Age Modifies the Immunologic Response and Clinical Presentation of American Tegumentary Leishmaniasis

Augusto M. Carvalho Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), CNPq/MCT, Salvador, Bahia, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz FIOCRUZ-Salvador, Bahia, Brazil

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Camila F. Amorim Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), CNPq/MCT, Salvador, Bahia, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz FIOCRUZ-Salvador, Bahia, Brazil

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Juliana L. S. Barbosa Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), CNPq/MCT, Salvador, Bahia, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz FIOCRUZ-Salvador, Bahia, Brazil

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Alexsandro S. Lago Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), CNPq/MCT, Salvador, Bahia, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz FIOCRUZ-Salvador, Bahia, Brazil

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Edgar M. Carvalho Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), CNPq/MCT, Salvador, Bahia, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz FIOCRUZ-Salvador, Bahia, Brazil

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Leishmania (Viannia) braziliensis is the main causal agent of American tegumentary leishmaniasis (ATL) that may present as cutaneous, mucosal, or disseminated cutaneous leishmaniasis. The disease is highly prevalent in young males and there is a lack of studies of ATL in the elderly. Herein, we compared clinical manifestations, immunologic response, and response to antimony therapy between patients > 60 years of age (N = 58) and patients who were 21–30 years of age (N = 187). The study was performed in Corte de Pedra, Bahia, Brazil, a well-known area of L. braziliensis transmission. Cytokine production by cultured peripheral blood mononuclear cells stimulated with soluble Leishmania antigen was performed. Elderly subjects more frequently had a previous history of cutaneous leishmaniasis, large lesions, or mucosal leishmaniasis, and they were less likely to have lymphadenopathy. There was no difference regarding gender and response to therapy. Peripheral blood mononuclear cells from elderly subjects produced a similar amount of tumor necrosis factor than young patients but they produced less interferon-gamma and more interleukin-10 than young subjects. We concluded that elderly patients with cutaneous leishmaniasis should be searched for mucosal or disseminated leishmaniasis. The decreased interferon-gamma production and increase in interleukin-10 observed in elderly patients may contribute to parasite persistence and L. braziliensis infection dissemination.

Author Notes

* Address correspondence to Edgar M. Carvalho, Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, 5 andar, Rua João das Botas s/n, Canela 40110-160, Salvador-Bahia, Brazil. E-mail: imuno@ufba.br

Financial support: This work was supported by National Institutes of Health (NIH AI 30639).

Authors' addresses: Augusto M. Carvalho, Camila F. Amorim, Juliana L. S. Barbosa, and Alexsandro S. Lago, Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil, E-mails: augustomarcelino1@hotmail.com, camilafarias112@gmail.com, julianalbarbosa@hotmail.com, and alex-lago@hotmail.com. Edgar M. Carvalho, Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil, and Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), CNPq/MCT, Salvador, Bahia, Brazil, E-mail: imuno@ufba.br.

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