Diabetes Modifies the Clinic Presentation of Cutaneous Leishmaniasis

Abstract

Background Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by one or multiple well limited ulcerated lesions. Diabetes mellitus (DM) impair neutrophil and monocyte function and there is a report of a vegetative lesions in a patient with both diseases in Morocco. Here we evaluate the influence of DM on clinical manifestations, immune response and in the treatment of CL. Methods Participants were 36 DM patients with CL and 36 patients with CL without DM matched by age and gender. The diagnosis of CL was performed by documentation of DNA of L. braziliensis by PCR in the lesion biopsy and histopathologic findings. All patients were treated with Glucantime (Sanofi-Aventis) 20mg/Kg of weight/day for 20 days. Results There was no difference in the majority of the clinic variables between the groups and the cure rate in patients with CL and DM (67%) was similar to that observed in CL patients (56%) (P˃.05). The most important finding was the documentation that 36% of the patients with DM and CL had atypical cutaneous lesions characterized by large superficial ulcers without defined borders. High levels of IFN-γ, TNF and IL-1β were detected in supernatants of mononuclear cells stimulated with leishmania antigen in patients with DM and atypical CL. Moreover, while cure was observed in only 33% of the patients with DM and atypical CL lesions it was 85% in patients with typical lesions (P<0.05). Conclusions DM modify the clinical presentation of CL, enhances pro-inflammatory cytokine production and impair response to antimony therapy.

Leishmaniasis visceral en paciente inmunocompetente

“…Por otro lado, el uso de metrotexato o antagonista de factor de necrosis tumoral alfa como el infliximab y etarnecept se ha asociado a numerosos casos de leishmaniasis 5 . Cabe destacar también que los pacientes con diabetes mellitus tienen un mayor riesgo de leishmaniasis visceral y pueden enfrentar una curación más baja y tasas de recaída más altas, así como lesiones cutáneas atípicas en leishmaniasis cutánea 6,7 .…”

Network pharmacology-based strategy for predicting therapy targets of Sanqi and Huangjing in diabetes mellitus

“…Individuals with chronic HBV infection or anti-HBc positivity may have an increased risk of diabetes, and the association may be modified by the different statuses of metabolism-related variables and age[ 60 ]. DM modifies the clinical presentation of cutaneous leishmaniasis, enhances proinflammatory cytokine production, and impairs the response to antimony therapy[ 61 ]. To date, few studies have focused on the effects of cancer pathways, the thyroid hormone signaling pathway, pertussis, and proteoglycans in cancer on DM.…”

Association between Hypertriglyceridemia and Disease Severity in Visceral Leishmaniasis

“…Conversely, metabolic diseases have been considered to increase one's susceptibility to infections, especially diabetes and obesity. 19,20 Diabetes mellitus has also been associated with a more severe clinical presentation and worse response to therapy of cutaneous leishmaniasis (CL), 21 and a case report showed an association between diabetes and VL. 22 Sernaglia et al 23 demonstrated that diet-induced obesity promotes systemic inflammation and increases susceptibility to murine visceral leishmaniasis.…”