ABSTRACT
Abstract Background: The treatment of cutaneous leishmaniasis is a challenge. A better understanding of the in situ mechanisms involved in the evolution and cure of the disease is essential for the development of new therapies. Objective: Correlate histopathological and immunological characteristics of cutaneous leishmaniasis lesions with clinical outcome after different treatment regimens. Methods: The authors analyzed cellular infiltration and immunohistochemistry staining for CD4, CD8 and IL-17 in biopsy samples from 33 patients with cutaneous leishmaniasis before treatment. All patients were recruited in a randomized clinical trial at Corte de Pedra (Bahia-Brazil) and assigned to receive Glucantime®, Glucantime® + Oral Tamoxifen or Glucantime® + Topical Tamoxifen. Patients were followed for 2 to 6 months to define disease outcome. Results: A similar expression of CD4, CD8 and IL-17 was observed in lesion samples regardless of clinical outcome. In general, a higher amount of CD8 cells were observed compared with CD4 cells. An important observation was that all patients whose cellular infiltrate did not contain plasma cells were cured after treatment. Study limitations: Isolated quantification of TCD8 and IL-17 using immunohistochemistry is insufficient to analyze the role of these molecules in the immunopathogenesis of cutaneous leishmaniasis. In addition, the expansion of the immunohistochemistry panel would allow a more complete analysis of the immune response in situ. Conclusions: The absence of plasma cells in cutaneous leishmaniasis lesions was related to a favorable therapeutic outcome.
Subject(s)
Humans , Leishmaniasis, Cutaneous/drug therapy , CD4-Positive T-Lymphocytes , Treatment Outcome , CD8-Positive T-Lymphocytes , Meglumine AntimoniateABSTRACT
Introducción: la candidiasis bucal es la infección oportunista más frecuente en pacientes infectados por el VIH, se constituye muchas ocasiones en la primera manifestación de esta enfermedad. Objetivo: determinar la asociación entre la candidiasis bucal, los niveles de linfocitos CD4 y el tratamiento antirretroviral en pacientes VIH/SIDA. Métodos: estudio descriptivo de corte transversal. La población estuvo conformada por 141 pacientes diagnosticados como seropositivos al VIH. Un mismo examinador realizó examen clínico intrabucal. Los datos de niveles de linfocitos CD4 y terapia antirretroviral se obtuvieron de la historia clínica médica. La información se procesó en paquete estadístico Stata versión 11. Resultados: el 66,7 por ciento de la población fueron hombres. La vía de transmisión del virus más frecuente fue la sexual (96 por ciento). La prevalencia de manifestaciones bucales asociadas al VIH fue de 59,5 por ciento; la candidiasis pseudomembranosa se presentó con mayor frecuencia (31,3 por ciento), seguida por la variante eritematosa (4,2 por ciento). En relación con la candidiasis pseudomembranosa y los niveles de CD4, 22 pacientes presentaron valores de CD4 menores de 200 células/mL3 y 29 estaban bajo esquema antirretroviral que incluía dos grupos de fármacos inhibidores de la proteasa/inhibidores análogos de nucleósidos de la transcriptasa reversa. Conclusión: la candidiasis pseudomembranosa está altamente relacionada con niveles de linfocitos CD4 menores de 200 células/mL3. Los pacientes bajo esquema de tratamiento farmacológico antirretroviral monoterapia presentaron menos candidiasis que aquellos tratados con biterapia(AU)
Introduction: oral candidiasis is the most common opportunistic infection in HIV-infected patients, and on many occasions it is the first manifestation of the disease. Objective: determine the association between oral candidiasis, CD4 lymphocyte levels and antiretroviral treatment in HIV/AIDS patients. Methods: a descriptive cross-sectional study was conducted. The study population was 141 patients diagnosed as HIV-positive. All clinical intraoral examinations were performed by the same examiner. Data about CD4 lymphocyte levels and antiretroviral therapy were obtained from the patients' medical records. The information was processed with the statistical package Stata v11. Results: 66.7 percent of the study population were men. Sexual transmission was the most common form of transmission (96 percent). Prevalence of oral manifestations associated with HIV was 59.5 percent; the most common form of the disease was pseudomembranous candidiasis (31.3 percent), followed by erythematous candidiasis (4.2 percent). With respect to pseudomembranous candidiasis and CD4 levels, 22 patients had CD4 values below 200 cell/mm3, and 29 were undergoing antiretroviral therapy with two drug groups: IP/INTR. Conclusion: pseudomembranous candidiasis is highly correlated with CD4 lymphocyte levels below 200 cell/mm3. Patients under antiretroviral monotherapy presented less candidiasis than those under bitherapy(AU)