title: Visceral leishmaniasis emerging as an important opportunistic infection in HIV-infected persons living in areas nonendemic for Leishmania donovani.
abstract: BACKGROUND
  Visceral leishmaniasis is an important infection in patients infected with human immunodeficiency virus and living in areas endemic for Leishmania sp. Leishmaniasis, however, is rarely suspected in patients residing in nonendemic countries.
  
  
  METHODS
  Retrospective case analysis of 15 patients with human immunodeficiency virus infection and leishmaniasis treated at seven German clinics. The clinicopathological features and the diagnostic role of biopsy and/or cytology as compared to serology were evaluated.
  
  
  RESULTS
  All patients were severely immunocompromised. One patient was first diagnosed at autopsy. One patient with mucocutaneous disease was diagnosed by nasal biopsy. All others had amastigotes detected in bone marrow (13/13), liver (3/3), and gastrointestinal mucosa (4/4). Serology was positive in only 6 or 13.
  
  
  CONCLUSIONS
  Visceral leishmaniasis is an important opportunistic infection in patients with acquired immunodeficiency syndrome and it must be ruled out in every patient with fever and/or pancytopenia and an appropriate travel history. Because serological diagnosis is often insufficient, pathologists must be aware of the association between human immunodeficiency virus infection and leishmaniasis. Diagnosis depends on detection of the parasite in submitted specimens.
authors.affiliation: Department of Internal Medicine, University Clinic Eppendorf, Hamburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Albrecht
authors.forename: I
authors.initials: I
authors.lastname: Sobottka
authors.forename: C
authors.initials: C
authors.lastname: Emminger
authors.forename: H
authors.initials: H
authors.lastname: Jablonowski
authors.forename: G
authors.initials: G
authors.lastname: Just
authors.forename: A
authors.initials: A
authors.lastname: Stoehr
authors.forename: T
authors.initials: T
authors.lastname: Kubin
authors.forename: B
authors.initials: B
authors.lastname: Salzberger
authors.forename: T
authors.initials: T
authors.lastname: Lutz
authors.forename: J
authors.initials: J
authors.lastname: van Lunzen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000818:Animals; D017809:Fatal Outcome; D006801:Humans; D007893:Leishmania donovani; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence