Atypical American visceral leishmaniasis caused by disseminated Leishmania amazonensis infection presenting with hepatitis and adenopathy

Department of Biochemistry, Universidade Federal do Rio Grande do Norte, CP 1624, Natal, RN 59072-970, Brazil.
Transactions of the Royal Society of Tropical Medicine and Hygiene (Impact Factor: 1.84). 02/2006; 100(1):79-82. DOI: 10.1016/j.trstmh.2005.06.025
Source: PubMed


Leishmania amazonensis is widely recognised as a cause of cutaneous leishmaniasis in Latin America, but it can also disseminate to produce atypical visceral leishmaniasis with hepatitis and lymphadenopathy. The patient, an 8-year-old Brazilian boy, presented with a febrile illness and hepatosplenomegaly, elevated liver enzymes and generalised adenopathy. Serological tests using antigens of L. chagasi, the typical cause of visceral leishmaniasis in Latin America, were inconclusive. Leishmania amazonensis was eventually isolated in a culture of a lymph node. The patient recovered fully after treatment with meglumine antimoniate. As this case illustrates, L. amazonensis produces a spectrum of disease that includes atypical American visceral leishmaniasis with evidence of hepatocellular injury and generalised lymphadenopathy.

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    • "Furthermore, the proper identification of parasite species through highly sensitive and specific alternative techniques such as RFLP-PCR is of epidemiological and clinical importance. This is particularly true in areas where Leishmania amazonensis could be present, such as Argentina (Frank et al. 2003), as well as MS (Lima Junior et al. 2009), where it could be infecting Lu. longipalpis (Savani et al. 2009), a species that is also capable of transmitting VL (Almeida et al. 1996, Aleixo et al. 2006, Tolezano et al. 2007). "
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    ABSTRACT: In this study, a genotypification of Leishmania was performed using polimerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and sequencing techniques to identify species of Leishmania parasites in phlebotomine sand flies and dogs naturally infected. Between January-February of 2009, CDC light traps were used to collect insect samples from 13 capture sites in the municipality of Posadas, which is located in the province of Misiones of Argentina. Sand flies identified as Lutzomyia longipalpis were grouped into 28 separate pools for molecular biological analysis. Canine samples were taken from lymph node aspirates of two symptomatic stray animals that had been positively diagnosed with canine visceral leishmaniasis. One vector pool of 10 sand flies (1 out of the 28 pools tested) and both of the canine samples tested positively for Leishmania infantum by PCR and RFLP analysis. PCR products were confirmed by sequencing and showed a maximum identity with L. infantum. Given that infection was detected in one out of the 28 pools and that at least one infected insect was infected, it was possible to infer an infection rate at least of 0.47% for Lu. longipalpis among the analyzed samples. These results contribute to incriminate Lu. longipalpis as the vector of L. infantum in the municipality of Posadas, where cases of the disease in humans and dogs have been reported since 2005.
    Full-text · Article · Sep 2010 · Memórias do Instituto Oswaldo Cruz
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    • "Afterward, Leishmania amazonensis and Leishmania guyanensis were also isolated from Argentinean TL human cases (Marco et al. 2005). L. amazonensis can disseminate from the cutaneous ulcers to produce atypical visceral leishmaniasis with hepatitis and lymphadenopathy (Aleixo et al. 2006). However, the risk of VL transmission changed when Paraguay reported an autochthonous human case during 2000 in Asunción, just across the border with Clorinda city, Formosa, Argentina. "
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    ABSTRACT: An eight-year old boy from Posadas (27 masculine 23'S, 55 masculine 54'W) was diagnosed with visceral leishmaniasis (VL) during 2006. Lutzomyia longipalpis was discovered in the backyard of his house, while the spread of canine visceral leishmaniasis was confirmed in Posadas. This is the southernmost report of a VL transmission focus and the first in Argentina.
    Preview · Article · Mar 2008 · Memórias do Instituto Oswaldo Cruz
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    ABSTRACT: Leishmaniases remain a major public health problem today despite the vast amount of research conducted on Leishmania pathogens. The biological model is genetically and ecologically complex. This paper explores the advances in Leishmania genetics and reviews population structure, taxonomy, epidemiology and pathogenicity. Current knowledge of Leishmania genetics is placed in the context of natural populations. Various studies have described a clonal structure for Leishmania but recombination, pseudo-recombination and other genetic processes have also been reported. The impact of these different models on epidemiology and the medical aspects of leishmaniases is considered from an evolutionary point of view. The role of these parasites in the expression of pathogenicity in humans is also explored. It is important to ascertain whether genetic variability of the parasites is related to the different clinical expressions of leishmaniasis. The review aims to put current knowledge of Leishmania and the leishmaniases in perspective and to underline priority questions which 'leishmaniacs' must answer in various domains: epidemiology, population genetics, taxonomy and pathogenicity. It concludes by presenting a number of feasible ways of responding to these questions.
    Preview · Article · Feb 2007 · Advances in Parasitology
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