ABSTRACT
La Leishmaniasis es un grupo de enfermedades transmitidas por vectores y causada por la Leishmania, un parásito intracelular, que se presenta de preferencia en regiones tropicales y subtropicales. Se manifiesta mediante un amplio rango de formas clínicas como la cutánea, mucocutánea, y visceral, dependiendo de la especie y respuesta inmunológica del paciente. Se presenta el caso de un hombre de 35 años que acudió derivado a Unidad de Estomatología del Hospital Señor del Milagro, Salta, Argentina, presentando en la cavidad oral lesión, granulomatosa, ulcerada, dolorosa a la palpación, única, en paladar blando, de tres meses de evolución. Se realizaron estudios serológicos, parasitológicos y PCR. Los ELISAs lisados, PCRs y cultivos de materiales de lesiones fueron positivos, confirmando diagnóstico de leishmaniasis mucocutánea. El paciente fue derivado al Servicio de Dermatología donde recibió tratamiento con Antimoniato de Meglumina, con repuesta clínica favorable. El conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de leishmaniasis mucocutánea por parte del odontólogo, pudiendo entregar un tratamiento oportuno y a la vez ayudar al paciente, evitando complicaciones de esta enfermedad.
Leishmaniasis is a group of vector-borne diseases caused by Leishmania, an intracellular parasite, which occurs preferentially in tropical and subtropical regions. It manifests itself through a wide range of clinical forms such as cutaneous, mucocutaneous, and visceral, depending on the species and the patient's immune response. We present a case of a 35-year-old man who was referred to the Stomatology Unit of the Señor del Milagro Hospital, Salta, Argentina, presenting in the oral cavity lesion, granulomatous, ulcerated, painful on palpation, unique, soft palate with three months of evolution. Serological, parasitological and PCR studies were performed. Lysed ELISAs, PCRs and cultures of lesion materials were positive, confirming diagnosis of mucocutaneous leishmaniasis. The patient was referred to the Dermatology Service where he received treatment with Meglumine Antimony, with favorable clinical response. The knowledge of the oral manifestations can lead to the clinical diagnosis of mucocutaneous leishmaniasis by the dentist, being able to provide timely treatment and at the same time help the patient, avoiding complications of this disease.
Subject(s)
Humans , Male , Adult , Leishmaniasis, Mucocutaneous/diagnosis , Leishmaniasis, Mucocutaneous/parasitology , Mouth Diseases/diagnosis , Mouth Diseases/parasitology , Paracoccidioidomycosis/diagnosis , Enzyme-Linked Immunosorbent Assay , Polymerase Chain Reaction , Diagnosis, Differential , Histoplasmosis/diagnosis , Leishmania/isolation & purification , Mouth Mucosa/parasitologyABSTRACT
BACKGROUND Unfortunately, no any vaccine against leishmaniasis has been developed for human use. Therefore, a vaccine based on total Leishmania antigens could be a good and economic approach; and there are different methodologies to obtain these antigens. However, it is unknown whether the method to obtain the antigens affects the integrity and immune response caused by them. OBJECTIVES to compare the protein profile and immune response generated by total L. amazonensis antigens (TLA) produced by different methods, as well as to analyse the immune response and protection by a first-generation vaccine formulated with sonicated TLA (sTLA) and polyinosinic:polycytidylic acid [Poly (I:C)]. METHODS TLA were obtained by four different methodologies and their integrity and immune response were evaluated. Finally, sTLA was formulated with Poly (I:C) and their protective immune response was measured. FINDINGS sTLA presented a conserved protein profile and induced a strong immune response. In addition, Poly (I:C) improved the immune response generated by sTLA. Finally, sTLA + Poly (I:C) formulation provided partial protection against L. amazonensis infection. MAIN CONCLUSIONS The protein profile and immune response depend on the methodology used to obtain the antigens. Also, the formulation sTLA + Poly (I:C) provides partial protection against cutaneous leishmaniasis in mice.
Subject(s)
Humans , Animals , Mice , Protozoan Vaccines/immunology , Leishmaniasis, Cutaneous/immunology , Leishmaniasis, Cutaneous/prevention & control , Toll-Like Receptor 3/immunology , Leishmaniasis Vaccines , Leishmania , Mice, Inbred BALB C , Antigens, Protozoan/immunologyABSTRACT
En las normas actuales de tratamiento etiológico de la fase crónica tardía de la enfermedad de Chagasen Argentina, Brasil y la Organización Mundial de la Salud, se recomienda controlar la eficaciaterapéutica con pruebas serológicas y parasitológicas convencionales. Sin embargo las primerassuelen continuar positivas 10 años o más luego del tratamiento, y las segundas son, en general, debaja sensibilidad en esta etapa de la enfermedad. La Reacción en Cadena de la Polimerasa (PCR)al ser más sensible que los exámenes parasitológicos convencionales, podría informar con unacobertura mayor si hubo falla terapéutica. Hemos ofrecido tratamiento con benznidazol (5 mg/kg/día, por 60 días) a 138 pacientes de 16 a 35 años de edad, infectados crónicamente con Trypanosomacruzi. La eficacia terapéutica se controló con PCR periódicas, hemocultivo y serología convencionalen dos grupos de pacientes: uno (GT, 57 pacientes) que aceptó y cumplió el tratamiento y otro(GNT, 37 pacientes) que lo rechazó. Antes de la administración de benznidazol la PCR mostró unasensibilidad diagnóstica de 41 por ciento (57/138 pacientes) y el hemocultivo 7,2 por ciento (10/138). Sesenta mesespostratamiento el grupo GT mostró una positividad de PCR acumulada de 28,1 por ciento (16/57) y el grupoGNT 54,1 por ciento (20/37; p=0.0016). A pesar de que la sensibilidad diagnóstica de PCR es limitada, lanegatividad de pruebas repetidas con método normatizado podría evidenciar disminución de laparasitemia o probable curación en 71,9 por ciento de los pacientes tratados, lo que habría que confirmar conel seguimiento serológico...
Current norms for the etiological treatment of chronic Chagas disease, recommended by WHOor currently in force for Argentina and Brazil, advise the control of therapeutic efficacy usingconventional serological and parasitological tests. However, serology usually remains positive 10 ormore years after treatment and parasitological tests are insensitive in the chronic stage. PolymeraseChain Reaction (PCR) is more sensitive than parasitological tests and could provide earlier evidenceof therapeutic failure. We offered benznidazole treatment (5 mg/kg/day, 60 days) to 138 patients(age=16 to 35 years old), chronically infected with Trypanosoma cruzi. Therapeutic efficacy waschecked with periodic PCR, haemoculture and conventional serology in two groups of patients: One(TG) accepting and complying with treatment and the other (NTG) rejecting it. Before benznidazoleadministration, PCR displayed a diagnostic sensitivity of 41.3 percent (57/138) and haemoculture 7.2 percent(10/138). Sixty months after treatment, TG displayed a cumulated PCR positivity of 28.1 percent (16/57)and NTG 54.1 percent (20/37; p=0.0166). Even though the sensitivity of PCR is limited, repeated negativeresults of a standardized method may reveal lower parasitaemia or probable cure, in 71.9 percent of treatedpatients, to be confirmed with serological follow up...
Subject(s)
Humans , Antiparasitic Agents , Chagas Disease/diagnosis , Trypanosoma cruzi , Enzyme-Linked Immunosorbent Assay , Polymerase Chain ReactionABSTRACT
A patient with localized cutaneous leishmaniasis due to Leishmania (Leishmania) amazonensis infection was treated with an antigen containing heat-killed L. (L.) amazonensis promastigotes plus BCG. Expression of T-cell differentiation, memory and senescence receptors markers were analyzed on T cell subpopulations, in order to establish the correlation between the percentages of expression of these receptors and his clinical status, at different stages of his follow up. The following case reports on the achievement of a successful clinical outcome with complete resolution after receiving immunotherapy. A thorough clinical and immunological follow up supporting the healing process of this patients lesion is presented in detail.
Un paciente con leishmaniasis cutánea localizada producida por Leishmania (Leishmania) amazonensis fue tratado con un antígeno compuesto por promastigotes de L. (L.) amazonensis muertos por calor combinado con BCG. Se analizó la expresión de distintos receptores de diferenciación, de memoria y de senescencia en las subpoblaciones de células T, con el fin de establecer una relación entre los porcentajes de expresión de dichos receptores y la clínica del paciente en diferentes momentos del seguimiento. Se reporta en este caso un resultado exitoso, con resolución completa de la lesión después de recibir la inmunoterapia, y se presenta en detalle un seguimiento clínico e inmunológico completo durante el proceso de curación.