Clinical characteristics of human Leishmania braziliensis braziliensis infections

Cuentas, Elmer Alejandro Llanos; Cuba, César Augusto Cuba; Barreto, A. C.; Marsden, Philip D.

doi:10.1016/0035-9203(84)90043-9

Cited by 34 publications

(10 citation statements)

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“…10,11 However, an increasing higher number of cases in children, as well as in both sexes, have been documented. 12 These findings suggest changes in disease transmission pattern, reinforcing the current importance of peridomiciliary and intradomiciliary transmission.…”

Section: Discussionmentioning

confidence: 99%

A proposed new clinical staging system for patients with mucosal leishmaniasis

Lessa

Guimarães

et al. 2012

Transactions of the Royal Society of Tropical Medicine and Hygi

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Mucosal leishmaniasis occurs mainly in areas where Leishmania braziliensis is transmitted. It affects predominantly the nasal mucosa and, in more severe forms, can lead to significant tissue destruction. There is no standard method for grading the severity of disease. We categorised 50 patients with mucosal leishmaniasis according to a proposed clinical staging system. Their age ranged from 10 to 86 y (mean ± SD: 36 ± 16 y) and 43 (86%) patients were male. The different degrees of evolution of mucosal disease, from the initial stage to the more severe long-term cases, enabled mucosal leishmaniasis to be graded into five stages. Stage I is characterised by nodular lesions of the mucosa without ulcerations. Stage II is represented by superficial mucosal ulcerations with concomitant fine granular lesions. Stage III is characterised by deep mucosal ulcerations with granular tissue formation. In stage IV there are irreversible lesions leading to perforation of the cartilaginous nasal septum with necrosis. In stage V the nasal pyramid is compromised with alterations of facial features as a consequence of severe tissue destruction. These stages may be useful in characterising the severity of the lesion and optimising the therapeutic outcome.

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Section: Discussionmentioning

confidence: 99%

A proposed new clinical staging system for patients with mucosal leishmaniasis

Lessa

Guimarães

et al. 2012

Transactions of the Royal Society of Tropical Medicine and Hygi

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“…Lesions may also be vegetative, verrucous, sporotricoid, or lupoid. 3,4 Host and parasite factors may influence the clinical outcome and response to therapy for leishmaniasis. 5–7 In the Old World, ulcers caused by L. major heal even without antimony therapy.…”

Section: Introductionmentioning

confidence: 99%

Association of Treatment of American Cutaneous Leishmaniasis Prior to Ulcer Development with High Rate of Failure in Northeastern Brazil

Unger¹,

Carvalho²,

Glesby³

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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Cure rates for American cutaneous leishmaniasis (ACL) range between 60% and 90%. Early evidence suggests lower cure rates for early ACL before the development of the ulceration. We evaluated risk factors for treatment failure in patients with early and classic ulcerative ACL. Patients (n = 136) were 13–60 years of age and had lesions with a duration of 15–90-days. Patients were treated with antimony (20 mg/kg/day for 20 days). The primary outcome was lesion cure by 90 days without recurrence. Patients with early ACL (n = 16) had papules, nodules, plaques, or superficial ulcerations with less than 30 days of illness. Patients with classic ulcerative ACL (n = 120) had ulcerated classic lesions, longer duration, larger lesions, and higher levels of interferon-γ and tumor necrosis factor-α (P ≤ 0.01 for all comparisons). Ulcerated lesions were associated with a lower treatment failure rate compared with early ACL (25.8% versus 75.0%; P < 0.001). Early treatment of ACL does not prevent lesion ulceration and is associated with higher rates of treatment failure.

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“…Subclinical or asymptomatic infection, manifest as cutaneous delayed type hypersensitivity (DTH) to Leishmania antigen, occurs with variable frequency in different epidemiological settings [6–8]. Exuberant DTH responses have long been noted in chronic disease, whether mucosal or cutaneous [9, 10, 11], and the inflammatory response has been clinically [12] and experimentally linked with activation of subclinical infection and pathogenesis [13,14]. Although the host response to infection is known to be a primary determinant of the outcome of infection, the immunological mechanisms that are conducive to non-healing dermal disease versus asymptomatic infection in the human host have yet to be deciphered.…”

Section: Introductionmentioning

confidence: 99%

“…In vitro and in situ analyses of cytokine responses during active human dermal Leishmaniasis including localized disease caused by L. mexicana have revealed diverse profiles of both Th1 and Th2 cytokines, however no clear or consistent bias towards one or the other [19, 20–22]. Marked cutaneous hypersensitivity generally characterizes mucosal disease [10, 11] and has been linked with a poorly regulated Th1- like proinflammatory response, yet occurs in the presence of Th2 cytokines [23]. Differentiation of the T cell response and its impact on pathogenesis or protection from disease in human dermal leishmaniasis caused by Leishmania of the Viannia subgenus, or indeed any species of Leishmania , has not been discernable based on cytokine production alone.…”

Section: Introductionmentioning

confidence: 99%

T‐bet, GATA‐3, and Foxp3 Expression and Th1/Th2 Cytokine Production in the Clinical Outcome of Human Infection withLeishmania (Viannia)Species

et al. 2010

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Background T cell differentiation determines susceptibility and resistance to experimental cutaneous leishmaniasis, yet mixed T1/Th2 responses characterize the clinical spectrum of human infection with Leishmania Viannia species. Materials and Methods To discern the inter-relationship of T cell differentiation and outcome of human infection, we examined factors that regulate T cell differentiation and Th1/Th2 cytokine responses in asymptomatic infection, active and historical chronic and recurrent cutaneous leishmaniasis. T-bet, GATA-3, Foxp3 and cytokine gene expression were quantified by real time PCR, and correlated with IL-2, IFN-γ, TNF-α, IL-4, IL-13, IL-10 secretion during in vitro response to live L. panamensis. Results Higher GATA-3 than T-bet expression occurred throughout the 15 days of co-culture with promastigotes, however neither transcription nor secretion of IL-4 was detected. Sustained, inverse correlation between GATA-3 expression and secretion of proinflammatory cytokines IFN-γ and TNF-α was observed in asymptomatic infection. In contrast, higher T-bet expression and T-bet:GATA-3 ratio characterized active recurrent disease. Down-regulation of T-bet and GATA-3 expression and increased IL-2 secretion compared to control was directly correlated with Foxp3 expression and IL-13 secretion in chronic disease. Conclusions Regulation of the inflammatory response rather than biased Th1/Th2 response distinguished asymptomatic and recalcitrant outcomes of infection with Leishmnania Viannia species.

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Clinical characteristics of human Leishmania braziliensis braziliensis infections

Cited by 34 publications

References 0 publications

A proposed new clinical staging system for patients with mucosal leishmaniasis

A proposed new clinical staging system for patients with mucosal leishmaniasis

Association of Treatment of American Cutaneous Leishmaniasis Prior to Ulcer Development with High Rate of Failure in Northeastern Brazil

T‐bet, GATA‐3, and Foxp3 Expression and Th1/Th2 Cytokine Production in the Clinical Outcome of Human Infection withLeishmania (Viannia)Species

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