Histopathological patterns of the liver involvement in visceral leishmaniasis

Duarte, Maria Irma Seixas; Corbett, Carlos Eduardo Pereira

doi:10.1590/s0036-46651987000300003

Cited by 51 publications

(39 citation statements)

References 6 publications

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“…This pattern was different from descriptions in other organs, such as the liver, spleen, kidney and lung 10 . The increased expression of IL-4 and IL-10 with lower IFN-gamma is associated with an old concept of Th2 pattern of immune response.…”

Section: Ethicalcontrasting

confidence: 97%

Cytokine expression in the duodenal mucosa of patients with visceral leishmaniasis

Luz

Tuon

Duarte

et al. 2010

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Visceral leishmaniasis (VL) is a neglected tropical disease with a complex immune response in different organs. This pattern of organ-specific immune response has never been evaluated in the gastrointestinal tract. The aim of this study was to determine the in situ immune response in duodenal biopsies on patients with VL. METHODS: A case-control study was conducted on 13 patients with VL in comparison with nine controls. The immune response was evaluated using immunohistochemistry, for CD4, CD8, CD68, IL-4, IFN-γ, TNF-α and IL-10. Histological findings from the villi, crypts and inflammatory process were analyzed. RESULTS: All the cases of VL presented Leishmania antigens. No antigen was detected in the control group. The villus size was greater in the VL patients (p < 0.05). CD68 (macrophages) and CD4 levels were higher in the VL patients (p < 0.05). No differences in the expression of CD8, TNF-α, IL-10 or IL-4 were demonstrated. The number of cells expressing IFN-γ was lower in the VL patients (p < 0.05). CONCLUSIONS: Low levels of cytokines were found in the gastrointestinal tract of patients with VL. This pattern was not found in other organs affected by the disease. Immunotolerance of this tissue against Leishmania could explain these findings, as occurs with intestinal bacteria.

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Section: Ethicalcontrasting

confidence: 97%

Cytokine expression in the duodenal mucosa of patients with visceral leishmaniasis

Luz

Tuon

Duarte

et al. 2010

Rev. Soc. Bras. Med. Trop.

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“…The relationship with bleeding might give the impression that absolute liver failure is frequent in VL. However, although hepatitis is common in VL, death by fulminant hepatitis is unusual 19 . Thus, the role of the liver in bleeding in VL is probably restricted to a relative deficiency of coagulation factors during established DIC.…”

Section: Discussionmentioning

confidence: 99%

Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

Costa

Werneck

Costa

et al. 2010

Rev. Soc. Bras. Med. Trop.

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Introduction: The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. Methods: Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. Results: Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count), while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load). Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. Conclusions: The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome. Keywords: Visceral leishmaniasis. Kala-azar. Severe inflammatory response syndrome. AIDS. Bleeding. RESUMO Introdução: O objetivo do estudo foi identificar os principais fatores de risco para morte na leishmaniose visceral do Novo Mundo e estabelecer um substrato patogênico baseado nos achados clínicos coerente para doença grave. Métodos: Em um estudo caso-controle, foram estudados 76 pacientes internados que faleceram e 320 pacientes internados tratados com sucesso. Resultados: Infecção bacteriana e sangramento foram eventos que levaram à morte, mutuamente exclusivos. Cinco fatores de risco foram únicos para morte por infecção bacteriana (desnutrição, estertores pulmonares, anemia grave, neutropenia absoluta grave e número de leucócitos aumentados), enquanto outros seis foram exclusivos para morte por sangramento (icterícia, neutropenia relativa grave, trombocitopenia grave, lesão hepática, insuficiência renal, maior carga de parasitas na medula óssea). Entre os pacientes tratados com sucesso, as principais síndromes de leishmaniose visceral foram infecções bacterianas, sangramento, anemia grave, diarreia, dispneia, edema, icterícia e carga de parasitas na medula óssea. Conclusões: Os dados apoiam a ideia de que as infecções bacterianas são secundárias a imunoparalisia. O amplo envolvimento de órgãos e sistemas é de forma plausível devido a elevada produção de citocinas pró-inflamatórias, cujas ações se encaixam com a leishmaniose visceral. As síndromes e os mediadores causais são típicos da síndrome de resposta inflamatória sistêmica, desenrolando-se lentamente. Palavras-chaves: Leishmaniose visceral. Calazar. Síndrome da resposta inflamatória sistêmica. AIDS. Sangramento.

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“…11, 12 Other patients with severe disease show renal impairment, 13,14 hepatitis, 15 and interstitial pneumonitis. 16 The amastigote forms of L. infantum and L. donovani are found inside neutrophils and monocuclear phagocytes, or freely, mostly in the spleen, which may harbor the largest parasite burden.…”

Section: Introductionmentioning

confidence: 99%

Bone Marrow Parasite Burden among Patients with New World Kala-Azar is Associated with Disease Severity

Silva¹,

Zacarias

Figueirêdo

et al. 2014

The American Journal of Tropical Medicine and Hygiene

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Abstract. Kala-azar or visceral leishmaniasis, found mostly throughout the Indian Subcontinent, East Africa, and Brazil, kills 20,000-40,000 persons annually. The agents, Leishmania donovani and Leishmania infantum, are obligatory intracellular protozoa of mononuclear phagocytes found principally in the spleen and bone marrow. Protracted fever, anemia, wasting, hepatosplenomegaly, hemorrhages, and bacterial co-infections are typical features. One hundred and twenty-two (122) in-hospital patients were studied to verify if higher bone marrow parasite load estimated by quantitative polymerase chain reaction is associated with severe disease. The estimated median parasite load was 5.0 parasites/ 10 6 human nucleated cells. It is much higher in deceased than among survivors (median 75.0 versus 4.2). Patients who lost more weight had a higher parasite burden, as well as patients with epistaxis, abdominal pain, edema, and jaundice. This study suggests that higher parasite load is influenced by wasting, which may lead to more severe disease.

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Histopathological patterns of the liver involvement in visceral leishmaniasis

Cited by 51 publications

References 6 publications

Cytokine expression in the duodenal mucosa of patients with visceral leishmaniasis

Cytokine expression in the duodenal mucosa of patients with visceral leishmaniasis

Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

Bone Marrow Parasite Burden among Patients with New World Kala-Azar is Associated with Disease Severity

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