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Influence of Intestinal Helminth Burden on Clinical Manifestations, Therapeutic Response, and Leishmania braziliensis Load in Patients with New World Cutaneous Leishmaniasis

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  • 1 Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusettes;
  • | 2 Serviço de Imunologia, Complexo Hospitalar Universitário Prof. Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Brazil;
  • | 3 Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, CNPq, Ministério de Ciência, Tecnologia e Inovação, Bahia, Brazil;
  • | 4 Universidade Federal do Sul da Bahia, Ilhéus, Brazil;
  • | 5 Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York;
  • | 6 Instituto Gonçalo Moniz, Fudação Oswaldo Crux (Fiocruz), Salvador, Brazil

ABSTRACT.

Leishmania braziliensis is the most important cause of cutaneous leishmaniasis (CL) in the Americas. A Th1-type immune response is required to control Leishmania infection, but an exaggerated inflammatory response leads to the development of ulcers seen in CL. Infection with intestinal helminths has the potential to inhibit the Th1 response in a manner that depends both on the species of helminth present as well as the burden of helminthiasis. We conducted a prospective cohort study of CL patients from an endemic area between January and December 2017 with either negative or high intestinal helminth burden to characterize relationships between helminth burden, L. braziliensis quantification within CL lesions, clinical aspects of CL, and therapeutic response. Of 234 participants with leishmaniasis who underwent stool examination at the time of diagnosis, 45% had detectable helminth infection. The overall cure rate after 90 days was 66%, with a median time to resolution of disease of 40 days (interquartile range: 30–65 days). There was no significant association between the type of helminth infection or the magnitude of intestinal helminth burden at the time of diagnosis and L. braziliensis genomic DNA (gDNA) detected in biopsies from CL lesions. Likewise, there was no association between helminth burden and response to treatment after 90 days. Considering quantification of parasite DNA in CL lesions, participants who were cured at 90 days had a median of 0.017 ng/mg gDNA, and participants who failed therapy had a median of 0.091 ng/mg gDNA (P = 0.03). The results indicate that cutaneous Leishmania load may influence therapeutic response in CL.

Author Notes

Address correspondence to Brady Page, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114. E-mail: bradylpage@gmail.com

Financial support: This work was supported through the Fulbright-Fogarty Fellowship in Public Health by grants from the Fulbright Program, U.S. Department of State. and the Fogarty International Center, U.S. National Institutes of Health.

Authors’ addresses: Brady Page, Department of Medicine, Massachusetts General Hospital, Boston, MA, E-mail: bradylpage@gmail.com. Alex Lago, Juliana Almeida Silva, Albert Schriefer, Jamile Lago, and Edgar M. Carvalho, Serviço de Imunologia, Complexo Hospitalar Universitário Prof. Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil, E-mails: alex-lago@hotmail.com, july-meida@yahoo.com.br, nab.schriefer@gmail.com, Jamile.lago@hotmail.com, livia.alves.oliveira@hotmail.com, and imuno@ufba.br. Luiz Henrique Guimarães, Universidade Federal do Sul da Bahia, Itabuna, Bahia, Brazil, E-mail: luizhenriquesg@yahoo.com.br. Marshall Glesby, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY, E-mail: mag2005@med.cornell.edu.

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