Case Report: Intravenous Pentamidine Rescue Treatment for Active Chronic Visceral Leishmaniasis in an HIV-1 Infected Patient

Flavia Chechi Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;

Search for other papers by Flavia Chechi in
Current site
Google Scholar
PubMed
Close
,
Paola Corsi Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;

Search for other papers by Paola Corsi in
Current site
Google Scholar
PubMed
Close
,
Dario Bartolozzi Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;

Search for other papers by Dario Bartolozzi in
Current site
Google Scholar
PubMed
Close
,
Giovanni Gaiera Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy;

Search for other papers by Giovanni Gaiera in
Current site
Google Scholar
PubMed
Close
,
Alessandro Bartoloni Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;
Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;
Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy

Search for other papers by Alessandro Bartoloni in
Current site
Google Scholar
PubMed
Close
, and
Lorenzo Zammarchi Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;
Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;
Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy

Search for other papers by Lorenzo Zammarchi in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

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.

Author Notes

Address correspondence to Lorenzo Zammarchi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Largo Brambilla 3, 50134, Firenze, Italia. E-mail: lorenzo.zammarchi@unifi.it

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: flavia.chechi@unifi.it. Paola Corsi and Dario Bartolozzi, Azienda Ospedaliero Universitaria Careggi, Infectious and Tropical Diseases Unit, Firenze, Toscana, Italy, E-mails: corsip@aou-careggi.toscana.it and bartolozzid@aou-careggi.toscana.it. Giovanni Gaiera, Universita Vita e Salute San Raffaele, Clinic of Infectious Diseases, Milano, Lombardia, Italy, E-mail: galera.gio@gmail.com. Alessandro Bartoloni, University of Florence, Infectious and Tropical Diseases, Largo Brambilla 3, Florence, Italy 50134, E-mail: alessandro.bartoloni@unifi.it. Lorenzo Zammarchi, Università di Firenze, Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy, E-mail: lorenzo.zammarchi@unifi.it.

  • 1.

    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.

    • PubMed
    • Export Citation
  • 2.

    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: 670673.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    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: 12921299.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    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: 17031710.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    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: 115.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Pagliano P, Esposito S, 2017. Visceral leishmaniosis in immunocompromised host: an update and literature review. J Chemother 29: 261--266.

    • PubMed
    • Export Citation
  • 7.

    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: E202E264.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    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.

    • PubMed
    • Export Citation
  • 9.

    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: 621624.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Stauffer WM , Magill A , Kain KC , 2006. Parasitic central nervous system infections in immunocompromised hosts: clarification of malaria diagnosis. Clin Infect Dis 43: 114115.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Llanos-Cuentas A, Valencia BM, Petersen CA, 2013. Neurological manifestations of human leishmaniasis. Handb Clin Neurol 114: 193--198.

    • PubMed
    • Export Citation
  • 12.

    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: 1619.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Hafiz S, Kyriakopoulos C. Pentamidine, 2021. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. PMID: 32491518.

    • PubMed
    • Export Citation
  • 14.

    Yang G , Choi G , No JH , 2016. Antileishmanial mechanism of diamidines involves targeting kinetoplasts. Antimicrob Agents Chemother 60: 68286836.

  • 15.

    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.

    • PubMed
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 2297 461 26
Full Text Views 233 13 2
PDF Downloads 93 15 2
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save