Dados do Trabalho

Título

CLINICAL AND IMMUNOLOGICAL EVOLUTION OF NON-ULCERATED CUTANEOUS LEISHMANIASIS CAUSED BY Leishmania (L.) infantum chagasi SHOWED A BENIGN CHARACTER OF INFECTION IN SOUTH HONDURAS

Introdução

In Honduras, Central America, L. (L.) infantum chagasi-infection leads to atypical clinical manifestations in humans, causing non-ulcerated cutaneous leishmaniasis (NUCL) in adolescents and young adults, and visceral leishmaniasis (VL) in children under five years old.

Objetivo (s)

The lack of reports on the natural progression of NUCL, lead us to evaluate the dynamics of the clinical-immunological evolution of the patients.

Material e Métodos

Individuals from Amapala (Honduras) where NUCL is endemic were submitted to clinical and parasitological exams, to the Montenegro skin test (DTH) with homologous antigen and to serology to detect IgG specific antibodies by ELISA. According to the clinical and immunological exams, 104 patients presenting non-ulcerated lesions were enrolled and were classified as having: Early Symptomatic Infection-ESI (ELISA-/DTH-), Initial Symptomatic Infection-ISI (ELISA+/DTH-), Resistant Symptomatic Infection-RSI (ELISA+/DTH+), and Final Symptomatic Infection-FSI (ELISA-/DTH+)]. All of them were followed up for 2 years without therapeutic intervention.

Resultados e Conclusão

All NUCL patients showed a positive parasitological diagnosis in skin lesion scraping and L. (L.) infantum chagasi was confirmed by PCR-RFLP. The most frequent infection profile observed in the NUCL patients during the prevalence study was the FSI, which was found in 30.8% of them. During the follow-up, 59% of the patients with ESI profile, who have negative immunological tests, converted to FSI, 18% to RSI and 18% to ISI profile. Regarding the ISI profile, where DTH is negative, 10% converted to RSI and 25% to FSI, both of them characterized as DTH+ profiles. Finally, the majority of patients with RSI profile converted to FSI. It is important to note that during all study period, none of NUCL cases developed visceral disease.
The dynamics of the clinical-immunological evolution of the NUCL patients showed a progressive development of positive cellular immunity (DTH+) in those negative (DTH-) individuals (ESI/ISI) and a predominant migration of all patients to FSI profile, the most capable profile to restrain the parasitism. Corroborating these findings, a benign evolution of the lesions was detected, since the non-ulcerated lesions kept their small size during the follow-up, and one patient showed spontaneous cure.

Palavras-chave

Atypical Cutaneous Leishmaniasis; L. (L.) infantum chagasi; Immunity, Honduras.

Agradecimentos

FAPESP #2014/50315-0, CAPES, CNPq, LIM50 HC-FMUSP.