VISCERAL LEISHMANIASIS EMERGING AS AN IMPORTANT OPPORTUNISTIC INFECTION IN HIV-INFECTED PERSONS LIVING IN AREAS NONENDEMIC FOR LEISHMANIA-DONOVANI

Background.-Visceral leishmaniasis is an important infection in patien ts infected with human immunodeficiency virus and living in areas ende mic for Leishmania sp. Leishmaniasis, however, is rarely suspected in patients residing in nonendemic countries. Methods.-Retrospective case analysis of 15 patients with human immunodeficiency virus infection a nd leishmaniasis treated at seven German clinics. The clinicopathologi cal features and the diagnostic role of biopsy and/or cytology as comp ared to serology, were evaluated. Results.-All patients were severely immunocompromised. One patient was first diagnosed at autopsy. One pat ient with mucocutaneous disease was diagnosed by nasal biopsy. Ail oth ers had amastigotes detected in bone marrow (13/13), liver (3/3), and gastrointestinal mucosa (4/4). Serology was positive in only 6 of 13. Conclusion.-Visceral leishmaniasis is an important opportunistic infec tion in patients with acquired immunodeficiency syndrome and it must b e ruled out in every patient with fever and/or pancytopenia and an app ropriate travel history. Because serological diagnosis is often insuff icient, pathologists must be aware of the association between human im munodeficiency virus infection and leishmaniasis. Diagnosis depends on detection of the parasite in submitted specimens.