Unusual Clinical Manifestations of Leishmania (L.) infantum chagasi in an HIV-coinfected Patient and the Relevance of ITS1-PCR-RFLP: A Case Report

  • De Godoy NATALIA SOUZA DE Laboratory of Investigation in Medical Parasitology, Clínicas Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil Dept. of Infectious and Parasitic Diseases, Clínicas Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
  • Aiello VERA DEMARCHI Laboratory of Pathological Anatomy, Hearth Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
  • de Souza REGINA MAIA Laboratory of Investigation in Medical Parasitology, Clínicas Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
  • Okay THELMA Laboratory of Seroepidemiology and Immunobiology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
  • Braz LUCIA MARIA ALMEIDA Laboratory of Parasitology, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
Keywords: Visceral leishmaniasis, HIV coinfeccion, Mucocutaneous manifestation, Leishmania (L.) infantum chagasi, RFLP

Abstract

Patients coinfected with Leishmania/HIV can develop atypical forms of visceral leishmaniasis (VL), making it indispensable to identify the etiological agent. We are presenting a postmortemspecie definition by ITS1-PCR-RFLP in a larynx tissue of a patient presented coinfectionLeishmania/HIV. This patient was from a leishmaniasis endemic region in São Paulo(SP), Brazil, and was diagnosed clinically with mucocutaneous leishmaniasis. Before a rK39immunochromatographic test positive, a tiny stored paraffin-embedded larynx tissue wasobtained post-mortem and submitted to 3 conventional PCR assays: kDNA (K20/K22 andRV1/RV2), and ITS1 (LITSR/ L5.8S). The last one was followed by RFLP (HaeIII) andanalyzed by 4% Metaphor agarose gel electrophoresis. Leishmania genus and Leishmania(Leishmania) subgenus were defined by kDNA-PCR, with K20/K22 (120 bp) and RV1/RV2(145 bp), respectively. ITS1-PCR-RFLP identified L. (L.) infantum chagasi species visualizedby the restriction patterns of 180, 70 and 50 bp. This case draws attention to the necessityfor a clear identification of the etiological agent causing infection, especially in endemicregions of cutaneous and visceral leishmaniasis, and particularly in patients with comorbiditieswho often present atypical forms of the disease. L. (L.) infantum chagasi, which is usuallyresponsible for VL, had changed its clinical spectrum for mucocutaneous. Unequivocalidentification was carried out by ITS-PCR-RFLP, therefore confirming rK39 result. Thesetechniques, which complemented each other, have a convenient cost-benefit ratio thatmakes them suitable to be applied in developing countries.

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Published
2018-12-22
How to Cite
1.
NATALIA SOUZA DE DG, VERA DEMARCHI A, REGINA MAIA de S, THELMA O, LUCIA MARIA ALMEIDA B. Unusual Clinical Manifestations of Leishmania (L.) infantum chagasi in an HIV-coinfected Patient and the Relevance of ITS1-PCR-RFLP: A Case Report. IJPA. 13(4):655-60.
Section
Case Report(s)