Natural Leishmania (Viannia) spp. infections in phlebotomine sand flies (Diptera: Psychodidae) from the Brazilian Amazon region reveal new putative transmission cycles of American cutaneous leishmaniasis.

In Amazonian Brazil the etiological agents of American cutaneous leishmaniasis (ACL) belong to at least seven Leishmania species but little is known about the putative phlebotomine sand fly vectors in different biomes. In 2002-2003 a survey of the phlebotomine fauna was undertaken in the "Floresta Nacional do Tapajós", Belterra municipality, in the lower Amazon region, western Pará State, Brazil, where we recently confirmed the presence of a putative hybrid parasite, L. (V.) guyanensis × L. (V.) shawi shawi. Sand flies were collected from Centers for Disease Control (CDC) light traps, Shannon traps and by aspiration on tree bases. Females were dissected and attempts to isolate any flagellate infections were made by inoculating homogenized midguts into Difco B(45) medium. Isolates were characterized by monoclonal antibodies and isoenzyme electrophoresis. A total of 9,704 sand flies, belonging to 68 species or subspecies, were collected. Infections were found in the following sand flies: L. (V.) naiffi with Psychodopygus hirsutus hirsutus (1) and Ps. davisi (2); and L. (V.) shawi shawi with Nyssomyia whitmani (3) and Lutzomyia gomezi (1). These results provide strong evidence of new putative transmission cycles for L. (V.) naiffi and L. (V.) s. shawi.

Phenotypic characterization of Leishmania spp. causing cutaneous leishmaniasis in the lower Amazon region, western Pará state, Brazil, reveals a putative hybrid parasite, Leishmania (Viannia) guyanensis × Leishmania (Viannia) shawi shawi.

We phenotypically characterized 43 leishmanial parasites from cutaneous leishmaniasis by isoenzyme electrophoresis and the indirect immunofluorescence antibody test (23 McAbs). Identifications revealed 11 (25.6%) strains of Leishmania (V.) braziliensis, 4 (9.3%) of L. (V.) shawi shawi, 7 (16.3%) of L. (V.) shawi santarensis, 6 (13.9%) of L. (V.) guyanensis and L. (V.) lainsoni, 2 (4.7%) of L. (L.) amazonensis, and 7 (16.3%) of a putative hybrid parasite, L. (V.) guyanensis/L. (V.) shawi shawi. McAbs detected three different serodemes of L. (V.) braziliensis: I-7, II-1, and III-3 strains. Among the strains of L. (V.) shawi we identified two populations: one (7 strains) expressing the B19 epitope that was previously considered to be species-specific for L. (V.) guyanensis. We have given this population sub-specific rank, naming it L. (V.) s. santarensis. The other one (4 strains) did not express the B19 epitope like the L. (V.) shawi reference strain, which we now designate as L. (V.) s. shawi. For the first time in the eastern Brazilian Amazon we register a putative hybrid parasite (7 strains), L. (V.) guyanensis/L. (V.) s. shawi, characterized by a new 6PGDH three-band profile at the level of L. (V.) guyanensis. Its PGM profile, however, was very similar to that of L. (V.) s. shawi. These results suggest that the lower Amazon region - western Pará state, Brazil, represents a biome where L. (V.) guyanensis and L. (V.) s. shawi exchange genetic information.

Canine visceral leishmaniasis due to Leishmania (L.) infantum chagasi in Amazonian Brazil: comparison of the parasite density from the skin, lymph node and visceral tissues between symptomatic and asymptomatic, seropositive dogs.

Canine visceral leishmaniasis (CVL) is recognizable by characteristic signs of disease and is highly lethal. The infection, however, may be quite inapparent in some seropositive dogs, and this has raised the polemic question as to whether or not such animals can be a source of infection for Lutzomyia longipalpis, the vector of American visceral leishmaniasis (AVL). In this study we have examined 51 dogs with acute CVL from an AVL area in Pará State, northern Brazil, and compared the parasite density, amastigotes of Leishmania (L.) infantum chagasi, in the skin, lymph node and viscera of symptomatic with that of nine asymptomatic but seropositive dogs (IFAT-IgG). Post-mortem biopsy fragments of these tissues were processed by immunohistochemistry, using a polyclonal antibody against Leishmania sp. The X² and Mann Whitney tests were used to evaluate the means of infected macrophage density (p < 0.05). There was no difference (p > 0.05) in the skin (10.7/mm² x 15.5/mm²) and lymph node (6.3/mm² x 8.3/mm²), between asymptomatic and symptomatic dogs, respectively. It was higher (p < 0.05), however, in the viscera of symptomatic (5.3/mm²) than it was in asymptomatic (1.4/mm²) dogs. These results strongly suggest that asymptomatic or symptomatic L. (L.) i. chagasi-infected dogs can serve as a source of infection, principally considering the highest (p < 0.05) parasite density from skin (10.7/mm² x 15.5/mm²), the place where the vetor L. longipalpis takes its blood meal, compared with those from lymph node (6.3/mm² x 8.3/mm²) and viscera (1.4/mm²x 5.3/mm²).

Canine visceral leishmaniasis due to Leishmania (L.) infantum chagasi in Amazonian Brazil: comparison of the parasite density from the skin, lymph node and visceral tissues between symptomatic and asymptomatic, seropositive dogs / Leishmaniose visceral canina causada por Leishmania (L.) infantum chagasi na Amazônia brasileira: comparação da densidade parasitária da pele, linfonodo e vísceras entre cães soropositivos, sintomáticos e assintomáticos

Canine visceral leishmaniasis (CVL) is recognizable by characteristic signs of disease and is highly lethal. The infection, however, may be quite inapparent in some seropositive dogs, and this has raised the polemic question as to whether or not such animals can be a source of infection for Lutzomyia longipalpis, the vector of American visceral leishmaniasis (AVL). In this study we have examined 51 dogs with acute CVL from an AVL area in Pará State, northern Brazil, and compared the parasite density, amastigotes of Leishmania (L.) infantum chagasi, in the skin, lymph node and viscera of symptomatic with that of nine asymptomatic but seropositive dogs (IFAT-IgG). Post-mortem biopsy fragments of these tissues were processed by immunohistochemistry, using a polyclonal antibody against Leishmania sp. The X² and Mann Whitney tests were used to evaluate the means of infected macrophage density (p < 0.05). There was no difference (p > 0.05) in the skin (10.7/mm² x 15.5/mm²) and lymph node (6.3/mm² x 8.3/mm²), between asymptomatic and symptomatic dogs, respectively. It was higher (p < 0.05), however, in the viscera of symptomatic (5.3/mm²) than it was in asymptomatic (1.4/mm²) dogs. These results strongly suggest that asymptomatic or symptomatic L. (L.) i. chagasi-infected dogs can serve as a source of infection, principally considering the highest (p < 0.05) parasite density from skin (10.7/mm² x 15.5/mm²), the place where the vetor L. longipalpis takes its blood meal, compared with those from lymph node (6.3/mm² x 8.3/mm²) and viscera (1.4/mm²x 5.3/mm²).

A leishmaniose visceral canina (LVC) é reconhecida pelas características clínicas da doença e é altamente letal. A infecção, entretanto, pode ser totalmente assintomática em alguns cães soropositivos, o que tem levantado questão polêmica sobre a possibilidade desses animais, serem ou não uma fonte importante da infecção para o flebotomíneo, Lutzomyia longipalpis, o principal vetor da leishmaniose visceral americana (LVA). Neste estudo foram examinados 51 cães com LVC aguda, provenientes de área endêmica de LVA no Estado do Pará, Brasil, e a carga parasitária, formas amastigotas de Leishmania (L.) infantum chagasi, na pele, linfonodo poplíteo e vísceras (fígado e baço) foi comparada com a de nove cães assintomáticos soropositivos (IFAT-IgG). Fragmentos de biópsia desses tecidos obtidos post-mortem foram processados para análise através de imunohistoquímica, usando um anticorpo policlonal contra Leishmania sp. Os testes do Qui-quadrado (X²) e Mann Whitney foram usados para avaliar as médias da densidade de macrófagos infectados (p < 0,05). Os resultados mostraram que não houve diferença (p > 0,05) na densidade de macrófagos infectados da pele (10,7/mm² x 15,5/mm²) e do linfonodo (6,3/mm² x 8,3/mm²) entre cães assintomáticos e sintomáticos. Entretanto, a densidade de macrófagos infectados da víscera de cães sintomáticos (5,3/mm²) foi maior (p < 0,05) que a de cães assintomáticos (1,4/mm²). Estes resultados sugerem, fortemente, que cães naturalmente infectados por L. (L.) i. chagasi, assintomáticos ou sintomáticos, podem servir como fonte de infecção, principalmente, considerando-se que a densidade de macrófagos infectados da pele (10,7/mm² x 15,5/mm²), local onde o flebotomíneo vetor Lu. longipalpis realiza a hematofagia, foi maior (p < 0,05) que as do linfonodo (6,3/mm² x 8.3/mm²) e vísceras (1,4/mm²x 5,3/mm²).

A prospective study on the dynamics of the clinical and immunological evolution of human Leishmania (L.) infantum chagasi infection in the Brazilian Amazon region.

This prospective study was carried out from October 2003 to December 2005 and involved a cohort of 946 individuals of both genders, aged 1-89 years, from an endemic area for American visceral leishmaniasis (AVL), in Pará State, Brazil. The aim of the study was to analyze the dynamics of the clinical and immunological evolution of human Leishmania (L.) infantum chagasi infection represented by the following clinical-immunological profiles: asymptomatic infection (AI); symptomatic infection (SI=AVL); subclinical oligosymptomatic infection (SOI); subclinical resistant infection (SRI); and indeterminate initial infection (III). Infection diagnosis was determined by the indirect fluorescent antibody test and leishmanin skin test. In total, 231 cases of infection were diagnosed: the AI profile was the most frequent (73.2%), followed by SRI (12.1%), III (9.9%), SI (2.6%) and SOI (2.2%). The major conclusion regarding evolution dynamics was that the III profile plays a pivotal role from which the cases evolve to either the resistant, SRI and AI, or susceptible, SOI and SI, profiles; only one of the 23 III cases evolved to SI, while most evolved to either SRI (nine cases) or SOI (five cases) and eight cases remained as III.

Hematological parameters of Ameiva ameiva (Reptilia: Teiidae) naturally infected with hemogregarine: confirmation of monocytosis.

Little is known on how hematozoan infection changes reptile hematology. The lizard Ameiva ameiva is widely distributed in the Americas and is infected by hematozoan parasites. Previous studies on this lizard have shown that the parasite of monocytes causes a variety of ultrastructural changes in infected host cells. The present study reports that this infection does not cause any change to the erythrocytic values. However, a marked increase in the number of leukocytes (especially monocytes) was detected. This indicates that the hemogregarine not only modulates the infected monocyte, but also increases the blood pool of this leukocyte. A Plasmodium sp was also found infecting erythrocytes of one lizard.

Further evidences on a new diagnostic approach for monitoring human Leishmania (L.) infantum chagasi infection in Amazonian Brazil.

This was a prospective study carried out during a period over 2 years (May/2006-September/2008) with a cohort of 1,099 individuals of both genders, aged 1 year old and older, from an endemic area of American visceral leishmaniasis (AVL) in Pará state, Brazil. The object was to analyze the prevalence and incidence of human Leishmania (L.) infantum chagasi infection as well as the dynamics evolution of its clinical-immunological profiles prior identified: (1) asymptomatic infection (AI); (2) symptomatic infection (SI = AVL); (3) sub-clinical oligosymptomatic infection (SOI); (4) sub-clinical resistant infection (SRI) and; (5) indeterminate initial infection (III). The infection diagnosis was performed by using both the indirect fluorescent antibody test and leishmanin skin test with amastigotes and promastigotes antigens of L. (L.) i. chagasi, respectively. A total of 187 cases of infection were recorded in the prevalence (17%), 117 in the final incidence (6.9%), and 304 in the accumulated prevalence (26.7%), which provided the following distribution into the clinical-immunological profiles: AI, 51.6%; III, 22.4%; SRI, 20.1%; SOI, 4.3%; and SI (=AVL), 1.6%. The major finding regarding the dynamics evolution of infection was concerned to III profile, from which the cases of infection evolved to either the resistant profiles, SRI (21 cases, 30.8%) and AI (30 cases, 44.1%), or the susceptible SI (=AVL; 1 case, 1.5%); the latter 16 cases remained as III till the end of the study. These results provided the conclusion that this diagnostic approach may be useful for monitoring human L. (L.) i. chagasi infection in endemic area and preventing the high morbidity of severe AVL cases.

Fauna flebotomínica da Serra dos Carajás, Estado do Pará, Brasil, e sua possível implicação na transmissão da leishmaniose tegumentar americana / Phlebotominae fauna in Serra dos Carajás, Pará State, Brazil, and its possible implications for the transmission of American tegumentar leishmaniasis

A Serra dos Carajás, localizada no sudeste do Estado do Pará, Brasil, representa uma rica floresta tropical, onde são encontradas espécies de Leishmania sp. de interesse médico, como L. (V.) braziliensis, L. (V.) lainsoni, L. (V.) shawi e L. (L.)amazonensis, cuja transmissão é feita pelos flebotomíneos: Psychodopygus complexus ou Ps. wellcomei, Lutzomyia ubiquitalis, Lu. whitmani e Lu. flaviscutellata. Considerando o incremento de imigrantes na região do projeto Carajás, realizou-se estudo para avaliar a fauna de flebotomíneos e sua possível participação na transmissão da leishmaniose tegumentar americana (LTA). Os flebotomíneos foram capturados: i) Parque Zoobotânico de Parauapebas, ii) Área deproteção ambiental e, iii) Floresta Nacional de Tapirapé-Aquiri, de dezembro/2005 a setembro/2007, usando-se dez armadilhas luminosas tipo "CDC" (18 h às 6 h) e duas tipo Shannon (18 h às 20 h), durante 172 dias de coleta. Foram capturados 22.095 flebotomíneos, 6.789 (31 por cento) machos e 15.306 (69 por cento) fêmeas, pertencentes a 69 espécies e três gêneros: Psychodopygus, Lutzomyia e Brumptomyia. Foram detectadas 19 (0,16 por cento) infecções naturais nas seguintes espécies: Ps. davisi (4), Ps. h. hirsutus (3), Lu. umbratilis (3), Lu. richardward (2), Lu. brachipyga (2), Lu. ubiquitalis (2), Lu. trinidadenses (1) e Lu. migonei (1). Embora não tenha sido encontrada infecção em Ps. wellcomei/complexus, principalvetor da L. (V.) braziliensis na região, esta espécie foi a mais prevalente (16 por cento), seguida de Ps. davisi (15,4 por cento), Ps. carrerai (4,2 por cento), Lu. shawi (3,9 por cento), Lu. brachipyga (2,5 por cento) e Lu. richardward (1,2 por cento). Estes resultados evidenciam a importância destes flebotomíneos como possíveis vetores da LTA na Serra dos Carajás.

Serra dos Carajás, located in the southeast of Pará State, Brazil, is a rich tropical forest where species of Leishmania sp. of medical interest are found, such as Leishmania (V.) braziliensis, L. (V.) lainsoni, L. (V.) shawi and L. (L.) amazonensis. They are transmitted by the following phlebotomi: Psychodopygus complexus or Ps. wellcomei, Lutzomyia ubiquitalis, Lu. whitmani and Lu. flaviscutellata. Considering the increase of immigrants in the region of the Carajás project, this study aimed to assess the Phlebotominae fauna and their possible participation in the transmission of American cutaneous leishmaniasis (ACL). The phlebotomi were captured from December 2005 to September 2007 at the following locations: i)Parauapebas Botanical Park; ii) an environmental protection area; and iii) Tapirapé-Aquiri National Forest. During the 172 days of collection, 10 CDC (18 h to 6 h) and 2 Shannon (18 h to 20 h) light traps were used. Of the 22,095 phlebotomi captured, 6,789 (31 percent) were male and 15,306 (69 percent) were female, and they belonged to 69 species and three genera,including Psychodopygus, Lutzomyia and Brumptomyia. A total of 19 (0.16 percent) natural infections of the following species were detected: Ps. davisi (4), Ps. h. hirsutus (3), Lu. umbratilis (3), Lu. richardward (2), Lu. brachipyga (2), Lu. ubiquitalis (2),Lu. trinidadensis (1) and Lu. migonei (1). Although no infection was found in Ps. wellcomei/complexus, the main vector of L. (V.) braziliensis in the region, this species was the most prevalent (16 percent), followed by Ps. davisi (15.4 percent), Ps. carrerai (4.2percent), Lu. shawi (3.9 percent), Lu. brachipyga (2.5 percent) and Lu. richardward (1.2 percent). These results show the importance of these phlebotomi as possible vectors of ACL in Serra dos Carajás.

Novas evidências sobre o valor diagnóstico da reação de imunofluorescência indireta e reação intradérmica de hipersensibilidade tardia na infecção humana por Leishmania (L) infantum chagasi na Amazônia, Brasil / New evidences on the diagnostic value of indirect immunofluorescence test and delayed hypersensitivity skin test in human infection by Leishmania (L ) infantum chagasi in the Amazon, Brazil

Estudo prospectivo realizado no período de maio/2006-setembro/2008, numa coorte de 1.099 indivíduos, ambos os sexos, com idades de 1 a 84 anos (média 24, 4 anos), residente em área endêmica de leishmaniose visceral americana (LVA) no Município de Cametá, Pará, Brasil, objetivando analisar a prevalência e a incidência da infecção humana por Leishmania (L.) infantum chagasi, assim como a dinâmica da evolução dos seus perfis clínico-imunológicos previamente definidos: 1. Infecção assintomática (IA); 2. Infecção sintomática (IS=LVA); 3. Infecção subclínica oligossintomática (ISO); 4. Infecção subclínica resistente (ISR); e 5. Infecção inicial indeterminada (III). O diagnóstico da infecção baseou-se no uso simultâneo da reação de imunofluorescência indireta (RIFI) e reação intradérmica de hipersensibilidade tardia. Um total de 304 casos da infecção foi diagnosticado no período do estudo (187 na prevalência e 117 na incidência), gerando prevalência acumulada de 27,6 por cento, cuja distribuição no âmbito dos perfis clínico-imunológicos foi da seguinte ordem: IA 51,6 por cento, III 22,4 por cento, ISR 20,1 por cento, ISO 4,3 por cento e, IS (=LVA) 1,6 por cento. Com base na dinâmica da infecção, o principal achado recaiu no perfil III, que teve papel fundamental na evolução da infecção, dirigindo-a ora para o pólo imunológico de resistência, perfis ISR (21 casos - 30,8 por cento) e IA (30 casos - 44,1 por cento), ora para o polo imunológico de susceptibilidade, perfil IS (um caso -1,5 por cento); além destes, 16 casos mantiveram o perfil III até o fim do estudo. Concluiu-se que esta abordagem diagnóstica pode ajudar no monitoramento da infecção na área endêmica, visando, principalmente, prevenir a morbidade da LVA, assim como reduzir o tempo e despesas com o tratamento.

This is a prospective study on a cohort of 1099 individuals of both genders, aged 1-84 years (mean 24.4 years), living in an endemic area of American visceral leishmaniasis (AVL) in the Municipality of Cametá, Brazil, from May 2006 to September 2008. It aimed to analyze the prevalence and incidence rates of human infection by Leishmania (L.) infantum chagasi, as well as the evolutional process of its previously defined clinical and immunological profiles: 1. Asymptomatic infection (AI);2. Symptomatic infection (SI = AVL); 3. Subclinical oligosymptomatic infection (SOI); 4. Subclinical resistant infection (SRI); and 5. Indeterminate initial infection (III). The diagnosis was based on the simultaneous use of indirect immunofluorescence assay (IFA) and delayed hypersensitivity skin test. A total of 304 cases of infection were diagnosed during the period studied(187 for prevalence and 117 for incidence), generating an accumulated prevalence rate of 27.6 percent. The distribution regarding their clinical and immunological profiles presented the following order: AI 51.6 percent; III 22.4 percent; SRI 20.1 percent; SOI4.3 percent; and SI (= AVL) 1.6 percent. Based on the dynamics of the infection, the main discovery was about the III profile, which had an instrumental role in its evolution, directing it either to the resistant immunological pole – SRI (21 cases - 30.8 percent) and AI (30 cases - 44.1 percent) profiles – or to the susceptible immunological pole – SI (1 case - 1.5 percent) profile. In addition, 16 cases remained within the III profile until the end of the study. It was concluded that this diagnostic approach can help monitor the infection in endemic areas, aiming mainly at preventing morbidity caused by AVL, and reducing the treatment time and expenses.

The Neotropical Leishmania species: a brief historical review of their discovery, ecology and taxonomy / 117

This paper is a review of the major historical events leading to our present classification of the Neotropical Leishmania species, and apart from indicating the basic type of disease these different parasites may cause in humans, it does not discuss the clinical or epidemiological features of the leishmaniases. For each of these species, information is given on the known geographical distribution, recorded phlebotomine sand fly host(s) and the secondary, wild or domestic mammalian hosts. Reasons are given for regarding the parasite referred to as Leishmania (L.) infantum chagasi, the causative agent of American visceral leishmaniasis, as most probably indigenous to the Neotropics rather than imported during the Iberian colonisation...

Este artigo apresenta uma revisão dos mais importantes eventos históricos que levaram à atual classificação das espécies neotropicais de Leishmania e indica as doenças básicas causadas em seres humanos por estes diferentes parasitos, sem discutir os aspectos clínicos e epidemiológicos das leishmanioses. Para cada uma das espécies descritas, são fornecidas informações a respeito de sua conhecida distribuição geográfica, dos flebotomíneos hospedeiros registrados e de seus reservatórios mamíferos secundários, selvagens ou domésticos. Os dados apresentados levam à conclusão de que o parasito Leishmania (L.) infantum chagasi, agente causador da leishmaniose visceral americana, é provavelmente autóctone da região neotropical, e não importada durante a colonização ibérica...

Proven and putative vectors of American cutaneous leishmaniasis in Brazil: aspects of their biology and vectorial competence.

The aim of the present review is to give relevant information on aspects of the biology and ecology, including the vectorial competence of Lutzomyia sand fly species suggested as vectors of American cutaneous leishmaniasis in Brazil. The disease, due to Leishmania (Viannia) braziliensis, has been registered in most municipalities in all the Brazilian states and its transmission is associated with more than one sand fly species in each geographical region. A variety of Leishmania species can be found in the Amazon basin, where different epidemiological chains have been detected with the participation of different phlebotomine vectors. Finally, a discussion is presented on some sand fly species found naturally infected by Leishmania, but for which there is as yet no evidence regarding their epidemiological importance.

Proven and putative vectors of American cutaneous leishmaniasis in Brazil: aspects of their biology and vectorial competence

The aim of the present review is to give relevant information on aspects of the biology and ecology, including the vectorial competence of Lutzomyia sand fly species suggested as vectors of American cutaneous leishmaniasis in Brazil. The disease, due to Leishmania (Viannia) braziliensis, has been registered in most municipalities in all the Brazilian states and its transmission is associated with more than one sand fly species in each geographical region. A variety of Leishmania species can be found in the Amazon basin, where different epidemiological chains have been detected with the participation of different phlebotomine vectors. Finally, a discussion is presented on some sand fly species found naturally infected by Leishmania, but for which there is as yet no evidence regarding their epidemiological importance.

A cross-sectional study on the clinical and immunological spectrum of human Leishmania (L.) infantum chagasi infection in the Brazilian Amazon region.

The objectives of this study were to identify individuals with symptomatic and/or asymptomatic infection due to Leishmania (L.) infantum chagasi; to study the two types of infection, both clinically and immunologically, and to determine the prevalence rate of infection at the beginning of the study. This was a cross-sectional study with a cohort of 946 individuals, of both genders, from the age of 1 year, living in the municipality of Barcarena, PA, Brazil, an area endemic for American visceral leishmaniasis (AVL). The leishmanin skin test (LST) and the indirect fluorescent test (IFAT), were used for the diagnosis of infection. One hundred and twenty cases of infection were diagnosed, with a prevalence rate of 12.6%; eight cases showed high seroreactivity (1280-10240, IgG) in IFAT and no LST reaction; four of these cases were typical AVL and four had subclinical oligosymptomatic infection. Using two immunological methods with a clinical examination of the infected individuals enabled the identification of five clinical-immunological profiles which may promote a better understanding of the interaction between L. (L.) i. chagasi and the human immune response: asymptomatic infection (AI) 73.4%; subclinical resistant infection (SRI) 15%; subclinical oligosymptomatic infection (SOI) 3%; symptomatic infection (AVL) 3% and indeterminate initial infection (III) 5%.

A longitudinal study on the transmission dynamics of human Leishmania (Leishmania) infantum chagasi infection in Amazonian Brazil, with special reference to its prevalence and incidence.

This was a longitudinal study carried out during a period over 2 years with a cohort of 946 individuals of both sexes, aged 1 year and older, from an endemic area of American visceral leishmaniasis (AVL) in Pará State, Brazil. The object was to analyze the transmission dynamics of human Leishmania (Leishmania) infantum chagasi infection based principally on the prevalence and incidence. For diagnosis of the infection, the indirect fluorescent antibody test (IFAT) and leishmanin skin test (LST) were performed with amastigote and promastigote antigens of the parasite, respectively. The prevalence by LST (11.2%) was higher (p < 0.0001) than that (3.4%) by IFAT, and the combined prevalence by both tests was 12.6%. The incidences by LST were also higher (p < 0.05) than those by IFAT at 6 (4.7% x 0.6%), 12 (4.7% x 2.7%), and 24 months (2.9% x 0.3%). Moreover, there were no differences (p > 0.05) between the combined incidences by both tests on the same point surveys, 5.2%, 6.3%, and 3.6%. During the study, 12 infected persons showed high IFAT IgG titers with no LST reactions: five children and two adults developed AVL (2,560-10,120), and two children and three adults developed subclinical oligosymptomatic infection (1280-2560). The combined tests diagnosed a total of 231 cases of infection leading to an accumulated prevalence of 24.4%.

Reviewing the role of the dendritic Langerhans cells in the immunopathogenesis of American cutaneous leishmaniasis.

The role of dendritic Langerhans cells (LCs) in the immunopathogenesis of American cutaneous leishmaniasis (ACL) was reviewed in the light of more recent clinical and immunological features of ACL, caused by the principal human pathogenic leishmanial parasites found in Brazil: Leishmania (Viannia) braziliensis and L. (L.) amazonensis. The report shows a species-specific correlation between the LC density and the CD4+ and CD8+ T-cell profiles in the cellular infiltrate of skin lesions of ACL patients, providing the conclusion that LCs might be influencing the dichotomy of interaction between L. (V.) braziliensis and L. (L.) amazonensis with the human T-cell immune response. While L. (V.) braziliensis shows a clear tendency to direct infection to the hypersensitivity pole of the ACL clinical-immunological spectrum marked by a strong Th1-type immune response, L. (L.) amazonensis shows the opposite, directing infection to the hyposensitivity pole associated with a marked Th2-type immune response. These are probably the main immunological mechanisms of LCs regarding the immune response dichotomy that modulates infection outcome by these Leishmania parasites.

In vitro infectivity of species of Leishmania (Viannia) responsible for American cutaneous leishmaniasis.

There is little available information regarding the infectivity of New World Leishmania species, particularly those from the Amazonian Brazil, where there are six species of the subgenus Viannia causing American cutaneous leishmaniasis (ACL). The aim of this study was to compare, in vitro, the potential infectivity of the following Leishmania (Viannia) spp.: L. (V.) braziliensis from localized cutaneous leishmaniasis (LCL) and mucocutaneous leishmaniasis (MCL) patients, L. (V.) guyanensis, L. (V.) shawi, L. (V.) lainsoni and L. (V.) naiffi from LCL patients only, in cultured BALB/c mice peritoneal macrophage, as well as the production of NO by the infected cells. The infectivity of parasites was expressed by the infection index and, the nitric oxide (NO) production in the macrophage culture supernatant was measured by the Griess method. It was found that L. (V.) braziliensis from MCL, the more severe form of disease, showed the highest (p

Revisão sobre a patogenia da leishmaniose tegumentar americana na Amazônia, com ênfase à doença causada por Leishmania (V. ) braziliensis e Leishmania (L. ) amazonensis / Revisiting the pathogenesis of the american tegumentary leishmaniasis in Amazonian, with emphasis to the disease due to Leishmania (V. ) braziliensis and Leishmania (L.) amazonensis

A patogenia da leishmaniose tegumentar americana (LTA) na Amazônia foi revisada à luz dos mais recentes aspectos associados ao espectro clínico, histopatológico e imunopatológico da doença causada por Leishmania (V.) braziliensis e Leishmania (L.) amazonensis. Esta revisão mostrou a existência de uma dicotomia entre as duas espécies de Leishmania e a resposta imune celular; enquanto a L. (V.) braziliensis mostra forte tendência em dirigir a infecção, a partir da forma central do espectro clínico-imunológico, a leishmaniose cutânea localizada (LCL), para o pólo imunológico hiperreativo, representado pela leishmaniose cutâneo-mucosa (LCM), com exacerbação da hipersensibilidade e perfil da resposta CD4 tipo-Thl, a L. (L.) amazonensis mostra o oposto, dirige a infecção para o pólo imunológico hiporreativo, representado pela leishmaniose cutânea anérgica difusa (LCAD), com forte inibição da hipersensibilidade e perfil da resposta CD4 tipo- Th2. Entre a forma central LCL e as formas polares LCM e LCAD a infecção passa por uma fase intermediária, a leishmaniose cutânea disseminada borderline (LCDB), com inibição parcial da hipersensibilidade e peifil da resposta CD4 Thl + Th2. Estes são, provavelmente, os principais mecanismos imunológicos que modulam a patogenia da LTA causada por L. (V.) braziliensis e L. (L.) amazonensis.

The pathogenesis of American tegumentary leishmaniasis (ATL) was reviewed ifl the light of more recent features of clinical, histopathological and immunopathological spectrum of disease caused by Leishmania (V.) braziliensis and Leishmania (L.) amazonensis. This review has shown a dichotomy in the interaction between these two species of Leishmania with the human .cellular immune response; while L. (V.) braziliensis shows a clear tendency to direct infection, from the localized cutaneous leishmaniasis (LCL) in the center of the clinical-immunological spectrum of disease, to the hyperactive immunologic pole represented by mucocutaneous leishmaniasis (MCL), which shows exacerbated hypersensitivity reaction and CD4 Thl-type immune response, L. (L.) amazonensis shows the opposite,. directing infection to the hypoactive immunologic pole consisted by anergic diffuse cutaneous leishmaniasis (ADCL), associated with a marked inhibition of hypersensitivity reaction and CD4 Th2type immune response. Between the central LCL and thetwo polar MCL and ADCL forms the infection may present an intermediary phase, borderline disseminated cutaneous leishmaniasis (BDCL), which shows partial inhibition of hypersensitivity reaction and a mixed CD4 Thl plus Th2 immune response. These are probably the main immunological mechanisms regarding the immune response dichotomy that modulates the pathogenesis of ATL caused by these Leishmania parasites.