Promed Message HIV/VL

[Marian Ulrich]

Jeffrey Shaw wrote:

> A ProMED-mail post [copy]
> <http://www.healthnet.org/programs/promed.html>
>
> 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>
> .................................jw

While not specifically related to the question, since it concerns a report from
the New World (Venezuela),  the study cited below clearly demonstrated that
visceral manifestations of leishmaniasis were caused in a patient infected with
HIV by a species of Leishmania  which is normally associated with (muco)
cutaneous disease:
--Hernández, D., N. Rodríguez, C. Martínez, L. García and J. Convit (1993)
Leishmania braziliensis causing visceral leishmaniasis in a patient with human
immunodeficiency virus infection, identified with the aid of the polymerase
chain reaction.  Trans. Roy. Soc. Trop. Med Hyg 87, 627-628.--
The most obvious interpretation would be that visceralization occurred because
of the absence of an adequate cell-mediated immune response and failure to
localize the infection at the cutaneous level.  I don't have the article at
hand--the authors may have suggested other possible interpretations of their
findings.

Marian Ulrich
Instituto de Biomedicina
Caracas, Venezuela
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