Evaluación de la respuesta de isotipos de inmunoglobulina especifica a Leishmania en leishmaniasis tegumentaria Americana

Con el fin de determinar las clases de anticuerpo producido contra el parásito y la cinética de los mismos en relación a la evolución de la infección, se estudiaron los sueros de 133 pacientes infectados con Leishmania del complejo braziliensis. Se utilizó la prueba de inmunofluorescencia indirecta y amastigotas de L. mexicana amazonensis como antígeno. En los sueros obtenidos al momento de consultar para el diagnóstico se encontró IgM en 54 de los sueros absorbidos con Straphylococcus aureus Cowan I y en 5 de los no absorbidos. La IgM sólo se encontro en los sueros de pacientes con tiempo devolución de las lesiones < o = de 2 meses. la IgG se detectó en todos los sueros no absorbidos. Los sueros tomados durante recurrencia y después de cicatrización sólo presentaron IgG. El uso combinado de la prueba de Montenegro y/o título de IgM específico, aumentó el porcentage de pacientes con un diagnóstico inmunológico positivo en aquéllos cuyas lesiones tenían un tiempo de evolución menor de 2 meses. En los sueros de los 10 individuos sanos no se detectó inmunoglobulina específica a Leishmania y ninguno presentó reacción positiva a la prueba de Montenegro. Entre los 16 pacientes con otra etiología, 3 con esporotricosis, mostraron en su suero IgG reactiva con Leishmania pero ninguno incluyendo 2 con menos de dos meses de evolución de las lesiones presentó IgM. concluimos que en pacientes infectados con L. braziliensis la presencia de IgM e IgG específica a Leishmania esta asociado con el tiempo de evolución de las lesiones y el estado primario recurrente de la infección; demás la detección de IgM anti-Leishmania combinada con la respuesta de Mn sería de potencial utilidad en el diagnóstico clínico de la leishmaniasis tegumentaria temprana.

Studies on sandfly fauna (Diptera: Psychodidae) in a foci of cutaneous leishmaniasis in Mesquita, Rio de Janeiro State, Brazil

Lutzomyia intermedia was the predominant species. It was collected indoors but in much higher numbers outdoors, in the close vicinity of houses. In comparative captures it was found to feed more frequently on equines, and less frequently on man and dogs. Studies, using man and animals as baits, showed that blood-feeding started in the evening, and remained stable during the night, until early morning. June, August and October were the months of highest density.

Distinct ultrastructural aspects in different biopsies of a single patient with diffuse cutaneous leishmaniasis

The authors investigated the relation between parasites and host-cells in active and regressed lesions of a patient with diffuse cutaneous leishmaniasis, evaluating the frequency of different cell types, and the location and integrity of amastigotes. No correlation was found between parasite integrity and size of parasitophorous vacuoles. They observed ultrastructural findings characterizing a cell mediated immune response: macrophages lysis, parasitic destruction inside macrophages, close contact between parasitized macrophages and lymphocytes and between parasites and lymphocytes, lymphocytic infiltration and fibrosis. They suggest that in DCL there is a limited cellular immune response, although insufficient to control infection.

Immunopathology of american cutaneous leishmaniasis. Modulation of MHC class II gene products by Keratinocytes before and after glucantime therapy

Epidermal changes from 32 cutaneous and 3 mucosal American leishmaniasis (ACL) active lesions were studied for HLA-DR, -DP expression, Lanerhans cells and lymphocyte infiltration. In addition to a DR and DQ positivity at the surface of the cells of the inflammatory infiltrate, a strong reaction for DR antigens was detected on keratinocytes. Hyperplasia of Langerhans cells was present in al cutaneous lesions and epidermis was infiltrated by T lymphocytes. When healed lesions of 14 of these subjects were re-biopsied 1 to 12 months after the end of pentavalent antimonial therapy, MHC class antigens could no longer be seen on keratinocytes. Our data represrn evidence for hhe reversibility of the abnormal HLA-DR expression by keratinocytes in ACL after Glucantime therapy or spontaneous scar formation, demonstrating that this expresion is restricted to the period of active lesions. The present findings can be regarded as an indirect evidence that keratinocytes may be involved in the immunopathology of ACL.

Evaluation of the histopathological classifications of American cutaneous and mucocutaneous leishmaniasis

In order to evaluate the reliability of histopathological classifications of cutaneous and mucocutaneous leishmaniasis the authors compared the histopathological patterns of two biopsies taken simultaneously from the same patient, and classified the material according to Ridley et al. (1980), to Magalhães et al. (1986a), and to a more simplified classification with only three patterns. District histopathological aspects, were observed in different lesions or even in the same lesion. The authors concluded that histopathological patterns do not represent a stage of tegumentary leishmaniasis, thus they can not be correlated with prognosis and therapeutical response as suggested in the literature.