WHO Expert Committee on the Control of the Leishmaniases & World Health Organization, 2010. Control of the Leishmaniases: Report of a Meeting of the WHO Expert Commitee on the Control of Leishmaniases, Geneva, 22--26 March 2010. Geneva, Switzerland: World Health Organization. Available at: https://apps.who.int/iris/handle/10665/44412.
Bourgeois N et al.2010. ‘Active chronic visceral leishmaniasis’ in HIV-1-infected patients demonstrated by biological and clinical long-term follow-up of 10 patients. HIV Med 11: 670–673.
Trudel N et al.2008. Intracellular survival of Leishmania species that cause visceral Leishmaniasis is significantly reduced by HIV-1 protease inhibitors. J Infect Dis 198: 1292–1299.
Abongomera C et al.2017. The risk and predictors of visceral leishmaniasis relapse in human immunodeficiency virus-coinfected patients in Ethiopia: a retrospective cohort study. Clin Infect Dis 65: 1703–1710.
Diro E et al.2015. Use of pentamidine as secondary prophylaxis to prevent visceral leishmaniasis relapse in HIV infected patients, the first twelve months of a prospective cohort study. PLoS Negl Trop Dis 9: 1–15.
Pagliano P, Esposito S, 2017. Visceral leishmaniosis in immunocompromised host: an update and literature review. J Chemother 29: 261--266.
Aronson N et al.2016. 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 63: E202–E264.
Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/Adult_OI.pdf. Accessed October 27, 2021.
Troya J , Casquero A , Muñiz G , Fernández-Guerrero ML , Górgolas M , 2007. The role of splenectomy in HIV-infected patients with relapsing visceral leishmaniasis. Parasitology 134: 621–624.
Stauffer WM , Magill A , Kain KC , 2006. Parasitic central nervous system infections in immunocompromised hosts: clarification of malaria diagnosis. Clin Infect Dis 43: 114–115.
Llanos-Cuentas A, Valencia BM, Petersen CA, 2013. Neurological manifestations of human leishmaniasis. Handb Clin Neurol 114: 193--198.
Kiggundu R , Rhein J , Meya DB , Boulware DR , Bahr NC , 2014. Unmasking cryptococcal meningitis immune reconstitution inflammatory syndrome in pregnancy induced by HIV antiretroviral therapy with postpartum paradoxical exacerbation. Med Mycol Case Rep 5: 16–19.
Hafiz S, Kyriakopoulos C. Pentamidine, 2021. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. PMID: 32491518.
Yang G , Choi G , No JH , 2016. Antileishmanial mechanism of diamidines involves targeting kinetoplasts. Antimicrob Agents Chemother 60: 6828–6836.
Piccica M, Lagi F, Bartoloni A, Zammarchi L, 2021. Efficacy and safety of pentamidine isethionate for tegumentary and visceral human leishmaniasis: a systematic review. J Travel Med 28: taab065.
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The management of visceral leishmaniasis (VL) in HIV-infected patients is complex because of high mortality rates, toxic drug-related side effects, and a high risk of treatment failure and relapse. We report a case of active chronic VL in an HIV-1-infected woman presenting multiple secondary VL episodes over 7 years leading to massive splenomegaly and blood transfusion–dependent anemia despite several treatment courses and secondary prophylaxis. The patient was finally successfully treated with rescue treatment based on intravenous pentamidine. Twenty months after discontinuation of pentamidine the patient presented complete clinical and parasitological response. In patients with active chronic VL, treatment with intravenous pentamidine can be effective and should be considered as rescue treatment.
Financial support: This work was supported by funds of “Ministry of Education, University and Research (Italy) Excellence Departments 2018–2022” Project for the Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Authors’ addresses: Flavia Chechi, Università degli Studi di Firenze, Infectious and Tropical Diseases, Firenze, Italy 50121, E-mail: firstname.lastname@example.org. Paola Corsi and Dario Bartolozzi, Azienda Ospedaliero Universitaria Careggi, Infectious and Tropical Diseases Unit, Firenze, Toscana, Italy, E-mails: email@example.com and firstname.lastname@example.org. Giovanni Gaiera, Universita Vita e Salute San Raffaele, Clinic of Infectious Diseases, Milano, Lombardia, Italy, E-mail: email@example.com. Alessandro Bartoloni, University of Florence, Infectious and Tropical Diseases, Largo Brambilla 3, Florence, Italy 50134, E-mail: firstname.lastname@example.org. Lorenzo Zammarchi, Università di Firenze, Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy, E-mail: email@example.com.