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The Elderly Respond to Antimony Therapy for Cutaneous Leishmaniasis Similarly to Young Patients but Have Severe Adverse Reactions

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  • 1 Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil;
  • | 2 CNPq/MCT, Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil;
  • | 3 Laboratório de Pesquisas Clínicas do Instituto Gonçalo Moniz (IGM), Fiocruz, Salvador, Brazil;
  • | 4 Department of Internal Medicine, University of Iowa, Iowa City, Iowa
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There is evidence that elderly patients with cutaneous leishmaniasis (CL) have more mucosal and disseminated diseases than young patients and their cells produce less antigen-induced interferon (IFN)-γ. Herein, we compared the roles of interleukin (IL)-10 and IL-15 as modulators of antigen-induced immune responses and the incidence of adverse reaction and response to therapy in young versus elderly patients with CL. Study participants included 35 senior (60–85 years) and 35 young (18–40 years) patients who had a diagnosis of CL documented by typical cutaneous lesions containing Leishmania braziliensis DNA. Elderly patients had less lymph node enlargement. Antigen-induced blood cell cytokine responses were studied in the absence or presence of IL-10 antibody or exogenously added recombinant IL-15. The ratio of IFN-γ/IL-10 was lower in elderly patients, and IFN-γ production was enhanced by either neutralization of IL-10 or exogenous recombinant IL-15 in blood cells from elderly but not young patients. Patients were treated three times weekly with antimony at 20 mg/kg/day for 20 doses. Although there was no difference in response to therapy between the two groups, two young patients needed rescue therapy with amphotericin B. Ventricular arrhythmias and ventricular overload were more frequent in elderly patients. We conclude that elderly patients have alterations in the immune response that may influence clinical manifestations, but we did not find that they had a higher failure rate than young subjects to antimony therapy. However, because of the high rate of electrocardiographic abnormalities during therapy, antimony should not be used in elderly patients with CL.

Author Notes

Address correspondence to Edgar M. Carvalho, Serviço de Imunologia, Complexo Hospitalar Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Rua João das Botas s/n, Canela, Bahia 40110-160, Brazil. E-mail: imuno@ufba.br

Financial support: This work was supported by the National Institutes of Health (NIH) grant U01-AI136032.

Authors’ addresses: Alexsandro Souza do Lago, Augusto M. Carvalho, Neuza Lago, Juliana Silva, and Paulo Machado, Serviço de Imunologia, Universidade Federal da Bahia, Salvador, Brazil, E-mails: alex-lago@hotmail.com, augustomarcelino1@hotmail.com, neu.lago@yahoo.com.br, july_meida@yahoo.com.br, and prlmachado@uol.com.br. Maurício Nascimento and José Roberto Queiroz, Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil, E-mails: mauriciotnascimento@hotmail.com and jrabreu@cardiol.br. Lucas P. Carvalho, Serviço de Imunologia, Universidade Federal da Bahia, Salvador, Brazil, and Laboratório de Pesquisas Clínicas do Instituto Gonçalo Moniz, Salvador, Brazil, E-mail: carvalholp76@gmail.com. Albert Schriefer, Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Salvador, Brazil, E-mail: aschriefer@ufba.br. Mary Wilson, Department of Internal Medicine and Microbiology, University of Iowa, Iowa City, IA, E-mail: mary-wilson@uiowa.edu. Edgar M. Carvalho, Servico de Imunologia, Federal University of Bahia, Salvador, Brazil, and Laboratório de Pesquisas Clínicas, Instituto Gonçalo Moniz, Salvador, Brazil, E-mail: imuno@ufba.br.

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