LEISHMANIASIS AND HIV INFECTION IN TIGRAY
Padovese V., Terranova M., Morrone A.
Dermatological care for all “A basic human right”
Addis Abeba, 1-4 November, 2006
Introduction: 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 – June 2006). 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, among these, 62 were confirmed with microscopic and histological examination.
The HIV test was performed in suspected cases.
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 coinfection is probably being underestimated owing to constraints in surveillance and reporting of cases.
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