Lymphadenopathy as the First Sign of Human Cutaneous Infection by Leishmania braziliensis

Barral, Aldina; Guerreiro, Jaqueline; Bomfim, Glória; Correia, Dalmo; Barral‐Netto, Manoel; Carvalho, Edgar M.

doi:10.4269/ajtmh.1995.53.256

Cited by 88 publications

(64 citation statements)

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“…Exuberant lymphadenopathy is one of the first signs of CL as a result of L. braziliensis and indicates the presence of an immunological response to the parasite. 15 Mice that have surgically removed popliteal lymph nodes, which are subsequently infected in the footpad with L. amazonensis disseminated Leishmania infection, whereas intact mice contain the disease locally, indicating a role for local T cell responses in the control of parasite multiplication and dissemination. 16 Herein, lymphadenopathy was observed less frequently among the elderly than young subjects, and these patients also had a more severe disease based on the size of the lesion and development of ML.…”

Section: Discussionmentioning

confidence: 99%

Age Modifies the Immunologic Response and Clinical Presentation of American Tegumentary Leishmaniasis

Carvalho¹,

Amorim²,

Barbosa³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Leishmania (Viannia) braziliensis is the main causal agent of American tegumentary leishmaniasis (ATL) that may present as cutaneous, mucosal, or disseminated cutaneous leishmaniasis. The disease is highly prevalent in young males and there is a lack of studies of ATL in the elderly. Herein, we compared clinical manifestations, immunologic response, and response to antimony therapy between patients 60 years of age (N = 58) and patients who were 21-30 years of age (N = 187). The study was performed in Corte de Pedra, Bahia, Brazil, a well-known area of L. braziliensis transmission. Cytokine production by cultured peripheral blood mononuclear cells stimulated with soluble Leishmania antigen was performed. Elderly subjects more frequently had a previous history of cutaneous leishmaniasis, large lesions, or mucosal leishmaniasis, and they were less likely to have lymphadenopathy. There was no difference regarding gender and response to therapy. Peripheral blood mononuclear cells from elderly subjects produced a similar amount of tumor necrosis factor than young patients but they produced less interferon-gamma and more interleukin-10 than young subjects. We concluded that elderly patients with cutaneous leishmaniasis should be searched for mucosal or disseminated leishmaniasis. The decreased interferon-gamma production and increase in interleukin-10 observed in elderly patients may contribute to parasite persistence and L. braziliensis infection dissemination.

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Section: Discussionmentioning

confidence: 99%

Age Modifies the Immunologic Response and Clinical Presentation of American Tegumentary Leishmaniasis

Carvalho¹,

Amorim²,

Barbosa³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…It can explain the increased lymphocyte proliferation indexes observed in group CCL (who developed leishmaniasis years earlier) than asymptomatic individuals. Moreover, it is supposed that the frequent boosters provoked by endogenous parasites that may persist in lymphoid tissues (Barral et al 1995) or scars (Schubach et al 1998) as well as exogenous re-infections allow the establishment of a persistent pool of circulating experienced T-cells. This is in accordance with the idea that maintenance of T-cell mediated immunity requires the presence of an antigen (Kündig et al 1996, Mendez et al 2004, although it has been recently shown that a pool of memory T-cell can persist in the absence of antigen stimulation .…”

Section: Discussionmentioning

confidence: 99%

T-cell responses associated with resistance to Leishmania infection in individuals from endemic areas for Leishmania (Viannia) braziliensis

Bittar

Nogueira

Vieira-Gonçalves

et al. 2007

Mem. Inst. Oswaldo Cruz

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Subclinical or asymptomatic infection is documented in individuals living in endemic areas for leishmaniasis suggesting that the development of an appropriate immune response can control parasite replication and maintain tissue integrity. A low morbidity indicates that intrinsic factors could favor resistance to Leishmania infection. Herein, leishmanial T-cell responses induced in subjects with low susceptibility to leishmaniasis as asymptomatic subjects were compared to those observed in cured cutaneous leishmaniasis (CCL) patients, who controlled the disease after antimonial therapy. All of them have shown maintenance of specific long-term immune responses characterized by expansion of higher proportions of CD4 + as compared to CD8 + Leishmania reactive T-lymphocytes. Asymptomatic subjects had lower indexes of in vitro Leishmania induced lymphoproliferative responses and interferon-gamma (IFN-γ) production in comparison to CCL patients. On the other hand, interleukin (IL-10) production was much higher in asymptomatics than in CCL, while no differences in IL-5 levels were found. In conclusion, long lived T-cell responses achieved by asymptomatic individuals differed from those who had developed symptomatic leishmaniasis in terms of intensity of lymphocyte activation (proliferation or IFN-γ) and regulatory mechanisms (IL-10). The absence of the disease in asymptomatics could be explained by their intrinsic ability to create a balance between immunoregulatory (IL-10) and effector cytokines (IFN-γ), leading to parasite destruction without producing skin tissue damage. The establishment of profiles of cell-mediated immune responses associated with resistance against Leishmania infection is likely to make new inroads into understanding the long-lived immune protection against the disease.Key words: asymptomatic infection -Leishmania (Viannia) braziliensis -cured leishmaniasis -cytokines -T-cell subsetslong term immunity (Grimaldi Jr & MacMahon-Pratt 1991). The spectrum of the clinical presentation ranges from self-healing or benign cutaneous lesions to more severe forms, such as disseminated lesions or mucosal involvement (Da-Cruz & Pirmez 2005).Studies conducted in mice and humans have unequivocally shown that a major T-cell driven component underlies the establishment of acquired immunity and protection against re-infection ( Coutinho et al. 1996, Louis et al. 1998, Bosque et al. 2000. Cytokines such as interferon-gamma (IFN-γ) and tumor necrosis factoralpha (TNF-α) activate macrophages for killing parasites, while interleukin (IL)-4, IL-5, IL-10, and transforming grow factor-beta (TGF-β) favor intracellular parasite growth (Louis et al. 1998. In addition, IL-10 production by CD4 + CD25 + T-cells is required for maintenance of Leishmania after cure, which in turn preserves an adaptive immunity to L. (Leishmania) major (Belkaid et al. 2002).The majority of ATL patients develop cutaneous leishmaniasis (CL) (Oliveira-Neto et al. 2000), but occurrence of subclinical or asymptomatic infection strongly suggests that po...

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“…First, lymphatic spread and lymph node involvement are common in localized CL, and may actually precede lesion development. 1,6 Second, ML is characterized by the ability of the Leishmania organism to spread to mucosa by lymphatic or hematogenous dissemination. 1,35 Third, lifelong protection against reinfection may be caused by live parasite persistence in the host.…”

Section: Discussionmentioning

confidence: 99%

“…1 Indeed, several lines of evidence support that lymphatogenous and hematogenous dissemination of the parasite may occur, 1,[6][7][8][9][10] and that nonfocal reservoirs of parasite persistence may actually protect against future reinfection. 9,11,12 Theoretically, then, parasites in both CL and ML would have access to the circulatory compartment of the host, as supported by numerous studies of CL showing Leishmania DNA in the blood, [7][8][9][10] and may therefore be detectable in urine.…”

Section: Introductionmentioning

confidence: 99%

Polymerase Chain Reaction Detection of Leishmania kDNA from the Urine of Peruvian Patients with Cutaneous and Mucocutaneous Leishmaniasis

Veland¹,

Espinosa²,

Valencia³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. We hypothesized that Leishmania kDNA may be present in urine of patients with cutaneous leishmaniasis (CL). Urine samples and standard diagnostic specimens were collected from patients with skin lesions. kDNA polymerase chain reaction (PCR) was performed on samples from patients and 10 healthy volunteers from non-endemic areas. Eighty-six of 108 patients were diagnosed with CL and 18 (21%) had detectable Leishmania Viannia kDNA in the urine. Sensitivity and specificity were 20.9% (95% confidence interval [CI] 12.3-29.5%) and 100%. Six of 8 patients with mucocutaneous involvement had detectable kDNA in urine versus 12 of 78 patients with isolated cutaneous diseaseNo healthy volunteer or patient with an alternate diagnosis had detectable kDNA in urine. Sensitivity of urine PCR is sub-optimal for diagnosis. On the basis of these preliminary data in a small number of patients, detectable kDNA in urine may identify less localized forms of infection and inform treatment decisions.

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Lymphadenopathy as the First Sign of Human Cutaneous Infection by Leishmania braziliensis

Cited by 88 publications

References 0 publications

Age Modifies the Immunologic Response and Clinical Presentation of American Tegumentary Leishmaniasis

Age Modifies the Immunologic Response and Clinical Presentation of American Tegumentary Leishmaniasis

T-cell responses associated with resistance to Leishmania infection in individuals from endemic areas for Leishmania (Viannia) braziliensis

Polymerase Chain Reaction Detection of Leishmania kDNA from the Urine of Peruvian Patients with Cutaneous and Mucocutaneous Leishmaniasis

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