Visceral Leishmaniasis in HIV-Infected Patients in the South of France

By Dereure, J.; Reynes, J. et al. | Bulletin of the World Health Organization, March-April 1995 | Go to article overview

Visceral Leishmaniasis in HIV-Infected Patients in the South of France


Dereure, J., Reynes, J., Pratlong, F., Lamaury, I., Rioux, J. A., Janbon, F., Dedet, J. -P., Bulletin of the World Health Organization


Between 1989 and 1993, investigations by classical parasitological procedures of 139 HIV-infected adults living in visceral leishmaniasis (VL) endemic areas showed that 10 of them (7.2%) were positive for Leishmania (by stained smears and culture). In the same period we identified 15 VL cases in patients not infected with HIV. Thus, 40% (10/25) of our VL cases were associated with HIV infection.

Since 1985, about 400 cases of visceral leishmaniasis (VL) associated with AIDS--mainly from the Mediterranean region-- have been reported (1)(5); prevalence data of the co-infection in this endemic area are rarely available.

Methods and results

Since 1989, we systematically searched for VL --based on the recent CDC classification (2)-- in a cohort of HIV-infected adults who presented with prolonged fever of unexplained origin.

Several Grunwald-Giemsa-stained smears and NNN-medium cultures with bone marrow aspirate were carried out on 139 HIV-infected patients, 10 of whom were found to be infected with Leishmania (positive smears in 9 and positive cultures in all 10). These patients were aged 24 to 56 years, and presented with fever, pancytopenia, a raised erythrocyte sedimentation rate, and a CD4 count of <200 per cu.mm. The spleen was enlarged in five of the 10 patients. Leishmanial serological tests (indirect immunofluorescence and counter-immuno-electrophoresis) were positive in only four patients (Table 1).

[TABULAR DATA OMITTED]

The isoenzyme characterization of Leishmania isolates obtained from these 10 patients identified the following zymodemes of the L. infantum complex: MON-1, MON-29, MON-33 and MON-183. MON-1 is the common zymodeme found in VL of the Mediterranean countries. MON-29 and MON-33 zymodemes are responsible for localized cutaneous leishmaniasis in immunocompetent patients; they have nevertheless been found in co-infected VL--AIDS patients by others (3)(6). However, MON-183 zymodeme has only been reported so far in two VL--AIDS co-infected cases (7). The MON-29, MON-33 and MON-183 zymodemes vary slightly from the MON-1 zymodeme, differing in only two or three enzymes out of the 15 tested (7)(8).

Five of the 10 co-infected patients were living in the French department of Pyrenees-Orientales and occasionally travelled to Spain. Two were from Marseilles and three from the Cevennes region (south of France). One of the patients from Marseilles left the endemic area two years ago.

During the same observation period (1989--93), 15 VL cases (13 adults and 2 children) were diagnosed in our laboratory in patients not infected with HIV. The proportion of the VL--AIDS association in relation to the total number of VL cases found by our laboratory is 10/25 or 40%, which is comparable to that reported by others (4). …

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