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NDT Advance Access originally published online on July 26, 2007
Nephrology Dialysis Transplantation 2007 22(12):3674; doi:10.1093/ndt/gfm520
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


A typical presentation of cutaneous leishmaniasis after renal transplantation

Email: masouza{at}ufu.br

Sir,

Leishmania parasites are transmitted to humans through the bite of sand flies and may cause visceral, cutaneous or mucocutaneous disease, with clinical features ranging from localized ulcers to systemic lethal disease. The mucocutaneous form is mostly found in Latin America and millions of people live in areas of active parasite transmission [1]. A 49-year-old female transplant recipient under immunosuppressive treatment developed multiple erythematous and painful lesions on the legs (Figure 1A). The diagnosis of leishmaniasis was confirmed by enzyme-linked immunoassay, immunofluorescence assay and immunohistochemistry, as well as by multiplex polymerase chain reaction (PCR) analysis as previously described [2]. Leishmania amastigotes were present in the lesions and PCR analyses revealed parasites from the L. braziliensis complex (Figure 1B). By conventional reverse transcriptase-PCR reaction (RT-PCR) [3] expression of IL-4 (Figure 1C) and IL-13 (Figure 1D) mRNA was demonstrated and IFN-gamma mRNA (Figure 1E) was not detected in the wound tissue. After 50 days, the wounds completely healed after treatment with amphotericin B [4]. No relapses were observed after 18 months of maintaining normal renal function. Treatment with amphotericin B was efficient and safe in the case studied, while the patient was taking a calcineurin inhibitor. Thus, in endemic areas for leishmaniasis, atypical skin lesions in immunosuppressed patients should be investigated for the presence of Leishmania parasites.


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  		Fig. 1. (A) Detail of an erythema present on the patient's leg. (B) Multiplex PCR analysis (MW), 100 bp molecular weight marker; lane 1, L. braziliensis complex (149 bp); lane 2, L. mexicana complex (218 bp); lane 3, L. donovani complex (351 bp), lane 4, negative control (no DNA); lane 5, T. cruzi DNA sample; lane 6, patient's sample. (C–E), Conventional RT-PCR analyses for IL4 (437 bp), IL13 (342 bp) and IFN{gamma} (257 bp) expression. MW, 100 bp molecular weight marker; lanes 1 and 2, negative (no cDNA) and positive controls, respectively; lane 3, patient's sample. GAPDH, Glyceraldehyde 3-phosphate dehydrogenase, used as internal control.

 

Fernando A. Vinhal1,2, Sandra R. Afonso-Cardoso2, Adriano G. Silva2, Cristiano G. Pereira2, Waldir Sousa1, Silvia M. Botelho1, Joao B. S. Souza1, Wellinton D. Silva1, Janethe D. O. Pena2 and Maria A. Souza2

1Servico de Nefrologia da
Santa Casa de Goiania,
Goiania, GO, Brazil
2Instituto de Ciencias
Biomedicas da Universidade
Federal de Uberlandia,
Uberlandia, MG, Brazil

Acknowledgement

This work was supported by CNPq, Brazil and by a grant from the Sustainable Sciences Institute (SSI), USA, to M.A.S.

Notes

See http://www.oxfordjournals.org/our_journals/ndtplus/

References

  1. Alvar J, Yactayo S, Bern C. Leishmaniasis and poverty. Trends Parasitol (2006) 22:552–557.[CrossRef][Web of Science][Medline]
  2. Harris E, Kropp G, Belli A, Rodriguez B, Agabian N. Single-step multiplex PCR assay for characterization of new world Leishmania complexes. J Clin Microbiol (1998) 36:1989–1995.[Abstract/Free Full Text]
  3. Gomes MA, Rodrigues FH, Afonso-Cardoso SR, et al. Levels of immunoglobulin A1 and messenger RNA for interferon-gamma and tumor necrosis factor-alpha in total saliva from patients with diabetes mellitus type 2 with chronic periodontal disease. J Periodontal Res (2006) 41:177–183.[CrossRef][Web of Science][Medline]
  4. Davidson RN. Practical guide for the treatment of leishmaniasis. Drugs (1998) 56:1009–1018.[CrossRef][Web of Science][Medline]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
22/12/3674-a    most recent
gfm520v1
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