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 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

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Miriam L. Dorta 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

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Ana Joaquina C. S. Pereira 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

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Rosidete P. Bastos 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

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Milton A. P. Oliveira 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

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Sebastião A. Pinto 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

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Hélio Galdino Jr 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

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Wilson Mayrink 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

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Warly Barcelos 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

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Vicente P. C. P. Toledo 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

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Gloria Maria C. A. Lima 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

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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

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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 γ was not detected in mononuclear cell cultures stimulated with Leishmania antigens. The frequencies of CD16 +CD56+ NK cells (~2×) and CD14 +CD16+ proinflammatory monocytes (~8×) 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.

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