Chronic generalized fibrotic skin lesions from disseminated leishmaniasis caused by Leishmania martiniquensis in two HIV-infected patients from northern Thailand

Chiewchanvit, S. and Tovanabutra, N. and Jariyapan, N. and Bates, M. D. and Mahanupab, P. and Chuamanochan, M. and Tantiworawit, A. and Bates, P. A. (2015) Chronic generalized fibrotic skin lesions from disseminated leishmaniasis caused by Leishmania martiniquensis in two HIV-infected patients from northern Thailand. British Journal of Dermatology, 173 (3). pp. 663-670. ISSN 0007-0963

Abstract

BACKGROUND: Leishmaniasis is a newly emerging infection in Thailand. Most of the previous human cases have presented with the clinical features of visceral leishmaniasis and were mainly found in the south of Thailand. Here we report the first two patients from northern Thailand presenting with disseminated cutaneous leishmaniasis. OBJECTIVES: A full clinical investigation of both patients was carried out to determine the nature of the infection and, once leishmaniasis was confirmed by parasitological diagnosis, molecular methods were used to identify the species of parasite responsible. METHODS: Clinical investigations included taking of biopsy samples and histology. Parasitological diagnosis was performed by establishment of Leishmania promastigote cultures, and identification was performed by DNA sequencing of four independent gene loci (ribosomal RNA internal transcribed spacer 1; large subunit of RNA polymerase II; heat shock protein 70; RPL23a intergenic sequence). RESULTS: Both patients were HIV-infected with multiple cutaneous lesions and accompanying visceral leishmaniasis. They had similar cutaneous manifestations characterized by chronic generalized fibrotic lesions, which were more prominent on traumatic areas. The species of parasite was identified as Leishmania martiniquensis in both patients. This is a recently described species that is distinct and only distantly related to the classical agents of cutaneous leishmaniasis in Asia, L. major and L. tropica, or of visceral leishmaniasis, L. donovani and L. infantum. Each patient responded well to therapy with intravenous amphotericin B followed by oral itraconazole. CONCLUSIONS: L. martiniquensis is a cause of cutaneous leishmaniasis in Thailand. This article is protected by copyright. All rights reserved.