Clinical manifestations of visceral leishmaniasis associated with HIV infection: a retrospective study of 91 French cases

A retrospective study was conducted in France to determine the clinical fea tures of visceral leishmaniasis (VL) seen, between 1986 and 1997, in 91 pat ients co-infected with human immunodeficiency virus (HIV). Fever (87% of pa tients), splenomegaly (74%) and hepatomegaly (49%) mere common, 43% of the patients having all of these signs and only 9% having none of them. Amastig otes were reported in atypical locations in 31 (34%) of the patients, and 1 5 patients had only had their VL diagnosed following accidental discovery o f amastigotes in samples from their digestive tract and lungs tone), digest ive tracts only (11 patients), lungs only (two), or skin tone). Some of the digestive symptoms observed are probably attributable to the intestinal in fections with Leishmania. Overall, VL diagnosis mas fortuitous in 27% of th e subjects. Even in endemic areas, therefore, VL is not considered routinel y by physicians attempting diagnoses.