Peters B S, Fish D, Golden R, Evans D A, Bryceson A D, Pinching A J
Department of Immunology, St. Mary's Hospital Medical School, London, UK.
Q J Med. 1990 Nov;77(283):1101-11. doi: 10.1093/qjmed/77.2.1101.
The development of visceral leishmaniasis with atypical features in an AIDS patient, and the recent flurry of reports of visceral leishmaniasis in HIV-infected individuals prompted the review of its manifestations in the 47 reported cases. Splenomegaly, which is almost always a feature of visceral leishmaniasis in the immunocompetent host, was absent in eight. Antibodies to Leishmania donovani, which are present in approximately 95 per cent of immunocompetent patients with visceral leishmaniasis, were absent in 29 of 45 (66 per cent) of HIV-infected patients tested. Nine HIV-positive patients with visceral leishmaniasis did not exhibit a primary clinical response to therapy with antimonials and of those who did show a response, relapse occurred in 13, at a mean 4.5 months after stopping therapy. Seventeen patients are known to have died often in association with respiratory disease; Leishmania was seen in one bronchial lavage specimen and in lung tissue in one post-mortem performed. In order to improve the prognosis of visceral leishmaniasis in HIV-infected patients diagnosis will have to be made earlier, taking account of the atypical features, and treatment will need to be improved, both initially and perhaps also by the use of long-term maintenance therapy.
一名艾滋病患者出现非典型内脏利什曼病，且近期有大量关于HIV感染者患内脏利什曼病的报道，促使我们对47例已报告病例的临床表现进行回顾。脾肿大在免疫功能正常的宿主中几乎总是内脏利什曼病的一个特征，但在8例患者中未出现。杜氏利什曼原虫抗体在约95%免疫功能正常的内脏利什曼病患者中存在，但在45例接受检测的HIV感染患者中有29例（66%）未检测到。9例患内脏利什曼病的HIV阳性患者对锑剂治疗未表现出初始临床反应，而那些有反应的患者中，13例复发，平均在停药后4.5个月复发。已知17例患者死亡，常与呼吸系统疾病相关；在一份支气管灌洗标本中以及在1例尸检的肺组织中发现了利什曼原虫。为改善HIV感染患者内脏利什曼病的预后，必须更早地进行诊断，考虑到非典型特征，并且需要改善治疗，包括初始治疗以及可能通过使用长期维持治疗。
