Infection

, Volume 26, Issue 2, pp 93–99

Mediterranean leishmaniasis in HIV-infected patients: Epidemiological, clinical, and diagnostic features of 22 cases

Authors

  • C. Agostoni
    • Parasitology Lab, Virology ServiceIRCCS Policlinico
  • N. Dorigoni
    • Div. of Infectious DiseasesTrento Hospital
  • A. Malfitano
    • Div. of Infectious and Tropical DiseasesIRCCS Policlinico
  • L. Caggese
    • Div. of Infectious DiseasesCa Granda Hospital
  • G. Marchetti
    • Div. of Infectious DiseasesGeneral Hospital
  • S. Corona
    • Parasitology Lab, Virology ServiceIRCCS Policlinico
  • S. Gatti
    • Parasitology Lab, Virology ServiceIRCCS Policlinico
  • M. Scaglia
    • Infectious Diseases Research Labs (Parasitology Lab)University-IRCCS San Matteo, viale Taramelli 5
Clinical and Epidemiological Studies Originalia

DOI: 10.1007/BF02767767

Cite this article as:
Agostoni, C., Dorigoni, N., Malfitano, A. et al. Infection (1998) 26: 93. doi:10.1007/BF02767767

Summary

Twenty-two Italian HIV-infected patients developed leishmaniasis, clinically manifested as visceral (13 cases), cutaneous (2 cases) and disseminated disease (7 cases). Twenty were males and two females (mean age: 32.8 years) with a mean CD4+ cell count of 46.8/μl at diagnosis; risk factors were intravenous drug use (17 patients) and sexual behaviour (two bisexual, two homosexual, one heterosexual). All but one patient lived or travelled in hypoendemic Italian regions and other Mediterranean countries. Apart from the two patients with cutaneous leishmaniasis, the clinico-pathological and biological spectrum of the infection was often atypical, especially in patients with disseminated disease. The diagnosis was routinely made by direct recovery of parasites in biological specimens, mainly in bone marrow aspirate, whereas serology was negative or borderline in most of the patients. Among 17in vitro isolates,Leishmania infantum was the only species involved with previously undescribed isoenzyme patterns in two cases. Treatment with antimonials and other drugs showed only temporary clinical improvement in some patients. Relapses were the rule. Leishmaniasis confirms itself as an opportunistic infection in HIV-positive persons. Secondary chemoprophylaxis should be considered in cases of relapsing disease.

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© MMV Medizin Verlag GmbH Mönchen 1998