Unusual Signs and Symptoms in HIV-Positive Patients Coinfected with Leishmania spp: The Importance of Neglected Tropical Disease in Differential Diagnosis
DOI:
https://doi.org/10.3889/oamjms.2018.186Keywords:
Leishmania, HIV, coinfectionAbstract
Leishmaniasis is a parasitic disease affecting both animals and humans, acquired with the bite of sand flies or, in Injection Drug Users (IDUs), with contaminated needles, still hypoendemic in Sicily and the Mediterranean basin. Even though it is responsible for 20,000 to 40,000 deaths per year, this parasitic infection is still considered a neglected tropical disease. People Living with HIV (PLWH) are considered at high-risk of developing Leishmaniasis and, despite the introduction of Highly Active Anti-Retroviral Therapy (HAART), mortality rate and relapses prevalence are still high in coinfected people.
We present a case of HIV-Leishmania coinfection, posing the attention on the atypical signs and symptoms and the importance of thinking about other causes than the HIV infection progression when the patient presents with a worsening of his immune status during HAART.
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Lai V, Zizi B, Calia GM, Bagella P, Fiore V, Peruzzu F, Caruana G, Babudieri S, Mura MS, Madeddu G. Fib-4 values and neurocognitive function in hiv-infected patients without hepatic coinfections. Infect Dis Trop Med. 2016; 2:e293.
La Ferla L, Lo Presti Costantino MR, Mondello P. Kaposi's sarcoma in HIV-infected patients: a review of the literature. Infect Dis Trop Med. 2016; 2:e239.
Bruno R, Scuderi D, Locatelli ME, Pampaloni A, Pinzone MR. Prevalence of micronutrients deficiencies in a cohort of HIV-positive individuals on ART. Infect Dis Trop Med. 2017; 3:e431.
Pinzone MR, Di Rosa M, Celesia BM, Condorelli F, Malaguarnera M, Madeddu G, Martellotta F, Castronuovo D, Gussio M, Coco C, Palermo F, Cosentino S, Cacopardo B, Nunnari G. LPS and HIV gp120 modulate monocyte/macrophage CYP27B1 and CYP24A1 expression leading to vitamin D consumption and hypovitaminosis D in HIV-infected individuals. Eur Rev Med Pharmacol Sci. 2013; 17:1938–1950. PMid:23877860
Celesia BM, Nigro L, Pinzone MR, Coco C, La Rosa R, Bisicchia F, Mavilla S, Gussio M, Pellicanò G, Milioni V, Palermo F, Russo R, Mughini MT, Martellotta F, Taibi R, Cacopardo B, Nunnari G. High prevalence of undiagnosed anxiety symptoms among HIV-positive individuals on cART: A cross-sectional study. Eur Rev Med Pharmacol Sci. 2013; 17:2040–2046. PMid:23884824
Scarpino M, Santoro M, Pellicanò G. HIV infection and kidney disease: literature review. Infectious Diseases and Tropical Medicine. 2015; 1:e195.
Facciolà A, Venanzi Rullo E, Ceccarelli M, D'Aleo F, Di Rosa M, Pinzone MR, Condorelli F, Visalli G, Picerno I, Fisichella R, Nunnari G, Pellicanò GF. Kaposi's sarcoma in HIV-infected patients in the era of new antiretrovirals. Eur Rev Med Pharmacol Sci. 2017; 21:5868–5879. PMid:29272026
Montrucchio C, Biagini R, Alcantarini C, Calcagno A, Barco A, Ferrara M, Milesi M, Costa C, Trentalange A, Trunfio M, Tettoni MC, Grosso Marra W, D'Ascenzo F, Ballocca F, Lonni E, Gili S, Vai D, Imperiale D, Gaita F, Bonora S, Di Perri G. Cardiovascular risk and neurocognitive deficits in HIV-positive individuals. Infect Dis Trop Med. 2017; 3:e370.
Castronuovo D, Cacopardo B, Pinzone MR, Di Rosa M, Martellotta F, Schioppa O, Moreno S, Nunnari G. Bone disease in the setting of HIV infection: update and review of the literature. Eur Rev Med Pharmacol Sci. 2013; 17:2413–2419. PMid:24089217
Di Rosa M, Tibullo D, Vecchio M, Nunnari G, Saccone S, Di Raimondo F, Malaguarnera L. Determination of chitinases family during osteoclastogenesis. Bone. 2014; 61:55–63. https://doi.org/10.1016/j.bone.2014.01.005 PMid:24440516
Visalli G, Bertuccio MP, Currò M, Pellicanò G, Sturniolo G, Carnevali A, Spataro P, Ientile R, Picerno I, Cavallari V, Piedimonte G. Bioenergetics of T cell activation and death in HIV type 1 infection. AIDS Res Hum Retroviruses. 2012; 28:1110–1118. https://doi.org/10.1089/aid.2011.0197
Pinzone MR, Nunnari G. Prevalence of comorbidities in a cohort of women living with HIV. Infect Dis Trop Med. 2015; 1:e165.
Kulkosky J, Bouhamdan M, Geist A, Nunnari G, Phinney DG, Pomerantz RJ. Pathogenesis of HIV-1 infection within bone marrow cells. Leukemia and Lymphoma. 2000; 37:497–515. https://doi.org/10.3109/10428190009058502 PMid:11042510
Bellissimo F, Pinzone MR, Cacopardo B, Nunnari G. Diagnostic and therapeutic management of hepatocellular carcinoma. World J Gastroenterol. 2015; 21:12003–12021. https://doi.org/10.3748/wjg.v21.i42.12003 PMid:26576088 PMCid:PMC4641121
Nunnari G, Otero M, Dornadula G, Vanella M, Zhang H, Frank I, Pomerantz RJ. Residual HIV-1 disease in seminal cells of HIV-1-infected men on suppressive HAART: Latency without on-going cellular infections. AIDS. 2002; 16:39. https://doi.org/10.1097/00002030-200201040-00006 PMid:11741161
D'Aleo F, Ceccarelli M, Venanzi Rullo E, Facciolà A, Di Rosa M, Pinzone MR, Condorelli F, Visalli G, Picerno I, Berretta M, Pellicanò GF, Nunnari G. Hepatitis C-related hepatocellular carcinoma: diagnostic and therapeutic management in HIV-patients. Eur Rev Med Pharmacol Sci. 2017; 21:5859–5867. PMid:29272025
Squillace N, Pellicanò GF, Ricci E, Quirino T, Bonfanti P, Gori A, Bandera A, Carenzi L, De Socio GV, Orofino G, Martinelli C, Madeddu G, Rusconi S, Maggi P, Celesia BM, Cordier L, Vichi F, Calza L, Falasca K, Di Biagio A, Pellicanò GF, Bonfanti P. Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project. PLoS ONE. 2017; 12:e0179254. https://doi.org/10.1371/journal.pone.0179254 PMid:28632758 PMCid:PMC5478131
Pomerantz RJ, Nunnari G. HIV and GB Virus C - Can Two Viruses be Better Than One? N Engl J Med. 2004; 350:963–965. https://doi.org/10.1056/NEJMp048004 PMid:14999105
Colafigli M, Bonadies A, Ferraresi V, Tonachella R, Cristaudo A, Latini A. Kaposi Sarcoma in HIV-infected patients: an infectious-dermatological outpatient service experience. Infect Dis Trop Med. 2017; 3:e410.
Ceccarelli G, Vassalini P, Corano Scheri G, Cavallari EN, Bianchi L, Di Girolamo G, Fratino M, Vullo V, D'Ettorre G. Improvement of neuropsychological performances and reduction of immune-activation markers after probiotic supplementation and change of life-style in an HIV positive male: targeting the microbiota to act on gut-brain axis. Infect Dis Trop Med. 2017; 3:e404.
Scarpino M, Pinzone MR, Di Rosa M, Madeddu G, Focà E, Martellotta F, Schioppa O, Ceccarelli G, Celesia BM, D'Ettorre G, Vullo V, Berretta S, Cacopardo B, Nunnari G. Kidney disease in HIV-infected patients. Eur Rev Med Pharmacol Sci. 2013; 17:2660–2667. PMid:24142615
Visalli G, Paiardini, Chirico C, Cervasi B, Currò M, Ferlazzo N, Bertuccio MP, Favaloro A, Pellicanò G, Sturniolo G, Spataro P, Ientile R, Picerno I, Piedimonte G. Intracellular accumulation of cell cycle regulatory proteins and nucleolin re-localization are associated with pre-lethal ultrastructural lesions in circulating T lymphocytes: The HIV-induced cell cycle dysregulation revisited. Cell Cycle. 2010; 9:2130–2140. https://doi.org/10.4161/cc.9.11.11754 PMid:20505329
Trovato M, Ruggeri RM, Sciacchitano S, Vicchio TM, Picerno I, Pellicanò G, Valenti A, Visalli G. Serum interleukin-6 levels are increased in HIV-infected patients that develop autoimmune disease during long-term follow-up. Immunobiology. 2017.
Nunnari G, Coco C, Pinzone MR, Pavone P, Berretta M, Di Rosa M, Schnell M, Calabrese G, Cacopardo B. The role of micronutrients in the diet of HIV-1 infected individuals. Front Biosci. 2012; e4:2442–2456.
Castronuovo D, Pinzone MR, Moreno S, Cacopardo B, Nunnari G. HIV infection and bone disease: a review of the literature. Infect Dis Trop Med. 2015; 1:e116.
Malaguarnera M, Vacante M, Motta M, Giordano M, Malaguarnera G, Bella R, Nunnari G, Rampello L, Pennisi G. Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial. Metabolic Brain Disease. 2011; 26:281–289. https://doi.org/10.1007/s11011-011-9260-z PMid:21870121
Calcagno A, Simiele M, Alberione MC, Bracchi M, Marinaro L, Ecclesia S, Di Perri G, D'Avolio A, Bonora S. Cerebrospinal Fluid Inhibitory Quotients of Antiretroviral Drugs in HIV-Infected Patients Are Associated With Compartmental Viral Control. Clin Infect Dis. 2015; 60:311–317. https://doi.org/10.1093/cid/ciu773 PMid:25281609
Pagliano P, Esposito S. Visceral leishmaniosis in immunocompromised host: an update and literature review. J Chemother. 2017; 29:261–266. https://doi.org/10.1080/1120009X.2017.1323150 PMid:28490252
Pagliano P, Ascione T, Di Flumeri G, Boccia G, De Caro F. Visceral leishmaniasis in immunocompromised: Diagnostic and therapeutic approach and evaluation of the recently released IDSA guidelines. Infez Med. 2016; 24:265. PMid:28011960
Madeddu G, Fiori ML, Ena P, Riu F, Lovigu C, Nunnari G, Bagella P, Maida I, Babudieri S, Mura MS. Mucocutaneous leishmaniasis as presentation of HIV infection in Sardinia, insular Italy. Parasitol Int. 2013; 63:35–36. https://doi.org/10.1016/j.parint.2013.10.002 PMid:24126182
de Sousa-Gomes ML, Romero GAS, Werneck GL. Visceral leishmaniasis and HIV/AIDS in Brazil: Are we aware enough? PLoS Negl Trop Dis. 2017; 11:e0005772. https://doi.org/10.1371/journal.pntd.0005772 PMid:28945816 PMCid:PMC5612457
Ezra N, Ochoa MT, Craft N. Human immunodeficiency virus and leishmaniasis. J Glob Infect Dis. 2010; 2:248–257. https://doi.org/10.4103/0974-777X.68528 PMid:20927287 PMCid:PMC2946682
Cota GF, de Sousa MR, de Assis TSM, Pinto BF, Rabello A. Exploring prognosis in chronic relapsing visceral leishmaniasis among HIV-infected patients: Circulating Leishmania DNA. Acta Trop. 2017; 172:186–191. https://doi.org/10.1016/j.actatropica.2017.05.011 PMid:28501450
Guarneri C, Tchernev G, Bevelacqua V, Lotti T, Nunnari G. The unwelcome trio: HIV plus cutaneous and visceral leishmaniasis. Dermatol Ther. 2016; 29:88–91. https://doi.org/10.1111/dth.12303 PMid:26555699
Linee Guida Italiane sull'utilizzo dei farmaci antiretrovirali e sulla gestione diagnostico-clinica delle persone con infezione da HIV-1. http://www.simit.org/medias/1047-lg-hiv-2016-c17pubblicazioni2545allegato.pdf Accessed 14 January 2018.
Lindoso JAL, Cunha MA, Queiroz IT, Moreira CHV. Leishmaniasis-HIV coinfection: current challenges. HIV AIDS (Auckl). 2016; 8:147–156. https://doi.org/10.2147/HIV.S93789 PMid:27785103 PMCid:PMC5063600
Cocuzza S, Strazzulla A, Pinzone MR, Cosentino S, Serra A, Caltabiano R, Lanzafame S, Cacopardo B, Nunnari G. Isolated laryngeal leishmaniasis in immunocompetent patients: an underdiagnosed disease. Case Rep Infect Dis. 2013; 2013:165409. https://doi.org/10.1155/2013/165409
Chenoweth CE, Singal S, Pearson RD, Betts RF, Markovitz DM. Acquired Immunodeficiency Syndrome-Related Visceral Leishmaniasis Presenting in a Pleural Effusion. Chest. 1993; 103:648-649. https://doi.org/10.1378/chest.103.2.648 PMid:8432183
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2016; 63:e202–e264. https://doi.org/10.1093/cid/ciw670 PMid:27941151
Strazzulla A, Cocuzza S, Pinzone MR, Postorino MC, Cosentino S, Serra A, Cacopardo B, Nunnari G. Mucosal leishmaniasis: an underestimated presentation of a neglected disease. Biomed Res Int. 2013; 2013:805108. https://doi.org/10.1155/2013/805108 PMid:23853773 PMCid:PMC3703408
Khadem F, Uzonna JE. Immunity to visceral leishmaniasis: implications for immunotherapy. Future Microbiol. 2014; 9:901–915. https://doi.org/10.2217/fmb.14.43 PMid:25156379
Santos-Oliveira JR, Giacoia-Gripp CBW, de Oliveira PA, Amato VS, Lindoso JÂL, Goto H, Oliveira-Neto MP, Mattos MS, Grinsztejn B, Morgado MG, Da-Cruz AM. High levels of T lymphocyte activation in Leishmania-HIV-1 co-infected individuals despite low HIV viral load. BMC Infect Dis. 2010; 10:358. https://doi.org/10.1186/1471-2334-10-358 PMid:21171992 PMCid:PMC3022832
Celesia BM, Cacopardo B, Massimino D, Gussio M, Tosto S, Nunnari G, Pinzone MR. Atypical Presentation of PKDL due to Leishmania infantum in an HIV-Infected Patient with Relapsing Visceral Leishmaniasis. Case Rep Infect Dis. 2014; 2014:370286.
Lu W, Mehraj V, Vyboh K, Cao W, Li T, Routy J-P. CD4:CD8 ratio as a frontier marker for clinical outcome, immune dysfunction and viral reservoir size in virologically suppressed HIV-positive patients. J Int AIDS Soc. 2015; 18:20052. https://doi.org/10.7448/IAS.18.1.20052 PMid:26130226 PMCid:PMC4486418
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