Case Report: In Situ and Systemic Immune Response to Mucosal Leishmaniasis in an HIV-Infected Patient

Valdir Sabbaga Amato Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil;
Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças e Moléstias Infecciosas, São Paulo, Brazil;

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Lucas Augusto Moyses Franco Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil;

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Regina Maia de Souza Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil;

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Camila Alves Maia da Silva Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil;

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Mariana Severo Ramundo Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil;

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Marina Farrel Côrtes Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Bacteriologia e Resistência Antimicrobiana, São Paulo, Brazil;

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Gabriela Corrêa-Castro Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil;
Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia – IFRJ, Rio de Janeiro, Brazil;

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Joanna Reis Santos-Oliveira Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil;
Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia – IFRJ, Rio de Janeiro, Brazil;

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Alda M. Da-Cruz Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil;

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Carla Pagliari Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil;

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Luciane Kanashiro Galo Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil;

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Felipe Francisco Tuon Pontifícia Universidade Católica do Paraná, Laboratório de Doenças Infecciosas e Emergentes, Curitiba, Brazil

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ABSTRACT.

In situ and systemic evaluations of the immune responses of HIV-infected patients to mucosal leishmaniasis have been poorly described. We describe a recently diagnosed HIV-infected patient with mucosal leishmaniasis who was characterized by a CD4 count of 85 cells/mm3 and nasal septum destruction resulting from pruritic and ulcerated nasal mucosa with crust formation and progression over 2 years. In situ and systemic immune evaluations of T cell activation, memory, and exhaustion were conducted using cytofluorometric assays, and sequencing of the Leishmania species was performed. The immune profile of HIV-infected patient with mucosal leishmaniasis shows a mixed Th1/Th2 pattern and an activated and exhausted status.

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Author Notes

Disclosure: The study protocol was approved by the Research Ethics Committee of the School of Medicine of the University of São Paulo (Protocol number: 2.315.702).

Financial support: This study was supported by Laboratório de Investigação Médica – Parasitologia LIM 46.

Authors’ addresses: Valdir Sabbaga Amato, Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil, and Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças e Moléstias Infecciosas, São Paulo, Brazil, E-mail: valdiramato@usp.br. Lucas Augusto Moyses Franco, Regina Maia de Souza, Camila Alves Maia da Silva, and Mariana Severo Ramundo, Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil, E-mails: lucasamfranco@hotmail.com, regina.maia@hc.fm.usp.br, camila.maia@usp.br, and marianasevero@gmail.com. Marina Farrel Côrtes, Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Bacteriologia e Resistência Antimicrobiana, São Paulo, Brazil, E-mail: marianasevero@gmail.com. Gabriela Corrêa-Castro and Joanna Reis Santos-Oliveira, Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil, and Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia – IFRJ, Rio de Janeiro, Brazil, E-mails: gabi.castro027@gmail.com and joannareisoliveira@gmail.com. Alda M. Da-Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil, E-mail: alda@ioc.fioctuz.br. Carla Pagliari and Luciane Kanashiro Galo, Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil, E-mails: cpagliari@usp.br and luciane_kanashiro@yahoo.com.br. Felipe Francisco Tuon, Pontifícia Universidade Católica do Paraná, Laboratório de Doenças Infecciosas e Emergentes, Curitiba, Brazil, E-mail: flptuon@gmail.com.

Address correspondence to Felipe Francesco Tuon, Rua Imaculada Conceição, 1155, Curitiba, Paraná 80215-901, Brazil. E-mail: felipe.tuon@pucpr.br
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