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Portilla Maya N, Kempf W, Perez Muñoz N, Rodríguez-Martínez P, Posada R, Fernández-Figueras MT. Histopathologic Spectrum of Findings Associated With Tattoos: Multicenter Study Series of 230 Cases. Am J Dermatopathol 2021; 43:543-553. [PMID: 34276026 DOI: 10.1097/dad.0000000000001695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Reactions to tattoo may simulate common dermatosis or skin neoplasms. Histopathology allows diagnosis and helps determining the level and degree of inflammation associated, consequently orientating treatment. OBJECTIVE To describe the histological features found in biopsies of cutaneous reactions to tattoo. DESIGN This study was designed as a multicenter case series. SETTING All consecutive histopathological samples of tattoos referred from 1992 to 2019 to the Hospital General de Catalunya, Hospital Germans Trias i Pujol, and a private practice, all in Barcelona, Spain, and from the Kempf und Pfaltz Histologische Diagnostik in Zurich, Switzerland were retrieved from the files. PARTICIPANTS AND EXPOSURE The inclusion criteria were all cosmetic/permanent makeup, artistic/professional, and traumatic tattoos associated with either inflammatory reactions alone and/or with tumors and/or infections. Exclusion criteria were cases without any associated pathologic finding in the place of the ink, amalgam tattoos, and medical or temporary tattoos. MAIN OUTCOMES AND MEASURES In all patients, clinical features (age, sex, location, tattoo color, and presentation) were recorded. Histological features evaluated included ink color, associated tumors or infections, and inflammatory reaction pattern. Inflammation was graded in low to moderate or severe. RESULTS From 477 biopsies diagnosed as tattoos, 230 cases from 226 patients met the inclusion criteria. Samples corresponded to 107 male and 120 female subjects and 3 of unknown gender. Median age was 39 years (ranging from 9 to 84 years). Fifty-three samples were referred from centers in Spain and 177 from the center in Switzerland. The series was analyzed in 2 parts: tattoos associated only with inflammatory reactions (117/230) and tattoos associated with tumors or infections (113/230). The most common form of inflammatory pattern associated with tattoo was the fibrosing reaction (79/117, 68%), followed by granulomatous reaction (56/117, 48%), lichenoid reaction (33/117, 28%), epithelial hyperplasia (28/117, 24%), pseudolymphoma (27/117, 23%) and spongiotic reaction (27/117, 23%). Combined features of 2 or more types of inflammatory patterns were seen in 64% cases. CONCLUSIONS AND RELEVANCE Our series confirms that cutaneous reactions to tattoos are polymorphous. Inflammation tends to present with combined patterns. Infections are tending to decline, and pathologic findings are not specific to ink color or clinical features.
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Affiliation(s)
- Nataly Portilla Maya
- Dermatologist, Dermatology Department, Clínica Erasmo LTDA. Valledupar, Colombia
| | - Werner Kempf
- Dermatopathologist, Pathology Department, Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Noelia Perez Muñoz
- Pathologist, Pathology Department, Hospital Universitari General de Catalunya (HUGC), Sant- Cugat del Vallès, Spain; and
- Pulmonologist, Pathology Department, Hospital University German Trias I Pujol, Barcelona, Spain
| | | | - Rodolfo Posada
- Pathologist, Pathology Department, Hospital Universitari General de Catalunya (HUGC), Sant- Cugat del Vallès, Spain; and
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2
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Zambarbieri J, Pigoli C, Caniatti M, Scarpa P. Leishmania spp. in a cutaneous histiocytoma of an old dog. Diagn Cytopathol 2021; 49:1067-1069. [PMID: 34324275 PMCID: PMC9291187 DOI: 10.1002/dc.24839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Jari Zambarbieri
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - Claudio Pigoli
- Laboratorio di Istologia, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), Brescia, Italy
| | - Mario Caniatti
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - Paola Scarpa
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
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3
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Charoensakulchai S, Bualert L, Manomat J, Mungthin M, Leelayoova S, Tan-Ariya P, Siripattanapipong S, Naaglor T, Piyaraj P. Risk Factors of Leishmania Infection among HIV-Infected Patients in Trang Province, Southern Thailand: A Study on Three Prevalent Species. Am J Trop Med Hyg 2020; 103:1502-1509. [PMID: 32700674 DOI: 10.4269/ajtmh.20-0332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
There are two main species of Leishmania reported in Thailand, that is, Leishmania siamensis and Leishmania martiniquensis. Moreover, leishmaniasis cases caused by Leishmania donovani complex were also reported. There is still a lack of information concerning risk factors of Leishmania infection in Thailand. This study aimed to identify the risk factors of Leishmania infection caused by these three species among HIV-infected patients. A cross-sectional study was conducted in HIV clinic at Trang Hospital, Thailand. Nested PCR and sequencing were performed to detect Leishmania DNA in blood and saliva samples and identify Leishmania species. A standardized questionnaire was used to interview individuals. A total of 526 patients were recruited in this study. Sixty-three (12.0%) were positive for L. siamensis, 24 (4.6%) were positive for L. martiniquensis, and 23 (4.4%) were positive for L. donovani complex. Risk factors of L. siamensis infection included using intravenous drug (adjusted odds ratio [AOR] 2.01, 95% CI: 1.01-4.02). Risk factors of L. martiniquensis infection included female gender (AOR 4.23, 95% CI: 1.52-11.75), using recreational drug (AOR 3.43, 95% CI: 1.00-11.74), and having comorbidities (AOR 4.94, 95% CI: 2.00-12.21). Risk factors of L. donovani complex infection included having opportunistic infection (AOR 4.22, 95% CI: 1.00-17.79), CD4 count 200-500 cells/mm3 (AOR 3.64, 95% CI: 1.14-6.86), and not using insect repellent (AOR 3.04, 95% CI: 1.08-8.58). This study identified the risk factors of Leishmania infection caused by three Leishmania species in Thailand. The data could be useful for disease prevention and control. Further studies on trends of Leishmania infection and preventive measures are recommended.
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Affiliation(s)
| | | | - Jipada Manomat
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Mathirut Mungthin
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Saovanee Leelayoova
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Peerapan Tan-Ariya
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Tawee Naaglor
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Phunlerd Piyaraj
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
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Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
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5
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Cutaneous and visceral leishmaniasis during anti-TNFα therapy. Wien Med Wochenschr 2016; 167:78-82. [DOI: 10.1007/s10354-016-0527-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
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6
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Gamba CS, Lambert Smith F, Wisell J, Brown M. Tattoo reactions in an HIV patient: Autoeczematization and progressive allergic reaction to red ink after antiretroviral therapy initiation. JAAD Case Rep 2016; 1:395-8. [PMID: 27051791 PMCID: PMC4809398 DOI: 10.1016/j.jdcr.2015.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Christina S Gamba
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Franki Lambert Smith
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Josh Wisell
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mariah Brown
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
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Roiko MS, Schmitt BH, Relich RF, Meyer TL, Zhang S, Davis TE. An unusual presentation of leishmaniasis in a human immunodeficiency virus-positive individual. JMM Case Rep 2016; 3:e005011. [PMID: 28348746 PMCID: PMC5343128 DOI: 10.1099/jmmcr.0.005011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/29/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction: Leishmaniasis is a neglected tropical disease caused by vector-borne protozoa of the genus Leishmania. Cutaneous and mucocutaneous forms result in disfiguration or mutilation, whilst visceral leishmaniasis (VL) affects multiple organs and is fatal if untreated. Notably, Leishmania are capable of establishing a chronic infection, which may reactivate years after initial infection when the host becomes immune-suppressed. Case Presentation: A 24-year-old human immunodeficiency virus (HIV)-positive male presented for excision of anal condylomas. At the time of his current condyloma excision, the patient had no additional symptoms or cutaneous findings, but was noted to have been only intermittently compliant with his antiretroviral therapy. Microscopic examination of the haematoxylin and eosin-stained anal condyloma tissue revealed koilocytic change, ulceration and brisk histiocytic inflammation containing numerous small intracellular bodies suggestive of Leishmania amastigotes. A bone marrow biopsy was performed and demonstrated similar intracellular forms. Anal condyloma tissue and bone marrow aspirate were sent to the Centers for Disease Control and Prevention's Parasitic Diseases Branch for confirmation of Leishmania and speciation. Specific immunohistochemical staining for Leishmania in the tissue section was positive and the species was confirmed as Leishmania donovani by PCR. Subsequently, the patient resumed highly active antiretroviral therapy and received anti-Leishmania therapy. Conclusion: Whilst the presentation of VL in HIV-positive patients is often similar to those without HIV, here we describe an unusual initial presentation of leishmaniasis in an HIV-positive patient where the parasite was found in an anal condyloma. VL is a critical diagnosis that should be considered and pursued when leishmaniasis is encountered in seemingly illogical clinical settings.
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Affiliation(s)
- Marijo S Roiko
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA
| | - Bryan H Schmitt
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA
| | - Ryan F Relich
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA
| | - Thomas L Meyer
- Division of Infectious Disease, Indiana University Health, Indianapolis , IN 46202 , USA
| | - Shanxiang Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA
| | - Thomas E Davis
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA
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Nafchi HR, Kazemi-Rad E, Mohebali M, Raoofian R, Ahmadpour NB, Oshaghi MA, Hajjaran H. Expression analysis of viscerotropic leishmaniasis gene in Leishmania species by real-time RT-PCR. Acta Parasitol 2016; 61:93-7. [PMID: 26751877 DOI: 10.1515/ap-2016-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022]
Abstract
UNLABELLED Viscerotropic leishmaniasis (VTL) is a parasitic disease with non-specific manifestations caused by Leishmania tropica. Specific antigens produced by Viscerotropic leishmaniasis gene have been used for diagnosis of VTL. The aim of this study was to compare the expression level of VTL gene among the viscerotropic L. tropica isolates (n: 3) and visceral L. infantum isolates (n: 4). Also, the expression level was compared in L. tropica (n: 21) and L. major (n: 8) isolates, the main causes of cutaneous leishmaniasis in Iran by real time-RT-PCR. Results showed viscerotropic leishmaniasis gene was expressed in all 3 species; L. tropica, L. major and L. infantum. The most expression rate was in L. tropica and L. major as the cutaneous species and the lowest in visceral isolates including L. infantum and viscerotropic L. tropica strains respectively. CONCLUSION Results revealed that VTL gene can play an important role in visceralization process of L. tropica although there are other mechanisms to keep parasite visceralized. According to these primary results, increased the expression level of VTL gene probably could contribute to inhibit the invasive behavior of Leishmania parasites. However, more experimental researches are needed to confirm this idea.
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Simunovic C, Shinohara MM. Complications of decorative tattoos: recognition and management. Am J Clin Dermatol 2014; 15:525-36. [PMID: 25385257 DOI: 10.1007/s40257-014-0100-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Tattooing is an ancient practice that enjoys continued popularity. Although a modern, professionally performed tattoo is generally safe, complications can occur. A skin biopsy of all tattoo reactions is recommended as some tattoo reactions have systemic implications. Tattoo-related infections are seen days to decades after tattooing, and range from acute pyogenic infections to cutaneous tuberculosis. In particular, non-tuberculous mycobacterial infections happen in tattoos with increasing frequency and are introduced at the time of tattooing through contaminated ink or water used to dilute inks. Despite a transition in tattoo pigments from metal salts to industrial azo dyes, hypersensitivity reactions also persist, and include eczematous, granulomatous, lichenoid, and pseudoepitheliomatous patterns (among others). Granulomatous tattoo reactions can be a clue to cutaneous or systemic sarcoidosis, particularly in the setting of interferon use. Pseudoepitheliomatous tattoo reactions have substantial overlap with squamous cell carcinoma and keratoacanthoma, making diagnosis and management difficult. Other malignancies and their benign mimics can occur in tattoos, raising questions about the safety of tattoo ink and its role in carcinogenesis.
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10
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PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses. PLoS Negl Trop Dis 2014; 8:e3258. [PMID: 25412435 PMCID: PMC4238984 DOI: 10.1371/journal.pntd.0003258] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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11
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Diro E, van Griensven J, Mohammed R, Colebunders R, Asefa M, Hailu A, Lynen L. Atypical manifestations of visceral leishmaniasis in patients with HIV in north Ethiopia: a gap in guidelines for the management of opportunistic infections in resource poor settings. THE LANCET. INFECTIOUS DISEASES 2014; 15:122-9. [PMID: 25300862 DOI: 10.1016/s1473-3099(14)70833-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In regions where it is endemic, visceral leishmaniasis is an important opportunistic infectious disease in people living with HIV. Typically, clinical presentation of visceral leishmaniasis includes chronic fever, hepatosplenomegaly, and weight loss. In Leishmania infantum endemic regions in Europe, atypical visceral leishmaniasis presentations have been well documented, with almost every possible organ involved. However, such reports are rare in Leishmania donovani endemic regions such as east Africa. In this Personal View, we describe the various atypical disease presentations in patients screened as part of an HIV and visceral leishmaniasis clinical trial in north Ethiopia, where up to 40% of patients with visceral leishmaniasis are co-infected with HIV. Atypical presentations such as these are not covered in clinical guidelines used in these settings. Apart from the lack of diagnostic facilities, this gap contributes to the underdiagnosis of atypical visceral leishmaniasis, with associated morbidity and mortality. Involvement of clinicians experienced with the management of HIV and visceral leishmaniasis co-infection in the development of HIV clinical guidelines in affected regions is warranted.
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Affiliation(s)
- Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium
| | - Rezika Mohammed
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Robert Colebunders
- Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium
| | - Mesfin Asefa
- Department of Pathology, University of Gondar, Gondar, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Parasitology and Immunology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium
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van Griensven J, Carrillo E, López-Vélez R, Lynen L, Moreno J. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect 2014; 20:286-99. [DOI: 10.1111/1469-0691.12556] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Kluger N. Cutaneous complications related to permanent decorative tattooing. Expert Rev Clin Immunol 2014; 6:363-71. [DOI: 10.1586/eci.10.10] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Juzlova K, Votrubova J, Kacerovska D, Lukas M, Bortlik M, Rohacova H, Nohynkova E, Vojackova N, Fialova J, Hercogova J. Visceral leishmaniasis with cutaneous symptoms in a patient treated with infliximab followed by fatal consequences. Dermatol Ther 2013; 27:131-4. [DOI: 10.1111/dth.12083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Katerina Juzlova
- Department of Dermatovenereology, 2nd Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Jana Votrubova
- Department of Dermatovenereology, 2nd Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Denisa Kacerovska
- Department of Pathology, Faculty of Medicine in Pilsen; Charles University in Prague; Prague Czech Republic
| | - Milan Lukas
- IBD Clinical and Research Centre, ISCARE a.s., 1st Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE a.s., 1st Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Hana Rohacova
- Department of Infectious Diseases, Bulovka Hospital, 2nd Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Eva Nohynkova
- Department of Infectious and Tropical Diseases, 1st Faculty of Medicine; Charles University in Prague and Hospital Bulovka; Prague Czech Republic
| | - Nadezda Vojackova
- Department of Dermatovenereology, 2nd Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Jorga Fialova
- Department of Dermatovenereology, 2nd Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Jana Hercogova
- Department of Dermatovenereology, 2nd Faculty of Medicine; Charles University in Prague; Prague Czech Republic
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15
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Wenzel SM, Rittmann I, Landthaler M, Bäumler W. Adverse reactions after tattooing: review of the literature and comparison to results of a survey. Dermatology 2013; 226:138-47. [PMID: 23689478 DOI: 10.1159/000346943] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022] Open
Abstract
The number of tattooed people has substantially increased in the past years. Surveys in different countries reveal this to be up to 24% of the population. The number of reported adverse reactions after tattooing has also increased including infections, granulomatous and allergic reactions and tumors. However, the case reports do not reflect the frequency of adverse reactions. This review compares the medically documented adverse reactions published in 1991-2011 with the findings of a nation-wide survey that recently revealed the features and health problems associated with tattoos. To compare the data with the survey, the sex of patients was reported and the location and color of tattoos were evaluated. The results show clearly that colored tattoo inks are mainly responsible for adverse skin reactions and that tattoos on the extremities are involved most.
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Affiliation(s)
- Sabrina M Wenzel
- Department of Dermatology, University of Regensburg Medical Center, Regensburg, Germany
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16
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Cavalcanti A, Lobo R, Cupolillo E, Bustamante F, Porrozzi R. Canine cutaneous leishmaniasis caused by neotropical Leishmania infantum despite of systemic disease: A case report. Parasitol Int 2012; 61:738-40. [PMID: 22583758 DOI: 10.1016/j.parint.2012.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 11/26/2022]
Abstract
Visceral leishmaniasis is an anthropozoonosis caused by a protozoan Leishmania infantum (syn. Leishmania chagasi). Here, we report a typical case of canine cutaneous leishmaniasis due to L. infantum infection without any other systemic symptom in one dog in the city of Rio de Janeiro, Brazil. A mongrel female dog was admitted in a veterinary clinic with reports of chronic wounds in the body. Physical examination revealed erosive lesions in the limbs, nasal ulcers, presence of ectoparasites and seborrheic dermatitis. Blood samples and fragments of healthy and injured skin were collected. The complete hemogram revealed aregenerative normocytic normochromic anemia and erythrocyte rouleaux, and biochemical analysis revealed normal renal and hepatic functions. Cytology of the muzzle and skin lesions suggested pyogranulomatous inflammatory process. The histopathology of a skin fragment was performed and revealed suspicion of protozoa accompanied by necrotizing dermatitis. The diagnosis of leishmaniasis was accomplished by positive serology, isolation of Leishmania from the skin lesion, and also by molecular test (PCR targeting the conserved region of Leishmania kDNA). Culture was positive for damaged skin samples. PCR targeting a fragment of Leishmania hsp70 gene was performed employing DNA extracted from damaged skin. RFLP of the amplified hsp70 fragment identified the parasite as L. infantum, instead of Leishmania braziliensis, the main agent of cutaneous leishmaniasis in Rio de Janeiro. Characterization of isolated promastigotes by five different enzymatic systems confirmed the species identification of the etiological agent. Serology was positive by ELISA and rapid test. This case warns to the suspicion of viscerotropic Leishmania in cases of chronic skin lesions and brings the discussion of the mechanisms involved in the parasite tissue tropism.
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Affiliation(s)
- Amanda Cavalcanti
- Laboratório de Pesquisa em Leishmaniose, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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17
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High frequency of asymptomatic Leishmania spp. infection among HIV-infected patients living in endemic areas for visceral leishmaniasis in Brazil. Trans R Soc Trop Med Hyg 2012; 106:283-8. [DOI: 10.1016/j.trstmh.2012.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 01/13/2012] [Accepted: 01/16/2012] [Indexed: 11/24/2022] Open
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Bañuls AL, Bastien P, Pomares C, Arevalo J, Fisa R, Hide M. Clinical pleiomorphism in human leishmaniases, with special mention of asymptomatic infection. Clin Microbiol Infect 2012; 17:1451-61. [PMID: 21933304 DOI: 10.1111/j.1469-0691.2011.03640.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review gives an update of current knowledge on the clinical pleiomorphism of Leishmania, with a special emphasis on the case of asymptomatic carriage. The first part describes the numerous unusual expressions of the disease that occur besides the classic (visceral, cutaneous, and mucocutaneous) forms of leishmaniases. The second part deals with progress in the understanding of disease outcome in humans, and the possible future approaches to improve our knowledge in the field. The third part highlights the role of the too often neglected asymptomatic carrier compartment. This group could be key to understanding infraspecific differences in virulence and pathogenicity of the parasite, as well as identifying the genetic determinants involved in the expression of the disease.
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Affiliation(s)
- A L Bañuls
- UMR MIVEGEC (IRD 224-CNRS 5290-Université Montpellier, France.
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19
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Santos-Oliveira JR, Da-Cruz AM, Pires LHS, Cupolillo E, Kuhls K, Giacoia-Gripp CBW, Oliveira-Neto MP. Atypical lesions as a sign of cutaneous dissemination of visceral leishmaniasis in a human immunodeficiency virus-positive patient simultaneously infected by two viscerotropic Leishmania species. Am J Trop Med Hyg 2011; 85:55-9. [PMID: 21734124 DOI: 10.4269/ajtmh.2011.10-0398] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leishmaniasis is considered an emerging opportunistic disease in human immunodeficiency virus (HIV)-infected patients who have considerably variable clinical presentation. We report a patient with visceral leishmaniasis who had unexpected clinical aspects (atypical cutaneous lesions appearing after long-term evidence of visceral parasites). The patient had hepatoesplenomegaly in the absence of fever, but was otherwise generally healthy. The HIV viral load was low despite severe immunossupression (low lymphocyte proliferation and low level of interferon-γ, concomitant with a high lymphocyte activation status). Surprisingly, two Leishmania strains were isolated from his bone marrow (typical L. infantum sequence MON-1, type A) and skin (L. donovani MON-2 sequence); this second strain had not been previously identified in Brazil. The association of visceral leishmaniasis and HIV/acquired immunodeficiency syndrome is a largely unknown disease, particularly in areas in which leishmaniasis is not endemic. Such atypical cases indicate that this disease can be undiagnosed in clinical settings.
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Affiliation(s)
- Joanna R Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, e Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.
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20
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Gelanew T, Hurissa Z, Diro E, Kassahun A, Kuhls K, Schönian G, Hailu A. Disseminated cutaneous leishmaniasis resembling post-kala-azar dermal leishmaniasis caused by Leishmania donovani in three patients co-infected with visceral leishmaniasis and human immunodeficiency virus/acquired immunodeficiency syndrome in Ethiopia. Am J Trop Med Hyg 2011; 84:906-12. [PMID: 21633027 DOI: 10.4269/ajtmh.2011.11-0055] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report paired strains of Leishmania parasites, one from the viscera and the other from skin lesions that were isolated from three patients with visceral leishmaniasis and disseminated cutaneous leishmaniasis that were co-infected with human immunodeficiency virus. The causative parasites were characterized by polymerase chain reaction-restriction length polymorphism of the ribosomal DNA internal transcribed spacer 1 and by a panel of multilocus microsatellite markers. We demonstrated that the causative agent was Leishmania donovani in all cases, irrespective of the phenotype of the disease. The paired strains from viscera and skin lesions of the same patients showed genetic identity across the 14 microsatellite markers investigated. These findings demonstrate that the skin lesions in these human immunodeficiency virus-positive patients with visceral leishmaniasis were caused by dissemination of viscerotropic L. donovani parasites as a consequence of severe immunosuppression. However, in all three patients, rapid clearance of the skin lesions was observed after antimonial therapy.
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Affiliation(s)
- Tesfaye Gelanew
- Institut für Mikrobiologie und Hygiene, Charité Universitätsmedizin Berlin, Dorotheenstrasse 96, Berlin, Germany.
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21
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Karp CL, Mahanty S. Approach to the Patient with HIV and Coinfecting Tropical Infectious Diseases. TROPICAL INFECTIOUS DISEASES: PRINCIPLES, PATHOGENS AND PRACTICE 2011. [PMCID: PMC7150329 DOI: 10.1016/b978-0-7020-3935-5.00139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Kluger N. [Cutaneous infections related to permanent tattooing]. Med Mal Infect 2010; 41:115-22. [PMID: 21144685 DOI: 10.1016/j.medmal.2010.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 11/28/2022]
Abstract
Decorative tattooing is made by introducing exogenous pigments and/or dyes into the dermis to permanently mark the body for decorative or other reasons. Unfortunately, this procedure is not harmless and various complications may occur including the potential inoculation of virulent microorganisms in the dermis. Cutaneous infections usually develop within days to weeks after the procedure and may include: pyogenic infections (staphylococcus, streptococcus, Pseudomonas aeruginosa, etc.), but also atypical bacteria (commensal mycobacteria, tuberculosis, leprosy, etc.), viral infections (molluscum contagiosum, verruca vulgaris, herpes, etc.), and also fungal and parasitic infections. This review focuses on dermatological infections occurring on tattoos and their management.
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Affiliation(s)
- N Kluger
- Service de dermatologie, université Montpellier-I, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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Leishmaniasis in Spanish tattoos. Enferm Infecc Microbiol Clin 2010; 28:667. [DOI: 10.1016/j.eimc.2010.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 07/08/2010] [Indexed: 11/23/2022]
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24
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Leishmaniasis sobre tatuaje en paciente infectado por el virus de la inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2010; 28:482-3. [DOI: 10.1016/j.eimc.2010.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 01/27/2010] [Indexed: 11/20/2022]
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25
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García-Río I, Daudén E, Ballestero-Díez M, Fraga J, García-Díez A. Leishmaniasis y nodulosis reumatoide en paciente con infección por el virus de la inmunodeficiencia humana. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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26
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Leishmaniasis and Rheumatoid Nodulosis in a Patient With HIV Infection. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Sobreelevación de tatuaje en un paciente infectado por virus de la inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2009; 27:602-4. [DOI: 10.1016/j.eimc.2008.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 11/22/2008] [Accepted: 11/27/2008] [Indexed: 11/18/2022]
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28
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Lindoso J, Barbosa R, Posada-Vergara M, Duarte M, Oyafuso L, Amato V, Goto H. Unusual manifestations of tegumentary leishmaniasis in AIDS patients from the New World. Br J Dermatol 2009; 160:311-8. [DOI: 10.1111/j.1365-2133.2008.08908.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mulvaney P, Aram G, Maggiore PR, Kutzner H, Carlson JA. Delay in diagnosis: trauma- and coinfection-related cutaneous leishmaniasis because ofLeishmania guyanensisinfection. J Cutan Pathol 2009; 36:53-60. [DOI: 10.1111/j.1600-0560.2007.00925.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 2008; 21:334-59, table of contents. [PMID: 18400800 DOI: 10.1128/cmr.00061-07] [Citation(s) in RCA: 566] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To date, most Leishmania and human immunodeficiency virus (HIV) coinfection cases reported to WHO come from Southern Europe. Up to the year 2001, nearly 2,000 cases of coinfection were identified, of which 90% were from Spain, Italy, France, and Portugal. However, these figures are misleading because they do not account for the large proportion of cases in many African and Asian countries that are missed due to a lack of diagnostic facilities and poor reporting systems. Most cases of coinfection in the Americas are reported in Brazil, where the incidence of leishmaniasis has spread in recent years due to overlap with major areas of HIV transmission. In some areas of Africa, the number of coinfection cases has increased dramatically due to social phenomena such as mass migration and wars. In northwest Ethiopia, up to 30% of all visceral leishmaniasis patients are also infected with HIV. In Asia, coinfections are increasingly being reported in India, which also has the highest global burden of leishmaniasis and a high rate of resistance to antimonial drugs. Based on the previous experience of 20 years of coinfection in Europe, this review focuses on the management of Leishmania-HIV-coinfected patients in low-income countries where leishmaniasis is endemic.
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Abstract
Recently, piercing and tattooing have gained increasing popularity worldwide, through all social classes and age groups. Besides pierced ear lobes, piercing of the tongue, nose, nipples, belly button, and even the genitals is quite common. The variety of tattoos range from temporary henna tattoos to permanent makeup and permanent tattoos, where the pigments are deposed in the dermis. These trends are supplemented by more invasive methods of body modification such as implanting, scarification, or branding. Parallel with the increasing popularity of piercing and tattoos, the knowledge about associated complications rose. Complications depend substantially on the circumstances in which body modifications are applied, the materials used, and the body region concerned. This article gives an overview of the most common complications of body modification methods, which mainly result from shortcomings in the application itself or in hygiene regimens. Consequences may be as severe as life-threatening events or permanent malfunction of different organs.
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Bañuls AL, Hide M, Prugnolle F. Leishmania and the leishmaniases: a parasite genetic update and advances in taxonomy, epidemiology and pathogenicity in humans. ADVANCES IN PARASITOLOGY 2007; 64:1-109. [PMID: 17499100 DOI: 10.1016/s0065-308x(06)64001-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Leishmaniases remain a major public health problem today despite the vast amount of research conducted on Leishmania pathogens. The biological model is genetically and ecologically complex. This paper explores the advances in Leishmania genetics and reviews population structure, taxonomy, epidemiology and pathogenicity. Current knowledge of Leishmania genetics is placed in the context of natural populations. Various studies have described a clonal structure for Leishmania but recombination, pseudo-recombination and other genetic processes have also been reported. The impact of these different models on epidemiology and the medical aspects of leishmaniases is considered from an evolutionary point of view. The role of these parasites in the expression of pathogenicity in humans is also explored. It is important to ascertain whether genetic variability of the parasites is related to the different clinical expressions of leishmaniasis. The review aims to put current knowledge of Leishmania and the leishmaniases in perspective and to underline priority questions which 'leishmaniacs' must answer in various domains: epidemiology, population genetics, taxonomy and pathogenicity. It concludes by presenting a number of feasible ways of responding to these questions.
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Affiliation(s)
- Anne-Laure Bañuls
- Institut de Recherche pour le Développement, UMR CNRS/IRD 2724, Génétique et Evolution des Maladies Infectieuses, IRD Montpellier, 911 avenue Agropolis, 34394 Montpellier cedex 5, France
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Lopez-Medrano F, Costa JR, Rodriguez-Peralto JL, Aguado JM. An HIV-Positive Man with Tattoo Induration. Clin Infect Dis 2007. [DOI: 10.1086/518875] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
With diminished and dysregulated cell-mediated immunity, HIV-infected individuals are susceptible to a myriad of skin infections. These infections include the conditions encountered in immunocompetent patients, as well as infections seen almost exclusively in the setting of HIV infection. The HIV/AIDS pandemic has made some previously rare infections more prominent. Although antiretroviral therapy has been helpful in relieving the burden of cutaneous infections in HIV-infected patients, it does not prevent all opportunistic infections in the skin and also has created new dilemmas.
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Affiliation(s)
- Molly T Hogan
- Division of Emergency Services, Harborview Medical Center, University of Washington School of Medicine, Box 359702, 325 9th Avenue, Seattle, WA 98104, USA.
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Catorze G, Alberto J, Afonso A, Vieira R, Cortes S, Campino L. [Leishmania infantum/HIV co-infection: cutaneous lesions following treatment of visceral leishmaniasis]. Ann Dermatol Venereol 2006; 133:39-42. [PMID: 16495850 DOI: 10.1016/s0151-9638(06)70841-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Mediterranean basin is an endemic region of leishmaniasis caused by Leishmania infantum. With the advent of human immunodeficiency virus (HIV) infection, the number of cases of visceral leishmaniasis has dramatically increased in this area over the last years, mainly in adults. Moreover, the presence of cutaneous lesions infested with Leishmania has been frequently reported in these patients. CASE-REPORT A 35-year-old Portuguese woman, a former intravenous drug user HIV1-positive since 1997, developed visceral leishmaniasis in 2000, with several relapses in 2001 and 2002, treated successively with pentavalent antimonial salts (Glucantime), liposomal amphotericin B and Glucantime associated with itraconazole. Several weeks after therapy for the second relapse of visceral leishmaniasis, physical examination revealed asymptomatic erythematous papules on the face that later spread to the trunk and upper limbs. Histopathologic studies of a skin biopsy revealed a granulomatous infiltrate in the dermis with the presence of Leishmania amastigotes. After culture, the parasite was identified as L. infantum MON-1. In spite of improvement of the patient's visceral leishmaniasis with the above-mentioned treatment, the cutaneous lesions became increasingly numerous and infiltrated. After 2 months of therapy with intravenous pentamidine (4 mg/kg/3 times a week) and oral dapsone (100 mg b.i.d), the cutaneous lesions disappeared completely. Prevention with dapsone was successfully maintained for 6 months. Several weeks after discontinuation of treatment, further lesions appeared. The patient improved again on reintroduction of dapsone. DISCUSSION This case confirmed the existence of a clinical form similar to post-kala-azar dermal leishmaniasis in a patient co-infected with L. infantum MON-1/HIV. The cutaneous lesions were resistant to classical antileishmanial drugs but disappeared on treatment with dapsone.
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Affiliation(s)
- G Catorze
- Serviço de Dermatologia, Hospital de Curry Cabral, Lisboa, Portugal.
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Schraner C, Hasse B, Hasse U, Baumann D, Faeh A, Burg G, Grimm F, Mathis A, Weber R, Günthard HF. Successful Treatment with Miltefosine of Disseminated Cutaneous Leishmaniasis in a Severely Immunocompromised Patient Infected with HIV-1. Clin Infect Dis 2005; 40:e120-4. [PMID: 15909255 DOI: 10.1086/430444] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 02/03/2005] [Indexed: 11/03/2022] Open
Abstract
We describe here a case of disseminated cutaneous leishmaniasis due to Leishmania major in a severely immunocompromised patient from Burkino Faso, Africa, who is infected with human immunodeficiency virus-1. The skin lesions failed to respond to full treatment courses of amphotericin B, sodium stibogluconate, and liposomal amphotericin B but were successfully treated with miltefosine, an alkylphosphocholine analogue.
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Affiliation(s)
- Christine Schraner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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Calza L, D'Antuono A, Marinacci G, Manfredi R, Colangeli V, Passarini B, Orioli R, Varoli O, Chiodo F. Disseminated cutaneous leishmaniasis after visceral disease in a patient with AIDS. J Am Acad Dermatol 2004; 50:461-5. [PMID: 14988693 DOI: 10.1016/j.jaad.2003.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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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Affiliation(s)
- Leonardo Calza
- Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna, St Orsola Hospital, via G. Massarenti 11, I-40138 Bologna, Italy.
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Puig L, Pradinaud R. Leishmania and HIV co-infection: dermatological manifestations. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2004; 97 Suppl 1:107-14. [PMID: 14678638 DOI: 10.1179/000349803225002589] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Leishmania species can cause a wide spectrum of cutaneous disease in HIV-positive patients: asymptomatic, localized cutaneous, mucosal, muco-cutaneous, diffuse cutaneous or post-kala-azar leishmaniasis. In such cases, which are usually severely immunocompromised, the leishmanial parasites reach the skin of the human host by dissemination after either a new infection (resulting from the bite of infected sandfly or, probably, the sharing of contaminated syringes by intravenous-drug users) or the re-activation of a latent infection. Recent experience and past observations on the dermatology of leishmaniasis in those with Leishmania/HIV co-infection are reviewed here.
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Affiliation(s)
- L Puig
- Departamento de Dermatología, Hospital de la Santa Creu I Sant Pau, Avenida de Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
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Aliaga L, Cobo F, Mediavilla JD, Bravo J, Osuna A, Amador JM, Martín-Sánchez J, Cordero E, Navarro JM. Localized mucosal leishmaniasis due to Leishmania (Leishmania) infantum: clinical and microbiologic findings in 31 patients. Medicine (Baltimore) 2003; 82:147-58. [PMID: 12792301 DOI: 10.1097/01.md.0000076009.64510.b8] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The clinical and microbiologic characteristics of 31 patients with mucosal leishmaniasis due to Leishmania (Leishmania) infantum are described. Twenty-eight (90%) patients were male. Mean age at presentation was 48 +/- 14 years. Thirteen (42%) patients had no underlying disease, while 18 (58%) patients had several other medical conditions. Fifteen (48%) patients were immunocompromised, 7 patients were infected with human immunodeficiency virus (HIV), and 3 were graft recipients. The primary location of lesions was the larynx in 11 (35%) patients, oral mucosa in 10 (32%) patients, and the nose in 5 (16%) patients. Mucosal lesions were painless in all patients but 2 and consisted of whitish, red, or violaceous nodular swelling or tumorlike masses. Ulceration was reported in 6 patients. Pathologically, the lesions showed a chronic inflammatory infiltrate. Granuloma may be seen. The localization of the lesions determined the symptomatology of the disease. Symptoms included hoarseness, difficulty swallowing, and nasal obstruction. The disease presentation was usually protracted, with a mean time from the onset of symptoms to diagnosis of 13 months (range, 3 wk-4.5 yr), and the clinical diagnosis was usually mistaken for neoplasia of the upper aerodigestive tract. No laboratory abnormalities were found in these patients due to the localized disease, apart from those attributed to underlying diseases. Parasites were easily identified in smears or sections by Giemsa stain or hematoxylin-eosin stain. Leishmania was grown in culture in 12 (60%) patients; culture was negative in 8 (40%) patients. Leishmania (Leishmania) infantum was identified in only 9 instances. The following zymodemes were reported: MON-1 (2 patients), MON-24 (2 patients), MON-27 (1 patient), and MON-34 (1 patient). Serologic test results were known in 25 patients. Serology was usually positive at low titer; 6 (24%) patients had negative serologic test results. Twenty patients were treated with antimonial compounds for between 3 and 36 days. Three patients were given drugs other than antimonial drugs. Five patients were treated only locally, by surgery (3 patients) or topical medical therapy. One patient received no therapy, and treatment was not reported in 2 cases. Patients were cured in 25 (89%) cases, and sequelae were uncommon (14%). Relapse was detected in 2 individuals and 1 patient developed visceral leishmaniasis after treatment. Two HIV-coinfected patients died of causes unrelated to leishmaniasis. The results of the present report stress the clinical importance of searching for the presence of Leishmania in patients with suspected neoplasia of the upper respiratory tract if they have visited or resided in zones endemic for Leishmania (Leishmania) infantum. The treatment of choice for these patients is not established yet, but most patients respond to antimonial compounds given for 28 days or less.
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Affiliation(s)
- Luis Aliaga
- Infectious Diseases Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
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40
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Forsyth SF, Lawn SD, Miller RF, Fernando JJR, Lockwood DNJ, Vega-Lopez F. Multiple dermatofibroma-like lesions in a human immunodeficiency virus-positive patient coinfected with visceral leishmaniasis. Br J Dermatol 2003; 148:185-7. [PMID: 12534629 DOI: 10.1046/j.1365-2133.2003.510413.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Tattoos are increasingly popular in today's society, especially with the advent of laser tattoo removal. As a result, observed reactions within tattoos are likely to become more abundant. Three main classes of tattoo-associated dermopathies can be distinguished in the English literature: allergic/granulomatous/lichenoid, inoculation/infection, and coincidental lesions. Injury to the dermis, such as during placement of a tattoo, can also flare a Koebner response in patients with active susceptible disease. OBJECTIVE This case report and review of the English literature provides a quick reference to tattoo reactions, techniques available for removal of tattoos, and disorders other than tattoos known to exhibit the Koebner response. METHODS The English literature was reviewed via MEDLINE citations from 1966 to December 2001 to delineate articles involving tattoo reactions and Koebner reactions significant to dermatology. CONCLUSION Numerous conditions have been documented in association with tattoos and the process of tattoo application. Awareness and identification of dermatoses associated with tattoos, tattoo removal options, and conditions associated with the Koebner response are important to both the dermatologist and dermatologic surgeon.
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Affiliation(s)
- Carolyn I Jacob
- Advanced Skin and Mohs Surgery Center, Northwestern University, Skokie, Illinois 60076, USA.
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42
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Bosch RJ, Rodrigo AB, Sánchez P, de Gálvez MV, Herrera E. Presence of Leishmania organisms in specific and non-specific skin lesions in HIV-infected individuals with visceral leishmaniasis. Int J Dermatol 2002; 41:670-5. [PMID: 12390190 DOI: 10.1046/j.1365-4362.2002.01610.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leishmania coinfection is frequently seen in human immunodeficiency virus (HIV)-infected patients in endemic areas, and from time to time the protozoan is detected in cutaneous biopsies. OBJECTIVE To establish the characteristics and possible ethiologic role of the presence of Leishmania in these lesions. METHODS We studied 12 cutaneous biopsies with Leishmania organisms from nine HIV-infected patients (seven men and two women) with visceral leishmaniasis, diagnosed by bone marrow examination, seen over a period of 9 years. RESULTS Based on clinical characteristics, evolution and response to anti-leishmanial treatment, cutaneous alterations were found to be related to the presence of the protozoan in six cases, whereas in the other six cases it was not considered responsible for the dermatological lesions (dermatofibroma, and lesions of psoriasis, Reiter's syndrome, bacillary angiomatosis, cryptococcosis and oral aphthae). Of note was the high prevalence of specific mucocutaneous manifestations, usually accompanied by intense pruritus, great variability, and a tendency to relapse after treatment stopped. On two occasions, detection of the protozoa in skin biopsies led to the diagnosis of a previously unsuspected visceral leishmaniasis. CONCLUSIONS Cutaneous detection of Leishmania is frequent in HIV-infected individuals with visceral leishmaniasis. Sometimes Leishmania is associated with changes attributable to other dermatological processes, and its presence does not imply a causative role. A clear relationship between the systemic process and the therapeutic response is necessary to demonstrate an ethiologic role.
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Affiliation(s)
- Ricardo J Bosch
- Department of Dermatology, University Hospital, School of Medicine, Malaga, Spain.
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Harms G, Feldmeier H. HIV infection and tropical parasitic diseases - deleterious interactions in both directions? Trop Med Int Health 2002; 7:479-88. [PMID: 12031069 DOI: 10.1046/j.1365-3156.2002.00893.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HIV and parasitic infections interact and affect each other mutually. Whereas HIV infection may alter the natural history of parasitic diseases, impede rapid diagnosis or reduce the efficacy of antiparasitic treatment, parasitoses may facilitate the infection with HIV as well as the progression from asymptomatic infection to AIDS. We review data on known interactions for malaria, leishmaniasis, Human African Trypanosomiasis, Chagas' disease, onchocerciasis, lymphatic filariasis, schistosomiasis and intestinal helminthiases. The common immunopathogenetic basis for the deleterious effects parasitic diseases may have on the natural history of HIV infection seems to be a particular type of chronic immune activation and a preferential activation of the T helper (Th)2 type of help. Control of parasitic diseases should complement the tools currently used in combating the HIV pandemic.
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Affiliation(s)
- Gundel Harms
- Institute of Tropical Medicine Berlin and Medical Faculty Charité, Humboldt-University Berlin, Germany.
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Calza L, Marinacci G, Manfredi R, Colangeli V, Fortunato L, Chiodo F. Pentamidine isethionate as treatment and secondary prophylaxis for disseminated cutaneous leishmaniasis during HIV infection: case report. J Chemother 2001; 13:653-7. [PMID: 11806628 DOI: 10.1179/joc.2001.13.6.653] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Leishmaniasis is emerging as a common and serious opportunistic infection in HIV-infected patients in endemic areas (such as Mediterranean countries), and may occur with various clinical presentations, ranging from typical visceral forms to atypical cases, including cutaneous disease. Although pentavalent antimony compounds have been the mainstay of antileishmanial treatment for half a century, new drugs seem today reliable, including liposomal amphotericin B and pentamidine isethionate. However, the most effective therapy is still unknown. An HIV-infected i.v. drug abuser patient with a very uncommon disseminated cutaneous leishmaniasis, following an initial visceral disease, is described. Primary and recurrent visceral forms of protozoan infection have been treated with liposomal amphotericin B, while pentamidine isethionate was successfully employed as treatment for subsequent cutaneous relapse and as secondary prophylaxis.
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Affiliation(s)
- L Calza
- Department of Clinical and Experimental Medicine, University of Bologna, S. Orsola Hospital, Italy.
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Affiliation(s)
- Z Bentwich
- Ruth Ben-Ari Institute of Clinical Immunology & AIDS Center, Kaplan Medical Center, Hebrew University Hadassah Medical School, Rehovot, Israel
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