LEISHMANIASIS AND HIV INFECTION IN TIGRAY

Morrone A., Terranova M., Padovese V., Latini O.

21° WORLD CONGRESS OF DERMATOLOGY
Buenos Aires, 30 September – 5 October 2007

Background
Leishmaniasis is a parasitic disease widely distributed throughout the world and considered to be endemic in 88 countries: 72 of which are developing countries. It is believed that 350 million people are at risk, and 12 million people are affected by leishmaniasis worldwide. Of this, 1.5-2 million new cases are estimated to occur annually of which only 600,000 cases are officially reported.
AIDS and leishmaniasis, can interact in a vicious cycle of mutual aggravation. The outbreak of HIV/AIDS pandemic during the past 20 years has modified the clinical spectrum of infection by Leishmania spp. in co-infected patients at different levels. Leishmaniasis is considered an opportunistic infection in HIV positive patients and is included among the AIDS defining conditions.
Methods
We report cutaneous and muco-cutaneous leishmaniasis (CL, MCL) cases observed in the Italian Dermatological Hospital (IDH), Tigray region, northern Ethiopia, during the first 18 months’ medical activity (January 2005 – January 2007). The hospital gives service to a rural region of 4 million people. A dermatologist has examined patients and, to confirm the clinical diagnosis of leishmaniasis, taken specimens with fine needle aspiration technique (FNA) for microscopic examination and biopsy for histological confirmation.
Results
235 patients had a clinical diagnosis of CL or MCL (2,2% of the total skin infections) and all diagnoses were confirmed with fine needle aspiration and macroscopic observation, and/or histological examination.
The HIV test was performed in 176 cases and 112 were positive.
Discussion: Diffuse cutaneous leishmaniasis, atypical locations and unusual forms (ulcerative, erisipeloid, neoplastic etc.) have been reported as consequences of the parasitic dissemination to the skin and of the defect in cell-mediated immunity. A characteristic of HIV-associated leishmaniasis is the poor response to standard therapy and a chronic and relapsing course.
In Africa, the number of cases is expected to rise and is further impaired by social adversities like mass migration, displacement, civil unrest, and war. The real impact of HIV/Leishmania co-infection is probably being underestimated owing to con¬straints in surveillance and reporting of cases.
References
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2. Arya SC, Agarwal N., HIV/AIDS and leishmaniasis coinfection in Ethiopia. CMAJ. 2005 Oct 25;173(9):1067
3. Sinha P.K, Pandey K., Bhuttacharya S.K. Diagnosis and management of leishmania/HIV co-infection. Indian J Med Res 121, April 2005, pp 407-414