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Features of solid organ transplant recipients with visceral leishmaniasis.
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Visceral leishmaniasis is an infectious disease that occurs only rarely in recipients of solid organ grafts but is associated
with an elevated mortality rate despite proper treatment. We report five cases diagnosed in our hospital. All the patients
were men aged 30 to 60 years who had undergone kidney transplantation (3 patients), heart transplanta...
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Background
Leishmaniasis is a rising opportunistic infection in individuals with human immunodeficiency virus (HIV). Cases of leishmania and HIV co-infection have been documented in several countries in the world with most reporting on the association between visceral leishmaniasis (VL) and HIV. We herein report the case of cutaneous leishmaniasis...
The analysis of promastigote excreted-secreted antigen (ESA) reactivity with 53 visceral leishmaniasis (VL) cases showed that each sample reacted regardless of the antigen or the Leishmania species used in enzyme-linked immunosorbent assay (ELISA) displayed 100% positivity with the L. (L.) chagasi ESA-blot recognizing bands of molecular weight rang...
There are many strategies to control leishmaniasis, but majority of them are inadequate. Killed Leishmania vaccine (KLV) has been applied for its immunogenicity in human and mouse model. Bacillus Calmette-Guerin (BCG) as adjuvant is an immune-modulator inducing humoral and cellular immune responses during zoonotic cutaneous leishmaniasis (ZCL). Bot...
Leishmaniasis is endemic in 98 countries with an estimated 350 million people at risk and approximately 2 million cases annually. Brazil is one of the most severely affected countries.
We applied Bayesian geostatistical negative binomial models to analyze reported incidence data of cutaneous and visceral leishmaniasis in Brazil covering a 10-year p...
Objective: To determine the pattern of cutaneous leishmaniasis cases in Sibi and to form a base line data.
Design: Single center descriptive study.
Place and Duration of Study: From Jan 2003 to Oct 2004 in CMH Sibi.
Patients and Method: A total of 293 patients of either age or sex with clinical features of cutaneous leishmaniasis or positive skin s...
Citations
... At the end of the process, we included 66 retrospective case reports and 4 retrospective case series. According to the modified Newcastle-Ottawa Scale, 11 items were classified as low-quality [7,[15][16][17][18][19][20][21][22][23][24], 34 as average-quality , and 25 as high-quality studies [4,10,. In total, our analysis includes 159 cases of Leishmania infection after KT. ...
... Information regarding the country of origin or travel activity was available for 153/159 (96.2%) patients. The vast majority (n = 143) of KT recipients with Leishmaniasis came from or had travelled to endemic regions, especially South America, North Africa, the Middle East, India, or the Mediterranean basin [4,[16][17][18][22][23][24][25][26][27][28]30,31,[34][35][36]38,[40][41][42]44,45,48,[50][51][52][54][55][56][57][59][60][61][62][63][64][65][66][67][69][70][71][72][73]75,76,78,79,81]. Only a few subjects (n = 10) were from non-endemic areas [7,10,19,49,80], whilst data were not available for the others (n = 6) [10,20,21,43,46,47]. ...
... Most episodes of Leishmania infection were registered in Brazil (n = 66) [22,29,30,40,58,68,74,79]. Several cases were also reported in the Mediterranean basin (n = 61), such as Spain (n = 20) [18,27,36,41,48,53,55,61,63,68,78], Italy (n = 14) [31,33,35,42,44,45,51,72,81], France (n = 10) [25,39,64], Tunisia (n = 8) [7,17,34,52,62,69], Greece (n = 4) [54], Turkey (n = 3) [59,67,77], Malta (n = 1) [38], and Algeria (n = 1) [23]. Overall, European countries outside the Mediterranean basin recorded a small number of infections: Portugal (n = 2) [24,66], Switzerland (n = 1) [73], Finland (n = 1) [60], United Kingdom (n = 1) [19], and Belgium (n = 1) [80]. ...
Current knowledge on Leishmania infection after kidney transplantation (KT) is limited. In order to offer a comprehensive guide for the management of post-transplant Leishmaniasis, we performed a systematic review following the latest PRISMA Checklist and using PubMed, Scopus, and Embase as databases. No time restrictions were applied, including all English-edited articles on Leishmaniasis in KT recipients. Selected items were assessed for methodological quality using a modified Newcastle–Ottawa Scale. Given the nature and quality of the studies (case reports and retrospective uncontrolled case series), data could not be meta-analyzed. A descriptive summary was therefore provided. Eventually, we selected 70 studies, describing a total of 159 cases of Leishmaniasis. Most of the patients were adult, male, and Caucasian. Furthermore, they were frequently living or travelling to endemic regions. The onset of the disease was variable, but more often in the late transplant course. The clinical features were basically similar to those reported in the general population. However, a generalized delay in diagnosis and treatment could be detected. Bone marrow aspiration was the preferred diagnostic modality. The main treatment options included pentavalent antimonial and liposomal amphotericin B, both showing mixed results. Overall, the outcomes appeared as concerning, with several patients dying or losing their transplant.
... is not well characterized, although it is likely that they do not substantially differ from those observed in the general population [37][38][39][40]. Some case reports have described SOT and hematopoietic stem-cell transplant (HSCT) recipients with hookworm infection presenting with diffuse rash and colic pain [91], obstructive jaundice due to ascaridiasis [111], or kidney allograft dysfunction induced by severe chronic diarrhea due to trichuriasis [37,[40][41][42]. ...
... Previous studies have investigated the risk factors, clinical course and determinant of outcomes in post-transplant leishmaniasis, albeit not specifically in recipients from Sub-Saharan African countries [108,[111][112][113]. High-dose corticosteroid therapy in the preceding 6 months has been described as the main risk factor, whereas fever (86% of cases), visceromegaly (81%) and pancytopenia (47%) constitute the main clinical manifestations. ...
International migration from Sub-Saharan African countries to the European Union and the United States has significantly increased over the past decades. Although the vast majority of these immigrants are young and healthy people, a minority can be affected by chronic conditions eventually leading to solid organ transplantation (SOT). Importantly, these candidates can bear geographically restricted fungal and parasitic latent infections that can reactivate after the procedure. An appropriate evaluation before transplantation followed by treatment, whenever necessary, is essential to minimize such risk, as covered in the present review. In short, infection due to helminths (Schistosoma spp. and Strongyloides stercoralis) and intestinal protozoa (Entamoeba histolytica, Giardia lamblia or Cyclospora cayetanensis) can be diagnosed by multiple direct stool examination, serological assays and stool antigen testing. Leishmaniasis can be assessed by means of serology, followed by nucleic acid amplification testing (NAAT) if the former test is positive. Submicroscopic malaria should be ruled out by NAAT. Screening for Histoplasma spp. or Cryptococcus spp. is not routinely indicated. Consultation with an Infectious Diseases specialist is recommended in order to adjust preemptive treatment among Sub-Saharan African SOT candidates and recipients.
... Visceral leishmaniasis (VL) is a neglected re-emerging chronic infectious disease in tropical and subtropical regions (176) where it is related to poor access to health care and poverty. Countries like Brazil have reported a high incidence of new cases annually (177) although it is not clear whether all cases result from recent infection or from reactivation of latent infection in patients that have chronic immunosuppressive conditions such as HIV (178) and organ transplantation (179). The rate of positive Leishmania skin test results in some areas of Brazil is extremely high in the elderly, and this might become a relevant geriatric issue (171). ...
Immunosenescence is marked by a systemic process named inflammaging along with a series of defects in the immunological activity that results in poor responses to infectious agents and to vaccination. Inflammaging, a state of low-grade chronic inflammation, usually leads to chronic inflammatory diseases and frailty in the elderly. However, some elderly escape from frailty and reach advanced age free of the consequences of inflammaging. This process has been called immunological remodeling, and it is the hallmark of healthy aging as described in the studies of centenarians in Italy. The biological markers of healthy aging are still a matter of debate, and the studies on the topic have focused on inflammatory versus remodeling processes and molecules. The sub-clinical inflammatory status associated with aging might be a deleterious event for populations living in countries where chronic infectious diseases are not prevalent. Nevertheless, in other parts of the world where they are, two possibilities may occur. Inflammatory responses may have a protective effect against these infectious agents. At the same time, the long-term consequences of protective immune responses during chronic infections may result in accelerated immunosenescence in these individuals. Therefore, the biological markers of healthy aging can vary according to environmental, cultural, and geographical settings that reflect worldwide, and in a non-biased, non-westernized perspective, the changes that we experience regarding our contacts with microorganisms and the outcomes of such contacts.
... Já os canídeos silvestres e marsupiais são os principais reservatórios silvestres já relatados, mas pouco se sabe sobre o papel deles na transmissão de LV em regiões rurais e periurbanas (Gontijo e Melo, 2004 além de existir a possibilidade de transplante de órgãos contaminados (Hernández-Pérez et al., 1999;Morales et al., 2003). ...
Leishmaniasis covers a group of zoonotic diseases caused by protozoa parasites of the Trypanosoma Family and the genus Leishmania, being transmitted by phlebotomine insect vectors. The genus Leishmania comprises 30 species, including 20 species capable of causing disease in humans, with different clinical manifestations, ranging from asymptomatic, cutaneous and mucocutaneous lesions, to severe visceral form, which is lethal if untreated. In the American continent, visceral leishmaniasis (VL) is caused by Leishmania infantum chagasi and Brazil accounts for 90% of the Latin America registered cases. The diagnosis of VL in America presents difficulties due to cross-reactions with other endemic trypanosomiasis. In addition, clinical signs and VL hematological alterations are found in other infectious diseases and hematological malignancies. In order to search for tools and strategies for the differential VL diagnosis, in this work we have developed methods of isolation and molecular detection of L. infantum chagasi, as well as the search for specific demographic characteristics and evaluation of the differential diagnosis of VL in bone marrow biopsies of patients with symptoms of haematological diseases in the region of Marília-SP, from 2010 to 2017. The method of L. infantum chagasi isolation was performed from samples of bone marrow and peripheral blood of symptomatic individuals. Conventional polymerase chain reaction (PCR) was developed using the single copy gene encoding the chitinase enzyme of L. infantum, which allows specific and direct diagnosis from different clinical samples. Both diagnostic tests showed high specificity and increased sensitivity when compared with routinely used methods in health services. The results of the demographic analysis and the differential diagnosis from bone marrow biopsy of patients with supposed hematological diseases indicated that 19.4% had VL, and that the population with the highest risk is less than 20 years old. The present study demonstrates that the investigation of VL in patients with hematological alterations is fundamental not only to identify cases of VL but also to correctly treat cases of VL associated infectious and hematological diseases.
... Secondary prophylaxis with intermittent weekly amphotericin [ 130 ], daily fl uconazol [ 100 ], and monthly meglumine antimoniate [ 99 ] has been reported. It has also been suggested that allopurinol could be effective to prevent relapses [ 131 ]. ...
Parasitic infections in the setting of transplantation, although uncommon, are being increasingly recognized. They may represent a significant threat for a successful outcome. Extensive human travel and immigration, and climatic changes are re-shaping the epidemiology of parasitic infections, allowing for their emergence in unexpected settings. Transplant physicians should get familiar with parasitic infections and promote adherence to preventive measures in transplant recipients. Parasitic diseases in the transplant recipient may result from recrudescence of dormant or unrecognized parasitic infections in the potential transplant recipient after starting immunosuppression, or from de novo acquisition either from transmission of an infected graft or infected blood products, or by naturally occurring infection. Thorough knowledge of clinical manifestations and diagnostic methods for parasitic disease allows for early diagnosis, implementation of preventive measures, or for adequate monitoring to detect reactivation and initiation of timely pre-emptive treatment.
... VL post SOT can occur in 4 ways: reactivation of latent infection, transmission by infected graft or blood transfusion, or a new infection (1,12). The first case reported in liver transplantation (LT) was in 1993 (13) and currently <15 cases have been described (1,(9)(10)(11)(12)(13)(14)(15). ...
... Infection is a well-recognized complication of immunosuppressive therapy. VL has been rarely observed in SOT recipients, with a few cases described in LT (1,(9)(10)(11)(12)(13)(14)(15). Our case is the first case of VL in patients who underwent LT in our institution (n = 1082 LT procedures, in 19 years) and, to our knowledge, is the first case in Portugal. ...
Visceral leishmaniasis (VL) was known as an opportunistic infection associated with immunosuppression, particularly related to human immunodeficiency virus infection and rarely to solid organ transplant recipients. We report a case of VL, 6 months after liver transplantation, in a patient who presented with febrile pancytopenia. The diagnosis was made by demonstration of amastigotes in smears from bone marrow. VL is a very rare infection in patients who undergo liver transplantation and, to our knowledge, this is the first case diagnosed in Portugal. This article is protected by copyright. All rights reserved.
... The need of secondary prophylaxis is not clear in SOT, but it prevents relapse in HIV þ patients [50,51]. Options for secondary prophylaxis include: fluconazole, antimonials or L-AmB [52,53]. ...
... Post-kala-azar dermal leishmaniasis (PKDL), a cutaneous disease observed months to years after apparent cure of VL and usually associated with L. donovani infection in East Africa and on the Indian subcontinent, has been rarely reported in transplant patients [97]. PKDL is mostly associated with L. infantum in Western countries [98,99]. ...
Tropical infectious diseases (IDs) remain a rare complication in transplant recipients even in tropical settings, but this topic has become increasingly important during the last decade due to multiple factors. Interestingly, non-tropical countries report most of the experiences with tropical diseases. The reported experience from non-endemic regions, however, does not always reflect the experience of endemic areas. Most of the guidelines and recommendations in the literature may not be applicable in tropical settings due to logistical difficulties, cost, and lack of proven benefit. In addition, certain post-transplant prevention measures, as prophylaxis and reducing exposure risk, are not feasible. Nonetheless, risk assessment and post-transplant management of tropical IDs in tropical areas should not be neglected, and clinicians need to have a higher clinical awareness for tropical ID occurring in this population. Herein, we review the more significant tropical ID in transplant patients, focusing on relevant experience reported by tropical settings.
... Rigorous follow-up for a long period is therefore recommended. Either liposomal amphotericin B, pentamidine, or pentavalent antimonies are proposed for individuals with heavy immunosuppression (eg, HIV infection) until immunity has been restored [12,13]. However, we did not administer any secondary prophylaxis to our patient, because his white blood cell count was normal at that time. ...
... However, we did not administer any secondary prophylaxis to our patient, because his white blood cell count was normal at that time. Furthermore, there is no official guideline for solid organ transplants [5,12], and VL has usually a low rate of recurrences in such a context [3]. Nonetheless, our patient relapsed 1 year later, because we found evidence of location of amastigotes in the liver. ...
... Although more than 100 VL case reports have been described and reviewed in the literature [1][2][3][4][5], there is a lack of information regarding risk factors, the role of immunosuppression and disease outcome across different types of transplantation. The recognition and management of VL remains challenging even in transplant recipients from endemic regions [6][7][8][9][10][11]. ...
Visceral leishmaniasis (VL) is a rare disease in solid-organ transplant (SOT) recipients. Therefore, little is known about the risk factors and disease behavior in the transplant setting. This multicenter, matched case-control study (1:2 ratio) was designed to determine the risk factors, clinical features and outcomes of VL among this population. Control and case subjects were matched by center, transplant type and timing. Thirty-six VL cases were identified among 25 139 SOT recipients (0.1%). VL occurred 5.7-fold more frequently in Brazil than in Spain, presenting a median time of 11 months after transplantation. High-dose prednisone in the preceding 6 months was associated with VL. Patients were diagnosed over 1 month after symptom onset in 25% of cases. Thirty-one patients (86%) were febrile upon diagnosis, 81% exhibited visceromegaly and 47% showed pancytopenia. Concomitant infection was common. Parasites were identified in 89% of patients; the remaining patients were diagnosed by serology. The majority of the patients received amphotericin B. Relapses occurred in 25.7% of cases, and the crude mortality rate was 2.8%. VL after SOT is related to the VL prevalence in the general population. Delayed diagnosis frequently occurs. Liposomal amphotericin is the most commonly used therapy; mortality is low, although relapses are common.
Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
