Disseminated leishmaniasis caused by Leishmania tropica in HIV-positive patients in the Islamic Republic of Iran

Abstract

Both cutaneous and visceral forms of leishmaniasis are prevalent in some parts of the Islamic Republic of Iran [1,2]. The Mediterranean type of visceral leishmaniasis (VL) is also reported sporadically throughout the country [3] with canines being the main animal reservoir hosts [4]. The cutaneous form of leishmaniasis is seen in 2 forms: anthroponotic and zoonotic. Anthroponotic cutaneous leishmaniasis (ACL) is caused by Leishmania tropica and is prevalent in many largeand medium-sized cities in the country [1,5]. Zoonotic cutaneous leishmaniasis (ZCL) is caused by L. major and is endemic in many foci in the north, east and south of the country [6]. Some studies have implicated L. tropica as another agent of VL in humans and dogs in reports from the north-west and south of the country [4,7,8]. Few data are available, however, about host immunological response and parasite destruction when leishmaniasis is associated with immunosuppressants. At present, the majority of cases of HIV– leishmaniasis co-infection reported in the Mediterranean basin were caused by L. infantum [9]. Disseminated leishmaniasis caused by L. tropica in patients with HIV infection is uncommon. Here, we report on 2 patients with HIV–leishmaniasis co-infection caused by L. tropica with generalized and multiple skin lesions and visceral involvement. This is the first such report from the Islamic Republic of Iran.