Anti - glucose regulated protein 78 [GRP78] antibody responses in Alum/ALM plus BCG vaccinee, visceral leishmaniasis, and Post Kala- azar Dermal leishmaniasis patients

The Glucose Regulated Protein 78 [GRP78] of Leishmania donovani is considered to be one of the potential Leishmania vaccine candidates. Using Enzyme-Linked Immunosorbent Assay [ELISA], we measured IgG antibody responses to GRP78 in 39 healthy Sudanese volunteers vaccinated with Leishmania Alum/ALM + BCG vaccine, 29 patients with visceral leishmaniasis [VL], and 26 patients with post kala-azar dermal leishmaniasis [PKDL]. There was, no significant statistical difference in plasma levels of GRP78 antibodies in immunized and control group [P=0.37]. Furthermore, no significant statistical difference in the levels of GRP78 antibodies in the pre and post vaccination plasma samples [P=0.60]. Plasma IgG levels to GRP78 was significantly higher in visceral leishmaniasis and PKDL patients compared with control group [P=0.00]. This study concludes that Alum/ALM vaccine does not induce a Th2 type of immune response. It also demonstrated clearly that VL and PKDL are associated with elevation of anti-GRP 78 antibodies and that GRP78 ELISA can be used to confirm diagnosis of Leishmania infections based on the clinical presentation

Safety, immunogenicity and possible efficacy of immunochemotherapy of persistent post Kala-azaz dermal leishmaniasis

Post kala-azar dermal leishmaniasis [PKDL] is a common skin condition that follows successful treatment of visceral leishmaniasis [VL] in Sudanese patients. Lesions persist for years in 15% of patients and are viewed as reservoirs for the disease. Drug treatment is protracted, toxic and costly. Cure is strongly correlated with conversion in the leishmanin skin test. To determine safety, immunogenecity and possible efficacy of Alum-precipitated autoclaved L. major + BCG VL candidate vaccine combined with sodium stibogluconate [SSG] in patients with persistent PKDL. Following informed consent, the vaccine mixture was administered in a stepwise manner as follows: 5 patients received a single intradermal injection of 10 microg, 5 patients received a single dose of 100 microg and 2 patients received 4 doses of 100 microg at weekly intervals. Subsequently, the three groups of patients received means of 63.0 +/- 8.0, 53.0 +/- 5.0 and 40 days courses of SSG treatment respectively and were cured. Side effects were minimal and were confined to the vaccine injection site. Following completion of the safety study, eight patients were injected with 4-6 vaccine doses of 100 microg/dose at weekly intervals in combination with SSG. Patients were closely followed up in hospital, with minimal side effects and complete clearance of the skin rash in forty days. Alum/ALM + BCG vaccine mixture plus SSG was safe and was apparently effective in healing persistent PKDL lesions. SSG treatment duration could be shortened with the SSG/vaccine combination

unusual case of mucosal leishmaniasis with cutaneous dissemination in Sudan and its epidemiological significance

Sudan is endemic for visceral, cutaneous and mucosal leishmaniasis. The latter is the least common of the three forms of leishmaniasis. It is caused by L. donovani, the same parasite that causes visceral leishmaniasis [VL] in the country. Most of the cases were reported from VL endemic areas, the majority in adults. The disease may be primary in the oral and or the upper respiratory mucosa or may follow or accompany visceral leishmaniasis. This paper is a report of a case of mucosal leishmaniasis of the nose and lips. It is unusual in several aspects: the disease was acquired in a village where no cases of VL or mucosal leishmaniasis were recorded within living memory, before an outbreak in 1981 during which the patient was infected; the patient was infected at the age of five years and the disease remained active for 22 years causing physical deformity and psychological trauma to the patient