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Fig 1.

Diagnosis of leishmaniasis (Case 1): direct parasitological methods.

(A) Amastigote form in bone marrow aspiration (arrow); (B) amastigote form found in skin lesion biopsy (arrow).

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Fig 2.

Molecular diagnosis by RFLP.

Positive product amplifications underwent digestion with the HaeIII restriction enzyme. 1: Ladder 100 bp; 2: positive control for Leishmania (Leishmania) amazonensis (IFLA/BR/1967/PH8), fragments of approximately 140 and 200 bp. 3: positive control for Leishmania (Leishmania) infantum (MHOM/BR/2022/072) fragments of approximately 50 and 200 bp. 4: Bone marrow aspirate (BMA) sample (Case 1). 5: Skin lesion biopsy sample (Case 1). 6: BMA sample (Case 2). 7: BMA sample (Case 3). 8: Skin lesion biopsy sample (Case 3). 9: positive control for L. (L.) infantum (MHOM/BR/2022/072). 10: positive control for L. (L.) amazonensis (IFLA/BR/1967/PH8). 11: Ladder 100 bp.

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Fig 3.

Main clinical events of Case 1.

Timeline of the main events that occurred in case 1. AIDS: Acquired human immunodeficiency syndrome; L-AmB: liposomal amphotericin B; AmB-d: amphotericin B deoxycholate; BMA: bone marrow aspirate; VL: Visceral leishmaniasis; Biopsy: biopsy of skin lesions; (+) positive diagnostic; (-) negative diagnostic; CD4+: CD4 Lymphocyte count; vl: viral load.

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Fig 3 Expand

Fig 4.

Diagnosis of leishmaniasis (Case 2): direct parasitological methods.

(A) amastigote forms in bone marrow aspirate (arrows); (B) amastigote form found in a biopsy of skin lesions (arrow).

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Fig 4 Expand

Fig 5.

Main clinical events of Case 2.

Timeline of the principal occurrences in Case 2. AIDS: Acquired human immunodeficiency syndrome; L-AmB: liposomal amphotericin B; AmB-d: amphotericin B deoxycholate; Pent: Pentamidine; BMA: bone marrow aspirate; VL: Visceral Leishmaniasis; Biopsy: biopsy of skin lesions; (+) positive diagnostic; (-) negative diagnostic; CD4+: CD4 Lymphocyte count; vl: viral load.

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Fig 5 Expand

Fig 6.

Diagnosis of leishmaniasis (Case 3): direct parasitological methods.

(A) amastigote forms in bone marrow aspirate (arrows); (B) amastigote form found in a biopsy of skin lesions (arrow).

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Fig 6 Expand

Fig 7.

Main clinical events of Case 3.

Timeline of the main events that occurred in case 3. AIDS: Acquired human immunodeficiency syndrome; L-AmB: liposomal amphotericin B; AmB-d: amphotericin B deoxycholate; Pent: Pentamidine; BMA: bone marrow aspirate; VL: Visceral Leishmaniasis; Biopsy: biopsy of skin lesions; (+) positive diagnostic; (-) negative diagnostic; CD4+: CD4 Lymphocyte count; lv: viral load.

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Fig 7 Expand

Table 1.

Summary of reported cases.

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Table 1 Expand