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Multiple cutaneous nodules in an HIV-infected patient.

Phumee A, Chusri S, Kraivichian K, Wititsuwannakul J, Hortiwakul T, Thavara U, Silpapojakul K, Siriyasatien P - PLoS Negl Trop Dis (2014)

View Article: PubMed Central - PubMed

Affiliation: Medical Science Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

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He was diagnosed with disseminated cutaneous and visceral leishmaniasis 2 years previously and was treated with amphotericin B deoxycholate and itraconazole for leishmaniasis and with tenofovir, lamivudine, and nevirapine for HIV... Diagnosis of relapsed Leishmania siamensis infection in this patient was performed by microscopic examination, culture, and polymerase chain reaction (PCR)... Microscopic examination of tissue sections from his brow showed numerous intracellular organisms (Fig. 2A), and typical Leishmania amastigote parasites containing nucleus and kinetoplast were shown in a tissue biopsy that was submerged in Schneider's medium for two days and its sections then cut and stained with hematoxylin and eosin (H&E) (Fig. 2B)... Numerous promastigotes were also observed in culture... After a final diagnosis of nodular leishmaniasis was established, the patient received 1 mg/kg/day of intravenous amphotericin B deoxylate for 28 days, followed by 300 mg of oral itraconazole twice a day for 5 months... Globally, leishmaniasis is a significant cause of morbidity and mortality in several countries... The disease is often a coinfection among HIV patients, tourists, refugees, and military personnel as well as among residents of endemic areas... Leishmaniasis is usually found in HIV patients who have a CD-4+T cell level less than 200 cells/mm–... Samples used for PCR for L. siamensis include blood, bone marrow, tissue, urine, and saliva... Recently, Phumee and colleagues demonstrated that saliva is a good source for PCR detection of L. siamensis DNA... They also demonstrated that L. siamensis DNA levels in saliva decreased after treatment... Recurrence of L. siamensis infection after amphotericin B therapy occurred in some patients... As documented in, a seronegative girl was successfully treated for a recurrent L. siamensis infection after amphotericin B treatment by extending amphotericin B therapy from 3 weeks to 5 weeks and following it with 6 months of prophylaxis.

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Related in: MedlinePlus

Numerous intracellular amastigotes (arrows) shown in a tissue biopsy of nodule from brow (A) and in a section of tissue submerged in Schneider's insect medium (B) with H&E staining. N, nucleus; K, kinetoplast (magnification x1000).
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pntd-0003291-g002: Numerous intracellular amastigotes (arrows) shown in a tissue biopsy of nodule from brow (A) and in a section of tissue submerged in Schneider's insect medium (B) with H&E staining. N, nucleus; K, kinetoplast (magnification x1000).

Mentions: Diagnosis of relapsed Leishmania siamensis infection in this patient was performed by microscopic examination, culture, and polymerase chain reaction (PCR). Microscopic examination of tissue sections from his brow showed numerous intracellular organisms (Fig. 2A), and typical Leishmania amastigote parasites containing nucleus and kinetoplast were shown in a tissue biopsy that was submerged in Schneider's medium for two days and its sections then cut and stained with hematoxylin and eosin (H&E) (Fig. 2B). Numerous promastigotes were also observed in culture. PCR was performed using a primer set specific to the 18S rRNA gene of the internal transcribed spacer 1 (ITS1) of Leishmania spp. [1]. L. siamensis infection was identified by nucleotide sequencing and comparison with a sequence of L. siamensis reported previously (accession number JQ001751) and was shown to be 100% identical. After a final diagnosis of nodular leishmaniasis was established, the patient received 1 mg/kg/day of intravenous amphotericin B deoxylate for 28 days, followed by 300 mg of oral itraconazole twice a day for 5 months. The nodules regressed, and PCR detection of L. siamensis DNA in saliva and blood samples after the treatment was negative.


Multiple cutaneous nodules in an HIV-infected patient.

Phumee A, Chusri S, Kraivichian K, Wititsuwannakul J, Hortiwakul T, Thavara U, Silpapojakul K, Siriyasatien P - PLoS Negl Trop Dis (2014)

Numerous intracellular amastigotes (arrows) shown in a tissue biopsy of nodule from brow (A) and in a section of tissue submerged in Schneider's insect medium (B) with H&E staining. N, nucleus; K, kinetoplast (magnification x1000).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263422&req=5

pntd-0003291-g002: Numerous intracellular amastigotes (arrows) shown in a tissue biopsy of nodule from brow (A) and in a section of tissue submerged in Schneider's insect medium (B) with H&E staining. N, nucleus; K, kinetoplast (magnification x1000).
Mentions: Diagnosis of relapsed Leishmania siamensis infection in this patient was performed by microscopic examination, culture, and polymerase chain reaction (PCR). Microscopic examination of tissue sections from his brow showed numerous intracellular organisms (Fig. 2A), and typical Leishmania amastigote parasites containing nucleus and kinetoplast were shown in a tissue biopsy that was submerged in Schneider's medium for two days and its sections then cut and stained with hematoxylin and eosin (H&E) (Fig. 2B). Numerous promastigotes were also observed in culture. PCR was performed using a primer set specific to the 18S rRNA gene of the internal transcribed spacer 1 (ITS1) of Leishmania spp. [1]. L. siamensis infection was identified by nucleotide sequencing and comparison with a sequence of L. siamensis reported previously (accession number JQ001751) and was shown to be 100% identical. After a final diagnosis of nodular leishmaniasis was established, the patient received 1 mg/kg/day of intravenous amphotericin B deoxylate for 28 days, followed by 300 mg of oral itraconazole twice a day for 5 months. The nodules regressed, and PCR detection of L. siamensis DNA in saliva and blood samples after the treatment was negative.

View Article: PubMed Central - PubMed

Affiliation: Medical Science Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

He was diagnosed with disseminated cutaneous and visceral leishmaniasis 2 years previously and was treated with amphotericin B deoxycholate and itraconazole for leishmaniasis and with tenofovir, lamivudine, and nevirapine for HIV... Diagnosis of relapsed Leishmania siamensis infection in this patient was performed by microscopic examination, culture, and polymerase chain reaction (PCR)... Microscopic examination of tissue sections from his brow showed numerous intracellular organisms (Fig. 2A), and typical Leishmania amastigote parasites containing nucleus and kinetoplast were shown in a tissue biopsy that was submerged in Schneider's medium for two days and its sections then cut and stained with hematoxylin and eosin (H&E) (Fig. 2B)... Numerous promastigotes were also observed in culture... After a final diagnosis of nodular leishmaniasis was established, the patient received 1 mg/kg/day of intravenous amphotericin B deoxylate for 28 days, followed by 300 mg of oral itraconazole twice a day for 5 months... Globally, leishmaniasis is a significant cause of morbidity and mortality in several countries... The disease is often a coinfection among HIV patients, tourists, refugees, and military personnel as well as among residents of endemic areas... Leishmaniasis is usually found in HIV patients who have a CD-4+T cell level less than 200 cells/mm–... Samples used for PCR for L. siamensis include blood, bone marrow, tissue, urine, and saliva... Recently, Phumee and colleagues demonstrated that saliva is a good source for PCR detection of L. siamensis DNA... They also demonstrated that L. siamensis DNA levels in saliva decreased after treatment... Recurrence of L. siamensis infection after amphotericin B therapy occurred in some patients... As documented in, a seronegative girl was successfully treated for a recurrent L. siamensis infection after amphotericin B treatment by extending amphotericin B therapy from 3 weeks to 5 weeks and following it with 6 months of prophylaxis.

No MeSH data available.


Related in: MedlinePlus