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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The peripheral blood smear is an easy method for the diagnosis of symptomatic visceral leishmaniasis (VL) in human immunodeficiency virus type 1 (HIV-1)-infected patients. However, its efficiency in diagnosing subclinical VL remains unknown. In this study, Leishmania amastigotes were seen in blood smears from 1 of 13 HIV-1-positive individuals with subclinical VL. This shows that this procedure is not suitable for subclinical-VL diagnosis.
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PMID:Low sensitivity of peripheral blood smear for diagnosis of subclinical visceral leishmaniasis in human immunodeficiency virus type 1-infected patients. 943 78

Cutaneous lesions attributed to Leishmania are very seldom observed in classic Kala-Azar, but recently some reports have mentioned them in patients with HIV infection. We found cutaneous lesions whose biopsy disclosed the presence of Leishmania organisms in six patients of a group of 32 HIV patients with visceral Leishmaniasis. These lesions did not present a uniform or specific appearance, even though they tended to localize symmetrically on acral zones. They consisted of erythematous papules and hypopigmented macules on the dorsa of the hands, feet, and elbows; small subcutaneous nodules on the thighs; and erythematoviolaceous, scaly plaques on the face. These lesions accompanied in every case the other symptoms and/or signs of visceral leishmaniasis, responded to anti-leishmanial treatment, and were sometimes the first indicator of recurrence. The histopathological study was non-specific, but showed in every case the presence of abundant amastigotes within the dermal histiocytes and free in the dermis or subcutaneous tissue. Data from literature review are similar to ours.
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PMID:Cutaneous lesions in patients with visceral leishmaniasis and HIV infection. 945

A case history of a 39-year-old male is reported. The patient was diagnosed to have visceral leishmaniasis and HIV infection in January 1997. HIV-infection manifested with advanced Kaposi's sarcoma, recurrent Candida and Herpes infection, a decrease of body mass by more than 10%. The diagnosis of visceral leishmaniasis was confirmed by detection of Leishmania in biopsy from the bone marrow. Glucantim treatment produced a good clinical effect.
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PMID:[The first case of visceral leishmaniasis in a patient with HIV infection in Russia]. 948 48

The majority of the 850 HIV-associated Leishmania infections reported worldwide involve men and women from Mediterranean countries, particularly Spain, Italy, and France. This article describes a retrospectively identified series of 22 patients (20 men and 2 women) from northern Italy's Lombardy region with HIV/Leishmania coinfection in the period 1989-97. At leishmania diagnosis, the mean CD4+ lymphocyte count was 46.8/mcl and 21 patients had been previously diagnosed with an AIDS-defining illness. Intravenous drug use was the HIV risk factor in 17 patients; an additional 4 were bisexual or homosexual. The diagnosis of leishmaniasis was made by direct recovery of parasites in biologic specimens, mainly in bone marrow aspirate. Serology was generally negative or borderline due to the frequent occurrence of humoral immunity imbalances. Anemia, leukopenia, thrombocytopenia, and hypergammaglobulinemia were present in all but 1 patient. Leishmaniasis was clinically manifested as visceral in 13 cases, cutaneous in 2 cases, and disseminated disease in 7 cases. The clinicopathologic and biologic spectrum of infection tended to be atypical, especially in patients with disseminated disease. Leishmania infantum was the only species involved in 17 in vitro isolates; 2 cases exhibited previously undescribed isoenzyme patterns. Treatment with antimonials and other drugs produced, at best, only temporary clinical improvement. Relapses were the rule during follow-up in all but the 2 patients with cutaneous leishmaniasis. Inclusion of Leishmania spp. among the infectious agents of AIDS-defining diseases is recommended.
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PMID:Mediterranean leishmaniasis in HIV-infected patients: epidemiological, clinical, and diagnostic features of 22 cases. 956 78

A rare case of an AIDS patient who developed scattered necrotic involvement of the liver caused by Leishmania infantum is described. Of interest, marked splenomegaly, hypergammaglobulinemia and serum anti-Leishmania antibodies were absent and an incomplete response to therapy was observed. Diagnosis of visceral leishmaniasis (VL) was achieved by the demonstration of numerous amastigotes in both hepatocytes and macrophages on liver biopsy. Hepatic necrotic lesions, which when extensive could lead to acute hepatic failure, possibly reflect an atypical manifestation of liver involvement caused by L. infantum and depend on the immunological impairment which characterizes AIDS patients, thus preventing the formation of granulomas. Our observation confirms that VL can manifest atypical aspects in HIV-positive patients depending on the degree of the immunodeficiency. The frequency and severity of this pathology accounts for the need to list VL among AIDS-defining conditions.
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PMID:Diffuse necrotic hepatic lesions due to visceral leishmaniasis in AIDS. 957 Jun 48

Visceral leishmaniasis (VL) is a well recognized opportunistic infection in patients with HIV-1 infection, which may occasionally present with atypical features. We describe two patients with advanced HIV-1 infection (CD4<100/ mm3) in whom visceral leishmaniasis presented with atypical features, and their response to therapy. Atypical features of visceral leishmaniasis in the two infected patients include absence of fever, dissemination to the duodenal mucosa and to the skin as xanthoma-like lesions. Therapy and secondary prophylaxis remain unsatisfactory, and studies to evaluate combinations of amphotericin B and immunotherapy are needed.
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PMID:Visceral leishmaniasis (Kala-azar) in two patients with HIV-1 infection: atypical features and response to therapy. 957 Jun 58

Almost all (98%) of 1593 visceral leishmaniasis (VL) patients treated with sodium stibogluconate (Pentostam; Wellcome) in Sudan between 1989 and 1995 and follow-up responded well to treatment. However, the other 33 patients, all of whom were seronegative for HIV, showed partial or no response. The two main causes of unresponsiveness were primary drug resistance (39.3%) and low drug dosages given at peripheral dispensaries (30.3%). All of those who had been sub-optimal doses were cured when adequate doses of the drug were given. A third cause was concurrent disease, particularly pulmonary tuberculosis (18%). With treatment of the concurrent disease, patients responded well to Pentostam. Eight patients who failed to respond to repeated courses of Pentostam did not benefit from pentamidine or sterol inhibitors. Three of these patients responded to liposomal amphotericin B, two responded to splenectomy in association with Pentostam therapy, and three died. Pentostam, given in adequate doses, still appears to be the drug of choice for the treatment of VL in the Sudan Liposomal amphotericin B is a suitable second-line drug.
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PMID:Treatment of visceral leishmaniasis with sodium stibogluconate in Sudan: management of those who do not respond. 962 10

Leishmaniasis is a public-health problem in most countries bordering the Mediterranean littoral. In Malta, where the disease has been recognized for many years, Phlebotomus perniciosus is the established vector and dogs act as reservoir hosts. Visceral leishmaniasis (VL) was the only form of the disease recorded in Malta until the early 1980s, when cutaneous leishmaniasis (CL) was recognized. Although the incidence of CL has recently increased, the overall numbers of cases of leishmaniasis have markedly decreased since the 1960s. Prior to 1963, almost all cases were aged < 10 years. Although leishmaniasis in Malta is still mainly a disease of children, adult cases are increasingly being recognized. HIV-VL co-infection is being seen more and more frequently in the Mediterranean basin, especially in Spain, France and Italy. During diagnosis, leishmaniasis should be suspected on the basis of the clinical picture in endemic areas and on the travel history of those patients from non-endemic areas. In Malta, VL and CL are generally confirmed by detection of the parasites in smears, of bone-marrow or, rarely, splenic aspirates and of lesions, respectively. Antimonials are the standard therapeutic agents for VL, although liposomal amphotericin B is a very effective but expensive alternative, with no significant adverse effects. In Malta, the treatment of choice for CL is cryotherapy.
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PMID:Leishmaniasis in Malta and the Mediterranean basin. 962 30

The prevalence of visceral leishmaniasis (VL) has been steadily increasing throughout the Mediterranean region. In HIV-infected patients, severe disruption of the immune system renders the standard technique of antibody detection unreliable and diagnosis must be based on the detection of parasites in bone marrow smears or cultures. This study evaluated the relative efficiency of detecting Leishmania by culturing peripheral blood and bone marrow on NNN medium in 65 HIV-positive and 30 HIV-negative patients with suspected VL. 128 bone marrow and 128 peripheral venous blood samples were cultured. At the initial diagnosis, 14 (6 HIV-positive and 8 HIV-negative) of 15 patients with a positive blood culture also had a positive bone marrow culture. 2 patients (1 HIV-positive and 1 HIV-negative) had a positive bone marrow culture but a negative blood culture. At post-therapeutic examination, 7 out of 8 patients with a positive blood culture (6 HIV-positive and 1 HIV-negative) also had a positive bone marrow culture, while 3 patients (2 HIV-positive and 1 HIV-negative) had a positive bone marrow but a negative blood culture. Relapses were more frequent among HIV-positive than HIV-negative patients (9/65 vs. 3/30) and the demonstration of Leishmania in the blood was more common (6/65 vs. 2/30). MON-1 was identified from 4 HIV-positive and 8 HIV-negative patients, MON-28 from 1 HIV-positive patient, and MON-29 from another HIV-infected patient. In each case, the same zymodeme was found in bone marrow and blood culture, both at initial diagnosis and at follow-up. These findings indicate that the minimally invasive hemoculture technique is an effective means of VL diagnosis in both HIV-infected and HIV-negative patients.
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PMID:Haemoculture as a tool for diagnosing visceral leishmaniasis in HIV-negative and HIV-positive patients: interest for parasite identification. 964 62

Compromised travelers represent a diverse and challenging group of individuals. They include HIV-infected patients who are at risk for potentially adverse reactions to immunizations, and new exposures to enteric water-borne opportunistic pathogens associated with chronic infections. Such travelers may encounter unfamiliar opportunistic fungi and classical tropical infections, such as leishmaniasis, whose pathogenesis can be enhanced by the presence of prior HIV infection. Other immunocompromised groups include those who are functionally or anatomically asplenic, and patients who are iatrogenically immunosuppressed from medications utilized for solid organ transplantation, chemotherapy, or treatment of malignancies. This population of travelers also includes those with diabetes mellitus who may require adjustments in their dosing, administration, and possibly even the types of insulin used on their trips. These patients are also at greater risk for acquisition of tuberculosis, severe community-acquired pneumonia, urinary tract infections, and pyomyositis. Older travelers present both the infectious disease and travel medicine specialist with issues such events, malignancy-related infections, myocardial infarction, and other forms of cardiopulmonary compromise, which the authors address in this article.
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PMID:The compromised traveler. 965 50


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