Cutaneous leishmaniasis, leprosy, and tuberculosis are caused by intracellular pathogens whose development depends on impaired cell-mediated immunity. We report an exceptional triple association of ...American cutaneous leishmaniasis, lepromatous leprosy, and pulmonary tuberculosis in a man with no recognized immunodeficiency. Normal immunological assessment of the interferon-γ pathway does not support the hypothesis of a genetic defect in any of the genes involved in the T helper (Th)-1 cytokine cascade in this patient. Unresponsiveness to interleukin (IL)-12 of his T cells after stimulation with Leishmania guyanensis, Mycobacterium bovis bacille Calmette-Guérin, and Mycobacterium leprae antigens suggested the inability to mount an appropriate Th cell response to upregulate the IL-12 receptor expression.
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Demodecidosis is an ectoparasitosis that is infrequently observed in subjects with human immunodeficiency virus (HIV) infection. It has a rosacea‐like presentation. We present three cases in patients ...with acquired immunodeficiency syndrome (AIDS). Two of these patients had a profuse eruption, and all three cases were cured by ivermectin. The single‐dose treatment could be repeated in cases of subsequent recurrence. Ivermectin thus seems to be a good alternative in the treatment of demodecidosis in patients with HIV infection.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Background Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)‐infected patients.
Objectives To describe nine cases of ...cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV– patients with the forms of leishmaniasis commonly found in French Guiana.
Methods A case–control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV‐infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection.
Results Eight of the HIV‐infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV‐infected subjects. HIV–Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0·02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0·02) than did HIV– subjects. The CD4+ lymphocyte counts exceeded 200 mm−3 in all HIV+ patients at the time of the diagnosis with leishmaniasis.
Conclusions In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV‐infected subjects (> 200 CD4+ T cells mm−3) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV– subjects.
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The intralesional expression of cytokines (interleukin IL–4, IL-13, IL-10, and interferon-γ) was analyzed in 65 patients with localized cutaneous leishmaniasis due to Leishmania guyanensis before ...specific treatment with pentamidine isethionate. The local expression of IL-10 was significantly higher in patients who responded poorly to treatment than in patients whose lesions were regressing. When an IL-10 level >10 (ratio of the concentration of IL-10 pg/μL to that of β-actin pg/μL) was used as an indicator of treatment failure, the sensitivity of this test was 78.6, and the specificity was 72.5. Thus, high intralesional expression of IL-10 might predict a poor response to conventional treatment
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Disseminated cutaneous leishmaniasis is characterized by the presence of a large (> or =10) number of lesions at several anatomic sites (head, limbs, and trunk). Most of the lesions are small, ...papular, and appear simultaneously with or secondarily to one or several ulcerated lesions of localized cutaneous leishmaniasis. We report the first case of disseminated cutaneous leishmaniasis in French Guiana. It concerns a 24-year-old woman who tested negative for human immunodeficiency virus (HIV). The disease began with three lesions that became ulcerated. One week later, multiple papulo-nodular lesions appeared. We counted a total of 425 lesions. Leishmania were observed in the lesions. The species involved was L. guyanensis, which has never been described in a case of disseminated cutaneous leishmaniasis. The patient was rapidly cured by a single course of pentamidine. Disseminated cutaneous leishmaniasis should be distinguished from other types of leishmaniasis with multiple lesions. These include anergic diffuse cutaneous leishmaniasis, post-kala-azar leishmaniasis, and leishmaniasis associated with HIV infection.
Concurrent infection with Taenia solium and HIV would be expected to occur more frequently because of the increasing frequency of HIV infection in endemic areas of cysticercosis. However, little is ...known about the influence of HIV infection on the frequency and the clinical course of cysticercosis. Giant cysts and racemose forms of neurocysticercosis seem to be more frequent in HIV‐infected patients and may be secondary to an uncontrolled parasitic growth because of an impaired cell‐mediated immune response. We report an unusual case of epidural spinal racemose neurocysticercosis revealed by compression of cauda equina in an HIV‐infected man and discuss the potential interactions between T. solium and HIV infections.
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