Leishmaniosi viscerale e cutanea in ambito familiare. Problematiche clinico-terapeutiche

Objectives: A sicilian woman with visceral leishmaniasis (VL) and her daughter with cutaneous leishmaniasis (LC), both caused by L. infantum, were recently observed in our Hospital. Patients and methods A 45 years old sicilian woman (AB) was admitted to our Clinic because she has been felt asthenia, fever and hepatosplenomegaly for three months; previously she has been discharged from another Hospital. In our Clinic we executed another microscopic exam of bone marrow which proved numerous Leishmania species amastygoti. The patient was treated with intravenous liposomial amphotericin B without important side effects. During therapy her clinical conditions improved quickly; at the end of the cycle microbiologic exams were negative and serologic title decreased. AB's daughter (DS) had an itching cutaneous nodule in DS's right cheek for several months; microscopic exam of nodule biopsy proved the presence of Leishmania amastygotes. The girl was initially treated with itraconazole (200 mg/die) for a month without improvement; the nodule regressed only after two cycles of meglumina antimoniate. Results We examined bone marrow and skin biopsy respectively; both specimens coltures (agar-NNN and 'sloppy' Evans) resulted positive for L. infantum zimodema MON 1. Conclusions: It is necessary to search Leishmania in patients resident in endemic area and with symptoms characteristic of this illness. Therapy with liposomial amfotericin B is always more effective than antimonial derivate drug against visceral leishmaniasis, while treatment with glucantim or pentostam sometimes doesn't clear up cutaneous infection. Leishmania colture and the zimodema determination are of considerable diagnostic importance; the valuation of serologic test at the end of treatment is necessary to confirm the complete regression of leishmaniasis.