Summary of reported cases.

Leishmaniases are a group of neglected vector-borne infectious diseases that are among the six priority endemic diseases worldwide. Visceral leishmaniasis (VL) is the most severe clinical manifestation, characterized by systemic and chronic visceral involvement and high mortality in immunosuppressed and untreated patients. VL can be complicated into post-kala-azar dermal leishmaniasis (PKDL), and when dermatologic disorders occur simultaneously with active VL, an intermediate clinical form called para-kala-azar dermal leishmaniasis (para-KDL) occurs. This clinical form is of great epidemiological relevance, as humans act as a source of infection for vectorial transmission. In the Americas, Brazil is among the seven countries responsible for more than 90% of VL cases, though reports of PKDL and para-KDL are rare. This paper presents three cases of VL-HIV co-infection with Leishmania-containing skin lesions resembling para-kala-azar dermal leishmaniasis. The cases were investigated by the team from the Infectious Diseases Department of University Hospital (HUMAP/UFMS) in Mato Grosso do Sul, Brazil. The three patients exhibited skin lesions where amastigote forms of L. (L.) infantum were identified. All cases exhibited similar clinical manifestations of para-KDL, including fever, hepatosplenomegaly, pancytopenia, and disseminated skin lesions. The study described the prevalence of comorbidities, the incidence of VL relapse, and the therapeutic regimen in relation to the outcomes. The study underscores the importance of follow-up and secondary prophylaxis in patients with VL, which are essential for the efficacy of the treatment. Furthermore, the study provides insight into the potential epidemiological profile of para-KDL cases in Brazil, which contributes to the development of more efficient clinical management strategies for patients.

利什曼病（Leishmaniases）是一类被忽视的虫媒传染病，位列全球六大优先关注地方病之列。内脏利什曼病（Visceral leishmaniasis, VL）是其最严重的临床表型，以全身性、慢性内脏受累为特征，免疫抑制及未接受治疗的患者死亡率较高。VL可并发黑热病后皮肤利什曼病（post-kala-azar dermal leishmaniasis, PKDL）；当皮肤病变与活动性VL同时发生时，会出现一种名为类黑热病后皮肤利什曼病（para-kala-azar dermal leishmaniasis, para-KDL）的中间型临床表型。该临床表型具有重要的流行病学意义，因为人类可作为虫媒传播的感染源。
在美洲地区，巴西是全球VL病例占比超90%的七个国家之一，但目前关于PKDL与para-KDL的报道较为罕见。本文报道了3例VL合并HIV感染的病例，患者出现含利什曼原虫的皮肤损害，临床表现与para-KDL相似。
上述病例由巴西马托格罗索州联邦大学附属医院（HUMAP/UFMS）感染病科团队完成调研。3例患者均出现皮肤病变，经检测确认存在婴儿利什曼原虫（L. (L.) infantum）的无鞭毛体（amastigote）。所有病例均表现出与para-KDL一致的临床特征，包括发热、肝脾肿大、全血细胞减少症及播散性皮肤损害。
本研究统计了合并症患病率、VL复发率，并分析了治疗方案与治疗结局的关联。研究强调了VL患者随访与二级预防的重要性，二者是保障治疗有效性的核心环节。此外，本研究深入解析了巴西境内para-KDL病例的潜在流行病学特征，可为制定更高效的患者临床管理策略提供科学依据。