National Reference Unit for Tropical Diseases, WHO Collaborating Centre for Clinical Management of Leishmaniasis, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS. CIBERINFEC, Madrid, Spain.
Curr Opin Infect Dis. 2024 Oct 1;37(5):342-348. doi: 10.1097/QCO.0000000000001034. Epub 2024 Jul 8.
The number of cases of visceral leishmaniasis associated with transplant-associated immunosuppression has increased in recent years. Reviewing and updating the latest developments in its diagnostic management, treatment, and follow-up is necessary and relevant.
Visceral leishmaniasis cases associated with non-HIV immunosuppression are a growing cause of the parasitic infections, and the transplant patients are included in this context. These have been described especially in kidney transplantation. Liposomal amphotericin B is the first-line treatment. Due to immunosuppression, these patients often suffer from recurrent infections. The use of markers that indicate whether the patient has developed an adequate cellular response against Leishmania after treatment seems to be good biomarkers of cure and useful for monitoring and guiding secondary prophylaxis.
There is a lack of consensus regarding the need for leishmaniasis screening in donors and recipients and the indications for secondary prophylaxis. The study of new biomarkers of cure may be useful in all three contexts.
近年来，与移植相关免疫抑制相关的内脏利什曼病病例有所增加。有必要对其诊断管理、治疗和随访的最新进展进行回顾和更新。
与非 HIV 免疫抑制相关的内脏利什曼病病例是寄生虫感染的一个日益增长的原因，而移植患者也包括在这一范畴内。这些情况尤其在肾移植中有所描述。两性霉素 B 脂质体是一线治疗药物。由于免疫抑制，这些患者经常遭受复发性感染。使用表明患者在治疗后对利什曼原虫产生适当细胞反应的标志物似乎是治愈的良好生物标志物，有助于监测和指导二级预防。
对于供体和受体是否需要进行利什曼病筛查以及二级预防的适应证尚缺乏共识。对治愈新生物标志物的研究在这三个方面可能都很有用。
