PMID- 19815866
OWN - NLM
STAT- MEDLINE
DCOM- 20091027
LR  - 20131121
IS  - 1476-1645 (Electronic)
IS  - 0002-9637 (Linking)
VI  - 81
IP  - 4
DP  - 2009 Oct
TI  - Tegumentary leishmaniasis as the cause of immune reconstitution inflammatory 
      syndrome in a patient co-infected with human immunodeficiency virus and 
      Leishmania guyanensis.
PG  - 559-64
LID - 10.4269/ajtmh.2009.09-0077 [doi]
AB  - We report a case of immune reconstitution inflammatory syndrome (IRIS) in a 
      32-year-old man infected with human immunodeficiency virus and Leishmania 
      guyanensis. Three months after initiation of highly active anti-retroviral 
      therapy (HAART), the patient had disseminated cutaneous leishmaniasis and started 
      anti-leishmanial therapy. The patient's leishmaniasis manifestations during HAART 
      ranged form an anergic response (46 CD4+ T cells/microL) to a disseminated 
      cutaneous leishmaniasis (112 CD4+ T cells/microL). Eight weeks later (168 CD4+ T 
      cells/microL, skin biopsy specimens showed inflammatory infiltrates with no 
      detectable amastigotes. The patient then became comatose. Prednisone therapy (60 
      mg/day) was initiated with a significant improvement within 48 hours. Three 
      months later (CD4+ T cell count = 184 cell/microL), localized, classic, cutaneous 
      leishmaniasis developed in the patient and anti-leishmanial treatment was 
      re-introduced. On that occasion, frequency of T regulatory cells was 1.82% of all 
      CD4+ cells. Our data suggest a pivotal role for CD4+ T cells in the onset of IRIS 
      and lesion ulceration and their association with a low frequency of T regulatory 
      cells.
FAU - Chrusciak-Talhari, Anette
AU  - Chrusciak-Talhari A
AD  - Fundacao de Medicina Tropical do Amazonas, Manaus, Amazonas, Brazil.
FAU - Ribeiro-Rodrigues, Rodrigo
AU  - Ribeiro-Rodrigues R
FAU - Talhari, Carolina
AU  - Talhari C
FAU - Silva, Roberto Moreira Jr
AU  - Silva RM Jr
FAU - Ferreira, Luis Carlos de Lima
AU  - Ferreira LC
FAU - Botileiro, Simone Ferreira de Castro
AU  - Botileiro SF
FAU - Santos, Lucilaide Oliveira
AU  - Santos LO
FAU - Dietze, Reynaldo
AU  - Dietze R
FAU - Talhari, Sinesio
AU  - Talhari S
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Am J Trop Med Hyg
JT  - The American journal of tropical medicine and hygiene
JID - 0370507
RN  - 0 (Anti-Infective Agents)
RN  - 0 (Anti-Inflammatory Agents)
RN  - VB0R961HZT (Prednisone)
SB  - IM
MH  - Adult
MH  - Animals
MH  - Anti-Infective Agents/therapeutic use
MH  - Anti-Inflammatory Agents/therapeutic use
MH  - Antiretroviral Therapy, Highly Active
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications/drug 
      therapy/parasitology/virology
MH  - *Leishmania guyanensis
MH  - Leishmaniasis, Mucocutaneous/*complications/drug therapy/*parasitology
MH  - Male
MH  - Prednisone/therapeutic use
MH  - Skin/pathology
EDAT- 2009/10/10 06:00
MHDA- 2009/10/29 06:00
CRDT- 2009/10/10 06:00
PHST- 2009/10/10 06:00 [entrez]
PHST- 2009/10/10 06:00 [pubmed]
PHST- 2009/10/29 06:00 [medline]
AID - 81/4/559 [pii]
AID - 10.4269/ajtmh.2009.09-0077 [doi]
PST - ppublish
SO  - Am J Trop Med Hyg. 2009 Oct;81(4):559-64. doi: 10.4269/ajtmh.2009.09-0077.