immunology of infectious and parasitic diseases - XXXVII Congress ...

VISCERAL LEISHMANIOSIS IN AN HIV-1-INFECTED CHILD IN SÃO PAULO
STATE, IMMUNOLOGICAL ASPECTS
PATRÍCIA RODRIGUES NAUFAL SPIR 1 , LOURDES APARECIDA ZAMPIERI
D‟ANDREA 2 , LUIZ EURIBEL PRESTES-CARNEIRO 3
Departamento de Infecto-Pediatria, Hospital Regional de Presidente Prudente,
SP 1 ; Laboratório Regional, Instituto Adolfo Lutz , PP, SP 2 ; Departamento de Pós
Graduação, Unoeste, PP, SP e Departamento de Infectologia, Hospital Ipiranga,
SP 3 .
INTRODUTION: Brazil was one of the first developing countries to adopt
measures against mother-to-child-transmission (MTCT) of HIV, and rates
decreased from 20% to 1-2% in some regions. The country contains about 80%
of individuals infected with Visceral Leishmaniosis (VL) in Latin America, and
the West region of São Paulo State faces an outbreak of the disease. The HIVinfection
increases the risk of developing VL by 100 to 2,320 times in endemic
areas. OBJECTIVE: to analyze immunological aspects of an HIV-infected, 11.4
years old girl, from Paulicéia, São Paulo, with a diagnosis of VL admitted in a
reference public hospital in an inner city of São Paulo State. METHODOLOGY
AND RESULTS: CD4, CD8 and HIV viral loads were determined by FACS and
PCR, respectively. VL diagnosis was obtained by Indirect Fluorescent Antibody
Test (IFAT), rK39 rapid test and bone marrow aspirate. The patient was
admitted with a diagnosis of AIDS, irregular antiretroviral therapy adhesion,
severe diarrhea, protein-caloric malnourishment, electrolyte disturbance, oral
and perineal candidiasis, precarious teething and depression. CD4/CD8
lymphocytes resulted in 28/801 cells/mL, respectively. HIV-viral load resulted in
45.089 copies/mL, and Neutrophilia, severe thrombocytopenia (18.000/mL) and
hypoalbuminemia (1,98 g/mL) was found. At day 17 o , she presented with
decrease of consciousness and hepatic dysfunction, and was sent to a
pediatrics critical care unit with clinical sepsis, and received antibiotics+human
IgG immunoglobulin. At day 23 o , she presented elevated fever and returned to
the pediatric critical care unity with a diagnosis of blood infection, sepsis of
fungal origin, cardiac and renal failure. Although a rapid test and IFAT for VL
resulted negative, liposomal amphotericin B was administered, and a VL bone
marrow aspirate resulted positive. The patient‟s symptoms improved, although a
relapse occurred and new doses of amphothericin were administered. The retreatment
was not sufficient to recover normal levels of platelets (p>0.05).