Background: Visceral leishmaniasis (VL) in HIV-positive individuals is a global health problem. HIV-Leishmania coinfection worsens prognosis and mortality risk, and HIV-Leishmania coinfected individuals are more susceptible to VL relapses. Early initiation of antiretroviral therapy can protect against Leishmania infection in individuals living in VL-endemic areas, and regular use of antiretrovirals might prevent VL relapses in these individuals. We conducted a cross-sectional study in Petrolina, Brazil, an VL-endemic area, to estimate the prevalence of asymptomatic Leishmania cases among HIV-positive outpatients. Methods: We invited any HIV-positive patients, aged ≥ 18-years-old, under antiretroviral therapy, and who were asymptomatic for VL. Patients were tested for Leishmania with enzyme-linked immunosorbent assays (ELISA)-rK39, immunochromatographic test (ICT)-rK39, direct agglutination test (DAT), latex agglutination test (KAtex), and conventional polymerase chain reaction (PCR). HIV-Leishmania coinfection was diagnosed when at least one VL test was positive. Results: A total of 483 patients were included. The sample was predominantly composed of single, < 48-years-old, black/pardo, heterosexual males, with fewer than 8 years of schooling. The prevalence of asymptomatic HIV-Leishmania coinfection was 9.11% (44/483). HIV mono-infected and HIV-Leishmania coinfected groups differed statistically significantly in terms of race (p = 0.045), marital status (p = 0.030), and HIV viral load (p = 0.046). Black/pardo patients, married patients, and those with an HIV viral load up to 100,000 copies/ml presented higher odds for HIV-Leishmania coinfection. Conclusions: A considerable number of asymptomatic Leishmania cases were observed among HIV-positive individuals in a VL-endemic area. Given the potential impact on transmission and health costs, as well as the impact on these coinfected individuals, studies of asymptomatic Leishmania carriers can be useful for guiding public health policies in VL-endemic areas aiming to control and eliminate the disease.

Visceral leishmaniasis (VL) is a severe parasitic disease that poses significant diagnostic challenges due to its complex presentation and the necessity for comprehensive diagnostic methods. This exploratory study investigates the potential of Chat Generative Pre-trained Transformer (ChatGPT)/GPT-4, an artificial intelligence (AI) chatbot, in assisting the diagnostic process for VL. We evaluated the diagnostic accuracy of ChatGPT/GPT-4 in generating differential diagnosis lists for eight clinical vignette cases of VL, authored by a Brazilian infectious disease doctor. Our findings reveal that ChatGPT/GPT-4 included VL in the top five differential diagnoses in 75% of the cases (95% confidence interval [CI]: 40.1 – 93.7%) and identified VL as the top diagnosis in 50% of the cases (95% CI: 30.3 – 86.5%). These results underscore the high potential of ChatGPT/GPT-4 as an AI-assisted diagnostic tool, which is capable of providing accurate differential diagnoses and assisting healthcare professionals in resource-limited settings. The study highlights the broader applicability of AI chatbots in medical diagnostics, not only for common conditions but also for specialized and less prevalent diseases like VL. By integrating AI tools into the diagnostic workflow, healthcare providers can enhance their diagnostic accuracy and efficiency, ultimately improving patient outcomes. This research contributes to the growing body of evidence supporting the utility of AI in healthcare and underscores the need for further studies to validate these findings across larger and more diverse clinical scenarios.

This study aimed to describe the kinetics of Leishmania parasite load determined using kinetoplast DNA (kDNA)-based quantitative polymerase chain reaction (qPCR) in visceral leishmaniasis (VL) patients. Parasite load in blood was assessed by qPCR at five time points, up to 12 months post-diagnosis. Sixteen patients were followed up. A significant reduction in the parasite load was observed after treatment (P < 0.0001). One patient had an increased parasite load 3 months post-treatment and relapsed clinically at month six. We have described the use of kDNA-based qPCR in the post-treatment follow-up of VL cases.

Visceral leishmaniasis (VL) is a severe zoonotic disease characterized by high mortality and a pronounced systemic inflammatory response. Although Pentraxin 3 (PTX3) has been implicated in infectious and inflammatory disorders, its role in human VL remains poorly defined, and host-derived indicators that simultaneously reflect inflammatory and parasitic activity are limited. This study investigated the association between plasma PTX3 levels, parasite load, and PTX3 gene polymorphisms (rs1840680 and rs2305619) in patients with VL. An observational study was conducted between 2017 and 2021, including 36 patients with confirmed VL and 45 healthy controls matched by age and sex. Plasma PTX3 concentrations were determined by ELISA, parasite load by quantitative PCR (qPCR), and cytokines (IL-2, IL-6, IL-10, IL-17A, IFN-γ and TNF-α) by flow cytometry. PTX3 levels were significantly higher in VL patients than in controls (23.2 ng/mL vs. 0.80 ng/mL; p < 0.0001) and correlated positively with parasite load (r = 0.39; p = 0.02) and cytokines IL-6, IL-10 and IFN-γ. No associations were observed between PTX3 polymorphisms and disease susceptibility. These findings suggest that PTX3 reflects both inflammatory responses and parasitic burden in VL and may serve as a potential indicator of disease activity.

We report a case of visceral leishmaniasis (VL)/H IV coinfection in a patient undergoing regular antiretroviral therapy and treatment with thalidomide for erythema nodosum leprosum. He presented at a health service with high fever, chills, asthenia, pale skin, lower limb edema, hepatomegaly, and splenomegaly. Visceral leishmaniasis was confirmed by direct examination, and serological and molecular tests. Serum levels of Th1/Th2 cytokines were measured. The patient began treatment with liposomal amphotericin B, with good clinical response; however, VL recurred 6 months later. Treatment was reinitiated, maintaining secondary prophylaxis with liposomal amphotericin B. The patient showed clinical improvement with important recovery of CD4(+)T-lymphocyte count.