Dipartimento di Scienze per la promozione della Salute e Materno-infantile, Università di Palermo, Palermo, Italy.
BMC Infect Dis. 2019 Apr 18;19(1):328. doi: 10.1186/s12879-019-3947-x.
Visceral leishmaniasis is a vector-borne parasitic disease caused by protozoa belonging to the genus Leishmania. The clinical presentation of visceral leishmaniasis strictly depends on the host immunocompetency, whereas depressive conditions of the immune system impair the capability to resolve the infection and allow reactivation from sites of latency of the parasite.
We describe a case of visceral leishmaniasis (VL) that occurred in a patient with chronic hepatitis C treated with direct-acting antiviral drugs (DAA). The hypothesized mechanism is the alteration of protective inflammation mechanisms secondary to DAA therapy. Downregulation of type II and III IFNs, their receptors, which accompany HCV clearance achieved during treatment with sofosbuvir and ribavirin might have a negative impact on a risk for reactivation of a previous Leishmania infection. We know indeed that IFN-γ is important to enhance killing mechanisms in macrophages, which are the primary target cells of Leishmania.
Since VL is endemic in Sicily as well as in other countries of the Mediterranean basin, physicians should be aware of the possible unmasking of cryptic Leishmania infection by DAAs.
内脏利什曼病是一种由原生动物属利什曼原虫引起的虫媒寄生虫病。内脏利什曼病的临床表现严格取决于宿主的免疫能力，而免疫系统的抑郁状态会削弱其清除感染的能力，并导致寄生虫潜伏部位的重新激活。
我们描述了一例慢性丙型肝炎患者在接受直接作用抗病毒药物（DAA）治疗后发生内脏利什曼病（VL）的病例。假设的机制是 DAA 治疗继发保护性炎症机制的改变。在索磷布韦和利巴韦林治疗期间清除 HCV 时，II 型和 III 型 IFN 及其受体的下调可能对先前利什曼原虫感染的再激活风险产生负面影响。我们确实知道 IFN-γ 对于增强巨噬细胞中的杀伤机制很重要，巨噬细胞是利什曼原虫的主要靶细胞。
由于 VL 在西西里岛以及地中海盆地的其他国家流行，医生应该意识到 DAA 可能会使隐匿性利什曼原虫感染显现出来。
