Global & Disaster Medicine

Fatal Visceral Leishmaniasis–like Disease

Maruyama et al. Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–like Disease, Brazil. Emerging Infectious Diseases DOI: 10.3201/eid2511.181548 (2019).

“…..During 2011–2012, we characterized 2 parasite strains, LVH60 and LVH60a, isolated from an HIV-negative man when he was 64 years old and 65 years old (Table; Appendix). Treatment-refractory VL-like disease developed in the man; signs and symptoms consisted of weight loss, fever, anemia, low leukocyte and platelet counts, and severe liver and spleen enlargements. VL was confirmed by light microscopic examination of amastigotes in bone marrow aspirates and promastigotes in culture upon parasite isolation and by a positive rK39 serologic test results. Three courses of liposomal amphotericin B resulted in no response. At the third hospital admission, the illness resembled diffuse cutaneous leishmaniasis, in which several disseminated papular skin lesions were observed (Appendix Figure 1, panel A), and a skin biopsy revealed macrophages filled with amastigotes (Appendix Figure 1, panel B), which his liver biopsy results also showed (Appendix Figure 1, panel C). During this third admission, the LVH60a strain was isolated from the skin. Dermal lesions known as post–kala-azar dermal leishmaniasis (PKDL) have rarely been reported in Brazil (13), and the clinical aspect of the disseminated papular skin lesions on this patient differed from the clinical presentation of PKDL. Because his illness did not respond to therapy, the patient underwent splenectomy. He died of disease and surgical complications...…”

Experimental infection of BALB/c mice with LVH60 and LVH60a clinical isolates obtained from a 64-year-old man with fatal visceral leishmaniasis–like illness, Brazil. LVH60 was isolated from bone marrow, LVH60a from a skin lesion biopsy. Female BALB/c mice were infected intravenously with 107 stationary-phase promastigotes. After 4 weeks of infection, spleen and liver samples were collected. Parasite loads were determined by a limiting dilution assay of spleen and liver homogenates and are expres

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