ABSTRACT
Visceral leishmaniasis (VL), also known as kala-azar, is an important public health problem. If not treated, virtually all clinically symptomatic patients die within months. The diagnosis is based on the Montenegro skin test (MST) and anti-Leishmania titers. Nevertheless, the time required for cured individuals living in a leishmaniasis-endemic area to present a positive skin test and negative anti-Leishmania serology is known. To determine the cellular and humoral immune response profile in relation to different times post-VL cure, a cross-sectional study was conducted on subjects from a kala-azar endemic area in Paço do Lumiar, MA, Brazil, on the basis of 1995-2005 notifications reported by the National Health Foundation/Regional Coordination of Maranhão. We visited cured individuals with a history of VL within the last 10 years. Seventy-four subjects (30 females) ranging in age from 1 to 44 years were included, all of them symptom free at the time of the study. A cellular immune response was observed in 73 (98.6 percent) subjects, whereas no significant antibody titers were detected by indirect immunofluorescence (IIF) in the sera of 69 (93.2 percent) cases. Ten years post-cure, 39 (52 percent) subjects had a positive MST and negative IIF reaction, while in one subject the skin and anti-Leishmania serology tests were negative. Two other subjects were positive in both tests 1 year after cure. These data suggest that a cellular immune response may still be present in subjects cured of VL regardless of post-cure time, and that the parasite persists in the host after clinical cure of the disease. This would explain the persistence of significant Leishmania sp antibody titers in some subjects after treatment.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Young Adult , Antibodies, Protozoan/blood , Immunity, Cellular/immunology , Leishmaniasis, Visceral/immunology , Antibodies, Protozoan/immunology , Cross-Sectional Studies , Fluorescent Antibody Technique, Indirect , Intradermal TestsABSTRACT
Leishmaniose visceral (calazar) entrou definitivamente como nosologia importante do Estado do Maranhão, Brasil, a partir de 1982. Desde então, vários autores têm trabalhado o tema do ponto de vista de relatos. No entanto, a parte de diagnóstico, tratamento e controle de cura percorreram caminhos difíceis e sempre preocupou os que estudam a doença que se instalou na Ilha de São Luís a partir da desestabilização dos ecótopos da Lutzomya longipalpis, o transmissor mais importante. Após 1993 a constatação de casos com má resposta ao antimoniato-n-metil glucamina (Glucantime®) veio se somar às outras preucupações. O estudo atual mostra como o Sistema Único de Saúde, através dos seus serviços, atua no controle da doença e conclui sobre a existência de refratariedade ao Glucantime® o que impõe maior vigilância no diagnóstico, tratamento e controle de cura dos pacientes.
Visceral leishmaniasis (kala-azar) was definitively an important disease of the state of Maranhão, Brasil since 1982. Since of then, many authors have been working with this topic in spite of reports. Nevertheless, the aspects of diagnosis, treatment an control of cure went through still hard worried the authors have been studying the disease, that came at São Luís Island since of the destabilization of the ecotopes of Lutzomya longipalpis, most important sandflies bites. After 1993 the constatation of cases with bad response to pentavalent antimonial (Glucantime) comes to add the other worries. This actual trial accost the disease and conclude about an existence of failures to Glucantime being important to have much vigilance in the diagnosis, treatment and control of cure of the patients.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Leishmaniasis, Visceral/diagnosis , Age Distribution , Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Brazil/epidemiology , Organometallic Compounds/therapeutic use , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Meglumine/therapeutic use , Retrospective Studies , Seasons , Sex DistributionABSTRACT
Os autores descrevem um caso de associacao de leishmaniose visceral, SIDA e provavel tuberculose disseminada. Discutem a possibilidade de associacao desta protozoonose e infeccao pelo virus da Imunodeficiencia Adquirida (VIH) principalmente pelo aumento de prevalencia de infeccao pelo VIH em areas endemicas para o calazar. A presenca de imunodepressao pelo VIH possibilita manifestacoes de agentes oportunistas muitas vezes associados e relacionados com as endemias prevalentes nestas regioes de subdesenvolvimento.