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Visceral leishmaniasis in immunocompromised hosts.

M L Fernández-Guerrero1, J M Aguado, L Buzón

  • 1Division of Internal Medicine, Fundación Jiménez Díaz, Madrid, Spain.

The American Journal of Medicine
|December 1, 1987
PubMed
Summary

Visceral leishmaniasis in immunocompromised patients presents atypically and can be fatal. Standard treatments often fail to clear Leishmania donovani infection in these vulnerable individuals.

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Area of Science:

  • Infectious Diseases
  • Immunology
  • Transplantation Medicine

Background:

  • Visceral leishmaniasis (kala-azar) is rarely documented in immunocompromised individuals.
  • Clinical presentation and outcomes in this population remain largely unknown.

Observation:

  • A series of 10 immunocompromised patients (renal transplant, hematologic neoplasms, systemic lupus erythematosus, HIV) developed visceral leishmaniasis.
  • Classic kala-azar signs like splenomegaly and hyperglobulinemia were frequently absent.
  • Diagnosis was often incidental during fever of unknown origin workups, with Leishmania amastigotes found in bone marrow.

Findings:

  • Antibodies against Leishmania donovani were detected in all tested patients.
  • Extensive visceral organ involvement was confirmed in four patients via biopsy or autopsy.

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  • Three patients succumbed to the infection, and two others developed chronic, treatment-refractory disease.

    • Implications:

    • Visceral leishmaniasis poses a significant, potentially fatal threat to immunocompromised hosts.
    • Current antiparasitic therapies demonstrate limited efficacy in eradicating Leishmania donovani in this patient group.
    • Further research is needed to understand and manage this opportunistic infection in immunocompromised populations.