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Leishmaniasis in immunosuppressed individuals.

J van Griensven1, E Carrillo, R López-Vélez

  • 1Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|January 24, 2014
PubMed
Summary

Immunosuppression increases the risk of severe leishmaniasis (VL), a parasitic disease. Co-infection with human immunodeficiency virus (HIV) and other conditions complicate diagnosis and treatment, necessitating increased awareness and surveillance.

Keywords:
Anti-TNF-αHIVimmunosuppressionleishmaniasistransplantvisceral

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Area of Science:

  • Infectious Diseases
  • Parasitology
  • Immunology

Background:

  • Leishmaniasis is a vector-borne parasitic disease caused by Leishmania genus protozoa.
  • Immunosuppression is a significant risk factor for developing leishmaniasis disease, particularly the severe visceral leishmaniasis (VL) form.
  • Visceral leishmaniasis (VL) is fatal if left untreated and is increasingly seen with human immunodeficiency virus (HIV) co-infection and other immunosuppressive states.

Purpose of the Study:

  • To review the clinical presentation, diagnosis, and treatment of leishmaniasis in immunosuppressed individuals.
  • To highlight the challenges and specific features of leishmaniasis in various immunosuppressive conditions, including HIV co-infection.
  • To emphasize the rising global burden of leishmaniasis in immunosuppressed populations and the need for enhanced surveillance.

Main Methods:

  • Review of clinical presentations and diagnostic approaches for leishmaniasis in immunosuppressed patients.
  • Discussion of treatment strategies, including drug of choice and challenges in specific patient groups.
  • Analysis of epidemiological trends and risk factors associated with leishmaniasis in immunocompromised individuals.

Main Results:

  • Immunosuppressed individuals, including those with HIV co-infection, exhibit atypical clinical presentations of leishmaniasis, often leading to misdiagnosis.
  • Combination of parasitological, serological, and molecular methods is optimal for diagnosis.
  • Liposomal amphotericin B is the preferred treatment; however, treatment failure and relapse rates are high in HIV co-infected patients.

Conclusions:

  • Leishmaniasis poses significant challenges in immunosuppressed patients, requiring heightened clinical awareness and diagnostic vigilance.
  • Secondary prophylaxis is recommended for immunosuppressed patients, while primary prophylaxis is not.
  • The increasing prevalence of leishmaniasis in immunosuppressed individuals globally necessitates enhanced surveillance and public health strategies.