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[Visceral leishmaniasis in patients with AIDS. Description of 2 cases].
Pathologica. 1989 Nov-Dec; 81(1076):591-600.P

Abstract

Cell-mediated immunity plays a pivotal role in the pathogenesis and in the recovery mechanisms of visceral leishmaniasis (V.L.). This disease, observed in two patients with AIDS, has peculiar anatomical and clinical characteristics and it is usually characterized by a severe clinical course. In addition, V.L. has been proposed to be included among the relevant infections for the case definition of AIDS. We describe two cases of V.L. occurred in association with AIDS. The most relevant characteristics of our cases are the followings: Diagnosis has been achieved by the identification of Leishmania donovani in the macrophages of the bone marrow in both the patients, and of the lymph node in one patient. The detection of anti-Leishmania antibodies was positive in one patients only. A significant defect of CD4+ cells was documented in both the patients. V.L. was associated in one patient with esophageal candidiasis, disseminated tuberculosis, P. carinii pneumonia; and in the other one with cerebral toxoplasmosis, pulmonary tuberculosis, esophageal candidiasis, Kaposi's sarcoma, CMV hepatitis. Specific chemotherapy has been partially or totally ineffective in both the patients. In fact, chemotherapy led to an apparent transient recovery in one patient, followed by a symptom-free period of more than one year. We think that V.L. has been the first infection occurred in this patients, beside of HIV infection. At the time of the first observation, the clinical conditions of this patient were satisfactory and there was only a slight alteration in cellular immunity. The detection of leishmania in bone marrow was coincident with the onset of fever, the development of a wasting syndrome and a dramatic decrease in cell-mediated immunity. A second cycle of specific treatment has been ineffective and the patient died. On the contrary, the second patient did not respond to the specific treatment and died. Two important anatomo-pathological characteristics were present in our cases: a) the presence of the parasite in several organs, namely bone marrow, spleen, liver. b) the absence of granulomatous lesions which indirectly indicates the defect in cell mediated immunity.

Authors

Federico G
No affiliation info available
Cauda R
No affiliation info available
Pizzigallo E
No affiliation info available
Ventura G
No affiliation info available
Ortona L
No affiliation info available
Capelli A
No affiliation info available
Larocca LM
No affiliation info available
Familiari U
No affiliation info available

MeSH

Acquired Immunodeficiency SyndromeAdultHumansLeishmaniasis, VisceralMaleOpportunistic Infections

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

ita

PubMed ID

2635290

Citation

Federico, G, et al. "[Visceral Leishmaniasis in Patients With AIDS. Description of 2 Cases]." Pathologica, vol. 81, no. 1076, 1989, pp. 591-600.
Federico G, Cauda R, Pizzigallo E, et al. [Visceral leishmaniasis in patients with AIDS. Description of 2 cases]. Pathologica. 1989;81(1076):591-600.
Federico, G., Cauda, R., Pizzigallo, E., Ventura, G., Ortona, L., Capelli, A., Larocca, L. M., & Familiari, U. (1989). [Visceral leishmaniasis in patients with AIDS. Description of 2 cases]. Pathologica, 81(1076), 591-600.
Federico G, et al. [Visceral Leishmaniasis in Patients With AIDS. Description of 2 Cases]. Pathologica. 1989 Nov-Dec;81(1076):591-600. PubMed PMID: 2635290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Visceral leishmaniasis in patients with AIDS. Description of 2 cases]. AU - Federico,G, AU - Cauda,R, AU - Pizzigallo,E, AU - Ventura,G, AU - Ortona,L, AU - Capelli,A, AU - Larocca,L M, AU - Familiari,U, PY - 1989/11/1/pubmed PY - 1989/11/1/medline PY - 1989/11/1/entrez SP - 591 EP - 600 JF - Pathologica JO - Pathologica VL - 81 IS - 1076 N2 - Cell-mediated immunity plays a pivotal role in the pathogenesis and in the recovery mechanisms of visceral leishmaniasis (V.L.). This disease, observed in two patients with AIDS, has peculiar anatomical and clinical characteristics and it is usually characterized by a severe clinical course. In addition, V.L. has been proposed to be included among the relevant infections for the case definition of AIDS. We describe two cases of V.L. occurred in association with AIDS. The most relevant characteristics of our cases are the followings: Diagnosis has been achieved by the identification of Leishmania donovani in the macrophages of the bone marrow in both the patients, and of the lymph node in one patient. The detection of anti-Leishmania antibodies was positive in one patients only. A significant defect of CD4+ cells was documented in both the patients. V.L. was associated in one patient with esophageal candidiasis, disseminated tuberculosis, P. carinii pneumonia; and in the other one with cerebral toxoplasmosis, pulmonary tuberculosis, esophageal candidiasis, Kaposi's sarcoma, CMV hepatitis. Specific chemotherapy has been partially or totally ineffective in both the patients. In fact, chemotherapy led to an apparent transient recovery in one patient, followed by a symptom-free period of more than one year. We think that V.L. has been the first infection occurred in this patients, beside of HIV infection. At the time of the first observation, the clinical conditions of this patient were satisfactory and there was only a slight alteration in cellular immunity. The detection of leishmania in bone marrow was coincident with the onset of fever, the development of a wasting syndrome and a dramatic decrease in cell-mediated immunity. A second cycle of specific treatment has been ineffective and the patient died. On the contrary, the second patient did not respond to the specific treatment and died. Two important anatomo-pathological characteristics were present in our cases: a) the presence of the parasite in several organs, namely bone marrow, spleen, liver. b) the absence of granulomatous lesions which indirectly indicates the defect in cell mediated immunity. SN - 0031-2983 UR - https://www.unboundmedicine.com/medline/citation/2635290/[Visceral_leishmaniasis_in_patients_with_AIDS__Description_of_2_cases]_ DB - PRIME DP - Unbound Medicine ER -