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Am. J. Trop. Med. Hyg., 81(3), 2009, pp. 378-383
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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CASE REPORT


Increase of NK Cells and Proinflammatory Monocytes Are Associated with the Clinical Improvement of Diffuse Cutaneous Leishmaniasis after Immunochemotherapy with BCG/Leishmania Antigens

Ledice I. A. Pereira, Miriam L. Dorta, Ana Joaquina C. S. Pereira, Rosidete P. Bastos, Milton A. P. Oliveira, Sebastião A. Pinto, Hélio Galdino, Jr, Wilson Mayrink, Warly Barcelos, Vicente P. C. P. Toledo, Gloria Maria C. A. Lima, AND Fátima Ribeiro-Dias*
Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiás Hospital de Doenças Tropicais Anuar Auad, Goiás, Brazil; Instituto Goiano de Oncologia e Hematologia, Goiás, Brazil; Departamento de Parasitologia/ICB, Federal University of Minas Gerais, Minas Gerais, Brazil; Departamento de Análises Clínicas e Toxicológicas da Faculdade de Farmácia, Federal University of Minas Gerais, Minas Gerais, Brazil

 

ABSTRACT

Diffuse cutaneous leishmaniasis (DCL) is characterized by disseminated lesions and the absence of a specific cellular immune response. Here, the immunochemotherapy outcome of a patient with DCL from Amazonian Brazil infected with Leishmania (Leishmania) amazonensis is presented. After several unsuccessful chemotherapy treatment regimens and many relapses, a monthly immunotherapy scheme of L. amazonensis PH8 plus L. (Viannia) braziliensis M2903 monovalent vaccines associated with Bacillus Calmette-Guerin (BCG) was established, one round of which also included an M2903 vaccine associated with intermittent antimonial treatment. Temporary healing of all lesions was achieved, although Leishmania skin tests were negative and interferon {gamma} was not detected in mononuclear cell cultures stimulated with Leishmania antigens. The frequencies of CD16 +CD56+ NK cells (~2x) and CD14 +CD16+ proinflammatory monocytes (~8x) increased in peripheral blood, and CD56 + lymphocytes were found infiltrating the lesions. An association between the increase of the frequency of innate immune system cells and the healing of lesions is shown, suggesting that this protocol of immunotherapy reduced the parasite load and activated NK cells and monocytes.

Received August 17, 2008. Accepted for publication May 23, 2009.

Acknowledgments: The authors thank Dr. Lucille M. Floeter-Winter and Ricardo A. Zampieri (University of São Paulo, São Paulo, Brazil) for helping us with Leishmania characterization.

Financial support: This work was supported by CNPq (Dr. Miriam Leandro Dorta, Grant 473490/03-0 and Dr. Milton Adriano Pelli de Oliveira, Grant 484504/2007-0), Funape/UFG (Dr. Fátima Ribeiro-Dias, Grant 70041/2004-5), and SECTEC/GO/CNPq (Dr. Glória Maria Collet de Araújo Lima, Grant 68.0067/2004-3).

* Address correspondence to Fátima Ribeiro-Dias, Setor de Imunologia–Instituto de Patologia Tropical e Saúde Pública, Rua 235 S/N Esquina c/1a Avenida, Setor Universitário, Goiânia, GO, Brazil 74605-050. E-mail: fdias{at}iptsp.ufg.br

Authors’ addresses: Ledice I. A. Pereira, Miriam L. Dorta, Rosidete P. Bastos, Milton A. P. Oliveira, Hélio Galdino Jr, Gloria Maria C. A. Lima, and Fátima Ribeiro-Dias, Setor de Imunologia–Instituto de Patologia Tropical e Saúde Pública, Rua 235 S/N esquina c/1a Avenida, Setor Universitário, Goiânia GO, Brazil 74605-050, Tel: 55-62-32096116, Fax: 55-62-35211839, E-mails: ledicepereira{at}gmail.com, mldorta{at}uol.com.br, rpbastos{at}hotmail.com, mapoliv{at}iptsp.ufg.br, heliogjr{at}yahoo.com.br, gmcal{at}usp.br, and fdias{at}iptsp.ufg.br. Ana Joaquina C. S. Pereira, Hospital de Doenças Tropicais Anuar Auad, Avenida Contorno 3556, Jardim Bela Vista, Goiânia GO, Brazil 74584-090, Tel: 55-62-32013673, E-mail: anajoaquinapereira{at}uol.com.br. Sebastião A. Pinto, Instituto Goiano de Oncologia e Hematologia, Rua 87 No. 598 St. Sul, Goiânia GO, Brazil 74093-300, Tel: 55-62-32260200, E-mail: sebastiaoap{at}ingoh.com.br. Warly Barcelos and Vicente P. C. P. Toledo, Departamento de Análises Clínicas e Toxicológicas da Faculdade de Farmácia, Universidade Federal de Minas Gerais, Campus Pampulha, Av. Presidente Antônio Carlos 6627, Belo Horizonte MG, Brazil 31270-901, Tel: 55-31-3499-6885, Fax: 55-31-3499-6985, E-mails: barce loswarly{at}yahoo.com.br and toledovp{at}terra.com.br. Wilson Mayrink, Departmento de Parasitologia, Instituto de Ciências Biomédicas, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Campus da Pampulha, Belo Horizonte MG, Brazil 31270-901, Tel: 55-31-34992871, E-mail: mayrink{at}icb.ufmg.br.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.