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Impaired expression of inflammatory cytokines and chemokines at early stages of infection with Leishmania amazonensis.

Infection of mice with Leishmania major results in disease progression or resolution, largely depending on the genetic backgrounds of the mouse strains. Infection with Leishmania amazonensis, on the other hand, causes progressive cutaneous lesions in most inbred strains of mice. We hypothesized that deficient activation of early immune responses contributes to the pathogenesis in L. amazonensis-infected mice. To distinguish early molecular events that determine the outcome of Leishmania infections, we examined cytokine gene expression in C57BL/6 mice infected with either L. amazonensis or L. major (a healing model). After 2 to 4 weeks, L. amazonensis-infected mice had significantly delayed and depressed expression of inflammatory cytokines (interleukin-12 [IL-12], gamma interferon, IL-1 alpha, IL-1 beta), CC chemokines (CC chemokine ligand 3 [CCL3]/macrophage inflammatory protein 1 alpha [MIP-1 alpha], CCL4/MIP-1 beta, CCL5/RANTES, MIP-2), and chemokine receptors (CCR1, CCR2, CCR5) in foot tissues and draining lymph nodes compared to the expression in L. major-infected controls. These findings correlated with defective T-cell responsiveness to parasite stimulation in vivo and in vitro. Adoptive transfer of L. amazonensis-specific Th1 cells prior to infection overcame the immune defects of the animals, leading to complete control of the disease. Studies with gene knockout mice suggested that IL-10, but not IL-4, contributed partially to compromised immunity in L. amazonensis-infected hosts. The data suggest that there is impairment in multiple immune functions at early stages of infection with L. amazonensis parasites and provide a compelling rationale to explore immune augmentation as an intervention in American cutaneous leishmaniasis.

Adoptive Transfer↗

Successful treatment with miltefosine of disseminated cutaneous leishmaniasis in a severely immunocompromised patient infected with HIV-1.

We describe here a case of disseminated cutaneous leishmaniasis due to Leishmania major in a severely immunocompromised patient from Burkino Faso, Africa, who is infected with human immunodeficiency virus-1. The skin lesions failed to respond to full treatment courses of amphotericin B, sodium stibogluconate, and liposomal amphotericin B but were successfully treated with miltefosine, an alkylphosphocholine analogue.

Adult↗

[American cutaneous leishmaniasis associated with HIV/AIDS: report of four clinical cases].

The co-infection American cutaneous leishmaniasis and AIDS has recently been described in the literature, observing differences between the clinical and immunological behavior of these patients. Four cases are reported here, attended at the Brasilia University Hospital, with diagnoses of infection by Leishmania species and immunodeficiency virus, with a view to illustrating the clinical presentations, course and therapeutic responses.

AIDS-Related Opportunistic Infections↗

Leishmaniasis disseminated by Leishmania braziliensis in a mare (Equus cabalus) immunotherapy and chemotherapy assays.

Cutaneous disseminated lesions caused by Leishmania sp. were found in a pregnant mare (Equus cabalus) from a rural city in the State of Rio de Janeiro, Brazil. Before delivering, treatment was undertaken by immunotherapy followed by chemotherapy. Histopatology and serology were performed during treatment, as well as the biochemical characterization of the parasite (L. braziliensis) that was isolated from one of the lesions.

Animals↗

The persistence, dissemination, and visceralization tendency of Leishmania major in Syrian hamsters.

I monitored the persistence, dissemination, and the possible visceralization tendency of Leishmania major, the causative parasite of cutaneous leishmaniasis in North Africa and the Middle East in Syrian hamsters (Mesocricetus auratus). Hamsters were inoculated subcutaneously in the hind footpad, with 1 x 10(6)L. major metacyclic promastigotes and were sacrificed at months 1, 3, 6 and 10 post-infection (pi). Skin lesions, blood, spleens, livers and kidneys were screened by both Giemsa-stained smears and a polymerase chain reaction (PCR) for detection of L. major amastigotes. A few weeks pi, 61.7% of the inoculated hamsters developed a cutaneous lesion only at the inoculation site, while 38.3% of them developed non-self-healed lesions at sites distant from the inoculation site. PCR identified all the positive stained smears as well as false-negative ones, indicating that PCR was more sensitive than stained smears. The results confirmed the dissemination and persistence of L. major amastigotes in all tissues examined, except the kidneys, for a period extending to 10 months, only in those hamsters suffering from disseminated cutaneous lesions. Parasite DNA was detected in the bloods starting from the first month pi and starting from month 3 pi in the spleens and livers. Some, but not all, the animals with disseminated infections proved to be positive for parasite DNA in their organs. Persistence of the L. major amastigotes in the tissues differed from those of other species causing visceral diseases. These findings demonstrate a possible visceralization tendency for L. major previously recorded for L. tropica and L. mexicana.

Animals↗

[Epidemic outbreak of tegumentary leishmaniasis in Puerto Esperanza, Misiones, 1998].

The province of Misiones reported 205 leishmaniasis cases during 1998, 98% of them from the locality of Puerto Esperanza. The reports of Puerto Esperanza Hospital (January to September 1998) for leishmaniasis were analysed (n: 129). The mainly reported lesion was the single cutaneous ulcer (97.2%), localized in the inferior limbs (72.5%), without any mucosa involvement. The results are consistent with the knowledge from other Argentinean leishmaniasis foci due to Leishmania (V.) braziliensis. The difference in incidence among sexes was not significant, leishmaniasis was reported in all age groups, and it was susceptible to the conventional treatment. The main focus was located in Km 1 neighbourhood, the transmission peak was during April 1998. The Montenegro skin test among general population (n: 205) did not show reactivity among asymptomatic people. The prevalent Phlebotominae species were Lutzomyia intermedia (79.7%) and Lu. whitmani (10.9%), among the 577 individuals belonging to 8 species collected. The Phlebotominae were abundant in peridomestic habitats of Km 1 neighbourhood, close to human dwellings, in places associated with residual primary forest and secondary vegetation. The results are discussed in the frame of surveillance and possible control strategies.

Adolescent↗

Disseminated cutaneous leishmaniasis.

Disseminated cutaneous leishmaniasis DCL is a condition rarely seen in the Middle East. We report a case of disseminated cutaneous leishmaniasis in a 60-years-old lady. The patient first presented 1996 with an initial lesion, which started on the butterfly area of the face and spread, probably due to immunosuppression, to involve the whole face. The lesions consisted of nodules, which did not ulcerate. The histology showed abundance of macrophages filled with amastigotes L-D bodies. The patient was started on oral zinc sulphate 10 mg/kg in 3 divided doses daily. The condition showed gradual improvement. Repeated biopsies showed upgrading of the histopathological picture. After 6-months of treatment there was complete clearance of the condition. The patient was followed up for 6-years with no recurrence. However, she presented with a new lesion on the butterfly area again in February 2003. The biopsy again showed abundance of macrophages filled with amastigotes L-D bodies. A 4-months course of zinc sulphate 10 mg/kg in 3 divided doses daily resulted in complete clearance of the lesions. Zinc sulphate might represent a new treatment for this condition that has no adequate treatment until now.

Administration, Oral↗

Leishmania mexicana: binding of promastigotes to type I collagen.

During leishmania infection, parasites are inoculated to the human host through the bite of a sandfly vector into the dermis, where they first interact with tissue components, cells and extracellular matrix molecules. Since collagen is the most abundant component of the skin matrix, we investigated whether there is a specific interaction of Leishmania mexicana promastigotes with this host component. Promastigotes were able to attach to collagen fibrils and move through the matrix of mouse skin sections and to penetrate easily into a type I collagen gel. Denatured type I collagen coated beads (Cytodex 3) readily bound to the parasite surface. The interaction of promastigotes with type I collagen was dose dependent and saturable and was competitively and specifically inhibited with increasing concentrations of gelatin. Biotin-labeled parasite surface molecules were able to associate with both denatured collagen from microcarriers and native type I collagen from bovine kidney. It is suggested that the presence of parasite cell membrane receptors to collagen may confer a specific tropism for the skin, where collagen is the most abundant component of the matrix.

Animals↗

Leishmania aethiopica: experimental infections in non-human primates.

Six Cercopithecus aethiops monkeys, 4 Theropithecus gelada baboons and 2 Papio anubis baboons were infected using Leishmania aethiopica isolates originating either from localized (LCL) or diffuse (DCL) cutaneous leishmaniasis patients. The history of lesions in 4 C. aethiops monkeys infected by LCL strains mimicked the process in human LCL patients. Infection of 2 C. aethiops monkeys using a DCL strain resulted in localized, non-ulcerative, self-healing nodular lesions. Such lesions were also observed in 2 T. gelada baboons infected by LCL strains. Active lesions and healing in C. aethiops and T. gelada, after infection by LCL stains, were accompanied by positive DTH and immunity to challenge by LCL or DCL strains.

Animals↗

Leishmania in the Old World: 3. The distribution of L. aethiopica zymodemes.

Isoenzyme profiles of 28 stocks of Leishmania aethiopica were compared with those of reference strains of L. aethiopica, L. tropica and L. major using starch-gel electrophoresis of 13 enzymes (GPI, GD, ES, PGM, PEPD, NH, ASAT, ALAT, PK, MPI, 6PGD, SOD, MDH). 13 zymodemes were seen. L. aethiopica showed some infraspecific variation. Stocks from Phlebotomus longipes and Procavia habessinica were indistinguishable from those from man. Stocks from cases of diffuse cutaneous and cutaneous leishmaniasis were indistinguishable. Only one enzyme pattern was held in common with the L. tropica reference strain enzyme profile, and none with the L. major reference strain. The status of L. aethiopica as a separate species is supported.

Electrophoresis, Starch Gel↗

Leishmania amazonensis: characterization of an ecto-phosphatase activity.

We have characterized a phosphatase activity present on the external surface of Leishmania amazonensis, using intact living parasites. This enzyme hydrolyzes the substrate p-nitrophenylphosphate (p-NPP) at the rate of 25.70+/-1.17 nmol Pi x h(-1) x 10(-7)cells. The dependence on p-NPP concentration shows a normal Michaelis-Menten kinetics for this ecto-phosphatase activity present a V(max) of 31.93+/-3.04 nmol Pi x h(-1) x 10(-7)cells and apparent K(m) of 1.78+/-0.32 mM. Inorganic phosphate inhibited the ecto-phoshatase activity in a dose-dependent manner with the K(i) value of 2.60 mM. Experiments using classical inhibitor of acid phosphatase, such as ammonium molybdate, as well as inhibitors of phosphotyrosine phosphatase, such as sodium orthovanadate and [potassiumbisperoxo(1,10-phenanthroline)oxovanadate(V)] (bpV-PHEN), inhibited the ecto-phosphatase activity, with the K(i) values of 0.33 microM, 0.36 microM and 0.25 microM, respectively. Zinc chloride, another classical phosphotyrosine phosphatase inhibitor, also inhibited the ecto-phosphatase activity in a dose-dependent manner with K(i) 2.62 mM. Zinc inhibition was reversed by incubation with reduced glutathione (GSH) and cysteine, but not serine, showing that cysteine residues are important for enzymatic activity. Promastigote growth in a medium supplemented with 1mM sodium orthovanadate was completely inhibited as compared to the control medium. Taken together, these results suggest that L. amazonensis express a phosphohydrolase ectoenzyme with phosphotyrosine phosphatase activity.

Animals↗

Tegumentary leishmaniasis in Northern Argentina: distribution of infection and disease, in three municipalities of Salta, 1990-1992.

This work describes the epidemiological pattern of tegumentary leishmaniasis in an area north of Salta, Argentina. The prevalence and incidence were estimated by means of a cross-sectional study and two follow-up studies during two consecutive years. The Montenegro Skin Test (MST) was administered to 7336 subjects at baseline. The prevalence and incidence between 1990 and 1992 of infection (MST reactive) was 38 per mil persons and 4.5 per mil persons/year respectively. The prevalence and incidence of tegumentary leishmaniasis (presence of clinical signs) was 1.8 per mil and 0.8 per mil persons/year, respectively. A physical examination performed on 264 patients with MST reactive during three years revealed that 130 cases (49.2%) had some evident sign of infection (scar and/or lesion), with a clinical presentation compatible with leishmaniasis. Our study demonstrated that after the epidemic outbreak of 1985 the transmission in the study area returned to endemic levels in 1992, and also demonstrated the presence of the asymptomatic infection in the area.

Adolescent↗

Leishmania and human immunodeficiency virus coinfection: the first 10 years.

Over 850 Leishmania-human immunodeficiency virus (HIV) coinfection cases have been recorded, the majority in Europe, where 7 to 17% of HIV-positive individuals with fever have amastigotes, suggesting that Leishmania-infected individuals without symptoms will express symptoms of leishmaniasis if they become immunosuppressed. However, there are indirect reasons and statistical data demonstrating that intravenous drug addiction plays a specific role in Leishmania infantum transmission: an anthroponotic cycle complementary to the zoonotic one has been suggested. Due to anergy in patients with coinfection, L. infantum dermotropic zymodemes are isolated from patient viscera and a higher L. infantum phenotypic variability is seen. Moreover, insect trypanosomatids that are currently considered nonpathogenic have been isolated from coinfected patients. HIV infection and Leishmania infection each induce important analogous immunological changes whose effects are multiplied if they occur concomitantly, such as a Th1-to-Th2 response switch; however, the consequences of the viral infection predominate. In fact, a large proportion of coinfected patients have no detectable anti-Leishmania antibodies. The microorganisms share target cells, and it has been demonstrated in vitro how L. infantum induces the expression of latent HIV-1. Bone marrow culture is the most useful diagnostic technique, but it is invasive. Blood smears and culture are good alternatives. PCR, xenodiagnosis, and circulating-antigen detection are available only in specialized laboratories. The relationship with low levels of CD4+ cells conditions the clinical presentation and evolution of disease. Most patients have visceral leishmaniasis, but asymptomatic, cutaneous, mucocutaneous, diffuse cutaneous, and post-kala-azar dermal leishmaniasis can be produced by L. infantum. The digestive and respiratory tracts are frequently parasitized. The course of coinfection is marked by a high relapse rate. There is a lack of randomized prospective treatment trials; therefore, coinfected patients are treated by conventional regimens. Prophylactic therapy is suggested to be helpful in preventing relapses.

Animals↗