Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.
Department of Clinical Sciences, Institute of Tropical Medicine, University Hospital Antwerp, Belgium.
Lancet Infect Dis. 2015 Jan;15(1):122-9. doi: 10.1016/S1473-3099(14)70833-3. Epub 2014 Oct 7.
In regions where it is endemic, visceral leishmaniasis is an important opportunistic infectious disease in people living with HIV. Typically, clinical presentation of visceral leishmaniasis includes chronic fever, hepatosplenomegaly, and weight loss. In Leishmania infantum endemic regions in Europe, atypical visceral leishmaniasis presentations have been well documented, with almost every possible organ involved. However, such reports are rare in Leishmania donovani endemic regions such as east Africa. In this Personal View, we describe the various atypical disease presentations in patients screened as part of an HIV and visceral leishmaniasis clinical trial in north Ethiopia, where up to 40% of patients with visceral leishmaniasis are co-infected with HIV. Atypical presentations such as these are not covered in clinical guidelines used in these settings. Apart from the lack of diagnostic facilities, this gap contributes to the underdiagnosis of atypical visceral leishmaniasis, with associated morbidity and mortality. Involvement of clinicians experienced with the management of HIV and visceral leishmaniasis co-infection in the development of HIV clinical guidelines in affected regions is warranted.
在流行地区，内脏利什曼病是 HIV 感染者中一种重要的机会性感染性疾病。内脏利什曼病的典型临床表现包括慢性发热、肝脾肿大和体重减轻。在欧洲利什曼原虫流行地区，已有大量关于不典型内脏利什曼病表现的记载，几乎涉及到每一个可能的器官。然而，在东非等利什曼原虫流行地区，此类报告却很少见。在这篇个人观点中，我们描述了在埃塞俄比亚北部进行的一项 HIV 和内脏利什曼病临床试验中筛查的患者中出现的各种不典型疾病表现，在这些患者中，高达 40%的内脏利什曼病患者同时感染了 HIV。这些不典型表现并未涵盖在这些环境中使用的临床指南中。除了诊断设施的缺乏之外，这种差距导致了不典型内脏利什曼病的漏诊，从而导致发病率和死亡率增加。在受影响地区，有必要让具有 HIV 和内脏利什曼病合并感染管理经验的临床医生参与制定 HIV 临床指南。
