Autoimmune manifestations of visceral leishmaniasis in Chinese patients

Abstract

Background: Visceral leishmaniasis (VL) is a rare, parasitic infection with distinctive features that may mimic autoimmune diseases. In this study, we report on the laboratory autoimmune manifestations of VL in Chinese patients.Methods: Twenty-seven patients who were hospitalized with VL were included in this retrospective study.Routine blood and biochemical tests were conducted, and a variety of autoimmune antibodies and complement fractions were detected. Continuous variables are expressed as means ± standard deviations, and categorical data are expressed as a number (percentage). Missing data were not included for statistical analysis. Data were analyzed with SPSS v. 13.0 statistical software.Results: All patients had cytopenia (82% with pancytopenia) and hepatosplenomegaly, and 25 (93%) patients also suffered from fever. The prevalence of autoantibodies (number of patients with antibody detected/total number of patients tested for the antibody) for each antibody tested was as follows: antinuclear antibodies (ANA; 18/22, 82%), anti-neutrophil cytoplasmic antibodies (ANCA; 4/5, 80%), anti-mitochondrial M2 antibodies (AMA-M2; 1/6, 17%), anti-liver cytosol specific type 1 antibodies (anti-LC1; 1/6, 17%), anti-liver/kidney microsomal type 1 antibodies (anti-LKM1; 1/6, 17%), anti-centromere protein-B antibodies (anti-CENP-B; 4/21, 19%), anti-Sjögren's syndrome type A antibodies (anti-SSA; 2/21, 10%), anti-Sjögren's syndrome type B antibodies (anti-SSB; 1/21, 5%), anti-Jo-1 antibodies (1/21, 5%), antidouble-stranded DNA antibodies (anti-dsDNA; 1/25, 4%), direct antiglobulin test (direct Coombs; 6/6, 100%), and rheumatoid factor (RF; 3/11, 27%). Increased serum C-reactive protein (CRP) was found in 14 (100%) patients. Of the 19 patients tested for serum IgG, 17 patients (89%) were found with increased IgG levels, while complement 3 protein (C3) and complement 4 protein (C4) levels were not decreased in any of the 19 patients. Of note, in one patient followed up 1 month after therapy, only ANA was still present, and all the other laboratory autoimmune manifestations had disappeared.Conclusions: VL infection associated with laboratory autoimmune manifestations is common. This may lead to patients with VL being misdiagnosed as having an autoimmune disorder. An obligatory differential diagnosis that considers VL should be undertaken for patients diagnosed with systemic lupus erythematosus (SLE), especially in endemic areas, is necessary.

The Thing (1982): un primer modelo de prediagnóstico para las infecciones y alteraciones de la fisiología

“…Para que la sangre contaminada reaccione ante el daño por calor, la disbiosis en el ser humano deber ser muy significativa, hecho constatado en el filme al representar cada individuo como una réplica que imita y sustituye al original. En relación al mimetismo, existe literatura que evidencia que determinados microorganismos se adaptan e imitan a las células inmunitarias para regular procesos fisiológicos o que pueden llegar a imitar a moduladores de los procesos inflamatorios y otras enfermedades autoinmunes [8][9][10] . Por ejemplo, la homeostasis inmunitaria en el intestino está estrechamente controlada por las células T reguladoras (Treg) FOXP3 + , cuyos defectos están relacionados con el desarrollo de enfermedades crónicas, como la enfermedad inflamatoria intestinal.…”

Severe visceral leishmaniasis and COVID-19 coinfection in an immunosuppressed patient

“…According to Galvão-Castro et al . 8 , in American Visceral Leishmaniasis (AVL) there is polyclonal activation of B cells, which can lead to clinical manifestations similar to the ones of autoimmune diseases 9 .…”

Serological characteristics and clinical implications of IgG subclasses in visceral leishmaniasis

“…antigens between patient populations [8]. In China, elevated serum IgG levels have been reported in VL cases pre‐treatment [9]. However, the variation of IgG subclasses levels during the treatment process has not been reported yet, nor has the correlation between IgG subclasses ratios and other clinical laboratory parameters been studied.…”