HIV and American cutaneous leishmaniasis in the state of Sergipe: a study of the dissemination spectrum of co-infection

Abstract

In patients co-infected with HIV, American cutaneous leishmaniasis (ATL) commonly becomes widespread, in addition to presenting atypical and more severe manifestations due to immunosuppression. In these patients, the disease is characterized by multiple atypical lesions infested by parasites, affecting various body segments, and poor response to standard treatment, with a high rate of recurrence. The present study elucidates a description of a case admitted to the Hospital de Urgências de Sergipe (HUSE), with diagnostic and conduct analysis based on the literature referring to LTA-HIV co-infection. It is a JBA, 34 years old, male, HIV positive and with a previous diagnosis of pulmonary tuberculosis, in regular use of antiretroviral therapy and COXCIP, admitted to HUSE in 2018 with productive cough, yellowish discharge, daily fever and dyspnea on exertion for a long time. 2 weeks. He had hyperchromic macular lesions on the face and crusted ulcers with elevated edges of varying sizes in the upper limbs and trunk, diagnosed with ACL via biopsy of the lesions after negative serological test rk39 by immunosuppression. He denied regular use of prophylaxis for pneumocystosis and mycobacteria. Antibiotic therapy and a nasal O2 catheter were started. It is assumed, therefore, that the deviation from the Th1 cell response to the humoral Th2 type response in HIV patients is favorable to the spread of intracellular organisms such as leishmania. However, this clinical-immunological behavior of co-infection is poorly described in the literature. Still, J.B.A. showed an excellent therapeutic response to the use of liposomal amphotericin. The report of this case alerts to the clinical spectrum of co-infection and to a viable treatment option, especially in Sergipe, whose epidemiological expansion of diseases is evident.