2015 - TID 2015 Conference


Transplant in the Tropics

3.3 - Leishmaniasis

Presenter: Wanessa T., Clemente, , Brazil
Authors: Wanessa T. Clemente


Overview

Leishmaniasis is a vector-bourne disease caused by Leishmania species, which may result in a heterogeneous group of illnesses, clinically divided in cutaneous and visceral forms. Worldwide, it presents an estimated frequency of 1.3 million new cases per year. Tropical and Mediterranean countries are considered endemic areas. Cutaneous Leishmaniasis (CL) incidence is greater than Visceral Leishmaniasis (VL), respectively one million cases/year and 0.2 to 0.4 million cases/year. On the other hand, in transplant recipients VL is the predominant form, with prevalence ranging from 0.1% to 0.5% in endemic countries. Infection occurs through the vector bite or can be transmitted by the transplanted organ or blood transfusion. Only one-third of the patients with VL exhibited the triad of fever, visceromegaly and cytopenia. CL is often similar to immunocompetent individuals but atypical features show parasite dissemination, clinical polymorphism and visceralisation. Combination of multiple methods is recommended for diagnosis. As the recommended treatment varies by species, species identification should be pursued. Treatment options are diverse and depend on patient feature, Leishmania specie, extension of disease, drug availability, concomitant infections or previous treatments. Immunosuppressants reduction and secondary prophylaxis may be recommended, but decisions must be individualized. Serologic screening of recipients or donors is not routinely done, but active disease should be ruled out.

Objectives

  1. Geography of Leishmaniasis
  2. Who and when to screen or monitor (donor and recipient)?
  3. Clinical presentation on transplant recipients
  4. Which test to use for diagnosis?
  5. What are the treatment options?
  6. Should prophylaxis be considered?

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