Case Report: Coinfection by Leishmania amazonensis and HIV in a Brazilian Diffuse Cutaneous Leishmaniasis Patient.

Diffuse cutaneous leishmaniasis (DCL) is a rare type of leishmaniasis characterized by diffuse skin lesions. In Brazil, Leishmania (L.) amazonensis is the main etiological agent of this clinical form. The state of Maranhão has the highest prevalence of this disease in the country, as well as a high rate of HIV infection. Here, we report the first case of DCL/HIV of Brazil. A 46-year-old man from the Amazonian area of Maranhão state presented atypical lesion in the left upper limb and dissemination of diffuse erythematous nodules over his entire body. Histopathological examination confirmed the presence of intracellular amastigotes of Leishmania, and a polymerase chain reaction and molecular identification by restriction fragment profile identified L. (L.) amazonensis as the causative agent of the disease. The patient was also diagnosed with HIV virus after the leishmaniasis diagnosis. The initial treatments for leishmaniasis were liposomal amphotericin B (AmB-L) (4 mg/kg) for 10 days and prophylactic use of Glucantime® (10 mg/Sb+5/kg) for 2 months. After unsuccessful initial treatments, he was treated with a combination of AmB-L (4 mg/kg) alternated with pentamidine (4 mg/kg) for 10 days but failed in the first therapeutic cycle. Subsequently, he had a good response to treatment with pentamidine (4 mg/kg).

Detección de Leishmania (Viannia) braziliensis mediante la Reacción enCadena de la Polimerasa (PCR) en hamster dorado (Mesocricetusauratus) experimentalmente infectado / No disponible

El diagnóstico inmunológico y parasitológico de la leishmaniasis tegumentaria (LT) y visceral (LV)continúa siendo un desafío ya que una limitante es la demostración etiológica mediante extendidos coloreados, histopatología, cultivos, inoculación en animales de laboratorio, xenodiagnósticos. El procedimiento de PCR incrementa la sensibilidad del diagnóstico microscópico directo considerándola actualmente una herramienta muy valorable en la identificación y caracterización de las diferentes especies de Leishmania. En el presente trabajo se evalúan dos métodos de extracción de ADN en diferentes tejidos de hámster (Mesocricetus auratus) experimentalmente infectado con Leishmania (Viannia) braziliensis con material de un enfermo con LT con confirmación parasitológica. Los ADN obtenidos fueron sometidos a una técnica de PCR específica para Le. braziliensis. Se consideró positiva a toda muestra que evidenciara un amplicón de 126 pb en electroferograma de agarosa al 2%.Se realizaron otros métodos como el xenodiagnóstico y técnicas microscópicas directas para comparar la sensibilidad con la PCR. Todas las muestras del roedor infectado evidenciaron el amplicón correspondiente a Le. braziliensis. En este trabajo se demuestra que el detergente CTAB es adecuado para obtener una ADN óptimo para una amplificación específica y que PCR es el método más sensible ensayado (AU)

The etiologic diagnostic of Tegumentary Leishmaniasis (TL) and Visceral Leishmaniasis (VL) is performed by microscopic examination of stained smears of skin lesions, by histopathology, by culture, inoculation in animals or by xenodiagnostic. PCR procedure is currently considered as one promisory diagnostic tool due to its sensitivity, being usually used in identification and characteristization of Leishmania genus.In this work two DNA extraction methods using different golden hamster’s (Mesocricetus auratus)tissues experimentaly infected with Leishmania (Viannia) braziliensis from a patient with parasitologic confirmation of TL are evaluated. DNA obtained were put through specific L. braziliensis PCR, considering positive every sample showing an amplicon of 126 pb in the electroferogram of agarose 2%.PCR sensitivity was compared with xenodiagnostic and direct microscopic examination. All infected mice’s samples showed the corresponding amplicon to L. braziliensis, demonstrating that CTAB use is adecuated to obtain a top quality DNA and that, in these conditions, PCR is the highest sensitivity method (AU)