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Varicella Zoster Virus–Specific Immune Response after Treatment with Sodium Stibogluconate for Cutaneous Leishmaniasis

In-Kyu YoonAllergy and Immunology Division, Department of Clinical Investigation, and Infectious Disease Division, Walter Reed Army Medical Center, Washington, District of Columbia; Walter Reed Army Institute of Research, Rockville, Maryland

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Josephine CoxAllergy and Immunology Division, Department of Clinical Investigation, and Infectious Disease Division, Walter Reed Army Medical Center, Washington, District of Columbia; Walter Reed Army Institute of Research, Rockville, Maryland

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Yaling ZhouAllergy and Immunology Division, Department of Clinical Investigation, and Infectious Disease Division, Walter Reed Army Medical Center, Washington, District of Columbia; Walter Reed Army Institute of Research, Rockville, Maryland

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Yvonne LukesAllergy and Immunology Division, Department of Clinical Investigation, and Infectious Disease Division, Walter Reed Army Medical Center, Washington, District of Columbia; Walter Reed Army Institute of Research, Rockville, Maryland

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Brian ReinhardtAllergy and Immunology Division, Department of Clinical Investigation, and Infectious Disease Division, Walter Reed Army Medical Center, Washington, District of Columbia; Walter Reed Army Institute of Research, Rockville, Maryland

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Anais Valencia-MicoltaAllergy and Immunology Division, Department of Clinical Investigation, and Infectious Disease Division, Walter Reed Army Medical Center, Washington, District of Columbia; Walter Reed Army Institute of Research, Rockville, Maryland

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Glenn WortmannAllergy and Immunology Division, Department of Clinical Investigation, and Infectious Disease Division, Walter Reed Army Medical Center, Washington, District of Columbia; Walter Reed Army Institute of Research, Rockville, Maryland

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Sodium stibogluconate has been associated with the reactivation of varicella zoster virus (VZV) in otherwise healthy adults who receive the drug as treatment for cutaneous leishmaniasis. Ten patients receiving daily sodium stibogluconate underwent phlebotomy at baseline and at day 10. Flow cytometry–based immunophenotyping, VZV-specific IgG levels, and lymphocyte proliferative responses and intracellular cytokine secretion to VZV, cytomegalovirus, tetanus toxoid, superantigen, and mitogens were performed at both time points. The absolute number of total leukocytes, total lymphocytes, and lymphocyte subsets decreased overall without predilection for any particular subset of lymphocytes, such that the percentage of the total lymphocyte population for each lymphocyte subset did not change significantly (except for a marginal increase in percentage of cytotoxic T cells). Antibodies to VZV were measured in seven patients before and after treatment, and did not change. Lymphocyte proliferative responses to VZV and other antigens and mitogens did not change from baseline. The mechanism for the increased rate of VZV reactivation after treatment with sodium stibogluconate remains undefined.

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