Impact of a co-factor on the dynamics of Leishmania donovani infection: does HIV infection encourage the recurrence of visceral leishmaniasis following post-kala-azar dermal leishmaniasis?
Nandy, A.; Addy, M.; Maji, A.K.; Guha, S.K.
Annals of Tropical Medicine and Parasitology 98(6): 651-654
2004
ISSN/ISBN: 0003-4983 PMID: 15324473 DOI: 10.1179/000349804225021352Document Number: 237258
In June 2001, a 22-year-old male religious teacher from the central part of the city of Calcutta, West Bengal, India presented at the Central Kala-azar Laboratory of the Calcutta School of Tropical Medicine (CSTM), with extensive, depigmented skin lesions, some of which were discrete and some confluent. He developed VL 7 years before, when he had been treated with sodium antimony gluconate at the Medical College in Calcutta, and given 6 units of blood due to severe anaemia. On presentation, the skin lesions were non-itchy, non-anaesthetic and non-scaling. Leishmania donovani amastigotes were found in smears of skin and lymph node biopsies. A diagnosis of PKDL was made. The patient was treated with pentavalent antimony [Stibanate] at 500 mg/day for 120 days. Three months after hospital discharge, the patient returned to CSTM with a history of evening fevers for which he had received, from another institution, treatment against tuberculosis (TB). He had cervical lymphadenitis without hepato-splenomegaly. As a fine needle aspirate from a lymph node was found to contain acid-fast bacilli, he was treated with streptomycin, rifampicin, isoniazid and ethambutol. Once afebrile, the patient was again discharged. In December 2002, the patient presented again with emaciation, cough, fever, anaemia and hepato-splenomegaly. His sputum contain acid fast bacilli and amastigotes were seen in a smear of a bone marrow aspirate. The patient was found seropositive for HIV-1. Although VL responded to intramuscular treatment with pentamidine (4 mg/kg on alternate days for 30 days), the patient developed severe, uncontrolled, pulmonary TB and other AIDS-associated infections and died.