RECURRENT VISCERAL LEISHMANIASIS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT.

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Introduction:- Current treatment options for visceral leishmaniasis (pentavalent antimony, amphotericin B, liposomal amphotericin B and mitelfosine) achieve long-term clinical cure in the majority of immunocompetent patients. Disease relapse is usually provoked by T-cell number or function impairment (corticosteroid or cytotoxic therapy, transplant recipients, advanced human immunodeficiency virus disease). Case presentation:- We report a case of visceral leishmaniasis with multiple relapses in a 75-year-old Greek immunocompetent man. Visceral leishmaniasis relapses occurred despite appropriate treatment with liposomal amphotericin B 3mg/kg/day on days one to five, 14 and 21 (for the first episode and the first relapse) and mitelfosine 150mg/day for 28 days (for the second relapse). The third relapse was treated with high-dose liposomal amphotericin B (10mg/kg for two consecutive days), followed by a secondary prophylaxis of 3mg/kg once per month, which prevented disease reappearance during one year of follow-up. Conclusion:- An unusual case of recurrent visceral leishmaniasis in an older immunocompetent patient was treated with high-dose liposomal amphotericin B and a monthly prophylaxis with no evidence of a relapse after one year of follow-up.

  1. Banuls AL, Hide M, Prugnolle F: Leishmania and the leishmaniases: a parasite genetic update and advances in taxonomy, epidemiology and pathogenicity in humans. AdvParasitol. 2007, 64: 1-109.View ArticlePubMedGoogle Scholar
  2. Herwaldt BL: Leishmaniasis. Lancet. 1999, 354: 1191-1199. 10.1016/S0140-6736(98)10178-2.View ArticlePubMedGoogle Scholar
  3. Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, Peeling RW, Alvar J, Boelaert M: Visceral leishmaniasis: what are the needs for diagnosis, treatment and control?. Nat Rev Microbiol. 2007, 5: 873-882.View ArticlePubMedGoogle Scholar
  4. Weigle K, Saravia NG: Natural history, clinical evolution, and the host-parasite interaction in New World cutaneous leishmaniasis. ClinDermatol. 1996, 14: 433-450. 10.1016/0738-081X(96)00036-3.View ArticlePubMedGoogle Scholar
  5. Desjeux P: The increase in risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg. 2001, 95: 239-243. 10.1016/S0035-9203(01)90223-8.View ArticlePubMedGoogle Scholar
  6. Murray HW, Berman JD, Davies CR, Saravia NG: Advances in leishmaniasis. Lancet. 2005, 366: 1561-1577. 10.1016/S0140-6736(05)67629-5.View ArticlePubMedGoogle Scholar
  7. Okwor I, Uzonna J: Persistent parasites and immunologic memory in cutaneous leishmaniasis: implications for vaccine designs and vaccination strategies. Immunol Res. 2008, 41: 123-136. 10.1007/s12026-008-8016-2.View ArticlePubMedGoogle Scholar
  8. Simon I, Wissing KM, Del Marmol V, Antinori S, Remmelink M, NiluferBroeders E, Nortier JL, Corbellino M, Abramowicz D, Cascio A: Recurrent leishmaniasis in kidney transplant recipients: report of 2 cases and systematic review of the literature. Transpl Infect Dis. 2011, 13: 397-406. 10.1111/j.1399-3062.2011.00598.x.View ArticlePubMedGoogle Scholar
  9. Alvar J, Aparicio P, Aseffa A, Den Boer M, Canavate C, Dedet JP, Gradoni L, Ter Horst R, Lopez-Velez R, Moreno J: The relationship between leishmaniasis and AIDS: the second 10 years. ClinMicrobiol Rev. 2008, 21: 334-359. 10.1128/CMR.00061-07.View ArticlePubMedPubMedCentralGoogle Scholar
  10. Colomba C, Scarlata F, Salsa L, FrascaPolara V, Titone L: [Mediterranean visceral leishmaniasis in immunocompetent children. Report of two cases relapsed after specific therapy]. Infez Med. 2004, 12: 139-143.PubMedGoogle Scholar
  11. Bern C, Adler-Moore J, Berenguer J, Boelaert M, den Boer M, Davidson RN, Figueras C, Gradoni L, Kafetzis DA, Ritmeijer K, Rosenthal E, Royce C, Russo R, Sundar S, Alvar J: Liposomal amphotericin B for the treatment of visceral leishmaniasis. Clin Infect Dis. 2006, 43: 917-924. 10.1086/507530.View ArticlePubMedGoogle Scholar
  12. Sinha PK, van Griensven J, Pandey K, Kumar N, Verma N, Mahajan R, Kumar P, Kumar R, Das P, Mitra G, Flevaud L, Ferreyra C, Remartinez D, Pece M, Palma PP: Liposomal amphotericin B for visceral leishmaniasis in human immunodeficiency virus-coinfected patients: 2-year treatment outcomes in Bihar, India. Clin Infect Dis. 2011, 53: e91-e98. 10.1093/cid/cir521.View ArticlePubMedGoogle Scholar
  13. Sindermann H, Engel KR, Fischer C, Bommer W: Oral miltefosine for leishmaniasis in immunocompromised patients: compassionate use in 39 patients with HIV infection. Clin Infect Dis. 2004, 39: 1520-1523. 10.1086/425359.View ArticlePubMedGoogle Scholar
  14. Lopez-Velez R, Videla S, Marquez M, Boix V, Jimenez-Mejias ME, Gorgolas M, Arribas JR, Salas A, Laguna F, Sust M, Canavate C, Alvar J: Amphotericin B lipid complex versus no treatment in the secondary prophylaxis of visceral leishmaniasis in HIV-infected patients. J AntimicrobChemother. 2004, 53: 540-543. 10.1093/jac/dkh084.View ArticlePubMedGoogle Scholar
  15. Berenguer J, Cosin J, Miralles P, Lopez JC, Padilla B: Discontinuation of secondary anti-leishmania prophylaxis in HIV-infected patients who have responded to highly active antiretroviral therapy. AIDS. 2000, 14: 2946-2948. 10.1097/00002030-200012220-00020.View ArticlePubMedGoogle Scholar

[Mohanad Jebril Bosily, Alenazi Ahmad Awad R, Alanazi Saad Madallah T, Afnan Makki Alkhairi, Rahma Mustafa Muzaffar, Mohammednabil Zammo, Omar Mashhoor Alfayez, Saad Saif Elahi, Ahmed Faisal Althaher, Najeeb Saleh Al-salameh, Lama Abed Al-orabi, Mohammed Hassan Rizq and Naif Mohsen Salam Alwadai. (2017); RECURRENT VISCERAL LEISHMANIASIS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT. Int. J. of Adv. Res. 5 (Jan). 2999-3003] (ISSN 2320-5407). www.journalijar.com

Mohanad Jebril Bosily

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Article DOI: 10.21474/IJAR01/3102      
DOI URL: https://dx.doi.org/10.21474/IJAR01/3102

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