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Memórias do Instituto Oswaldo Cruz
Fundação Oswaldo Cruz, Fiocruz
ISSN: 1678-8060
EISSN: 1678-8060
Vol. 94, No. 4, 1999, pp. 537-542
Bioline Code: oc99099
Full paper language: English
Document type: Research Article
Document available free of charge

Memórias do Instituto Oswaldo Cruz, Vol. 94, No. 4, 1999, pp. 537-542

 en Atypical Mucocutaneous Leishmaniasis Caused by Leishmaniabraziliensis in an Acquired Immunodeficiency Syndrome Patient: T-cell Responses and Remission of Lesions Associated with Antigen Immunotherapy
Alda M Da-Cruz; Danilo V Filgueiras; Ziadir Coutinho; Wilson Mayrink; Gabriel Grimaldi Jr; Paula M De Luca; Sergio CF Mendonça & Sergio G Coutinho

Abstract

An atypical case of acquired immunodeficiency syndrome-associated mucocutaneous lesions due to Leishmaniabraziliensis 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.

Keywords
human mucocutaneous leishmaniasis - acquired immunodeficiency syndrome - CD8+ cells - interferon-y - immunotherapy

 
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