Visceral leishmaniosis in immunocompromised host: an update and literature review

Visceral leishmaniasis (VL) is a chronic infectious disease endemic in tropical and sub-tropical areas including the Mediterranean basin, caused by a group of protozoan parasites of the genus Leishmania and transmitted by phlebotomine sandflies. Immunocompromised patients, in particular HIV positive, are considered at risk of VL. They report atypical signs and poor response to treatment due to impairment of T-helper and regulatory cells activity. Laboratory diagnosis is based on microscopy on bone marrow or spleen aspirates. Value of serology remains high in term of sensibility, but a positive test must be confirmed by microscopy or molecular tests. Treatment is based on Liposomal amphotericin B whose administration is associated to lower incidence of side effects, in respect to antimonials and other formulations of AmB. Use of Miltefosine needs further investigation when L. infantum is the causative agent. Frequent relapses are observed in co-infected HIV who can benefit of a second cycle.