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PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses.
PLoS Negl Trop Dis. 2014; 8(11):e3258.PN

Abstract

BACKGROUND

Co-infection of leishmaniasis and HIV is increasingly reported. The clinical presentation of leishmaniasis is determined by the host immune response to the parasite; as a consequence, this presentation will be influenced by HIV-induced immunosuppression. As leishmaniasis commonly affects the skin, increasing immunosuppression changes the clinical presentation, such as in post-kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL); dermal lesions are also commonly reported in visceral leishmaniasis (VL) and HIV co-infection.

METHODS

We reviewed the literature with regard to dermal manifestations in leishmaniasis and HIV co-infection, in three clinical syndromes, according to the primary presentation: PKDL, VL, or CL.

RESULTS

A wide variety of descriptions of dermal leishmaniasis in HIV co-infection has been reported. Lesions are commonly described as florid, symmetrical, non-ulcerating, nodular lesions with atypical distribution and numerous parasites. Pre-existing, unrelated dermal lesions may become parasitized. Parasites lose their tropism and no longer exclusively cause VL or CL. PKDL in HIV co-infected patients is more common and more severe and is not restricted to Leishmania donovani. In VL, dermal lesions occur in up to 18% of patients and may present as (severe) localized cutaneous leishmaniasis, disseminated cutaneous leishmaniasis (DL) or diffuse cutaneous leishmaniasis (DCL); there may be an overlap with para-kala-azar dermal leishmaniasis. In CL, dissemination in the skin may occur resembling DL or DCL; subsequent spread to the viscera may follow. Mucosal lesions are commonly found in VL or CL and HIV co-infection. Classical mucocutaneous leishmaniasis is more severe. Immune reconstitution disease (IRD) is uncommon in HIV co-infected patients with leishmaniasis on antiretroviral treatment (ART).

CONCLUSION

With increasing immunosuppression, the clinical syndromes of CL, VL, and PKDL become more severe and may overlap. These syndromes may be best described as VL with disseminated cutaneous lesions (before, during, or after VL) and disseminated cutaneous leishmaniasis with or without visceralization.

Authors+Show Affiliations

Rotterdam Centre for Tropical Medicine, Rotterdam, The Netherlands.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25412435

Citation

Zijlstra, Eduard E.. "PKDL and Other Dermal Lesions in HIV Co-infected Patients With Leishmaniasis: Review of Clinical Presentation in Relation to Immune Responses." PLoS Neglected Tropical Diseases, vol. 8, no. 11, 2014, pp. e3258.
Zijlstra EE. PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses. PLoS Negl Trop Dis. 2014;8(11):e3258.
Zijlstra, E. E. (2014). PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses. PLoS Neglected Tropical Diseases, 8(11), e3258. https://doi.org/10.1371/journal.pntd.0003258
Zijlstra EE. PKDL and Other Dermal Lesions in HIV Co-infected Patients With Leishmaniasis: Review of Clinical Presentation in Relation to Immune Responses. PLoS Negl Trop Dis. 2014;8(11):e3258. PubMed PMID: 25412435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses. A1 - Zijlstra,Eduard E, Y1 - 2014/11/20/ PY - 2014/11/21/entrez PY - 2014/11/21/pubmed PY - 2016/5/25/medline SP - e3258 EP - e3258 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 8 IS - 11 N2 - BACKGROUND: Co-infection of leishmaniasis and HIV is increasingly reported. The clinical presentation of leishmaniasis is determined by the host immune response to the parasite; as a consequence, this presentation will be influenced by HIV-induced immunosuppression. As leishmaniasis commonly affects the skin, increasing immunosuppression changes the clinical presentation, such as in post-kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL); dermal lesions are also commonly reported in visceral leishmaniasis (VL) and HIV co-infection. METHODS: We reviewed the literature with regard to dermal manifestations in leishmaniasis and HIV co-infection, in three clinical syndromes, according to the primary presentation: PKDL, VL, or CL. RESULTS: A wide variety of descriptions of dermal leishmaniasis in HIV co-infection has been reported. Lesions are commonly described as florid, symmetrical, non-ulcerating, nodular lesions with atypical distribution and numerous parasites. Pre-existing, unrelated dermal lesions may become parasitized. Parasites lose their tropism and no longer exclusively cause VL or CL. PKDL in HIV co-infected patients is more common and more severe and is not restricted to Leishmania donovani. In VL, dermal lesions occur in up to 18% of patients and may present as (severe) localized cutaneous leishmaniasis, disseminated cutaneous leishmaniasis (DL) or diffuse cutaneous leishmaniasis (DCL); there may be an overlap with para-kala-azar dermal leishmaniasis. In CL, dissemination in the skin may occur resembling DL or DCL; subsequent spread to the viscera may follow. Mucosal lesions are commonly found in VL or CL and HIV co-infection. Classical mucocutaneous leishmaniasis is more severe. Immune reconstitution disease (IRD) is uncommon in HIV co-infected patients with leishmaniasis on antiretroviral treatment (ART). CONCLUSION: With increasing immunosuppression, the clinical syndromes of CL, VL, and PKDL become more severe and may overlap. These syndromes may be best described as VL with disseminated cutaneous lesions (before, during, or after VL) and disseminated cutaneous leishmaniasis with or without visceralization. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/25412435/PKDL_and_other_dermal_lesions_in_HIV_co_infected_patients_with_Leishmaniasis:_review_of_clinical_presentation_in_relation_to_immune_responses_ L2 - https://dx.plos.org/10.1371/journal.pntd.0003258 DB - PRIME DP - Unbound Medicine ER -