title: Severe Cutaneous Leishmaniasis in a Human Immunodeficiency Virus Patient Coinfected with Leishmania braziliensis and Its Endosymbiotic Virus.
abstract: Leishmania parasites cause a broad range of disease, with cutaneous afflictions being, by far, the most prevalent. Variations in disease severity and symptomatic spectrum are mostly associated to parasite species. One risk factor for the severity and emergence of leishmaniasis is immunosuppression, usually arising by coinfection of the patient with human immunodeficiency virus (HIV). Interestingly, several species of Leishmania have been shown to bear an endogenous cytoplasmic dsRNA virus (LRV) of the Totiviridae family, and recently we correlated the presence of LRV1 within Leishmania parasites to an exacerbation murine leishmaniasis and with an elevated frequency of drug treatment failures in humans. This raises the possibility of further exacerbation of leishmaniasis in the presence of both viruses, and here we report a case of cutaneous leishmaniasis caused by Leishmania braziliensis bearing LRV1 with aggressive pathogenesis in an HIV patient. LRV1 was isolated and partially sequenced from skin and nasal lesions. Genetic identity of both sequences reinforced the assumption that nasal parasites originate from primary skin lesions. Surprisingly, combined antiretroviral therapy did not impact the devolution of Leishmania infection. The Leishmania infection was successfully treated through administration of liposomal amphotericin B.
authors.forename: Laurent
authors.initials: L
authors.lastname: Parmentier
authors.forename: Alexia
authors.initials: A
authors.lastname: Cusini
authors.forename: Norbert
authors.initials: N
authors.lastname: Müller
authors.forename: Haroun
authors.initials: H
authors.lastname: Zangger
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Hartley
authors.forename: Chantal
authors.initials: C
authors.lastname: Desponds
authors.forename: Patrik
authors.initials: P
authors.lastname: Castiglioni
authors.forename: Patrick
authors.initials: P
authors.lastname: Dubach
authors.forename: Catherine
authors.initials: C
authors.lastname: Ronet
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Beverley
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fasel
mesh_terms: D060085:Coinfection / Q000469:parasitology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000469:parasitology / Q000473:pathology; D006801:Humans; D007892:Leishmania braziliensis / Q000821:virology; D016773:Leishmaniasis, Cutaneous / Q000150:complications* / Q000473:pathology / Q000821:virology; D019199:Leishmaniavirus; D008875:Middle Aged; D012867:Skin / Q000473:pathology
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