Article
Atypical Mucocutaneous Leishmaniasis Caused by Leishmania braziliensis in an Acquired Immunodeficiency Syndrome Patient: T-cell Responses and Remission of Lesions Associated with Antigen Immunotherapy
Registro en:
CRUZ, Alda M. da et al. Atypical Mucocutaneous Leishmaniasis Caused by Leishmania braziliensis in an Acquired Immunodeficiency Syndrome Patient: T-cell Responses and Remission of Lesions Associated with Antigen Immunotherapy. Memórias do Instituto Oswaldo Cruz, Rio de Janeiro, v. 94, n. 4, p. 537-542, July/Aug. 1999.
0074-0276
10.1590/S0074-02761999000400020
1678-8060
Autor
Cruz, Alda Maria da
Figueiras, Danilo V.
Coutinho, Ziadir
Mayrink, Wilson
Grimaldi Jr., Gabriel
Luca, Paula M. de
Mendonça, Sergio C. F.
Coutinho, Sergio G.
Resumen
An atypical case of acquired immunodeficiency syndrome-associated mucocutaneous lesions due to
Leishmania braziliensis is described. Many vacuolated macrophages laden with amastigote forms of the
parasite were found in the lesions. Leishmanin skin test and serology for leishmaniasis were both negative. The patient was resistant to therapy with conventional drugs (antimonial and amphotericin B).
Interestingly, remission of lesions was achieved after an alternative combined therapy of antimonial
associated with immunotherapy (whole promastigote antigens). Peripheral blood mononuclear cells
were separated and stimulated in vitro with Leishmania antigens to test the lymphoproliferative responses (LPR). Before the combined immunochemotherapy, the LPR to leishmanial antigens was negligible (stimulation index - SI=1.4). After the first course of combined therapy it became positive (SI=4.17).
The antigen responding cells were predominantly T-cells (47.5%) most of them with CD8+ phenotype
(33%). Very low CD4+ cells (2.2%) percentages were detected. The increased T-cell responsiveness to
leishmanial antigens after combined therapy was accompanied by interferon-γ (IFN-γ) production as
observed in the cell culture supernatants. In this patient, healing of the leishmaniasis lesions was associated with the induction of a specific T-cell immune response, characterized by the production of
IFN-γ and the predominance of the CD8+ phenotype among the Leishmania-reactive T-cells.