Leishmaniasis in HIV-infected patients: difficulties in diagnostics and treatment

In this article, leishmaniasis is considered in the context of HIV infection, in which this disease appears to be an opportunistic. A general characteristic  of leishmaniasis is given, and the features of the course of infection in immunodeficiency are also presented. In the example of clinical cases, issues featuring diagnostics and treatment  of leishmaniasis are reviewed, the mortality rate of which remains quite high. The accession of Crimea to Russia, the high prevalence of HIV infection in the world, as well as the annually increasing tourist flow to endemic countries, require physicians of all specialties to be aware of this disease. HIV patients deserve special attention, there are already a number of reports that people with HIV are diagnosed with visceral leishmaniasis and are at greater risk of infection than the general population. The manifestations of visceral leishmaniasis among patients with immunodeficiency, as a rule, do not differ from the classical course, however, depending on the degree of suppression of immunity, the disease can take on atypical forms, which complicates timely diagnosis and the appointment of adequate therapy. If the patient has HIV infection, prolonged fever of the wrong type, enlarged lymph nodes, spleen, liver, weight loss > 10%, progressive anemia, neutropenia, thrombocytopenia, hypoalbuminemia and data on stay in regions endemic for leishmaniasis, it is advisable to be tested for visceral leishmaniasis – puncture of bone marrow with staining of smears according to Romanovsky – Giemsa, staging of PCR punctate using a test system for leishmaniasis, and if positive results are obtained, the appointment of pentavalent antimony drugs, second-line  drugs – amphotericin B, liposomal amphotericin B or paromomycin.

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