Visceral leishmaniasis and HIV-1 co-infection in southern France.
Between 1986 and 1993 visceral leishmaniasis (VL) was diagnosed in 50 adult patients with human immunodeficiency virus type 1 (HIV-1) infection (8 females, 42 males: 31 intravenous drug users, 11 homosexual or bisexual men, 6 heterosexual individuals, 2 blood recipients) from 5 hospital centres in southern France. Diagnosis of VL was by demonstration of Leishmania and isolation of promastigotes by culture in Novy-McNeal-Nicolle medium. Leishmania isolates were identified by their isoenzyme profile in 28 patients. All the patients were immunocompromised when VL was diagnosed. Their median CD4 cell count was 25 x 10(6) (0-200). However, only 21 patients (42%) fulfilled the 1987 CDC criteria for the acquired immune deficiency syndrome before VL developed. Fever (84%), splenomegaly (56%), hepatomegaly (34%), and pancytopenia (62%) were the most common presenting features. Clinical signs were lacking in 10% of patients. Anti-leishmanial antibodies were detected by indirect immunofluorescence or enzyme-linked immunosorbent assay in 26/47 cases (55%). Combining these techniques with Western blotting (WB) gave a positivity rate of 95%. Amastigotes were demonstrated in bone marrow aspirates in 47 cases (94%). Unusual sites for parasites were found in 17 patients (34%), mainly in the digestive tract but also skin and lung. Viscerotropic L. infantum zymodeme MON-1 was characterized in 86% of cases. Dermotropic zymodemes MON-24, MON-29, MON-33, and a previously undescribed zymodeme MON-183, were isolated from 4 patients. The response rate to pentavalent antimony was 50% and to amphotericin B 100%, but clinical relapses were noted in both groups. In endemic areas, VL should be considered as a possible opportunistic infection in HIV-infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Rosenthal
E
E
Department of Internal Medicine, University Hospital, Nice, France.
Marty
P
P
Poizot-Martin
I
I
Reynes
J
J
Pratlong
F
F
Lafeuillade
A
A
Jaubert
D
D
Boulat
O
O
Dereure
J
J
Gambarelli
F
F
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000913:Antibodies, Protozoan / Q000032:analysis; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000913:Antibodies, Protozoan; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate