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.

[Diffuse cutaneous leishmaniasis (DCL) and visceral leishmaniasis (VL) concurrent with cancer: Presentation of a case]

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.

[Diffuse cutaneous leishmaniasis in a patient with AIDS]

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.

[American cutaneous leishmaniasis associated with HIV/AIDS: report of four clinical cases]

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.

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.

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.

Diffuse cutaneous leishmaniasis with atypical aspects

A 16-year-old man had long-standing diffuse cutaneous leishmaniasis with the following characteristics: diffuse infiltrated lesions rich in amastigotes, absence of mucosal involvement, and lack of parasite-specific cell-mediated immune response. In situ identification of Leishmania mexicana amazonensis was achieved by the use of monoclonal antibodies. Clinically, as an atypical finding there was deep and extensive ulceration in the lower limbs. Histologically, an atypical characteristic was the presence of a high number of eosinophils in the infiltrate predominantly in the ulcerated lesion. Ultrastructurally, parasitized and lysed eosinophils with dispersion of their granules were seen in the vicinity of parasitized or lysed macrophages.