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Human leishmaniasis

M. Doherty M_Doherty at NIH.gov
Mon Oct 23 07:34:25 EST 1995

In article <46di69$9vv$1 at mhafm.production.compuserve.com>, Eberhard Kniehl
<100674.1442 at CompuServe.COM> wrote:

> Hi, to all !
> I don´t know very much about leishmaniasis and I´ve only seen a 
> few cases in humans (leishmaniasis is not very often seen here in 
> Germany). So please excuse my "stupid" question:
> My question is, whether there is the possibility of  relapsing 
> cutaneous leishmaniasis in humans. And if so, where do the 
> amastigotes reside ?
> Suppose the following hypothetic case:
> HIV-positive person from Sudan, staying in Germany since more 
> than 3 years (i.e. no recent contact to sandflies). No history of 
> leishmaniasis, but perhaps inapparent infection. Now multiple 
> cutaneous granuloma and ulcerations (head, neck, upper 
> extremities).
> Is "relapsing" leishmaniasis, due to immundeficiency,  
> "reasonable" in differential diagnosis ?

Reappearance of the parasite is certainly possible even in the absence of
immunodeficiency, although relatively rare.  As you have described, when
you get recurrence, itoften occourrs at different sites and often presents
with multiple lesions.  Although the parasite is often difficult to find,
it is probably never completely eliminated even in immunocompetent hosts.

If the the lesions do not respond to pentostam (or whatever equivalent you
have available) you might like to check on the availability of
experimental combined cytokine/drug treatment, which is being used on some
similar cases here in teh states.

Hope this helps.

Cheers, Mark Doherty

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