title: Atypical manifestations of visceral leishmaniasis in patients with HIV in north Ethiopia: a gap in guidelines for the management of opportunistic infections in resource poor settings.
abstract: In regions where it is endemic, visceral leishmaniasis is an important opportunistic infectious disease in people living with HIV. Typically, clinical presentation of visceral leishmaniasis includes chronic fever, hepatosplenomegaly, and weight loss. In Leishmania infantum endemic regions in Europe, atypical visceral leishmaniasis presentations have been well documented, with almost every possible organ involved. However, such reports are rare in Leishmania donovani endemic regions such as east Africa. In this Personal View, we describe the various atypical disease presentations in patients screened as part of an HIV and visceral leishmaniasis clinical trial in north Ethiopia, where up to 40% of patients with visceral leishmaniasis are co-infected with HIV. Atypical presentations such as these are not covered in clinical guidelines used in these settings. Apart from the lack of diagnostic facilities, this gap contributes to the underdiagnosis of atypical visceral leishmaniasis, with associated morbidity and mortality. Involvement of clinicians experienced with the management of HIV and visceral leishmaniasis co-infection in the development of HIV clinical guidelines in affected regions is warranted.
authors.affiliation: Department of Internal Medicine, University of Gondar, Gondar, Ethiopia. Electronic address: ermi_diro@yahoo.com.
authors.forename: Ermias
authors.initials: E
authors.lastname: Diro
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: van Griensven
authors.affiliation: Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: Rezika
authors.initials: R
authors.lastname: Mohammed
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.affiliation: Department of Pathology, University of Gondar, Gondar, Ethiopia.
authors.forename: Mesfin
authors.initials: M
authors.lastname: Asefa
authors.affiliation: Department of Microbiology, Parasitology and Immunology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Asrat
authors.initials: A
authors.lastname: Hailu
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium.
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Lynen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D060085:Coinfection / Q000175:diagnosis* / Q000473:pathology*; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D017410:Practice Guidelines as Topic