disseminated cutaneous leishmaniasis (DCL) in a 26-year-old HIV-positive man. The diagnosis of DCL was established using skin biopsy and histopathology examinations and confirmed by molecular techniques. This is the first case of a Leishmania/HIV coinfection due to a mixed infection of Leishmania infantum/Leishmania major in Iran.

Características clínicas y epidemiológicas de leishmaniasis en el municipio de Trojes, El Paraíso, 2014-2017 / Clinical and epidemiological characteristics of Leishmaniasis in the municipality of Trojes, El Paraíso, 2014-2017

Antecedentes. Las enfermedades parasitarias tienen una distribución universal y son causa de una significativa mor - bimortalidad, principalmente en las regiones tropicales del mundo, asociadas a un bajo grado de desarrollo, malas condiciones higiénico-sanitarias, y determinadas condiciones ecológicas. Objetivo. describir las características clínicas y epidemiológicas de Leishmaniasis en el municipio Trojes, departamento de El Paraíso, Honduras en el período 2014-2017. Metodología. Estudio descrip - tivo transversal, 45,393 pacientes atendidos, 388 presentaron Leishmaniasis (0.8%). tamaño de muestra estimado de 204 (52.6%, IC95%). Variables incluidas: características sociodemográficas, epidemiológicas, datos clínicos, laboratoriales, diagnóstico y trata - miento. Se ingreso informacion en base de datos Epiinfo versión 7.1.5 (CDC, Atlanta). Los resultados se presentan como frecuencias, porcentajes, rangos y promedios. La información personal de los casos se manejó confidencialmente. Resultados. El tipo de Leish - maniasis más frecuente fue la forma cutánea en un 89.1% (188), el grupo etáreo más afectado fue el adulto joven (20-39 años) 37.8% (77), siendo estos de género masculino 61.8% (126). La zona anatómica más afectada fueron las extremidades superiores 43.6%(89), el tamaño de la lesión fue entre 2-10 cm 64.2%(131). El 96.1%(196) permaneció en zonas boscosas.74.5% (152) no presentaron síntomas. En el 100%(204) de los pacientes se utilizó Antimoniato de Meglumina (Glucantime) Discusión. Las herramientas para la prevención y el control de esta parasitosis son limitadas, por lo que es importante para las personas expuestas participar en acciones con el fin de reducir el contacto entre seres humanos y vectores. El diagnóstico precoz y oportuno, así como el tratamiento adecuado son cruciales para mejorar la calidad de vida del paciente...(AU)

[Diffuse cutaneous leishmaniasis (DCL) and visceral leishmaniasis (VL) concurrent with cancer: Presentation of a case]. / Leishmaniasis cutánea difusa (LCD) y visceral (LV) concurrentes con cáncer: Presentación de un caso.

Male of 52 year old with chronic alcoholism and ulcerated lesion on the face and disseminated nodular skin lesions, underwent to biopsy of ulcer edges where was observed a concomitant epidermoid malignancy with Leishmania (L.). Besides others, biopsies of nodule in the periumbilical region, lymph node and bone marrow were assayed, and all biopsies had abundant amastigotes. The amplified Polymerase Chain Reaction (PCR) products from nodule were sequenced and the alignment analysis demonstrated homology with L. mexicana confirming the infection by this parasite. This is considered the first case of visceral and diffuse cutaneous leishmaniasis concurrent with epidermoid cancer in the state of Campeche.

PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses.

BACKGROUND: Co-infection of leishmaniasis and HIV is increasingly reported. The clinical presentation of leishmaniasis is determined by the host immune response to the parasite; as a consequence, this presentation will be influenced by HIV-induced immunosuppression. As leishmaniasis commonly affects the skin, increasing immunosuppression changes the clinical presentation, such as in post-kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL); dermal lesions are also commonly reported in visceral leishmaniasis (VL) and HIV co-infection. METHODS: We reviewed the literature with regard to dermal manifestations in leishmaniasis and HIV co-infection, in three clinical syndromes, according to the primary presentation: PKDL, VL, or CL. RESULTS: A wide variety of descriptions of dermal leishmaniasis in HIV co-infection has been reported. Lesions are commonly described as florid, symmetrical, non-ulcerating, nodular lesions with atypical distribution and numerous parasites. Pre-existing, unrelated dermal lesions may become parasitized. Parasites lose their tropism and no longer exclusively cause VL or CL. PKDL in HIV co-infected patients is more common and more severe and is not restricted to Leishmania donovani. In VL, dermal lesions occur in up to 18% of patients and may present as (severe) localized cutaneous leishmaniasis, disseminated cutaneous leishmaniasis (DL) or diffuse cutaneous leishmaniasis (DCL); there may be an overlap with para-kala-azar dermal leishmaniasis. In CL, dissemination in the skin may occur resembling DL or DCL; subsequent spread to the viscera may follow. Mucosal lesions are commonly found in VL or CL and HIV co-infection. Classical mucocutaneous leishmaniasis is more severe. Immune reconstitution disease (IRD) is uncommon in HIV co-infected patients with leishmaniasis on antiretroviral treatment (ART). CONCLUSION: With increasing immunosuppression, the clinical syndromes of CL, VL, and PKDL become more severe and may overlap. These syndromes may be best described as VL with disseminated cutaneous lesions (before, during, or after VL) and disseminated cutaneous leishmaniasis with or without visceralization.

Disseminated cutaneous leishmaniasis in HIV positive patient--a case report.

Disseminated cutaneous leishmaniasis and HIV dual-infection is seldom reported. Leishmaniasis and HIV co-infection may intensify the immune defect and is the chief reason for atypical presentation and widespread progression of cutaneous leishmaniasis and its defiance to conventional therapy. Here we report a 38-year-old HIV-positive lady who presented with a 6-month history of a progressive papule and nodular eruptions of leishmaniasis on face, trunk and extremities that was recalcitrant to treatment.

Diffuse cutaneous leishmaniasis associated with the immune reconstitution inflammatory syndrome.

Leishmaniasis is an emerging disease in HIV-infected persons; visceral leishmaniasis is an AIDS-defining opportunistic infection. The parasite that causes this infection is usually transmitted by the sandfly and occasionally by nonsterile needles among intravenous drug users. Diffuse cutaneous leishmaniasis (DCL) is a rare anergic variant of leishmanial infection with the characteristic presentation of numerous nonulcerating nodules with an abundant parasite load, lack of visceral involvement, negative reaction to the leishmanin skin test, and a chronic course with incomplete response to treatment and frequent relapses. We report a case of DCL that developed in the context of the immune reconstitution inflammatory syndrome (IRIS) in a man with AIDS following initiation of antiretroviral therapy. We also review DCL to emphasize the importance of recognizing and treating this evolving disease in the growing population of patients on immunorestorative therapy.

Diffuse cutaneous leishmaniasis: co-infection with human immunodeficiency virus (HIV).

Cutaneous leishmaniasis is a disease caused by intracellular protozoal parasites belonging to the genus Leishmania. Immune suppression caused by HIV infection is an important factor for atypical presentation and widespread progression of cutaneous leishmaniasis. Diffuse (disseminated) cutaneous leishmaniasis and HIV co-infection is emerging as an extremely serious new disease. A 38-year-old HIV-positive man presented with a 12-month history of a progressive papule and nodular eruptions on face and extremities with infiltrations of nasal and oral mucosa. We report the case due to its atypical, widespread muco-cutaneous presentation masquerading as lepromatous leprosy.

[Diffuse cutaneous leishmaniasis in a patient with AIDS]. / Leishmaniasis cutánea difusa en un paciente con sida.

OBJECTIVE: A patient with a leishmaniasis-Aids co-infection was presented and discussed.. METHODS AND RESULTS: A 29-year -old soldier, coming from the Province of San José del Guaviare, Colombia, complained of a weight loss of 18 kgs in the previous ten months as well as a two-month-old cutaneous leision. Elisa and Western blot tests were positive for HIV infection. LT CD4 were 92/mm3. He had a generalized erythematous, psoriasiform dermal lesion, which, upon biopsy, revealed an abundance of phagocytosed microorganisms that stained black with Gomory's technique. Disseminated histoplasmosis was diagnosed. The patient received anti-retroviral therapy and itraconazole, without regression of the lesions. Amphotericin B was beneficial but the lesions recurred several months later, more numerous, nodular and with occurrence in the oral mucosa. Nine months after the initial diagnosis additional skin biopsies and review of the previous biopsies established that the patient had diffuse cutaneous leishmaniasis. The leishmania parasite did not grow in culture. Miltefosine produced marked improvement, but the lesions recurred and were cured finally with 52 Glucantime injections administered for two months. Presently, the patient remains in good condition 21 months after diagnosis of leishmaniasis. CONCLUSIONS: Diffuse cutaneous leishmaniasis may be a common clinical manifestation when leishmaniasis and AIDS co-occur. Its treatment is difficult and must include an antiparasitic drug as well as prophylactic, and anti-retroviral therapy. Leishmania amastigotes typically are not Gomory-positive and can be differentiated from Histoplasma by morphology, immunohistochemistry, culture, antibody-specific response and PCR. The leishmaniasis-AIDS co-infection enhances invasive capacity for both causal microorganisms. Increasing case numbers can be expected in Colombia, due to the high frequency of both diseases.

Co-infection by Leishmania amazonensis and L. infantum/L. chagasi in a case of diffuse cutaneous leishmaniasis in Bolivia.

We present the first report of a co-infection by Leishmania amazonensis and L. infantum/L. chagasi isolated in 1993 from a patient with diffuse cutaneous leishmaniasis (DCL), living in the sub-Andean region of Bolivia. This is the third reported case of DCL in Bolivia, but the first one with isoenzymatic identification of the aetiological agents involved and the first one giving evidence for a mixed infection by 2 Leishmania parasites in the same lesion.

Leishmaniose tegumentar americana associada à AIDS: relato de quatro casos / American cutaneous leishmaniasis associated with HIV/AIDS: report of four clinical cases

A co-infecção leishmaniose tegumentar americana e AIDS é de relato recente na literatura, observando-se diversidade quanto ao comportamento clínico e imunológico destes pacientes. Relatamos quatro casos acompanhados no Hospital Universitário de Brasília, com diagnóstico de infecçäo por parasitas do gênero Leishmania e pelo vírus da imunodeficiência humana, ilustrando diferentes apresentaçöes clínicas, evoluções e respostas terapêuticas

[American cutaneous leishmaniasis associated with HIV/AIDS: report of four clinical cases]. / Leishmaniose tegumentar americana associada à AIDS: relato de quatro casos.

The co-infection American cutaneous leishmaniasis and AIDS has recently been described in the literature, observing differences between the clinical and immunological behavior of these patients. Four cases are reported here, attended at the Brasilia University Hospital, with diagnoses of infection by Leishmania species and immunodeficiency virus, with a view to illustrating the clinical presentations, course and therapeutic responses.

Diabetes mellitus associated with pentamidine isethionate in diffuse cutaneous leishmaniasis

The authors report a case of a male patient from Bacabal, MA with diffuse cutaneous leishmaniasis (DCL), for at least nine years, with 168 lesions on his body. These were tumour-like nodules with some ulceration. He used pentavalent antimonial (glucantime) and an association of gamma interferon plus glucantime with improvement of the lesions but relapsed later. Recently, pentamidine isethionate (pentacarinat) was given a dosage of 4mg/kg/weight/day on alternate days for 20 applications. After 3 months a similar course of 10 application was given 2 times. Later he developed diabetic signs with weight loss of 10kg, polydypsia, polyuria and xerostomia. The lower limbs lesions showed signs of activity. Blood glucose levels normalised and remain like this at moment. Attention is drawn to the fact that pentamidine isethionate should be used as a therapy option with care, obeying rigorous laboratory controls including a glucose tolerance test.

Diabetes mellitus associated with pentamidine isethionate in diffuse cutaneous leishmaniasis.

The authors report a case of a male patient from Bacabal, MA with diffuse cutaneous leishmaniasis (DCL), for at least nine years, with 168 lesions on his body. These were tumour-like nodules with some ulceration. He used pentavalent antimonial (glucantime) and an association of gamma interferon plus glucantime with improvement of the lesions but relapsed later. Recently, pentamidine isethionate (pentacarinat) was given a dosage of 4mg/kg/weight/day on alternate days for 20 applications. After 3 months a similar course of 10 application was given 2 times. Later he developed diabetic signs with weight loss of 10kg, polydypsia, polyuria and xerostomia. The lower limbs lesions showed signs of activity. Blood glucose levels normalised and remain like this at moment. Attention is drawn to the fact that pentamidine isethionate should be used as a therapy option with care, obeying rigorous laboratory controls including a glucose tolerance test.