You are currently viewing Case Manager case studies. For other discipline-specific case studies, navigate using the left menu. Join our CME mailing list! High-risk heterosexual contact was her only risk factor for HIV acquisition.
In turn, VL might promote the clinical progression of HIV and of AIDS-defining conditions, thus, reducing the possibility of recovery after treatment and increasing the incidence of relapse After the first co-infection, by means of clinical and laboratory support, a follow-up protocol of the patient should be created for early detection of relapse and re-infection.
Additionally, in some cases a chronic course with multiple occurrences might take place. This represents an important predictor of relapse. In our case, only the 6th and 7th episodes were able to have the peripheral blood PB analyzed by PCR, which showed positive results for Leishmania spp.
Despite the medical importance of a clinical and laboratory monitoring of coinfected patients, this practice is still little used 12 19 ART plays an important role in reducing the effect of opportunistic diseases and in recent studies has shown a reduction in the incidence of VL.
The increased survival resulting from ART might partially explain the high incidence of relapse observed in this population In the present study, during the eight years of follow-up, we observed seven VL infections, despite the patient receiving ART before the first infection.
VL manifestations associated with HIV infection might appear in a classical form, particularly in patients from VL-endemic areas, as well as with relatively aggressive symptoms that are sometimes non-specific and difficult to clinically diagnose This patient presented classic clinical manifestations during the study period, although inwe observed the formation of skin lesions because of the parasite, as assessed by histopathological analysis.
Among the previously treated VL cases, several patients present a skin condition characterized by macular, popular, or nodular lesions, called Post-kala-azar dermal Leishmaniasis PKDL caused by the amastigotes of Leishmania donovani on the Indian subcontinent India, Nepal, Bangladesh and east Africa Sudan, Ethiopia, Kenya and caused by Leishmania chagasi in South America where it is rarely reported, as well as its presence in HIV positives 2 4 23 It is worth noticing that exclusive involvement of the skin is an unusual condition, because the simultaneous appearance of skin lesions along with other VL manifestations was more frequently observed In this case, the skin lesion suggests a clinical PKDL, which developed five years after the first VL episodes, administration of multiple therapeutic regimens, and treatments of discontinuous secondary prophylaxis.
Although it has been viewed amastigotes in biopsy specimens obtained from skin lesions, the hypothesis of PKDL can be suggested but not stated categorically because there was no characterization of Leishmania species involved in the cutaneous lesions, and may have been an infection of some sort cutaneous Leshmania endemic to the region as L.
Polymerase chain reaction PCR in peripheral blood and bone marrow is a useful tool to diagnose, for follow-up, and detect relapses Although the literature shows that serological analyses are not the most convenient in patients presenting co-infection 1 6two serological tests direct agglutination test and rKbased rapid immunochromatographic test performed enabled the diagnosis of such cases in and In the same years, latex agglutination test and PCR test showed positive results, thus, confirming the data in the literature.
There is currently sufficient evidence suggesting that secondary prophylaxis provides some protective effect but does not completely prevent the occurrence of relapse Based on this case study and literature review, it is evident that co-infection presents typical clinical, diagnostic, and therapeutic features, and can be observed in the prognosis of the disease.
Therefore, prospective studies are required to clarify gaps such as the efficacy of secondary prophylaxis and need for clinical and laboratory monitoring tools for the early assessment of relapse or re-infection.
Leishmania and human immunodeficiency virus coinfection: Discontinuation of secondary anti-Leishmania prophylaxis in HIV-infected patients who have responded to highly active antiretroviral therapy.
Post kala-azar dermal leishmaniasis associated with AIDS. Braz J Infect Dis. Long-term monitoring of visceral leishmaniasis in patients with AIDS: J Acquir Immune Defic Syndr.Revista do Instituto de Medicina Tropical de São Paulo CASE STUDY OF A PATIENT WITH HIV-AIDS AND VISCERAL LEISHMANIASIS CO-INFECTION IN MULTIPLE EPISODES.
Estudo de caso de paciente com múltiplos episódios da coinfecção HIV-AIDS e leishmaniose visceral. ANALYSIS OF CASE STUDIES The HIV/AIDS epidemic represents a growing health hazard for human populations worldwide. Globally, more than 60 million people have been afflicted with the disease and 25 million have already died.
Case A year-old male inmate with stage C3 HIV/AIDS presents with loose, watery stools, abdominal cramping, sweats, fevers, poor appetite (2 months) and 15 lbs weight loss. ♦Studies are conflicting regarding whether PTSD by itself is associated with non-adherence to ARVs. Three studies found reduced adherence, two found no impact, and one study found increased adherence.
♦PTSD is comorbid with many other mental illnesses, including depression and alcohol/substance use disorders which do interfere with adherence. JK was aware that if patients with HIV/AIDS lose more than 10% of their body weight, they need nutritional supplementation.
The case manager reassured her by telling her that she was doing well, to get plenty of rest, and to keep up the good work.
The Newly Diagnosed Patient with HIV Case Study (continued) After the patient tested negative for other STDs, the gynecologist referred her to a physician who specializes in HIV/AIDS management, and advised her to contact her insurance health plan to check if she qualified for case management services since she can greatly benefit from it.