Volume 85, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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 strains were isolated from his bone marrow (typical sequence MON-1, type A) and skin ( 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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  1. Russo L, Laguna F, Lopez-Velez R, Medrano FJ, Rosenthal E, Cacopardo B, Nigro L, , 2003. Visceral leishmaniasis in those infected with HIV: clinical aspects and other opportunistic infections. Ann Trop Med Parasitol 97 (Suppl 1): S99S105.[Crossref] [Google Scholar]
  2. Ara M, Maillo C, Peón G, Clavel A, Cuesta J, Grasa MP, Carapeto FJ, , 1998. Visceral leishmaniasis with cutaneous lesions in a patient infected with human immunodeficiency virus. Br J Dermatol 139: 114117.[Crossref] [Google Scholar]
  3. Danden E, Peñas PF, Rios L, Jimenez M, Fraga J, Alvar J, García-Diez A, , 1996. Leishmania presenting as dermatomyositis-like eruption in AIDS. J Am Acad Dermatol 35: 316319.[Crossref] [Google Scholar]
  4. Botelho R, SanMartin O, Febrer MI, 1990. Leishmaniasis cutaneo-visceral: una nuova infección oportunista en pacientes infectados con HIV. Med Cut ILA 18: 119123. [Google Scholar]
  5. Perrin C, Taillan B, Hofman P, Mondain V, Lefichoux Y, Michiels JF, , 1995. Atypical cutaneous histopathological features of visceral leishmaniasis in acquired immunodeficiency syndrome. Am J Dermatopathol 17: 145150.[Crossref] [Google Scholar]
  6. Colebunders R, Depraetera K, Verstraeten T, Lambert J, Hauben E, Van Marck E, Maurer T, Bañuls AL, Dujardin JC, , 1999. Unusual cutaneous lesions in two patients with visceral leishmaniasis and HIV infection. J Am Acad Dermatol 41: 847850.[Crossref] [Google Scholar]
  7. Mondain-Milton V, Toussaint-Gari M, Hofman P, Marty P, Carles M, De Salvador F, Miton F, Le Fichoux Y, Dellamonica P, , 1995. Atypical leishmaniasis in a patient infected with human immunodeficiency virus. Clin Infect Dis 21: 663665.[Crossref] [Google Scholar]
  8. Calza L, D'Antuono A, Marinacci G, Manfredi R, Colangeli V, Passarini B, Orioli R, Varoli O, Chiodo F, , 2004. Disseminated cutaneous leishmaniasis after visceral disease in a patient with AIDS. J Am Acad Dermatol 50: 461465.[Crossref] [Google Scholar]
  9. da Silva LA, de Sousa Cdos S, da Graça GC, Porrozzi R, Cupolillo E, , 2010. Sequence analysis and PCR-RFLP profiling of the hsp70 gene as a valuable tool for identifying Leishmania species associated with human leishmaniasis in Brazil. Infect Genet Evol 10: 7783.[Crossref] [Google Scholar]
  10. Cupolillo E, Grimaldi G, Jr Momen H, , 1994. A general classification of New World Leishmania using numerical zymotaxonomy. Am J Trop Med Hyg 50: 296311. [Google Scholar]
  11. Kuhls K, Mauricio IL, Pratlong F, Presber W, Schonian G, , 2005. Analysis of ribosomal DNA internal transcribed spacer sequences of the Leishmania donovani complex. Microbes Infect 7: 12241234.[Crossref] [Google Scholar]
  12. Ochsenreither S, Kuhls K, Schaar M, Presber W, Schonian G, , 2006. Multilocus microsatellite typing as a new tool for discrimination of Leishmania infantum MON-1 strains. J Clin Microbiol 44: 495503.[Crossref] [Google Scholar]
  13. Kuhls K, Keilonat L, Ochsenreither S, Schaar M, Schweynoch C, Presber W, Schonian G, , 2007. Multilocus microsatellite typing (MLMT) reveals genetically isolated populations between and within the main endemic regions of visceral leishmaniasis. Microbes Infect 9: 334343.[Crossref] [Google Scholar]
  14. Da-Cruz AM, Mattos M, Oliveira-Neto MP, Coutinho Z, Machado ES, Coutinho SG, , 2000. Cellular immune responses to Leishmania braziliensis in patients with AIDS-associated American cutaneous leishmaniasis. Trans R Soc Trop Med Hyg 94: 569571.[Crossref] [Google Scholar]
  15. Da-Cruz AM, Rodrigues AC, Mattos M, Oliveira-Neto MP, Sabbaga-Amato V, Posada MP, Lindoso JA, Goto H, , 2006. Alterações imunopatológicas na co-infecção HIV-Leishmania . Rev Soc Bras Med Trop 39 (Suppl 3): 7579. [Google Scholar]
  16. Rodrigues DS, Cunha RM, Kallas EG, Salomão R, , 2003. Distribution of naive/effector CD4+ T lymphocytes and expression of CD38 on CD8+ T lymphocytes in AIDS patients with tuberculosis. Braz J Infect Dis 7: 161165.[Crossref] [Google Scholar]
  17. Pourahmad M, Hooshmand F, Rahiminejad M, , 2009. Cutaneous leishmaniasis associated with visceral leishmaniasis in a case of acquired immunodeficiency syndrome (AIDS). Int J Dermatol 48: 5961.[Crossref] [Google Scholar]
  18. Herrera E, Bosch RJ, Fernández F, , 1996. The presence and significance of Leishmania in mucocutaneous biopsies from HIV+ patients with visceral leishmaniasis. Eur J Dermatol 6: 501504. [Google Scholar]
  19. Barrio J, Lecona M, Cosin J, Olalquiaga FJ, Hernanz JM, Soto J, , 1996. Leishmania infection occuring in herpes zoster lesions in a HIV patient. Br J Dermatol 134: 164166.[Crossref] [Google Scholar]
  20. Gallego MA, Aguilar A, Plaza S, Gomez JM, Burgos F, Agud JL, Marco J, García C, , 1996. Kaposi sarcoma with an intense parasitization by Leishmania . Cutis 57: 103105. [Google Scholar]
  21. Yebra M, Segovia J, Manzano L, Vargas JA, Bernaldo de Quirós L, Alvar J, , 1998. Disseminated-to-skin kala-azar and the acquired immunodeficiency syndrome. Ann Intern Med 108: 490491.[Crossref] [Google Scholar]
  22. Ramesh V, Singh R, Salotra P, , 2007. Post-kala-azar dermal leishmaniasis: an appraisal. Trop Med Int Health 12: 848851.[Crossref] [Google Scholar]
  23. Zijstra EE, Khalil EA, Kager PA, El-Hassan AM, , 2000. Post-kala-azar dermal leishmaniasis in Sudan: clinical presentation and differential diagnosis. Br J Dermatol 143: 136143.[Crossref] [Google Scholar]
  24. López-Velez R, Laguna F, Alvar J, Pérez-Molina JA, Molina R, Martinez P, Villarrubia J, , 1995. Parasitic culture of buffy-coat for diagnosis of visceral leishmaniasis in human immunodeficiency virus-infected paients. J Clin Microbiol 33: 937939. [Google Scholar]
  25. Dereure J, Pratlong F, Reynes J, Basset D, Bastien P, Dedet JP, , 1998. Haemoculture as a tool for diagnosing visceral leishmaniasis in HIV-negative and HIV-positive patients: interest for parasite identification. Bull World Health Organ 76: 203206. [Google Scholar]
  26. Pratlong F, Dereure J, Bucheton B, El-Saf S, Dessein A, Lanotte G, Dedet JP, , 2001. Sudan: the possible original focus of visceral leishmaniasis. Parasitology 122: 599605.[Crossref] [Google Scholar]
  27. Cacopardo B, Nigro L, Preiser W, Fama A, Satariano MI, Braner J, Celesia BM, Weber B, Russo R, Doerr HW, , 1996. Prolonged Th2 cell activation and increased viral replication in HIV-Leishmania co-infected patients despite treatment. Trans R Soc Trop Med Hyg 90: 434435.[Crossref] [Google Scholar]
  28. Spritzler J, Mildvan D, Russo A, Asthana D, Livnat D, Schock B, Kagan J, Landay A, Haas DW, , 2003. Adult AIDS Clinical Trials Group. Clin Infect Dis 37: 551558.[Crossref] [Google Scholar]
  29. Saha S, Mondal S, Banerjee A, Ghose J, Bhowmick S, Ali N, , 2006. Immune responses in kala-azar. Indian J Med Res 123: 245266. [Google Scholar]
  30. Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasil, 2004. Manual de Recomendações para Diagnóstico, Tratamento e Acompanhamento da Co-infecção Leishmania-HIV. Brasília: Programa Nacional de DST/HIV/AIDS. Available at: http://portal.saude.gov.br/portal/arquivos/pdf/manual_leish_hiv.pdf. [Google Scholar]

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  • Received : 13 Jul 2010
  • Accepted : 12 Oct 2010
  • Published online : 01 Jul 2011

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