Promed Message HIV/VL

[micro]

At 13:34 15/11/99 -0200, Jeffrey Shaw wrote:
>
>Date: Sun, 7 Nov 1999 18:27:34 +0200
>From: "michaeli dan @ micky" <michaeli at netvision.net.il>
>
>The item on coincidence of visceral leismaniasis with HIV infection is
>intriguing. For many years The fact that _L.tropica_ was producing cutaneous
>leishmaniasis in man but in other species would cause muco-cutaneous disease
>(e.g.  psamomys) was interpreted as due to different types of cellular
>immune reactions of different species. _L.donovani_ is not producing the
>same reaction in man and this is the explanation for its hematological
>spread, thus producing the visceral form of the disease. Now this
>association raises, in my mind, the possibility that we may not be dealing
>with _L.donovani_ but maybe with _L.tropica_ that infects a host with a
>modified cellular reaction as the result of the effect of the HIV infection.
>Therefore it would be very
>interesting to know if in those cases of visceral leishmaniasis that are
>reported in association with HIV infection, the serological type of the
>leishmania was definitely established. Maybe DNA fingerprinting should be
>done in those cases?
>
>Would anybody wish to comment on this idea?
>
>- --
>Dan Michaeli
>Kupat Holim Clalit
>101 Arlozorov st
>Tel Aviv 62098, Israel
><michaeli at netvision.net.il>


Leishmania infantum is the species causing nearly all cases of human
leishmaniasis in Spain, France and Italy.
In theese countries visceral leishmaniasis can be seen in infants, in HIV+
patients and in solid organ transplant recipients. Inmunocompetent adults
may develop cutaneous disease or may test positive with the Leishmanin test
without evidence of disease ( present or past). After succesfull treatment
of visceral leihsmaniasis HIV+ patients may develop focalized disease
involving "atypical" sites including skin tongue and larinx (personal
obsevations).
Our conclusion is that the clinical spectrum of human leishmaniasis results
from the interacion of the Leishmania-species-asociated virulence and and
host factors.
In the case of L. infantum, visceral disease will be developed in
individuals with inmature or defficient immune system while most
immunocompetent adults will develop cutaneous disease or subclinical
infection.
Exceptions to the above rule are well known, and the enzymotyping of
strains may eventually provide aditional insight into pathogen virulence,
but it seems very likely that host immunologic factors play a role as
important as species-related virulence in the clinical presentation of
disease.
P. Martín-Rabadán
Servicio de Microbiología/Enfermedades Infecciosas
Hospital General Universitario Gregorio Marañón
C/Doctor Esquerdo 46
Madrid 28007