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  • Title: AA-amyloidosis caused by visceral leishmaniasis in a human immunodeficiency virus-infected patient.
    Author: de Vallière S, Mary C, Joneberg JE, Rotman S, Bullani R, Greub G, Gillmore JD, Buffet PA, Tarr PE.
    Journal: Am J Trop Med Hyg; 2009 Aug; 81(2):209-12. PubMed ID: 19635871.
    Abstract:
    AA-amyloidosis in the setting of chronic visceral leishmaniasis (VL) has been reported in animal models but documentation in humans is unavailable. Here, we report on a Portuguese man who in 1996 was diagnosed with both human immunodeficiency virus (HIV)-infection and VL. Antiretroviral treatment led to sustained suppression of HIV viremia but CD4+ lymphocytes rose from 8 to only 160 cells/mL. Several courses of antimony treatment did not prevent VL relapses. Renal failure developed in 2006 and renal biopsy revealed AA-amyloidosis. The patient had cryoglobulinemia and serum immune complexes containing antibodies directed against seven leishmanial antigens. Antimony plus amphotericin B, followed by oral miltefosine resulted in a sustained VL treatment response with elimination of circulating Leishmania infantum DNA and CD4+ recovery. The concomitant reduction of serum AA levels and disappearance of circulating leishmanial immune complexes suggests that prolonged VL may lead to AA-amyloidosis in immunocompromised humans.
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