Indiana University Infectious Diseases Fellowship
12 Mar,
10 tweets, 5 min read
#idboardreview 40 M lived in refugee camps for decades, had 🐐 ,HIV undetectable on ART now w/ recent 20 lb Wt loss & 1 mo fever, chills, abd bloating, hypopigmented lesion on back. Diagnosis? #medEd #idmedEd #idtwitter 
Visceral #leishmaniasis Pathology demonstrated sheets of histiocytes with numerous intracytoplasmic amastigotes. Giemsa stain of touch imprints revealed numerous organisms with kinetoplasts consistent with leishmania amastigotes
#leishmaniasis dimorphic lifecycle w/ amastigote stage in sand fly transmitted w/blood meal. amastigote phagocytosed ➡️promastigote➡️survives➡️multiply intracellularly➡️develops kinetoplast as outpouching of DNA at R angle to its nucleus which aids in identification
Visceral #leishmaniasis (Kala-Azar) widely distributed in Africa, Asia, South/Central America
-reservoir small mammals
-spectrum of disease from mild or asymptomatic to fever, weight loss, hepatosplenomegaly, diffuse lymphadenopathy, pancytopenia, and hypergammaglobulinemia
-reservoir small mammals
-spectrum of disease from mild or asymptomatic to fever, weight loss, hepatosplenomegaly, diffuse lymphadenopathy, pancytopenia, and hypergammaglobulinemia
A hypopigmented rash can occur with leishmaniasis which can be macular, papular, or nodular. This can manifest even after the completion of treatment when it is called post-kala-azar dermal #leishmaniasis.
Treatment liposomal amphotericin B is the drug of choice in the US. In people with HIV, ART should be started immediately. Combination therapy with amphotericin B and miltefosine is an option for refractory cases #leishmaniasis
Relapse rates⬆️CD4<200
-case series 78 pt: 100% of AIDS pts relapsed post dc amphotericin -PLWH any CD4 2ndry px w/ ampho⬇️relapse from 80%-50% at 12 mo
-In prospective series 27 pt w/ initial dx Cd4 <100 risk for relapse despite on 2ndry px while CD4 >200 no relapses
-case series 78 pt: 100% of AIDS pts relapsed post dc amphotericin -PLWH any CD4 2ndry px w/ ampho⬇️relapse from 80%-50% at 12 mo
-In prospective series 27 pt w/ initial dx Cd4 <100 risk for relapse despite on 2ndry px while CD4 >200 no relapses
PMID:1195849, 14739148, 18300698 #leishmaniasis #hiv
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