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. 2014 Oct 30:14:561.
doi: 10.1186/s12879-014-0561-9.

Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients

Matteo Vassallo  1 , Olivier Moranne  2   3   4 , Damien Ambrosetti  5 , Pierre-Yves Jeandel  6 , Christelle Pomares  7 , Elisabeth Cassuto  8 , Annick Boscagli  9 , Guillaume Giraud  10 , Nathalie Montagne  11 , Chiara Dentone  12 , Ilaria Demacina  13 , Barbara Villaggio  14 , Giovanni Secondo  15 , Giuseppe Ferrea  16 , Corinne Passeron  17 , Laurence Saudes  18 , Regis Kaphan  19 , Pierre Marty  20 , Eric Rosenthal  21
Affiliations

Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients

Matteo Vassallo et al. BMC Infect Dis. .

Abstract

Background: We describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings.

Cases presentation: Four HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete recovery of renal function after anti-parasitic treatment. Main clinical presentations were nephrotic or nephritic syndrome and/or acute renal failure secondary to membranoproliferative type III glomerulonephritis or acute interstitial nephritis. Clinical outcome was poor, probably as a consequence of insufficient immuno-virological control of the HIV infection.

Conclusions: Our findings suggest that the main histological findings in case of renal involvement due to Leishmania infantum infection in HIV-infected patients are type III MPGN and acute interstitial nephritis, with a histological specificity similar to that observed in canine leishmaniasis. Poor immune status in HIV-infected patients, altering the capacity for parasite clearance, and prolonged course of chronic active VL in this population may lead to the development of specific renal lesions.

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Figures

Figure 1
Figure 1
Main histological findings in patient 2, who had type III membrano-proliferative glomerulonephritis (MPGN). A. Cortical kidney inflammation (PAS x1000). B. Clusters of circulating Leishmania free parasytes in capillary (arrow) (Trichrome stain x1000). C. Prominent double contour formations (arrow) (Silver stain x1000). D. Basement membrane spikes (Silver stain x1000).
Figure 2
Figure 2
Main histological results in patient 3, who presented acute interstitial nephritis without glomerular involvement. A. Acute interstitial nephritis: oedema associated with an infiltration of interstitial lymphoplasmacytoid cells (Arrowhead). Tubules are invaded by lymphocytes (Arrow). Glomeruli are uninvolved. (PAS x200). B. Free Leishmania in interstitial tissue (PAS x1000).
Figure 3
Figure 3
Description of renal biopsy results for patient 4, who presented type III MPGN. A. Inflammation within the cortical kidney (PAS x100). B. Giant cell granuloma. (HE stain x 400).
See this image and copyright information in PMC

References

    1. Berman JD. Human leishmaniasis: clinical, diagnostic and chemotherapeutic developments in the last 10 years. Clin Infect Dis. 1997;24(Suppl 4):684–703. doi: 10.1093/clind/24.4.684. - DOI - PubMed
    1. Alvar J, Cañavate C, Gutiérrez-Solar B, Jiménez M, Laguna F, López-Vélez R, Molina R, Moreno J. Leishmania and human immunodeficiency virus co-infection: the first 10 years. J Clin Microbiol Rev. 1997;10:298–319. - PMC - PubMed
    1. Oliveira CMC, Oliveira MLMB, Andrade SCA, Girao CS, Ponte CN, Mota MU, Fernandes PFCBC, Campos HH, Esmeraldo RM, Evangelista JB., Jr Visceral leishmaniasis in renal transplant recipients: clinical aspects, diagnostic problems, and response to treatment. Transplant Proc. 2008;40(Suppl 3):755–760. doi: 10.1016/j.transproceed.2008.02.039. - DOI - PubMed
    1. Alvar J, Velez ID, Bern C, Herrero M, Desjeux P, Cano J, Jannin J, Den Boer M. Leishmaniasis worldwide and global estimates of its incidence. Plos One. 2012;7(suppl. 5):e35671. doi: 10.1371/journal.pone.0035671. - DOI - PMC - PubMed
    1. Pérez-Molina JA, López V, Guerrero A. Secondary prophylaxis for visceral leishmaniasis in HIV-infected individuals. Am J Med. 1997;102(Suppl 1):132. - PubMed