Tegumentary leishmaniasis and coinfections other than HIV,PLOS Neglected Tropical Diseases

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Tegumentary leishmaniasis and coinfections other than HIV
PLOS Neglected Tropical Diseases ( IF 3.4 ) Pub Date : 2018-03-01 , DOI: 10.1371/journal.pntd.0006125
Dalila Y Martínez _{1,

2,

3} , Kristien Verdonck _{1,

2} , Paul M Kaye ₄ , Vanessa Adaui ₁ , Katja Polman ₅ , Alejandro Llanos-Cuentas ₁ , Jean-Claude Dujardin _{5,

6} , Marleen Boelaert ₂

Affiliation

Background

Tegumentary leishmaniasis (TL) is a disease of skin and/or mucosal tissues caused by Leishmania parasites. TL patients may concurrently carry other pathogens, which may influence the clinical outcome of TL.

Methodology and principal findings

This review focuses on the frequency of TL coinfections in human populations, interactions between Leishmania and other pathogens in animal models and human subjects, and implications of TL coinfections for clinical practice. For the purpose of this review, TL is defined as all forms of cutaneous (localised, disseminated, or diffuse) and mucocutaneous leishmaniasis. Human immunodeficiency virus (HIV) coinfection, superinfection with skin bacteria, and skin manifestations of visceral leishmaniasis are not included. We searched MEDLINE and other databases and included 73 records: 21 experimental studies in animals and 52 studies about human subjects (mainly cross-sectional and case studies). Several reports describe the frequency of Trypanosoma cruzi coinfection in TL patients in Argentina (about 41%) and the frequency of helminthiasis in TL patients in Brazil (15% to 88%). Different hypotheses have been explored about mechanisms of interaction between different microorganisms, but no clear answers emerge. Such interactions may involve innate immunity coupled with regulatory networks that affect quality and quantity of acquired immune responses. Diagnostic problems may occur when concurrent infections cause similar lesions (e.g., TL and leprosy), when different pathogens are present in the same lesions (e.g., Leishmania and Sporothrix schenckii), or when similarities between phylogenetically close pathogens affect accuracy of diagnostic tests (e.g., serology for leishmaniasis and Chagas disease). Some coinfections (e.g., helminthiasis) appear to reduce the effectiveness of antileishmanial treatment, and drug combinations may cause cumulative adverse effects.

Conclusions and significance

In patients with TL, coinfection is frequent, it can lead to diagnostic errors and delays, and it can influence the effectiveness and safety of treatment. More research is needed to unravel how coinfections interfere with the pathogenesis of TL.

中文翻译：

外皮利什曼病和 HIV 以外的合并感染

背景

外皮利什曼病（TL）是由利什曼原虫引起的皮肤和/或粘膜组织疾病。 TL患者可能同时携带其他病原体，这可能会影响TL的临床结果。

方法论和主要发现

本综述重点关注人群中 TL 合并感染的频率、动物模型和人类受试者中利什曼原虫与其他病原体之间的相互作用，以及 TL 合并感染对临床实践的影响。出于本综述的目的，TL 被定义为所有形式的皮肤利什曼病（局限性、播散性或弥漫性）和皮肤粘膜利什曼病。人类免疫缺陷病毒（HIV）合并感染、皮肤细菌重复感染以及内脏利什曼病的皮肤表现不包括在内。我们检索了 MEDLINE 和其他数据库，纳入了 73 条记录：21 项动物实验研究和 52 项人类受试者研究（主要是横断面研究和案例研究）。一些报告描述了阿根廷 TL 患者中克氏锥虫合并感染的频率（约 41%）和巴西 TL 患者中蠕虫病的频率（15% 至 88%）。关于不同微生物之间相互作用的机制已经探索了不同的假设，但没有出现明确的答案。这种相互作用可能涉及先天免疫与影响获得性免疫反应的质量和数量的调节网络。当并发感染引起相似的病变（例如，TL和麻风病），当不同的病原体存在于相同的病变中（例如，利什曼原虫和申克孢子丝菌），或者当系统发育上相近的病原体之间的相似性影响诊断测试的准确性时（例如，，利什曼病和查加斯病的血清学）。一些合并感染（例如蠕虫病）似乎会降低抗利什曼尼治疗的有效性，并且药物组合可能会导致累积的不良反应。