Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Nov 1;36(13):1819-1827.
doi: 10.1097/QAD.0000000000003336. Epub 2022 Jul 16.

Immune recovery-related patterns of post kala-azar dermal and ocular leishmaniasis in people living with HIV

Stella Rousset  1 , Mathilde Zenou  1 , Aurélie Saunier  2 , Fanny Varenne  3 , Vincent Soler  3 , Emilie Tournier  4 , Léa Legrand  5 , Laurence Lachaud  6 , Pierre Buffet  7 , Antoine Berry  8   9 , Pierre Delobel  1   9 , Guillaume Martin-Blondel  1   9
Affiliations
Free article
Review

Immune recovery-related patterns of post kala-azar dermal and ocular leishmaniasis in people living with HIV

Stella Rousset et al. AIDS. .
Free article

Abstract

Objective: Post kala-azar dermal leishmaniasis (PKDL) is a rare complication of visceral leishmaniasis. We aimed at reporting PKDL cases in people living with HIV (PLHIV) and compare their characteristics based on whether PKDL occurred in the context of immune recovery under antiretroviral therapy (ART) or not.

Design: National survey and literature review.

Methods: We called for observations in France in October 2020 and performed a literature review from PubMed (Medline) and Web of Science up to December 2020. Two groups of patients were defined based on whether PKDL occurred in the context of immune recovery under ART (group 1) or not (group 2), and compared.

Results: Three PLHIV with PKDL identified in France in the last decade were described and added to 33 cases from the literature. Compared with group 2 (16/36, 44.4%), patients from group 1 (20/36, 55.6%) originated more frequently from Europe (12/20, 60% vs. 2/16, 12.5%; P = 0.0038), had higher median blood CD4 + cell counts (221/μl vs. 61/μl; P = 0.0005) and increase under ART (122/μl, interquartile range 73-243 vs. 33/μl, interquartile range 0-53; P = 0.0044), had less frequently concomitant visceral leishmaniasis (3/20, 15% vs. 8/12, 66.7%; P = 0.006), and a trend to more frequent ocular involvement (7/20, 35% vs. 1/16, 6.25%; P = 0.0531).

Conclusion: In PLHIV, PKDL occurs after a cured episode of visceral leishmaniasis as part of an immune restoration disease under ART, or concomitant to a visceral leishmaniasis relapse in a context of AIDS. For the latter, the denomination 'disseminated cutaneous lesions associated with visceral leishmaniasis' seems more accurate than PKDL.

PubMed Disclaimer

References

    1. Zijlstra EE, Musa AM, Khalil EAG, el-Hassan IM, el-Hassan AM. Postkala-azar dermal leishmaniasis . Lancet Infect Dis 2003; 3:87–98.
    1. el Hassan AM, Khalil EA, el Sheikh EA, Zijlstra EE, Osman A, Ibrahim ME. Post kala-azar ocular leishmaniasis . Trans R Soc Trop Med Hyg 1998; 92:177–179.
    1. Roustan G, Jiménez JA, Gutiérrez-Solar B, Gallego JL, Alvar J, Patrón M. Postkala-azar dermal leishmaniasis with mucosal involvement in a kidney transplant recipient: treatment with liposomal amphotericin B . Br J Dermatol 1998; 138:526–528.
    1. Zijlstra EE. PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses . PLoS Negl Trop Dis 2014; 8:e3258.
    1. Zijlstra EE. The immunology of postkala-azar dermal leishmaniasis (PKDL) . Parasit Vectors 2016; 9:464.

MeSH terms