Case Report: Autochthonous Disseminated Cutaneous, Mucocutaneous, and Visceral Leishmaniasis Caused by Leishmania martiniquensis in a Patient with HIV/AIDS from Northern Thailand and Literature Review

Saranya Srivarasat Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

Search for other papers by Saranya Srivarasat in
Current site
Google Scholar
PubMed
Close
,
Narisa Brownell Center of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

Search for other papers by Narisa Brownell in
Current site
Google Scholar
PubMed
Close
,
Padet Siriyasatien Center of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

Search for other papers by Padet Siriyasatien in
Current site
Google Scholar
PubMed
Close
,
Nopadon Noppakun Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

Search for other papers by Nopadon Noppakun in
Current site
Google Scholar
PubMed
Close
,
Pravit Asawanonda Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

Search for other papers by Pravit Asawanonda in
Current site
Google Scholar
PubMed
Close
,
Krittaya Rattanakorn Division of Dermatology, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand

Search for other papers by Krittaya Rattanakorn in
Current site
Google Scholar
PubMed
Close
,
Kanok Preativatanyou Center of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

Search for other papers by Kanok Preativatanyou in
Current site
Google Scholar
PubMed
Close
, and
Chanat Kumtornrut Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

Search for other papers by Chanat Kumtornrut in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

Autochthonous leishmaniasis cases have been increasing continuously in Thailand over the years. We report multiple presentations of leishmaniasis in a 47-year-old patient with HIV/AIDS from Chiang Rai Province, northern Thailand. Physical examination showed multiple ulcerated papules, nodules, and plaques in a sporotrichoid distribution. Firm mucosal nodules on the hard palate and nasal opening, hepatosplenomegaly, and bilateral inguinal lymphadenopathy were found. Histopathological examination of the biopsies revealed an inflammatory infiltrate containing intramacrophage amastigotes compatible with Leishmania infection. In addition, Leishmania promastigotes were isolated successfully from the palatal biopsy and assigned the code MHOM/TH/2022/CULE6. Using internal transcribed spacer 1 polymerase chain reaction and sequence analysis, the causative parasite was identified as Leishmania martiniquensis. A definitive diagnosis of multiform leishmaniasis with disseminated cutaneous, mucocutaneous, and visceral involvement was established. The patient was administered intravenous amphotericin B 1 mg/kg/d for 2 weeks, followed by oral itraconazole 400 mg daily. At the 2-month follow-up, the cutaneous and mucosal lesions had improved significantly. To our knowledge, this is the first report of mucocutaneous involvement caused by L. martiniquensis in an immunocompromised patient with HIV/AIDS. In addition, we provide a literature review of leishmaniasis cases, reported formally in Thailand, resulting from this autochthonous parasite.

Author Notes

Address correspondence to Kanok Preativatanyou, Center of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mail: kanok.pr@chula.ac.th or Chanat Kumtornrut, Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mail: chanat_1@yahoo.com

Authors’ addresses: Saranya Srivarasat, Nopadon Noppakun, Pravit Asawanonda, and Chanat Kumtornrut, Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mails: bellsaranya1992@gmail.com, drnopadon@yahoo.com, fibrosis@gmail.com, and chanat_1@yahoo.com. Narisa Brownell, Padet Siriyasatien, and Kanok Preativatanyou, Center of Excellence in Vector Biology and Vector-Borne Disease, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mails: narisa.br@chula.ac.th, padet.s@chula.ac.th and kanok.pr@chula.ac.th. Krittaya Rattanakorn, Division of Dermatology, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand, E-mail: krittaya.ra005@gmail.com.

  • 1.

    Pearson RD , Sousa AQ , 1996. Clinical spectrum of leishmaniasis. Clin Infect Dis 22: 1–13.

  • 2.

    McGwire BS , Satoskar AR , 2014. Leishmaniasis: clinical syndromes and treatment. QJM 107: 7–14.

  • 3.

    Burza S , Croft SL , Boelaert M , 2018. Leishmaniasis. Lancet 392: 951–970.

  • 4.

    Espinosa OA , Serrano MG , Camargo EP , Teixeira MMG , Shaw JJ , 2016. An appraisal of the taxonomy and nomenclature of trypanosomatids presently classified as Leishmania and Endotrypanum. Parasitology 145: 430–442.

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

    Müller N , Welle M , Lobsiger L , Stoffel MH , Boghenbor KK , Hilbe M , Gottstein B , Frey CF , Geyer C , von Bomhard W , 2009. Occurrence of Leishmania sp. in cutaneous lesions of horses in Central Europe. Vet Parasitol 166: 346–351.

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

    Reuss SM , Dunbar MD , Calderwood Mays MB , Owen JL , Mallicote MF , Archer LL , Wellehan JF Jr , 2012. Autochthonous Leishmania siamensis in horse, Florida, USA. Emerg Infect Dis 18: 1545–1547.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Lobsiger L , Müller N , Schweizer T , Frey CF , Wiederkehr D , Zumkehr B , Gottstein B , 2010. An autochthonous case of cutaneous bovine leishmaniasis in Switzerland. Vet Parasitol 169: 408–414.

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

    Leelayoova S , Siripattanapipong S , Manomat J , Piyaraj P , Tan-Ariya P , Bualert L , Mungthin M , 2017. Leishmaniasis in Thailand: a review of causative agents and situations. Am J Trop Med Hyg 96: 534–542.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Sukmee T et al., 2008. A suspected new species of Leishmania, the causative agent of visceral leishmaniasis in a Thai patient. Int J Parasitol 38: 617–622.

  • 10.

    Suankratay C , Suwanpimolkul G , Wilde H , Siriyasatien P , 2010. Autochthonous visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected patient: the first in Thailand and review of the literature. Am J Trop Med Hyg 82: 4–8.

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

    Osatakul S , Mungthin M , Siripattanapipong S , Hitakarun A , Kositnitikul R , Naaglor T , Leelayoova S , 2014. Recurrences of visceral leishmaniasis caused by Leishmania siamensis after treatment with amphotericin B in a seronegative child. Am J Trop Med Hyg 90: 40–42.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Chusri S , Hortiwakul T , Silpapojakul K , Siriyasatien P , 2012. Consecutive cutaneous and visceral leishmaniasis manifestations involving a novel Leishmania species in two HIV patients in Thailand. Am J Trop Med Hyg 87: 76–80.

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

    Phumee A , Chusri S , Kraivichian K , Wititsuwannakul J , Hortiwakul T , Thavara U , Silpapojakul K , Siriyasatien P , 2014. Multiple cutaneous nodules in an HIV-infected patient. PLoS Negl Trop Dis 8: e3291.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Noppakun N , Kraivichian K , Siriyasatien P , 2014. Disseminated dermal leishmaniasis caused by Leishmania siamensis in a systemic steroid therapy patient. Am J Trop Med Hyg 91: 869–870.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Pothirat T , Tantiworawit A , Chaiwarith R , Jariyapan N , Wannasan A , Siriyasatien P , Supparatpinyo K , Bates MD , Kwakye-Nuako G , Bates PA , 2014. First isolation of Leishmania from northern Thailand: case report, identification as Leishmania martiniquensis and phylogenetic position within the Leishmania enriettii complex. PLoS Negl Trop Dis 8: e3339.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Chiewchanvit S , Tovanabutra N , Jariyapan N , Bates MD , Mahanupab P , Chuamanochan M , Tantiworawit A , Bates PA , 2015. Chronic generalized fibrotic skin lesions from disseminated leishmaniasis caused by Leishmania martiniquensis in two patients from northern Thailand infected with HIV. Br J Dermatol 173: 663–670.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Siriyasatien P , Chusri S , Kraivichian K , Jariyapan N , Hortiwakul T , Silpapojakul K , Pym AM , Phumee A , 2016. Early detection of novel Leishmania species DNA in the saliva of two HIV-infected patients. BMC Infect Dis 16: 89.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Spanakos G , Piperaki ET , Menounos PG , Tegoa N , Flemetakis A , Vakalis NC , 2008. Detection and species identification of Old World Leishmania in clinical samples using a PCR-based method. Trans R Soc Trop Med Hyg 102: 46–53.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Tobin EH , Jih WW , 2001. Sporotrichoid lymphocutaneous infections: etiology, diagnosis and therapy. Am Fam Physician 63: 326–332.

  • 20.

    Abadías-Granado I , Diago A , Cerro PA , Palma-Ruiz AM , Gilaberte Y , 2021. Cutaneous and mucocutaneous leishmaniasis. Acta Dermosifiliogr 112: 601–618.

  • 21.

    Miranda Lessa M , Andrade Lessa H , Castro TWN , Oliveira A , Scherifer A , Machado P , Carvalho EM , 2007. Mucosal leishmaniasis: epidemiological and clinical aspects. Rev Bras Otorrinolaringol (Engl Ed) 73: 843–847.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Sanchez IM , DiTommaso LE , Tsoukas MM , 2019. Oral Kaposi sarcoma. JAMA Dermatol 155: 370.

  • 23.

    Srisuton P , Phumee A , Sunantaraporn S , Boonserm R , Sor-Suwan S , Brownell N , Pengsakul T , Siriyasatien P , 2019. Detection of Leishmania and Trypanosoma DNA in field-caught sand flies from endemic and non-endemic areas of leishmaniasis in southern Thailand. Insects 10: 238.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Alvar J , Aparicio P , Aseffa A , Den Boer M , Cañavate C , Dedet JP , Gradoni L , Ter Horst R , López-Vélez R , Moreno J , 2008. The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 21: 334–359.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Garg R , Barat C , Ouellet M , Lodge R , Tremblay MJ , 2009. Leishmania infantum amastigotes enhance HIV-1 production in cocultures of human dendritic cells and CD4 T cells by inducing secretion of IL-6 and TNF-alpha. PLoS Negl Trop Dis 3: e441.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    d’Ettorre G , Ceccarelli G , Carnevalini M , Forcina G , Zaffiri L , Massetti AP , Mastroianni CM , Vullo V , 2006. Central role of interleukin-15 in human immunodeficiency virus (HIV)-infected patients with visceral leishmaniasis. Acta Trop 99: 83–87.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Clerici M , Shearer GM , 1993. A TH1 → TH2 switch is a critical step in the etiology of HIV infection. Immunol Today 14: 107–111.

  • 28.

    Monge-Maillo B , López-Vélez R , 2016. Treatment options for visceral leishmaniasis and HIV coinfection. AIDS Rev 18: 32–43.

  • 29.

    Paila YD , Bhaskar Saha B , Chattopadhyay A , 2010. Amphotericin B inhibits entry of Leishmania donovani into primary macrophages. Biochem Biophys Res Commun 399: 429–433.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Grabmeier-Pfistershammer K , Poeppl W , Brunner PM , Rappersberger K , Rieger A , 2012. Clinical challenges in the management of Leishmania/HIV coinfection in a nonendemic area: a case report. Case Rep Infect Dis 2012: 787305.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Phumee A , Jariyapan N , Chusri S , Hortiwakul T , Mouri O , Gay F , Limpanasithikul W , Siriyasatien P , 2020. Determination of anti-leishmanial drugs efficacy against Leishmania martiniquensis using a colorimetric assay. Parasite Epidemiol Control 9: e00143.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Akhoundi M , Kuhls K , Cannet A , Votýpka J , Marty P , Delaunay P , Sereno D , 2016. A historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies. PLoS Negl Trop Dis 10: e0004349.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Maroli M , Gramiccia M , Gradoni L , Ready PD , Smith DF , Aquino C , 1988. Natural infections of phlebotomine sandflies with Trypanosomatidae in central and south Italy. Trans R Soc Trop Med Hyg 82: 227–228.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Chusri S , Thammapalo S , Chusri S , Thammapalo S , Silpapojakul K , Siriyasatien P , 2014. Animal reservoirs and potential vectors of Leishmania siamensis in southern Thailand. Southeast Asian J Trop Med Public Health 45: 13–19.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Toontong P , Sunantaraporn S , Tiawsirisup S , Pengsakul T , Boonserm R , Phumee A , Siriyasatien P , Preativatanyou K , 2022. First report of anuran Trypanosoma DNA in flat-tailed house geckos (Reptilia: Gekkonidae) collected from southern Thailand: no evidence as a reservoir for human trypanosomatids. Pathogens 11: 247.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Siripattanapipong S , Leelayoova S , Ninsaeng U , Mungthin M , 2018. Detection of DNA of Leishmania siamensis in Sergentomyia (Neophlebotomus) iyengari (Diptera: Psychodidae) and molecular identification of blood meals of sand flies in an affected area, southern Thailand. J Med Entomol 55: 1277–1283.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Sriwongpan P et al., 2021. Prevalence and associated risk factors of Leishmania infection among immunocompetent hosts: a community-based study in Chiang Rai, Thailand. PLoS Negl Trop Dis 15: e0009545.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Sunantaraporn S , Thepparat A , Phumee A , Sor-Suwan S , Boonserm R , Bellis G , Siriyasatien P , 2021. Culicoides Latreille (Diptera: Ceratopogonidae) as potential vectors for Leishmania martiniquensis and Trypanosoma sp. in northern Thailand. PLoS Negl Trop Dis 15: e0010014.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 6789 1157 46
Full Text Views 532 61 1
PDF Downloads 359 71 1
 

 

 

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