title: Dyarrheal Syndrome in a Patient Co-Infected with Leishmania infantum and Schistosoma mansoni.
abstract: This case report describes an atypical clinical presentation of visceral leishmaniasis affecting the digestive tract and causing malabsorption syndrome in a patient without recognized immunosuppressive condition. After appropriate treatment for the classical visceral form of the disease, diarrhea persisted as the main symptom and massive infection by Leishmania was detected by histopathology analysis of the duodenal mucosa. Schistosoma mansoni coinfection was also confirmed and treated without impact on diarrhea. New course of amphotericin B finally led to complete improvement of diarrhea. Atypical visceral leishmaniasis involving the gastrointestinal tract is well recognized in HIV coinfection but very rare in immunocompetent patients. The factors determining the control or evolution of the Leishmania infection have not been completely identified. This case stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, and raises the possible influence of chronic infection by S. mansoni reducing the immune response to Leishmania.
authors.affiliation: Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (Fhemig), Rua Dr Cristiano Resende, 2213, 30622-020 Belo Horizonte, MG, Brazil ; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Instituto Oswaldo Cruz-FIOCRUZ, Avenida Augusto de Lima, 1715, 30190-002 Belo Horizonte, MG, Brazil.
authors.forename: Gláucia Fernandes
authors.initials: GF
authors.lastname: Cota
authors.forename: Luciana Inácia
authors.initials: LI
authors.lastname: Gomes
authors.forename: Bruna Fernandes
authors.initials: BF
authors.lastname: Pinto
authors.forename: Joanna R
authors.initials: JR
authors.lastname: Santos-Oliveira
authors.forename: Alda Maria
authors.initials: AM
authors.lastname: Da-Cruz
authors.forename: Moisés Salgado
authors.initials: MS
authors.lastname: Pedrosa
authors.forename: Wagner Luiz
authors.initials: WL
authors.lastname: Tafuri
authors.forename: Ana
authors.initials: A
authors.lastname: Rabello