title: Treatment of two patients with diffuse cutaneous leishmaniasis caused by Leishmania mexicana modifies the immunohistological profile but not the disease outcome.
abstract: Two patients with diffuse cutaneous leishmaniasis caused by Leishmania mexicana were treated with two leishmanicidal drugs (pentamidine and allopurinol) combined with recombinant interferon-gamma restoring Th-1 favouring conditions in the patients. Parasites decreased dramatically in the lesions and macrophages diminished concomitantly, while IL-12-producing Langerhans cells and interferon-gamma- producing NK and CD8 + lymphocytes increased in a reciprocal manner. The CD4+/CD8 + ratio in the peripheral blood normalized. During exogenous administration of interferon-gamma the parasites' capacity to inhibit the oxidative burst of the patients' monocytes was abolished. Even though Th-1-favouring conditions were restored, both patients relapsed two months after therapy was discontinued. We conclude that the tendency to develop a disease-promoting Th-2 response in DCL patients is unaffected by, and independent of, parasite numbers. Even though intensive treatment in DCL patients induced Th-1 disease restricting conditions, the disease-promoting immunomodulation of few persistent Leishmania sufficed to revert the immune response.
authors.affiliation: Departamento de Medicina Experimental, Faculdad de Medicina, UNAM, Mexico.
authors.forename: N
authors.initials: N
authors.lastname: Salaiza-Suazo
authors.forename: P
authors.initials: P
authors.lastname: Volkow
authors.forename: R
authors.initials: R
authors.lastname: Tamayo
authors.forename: H
authors.initials: H
authors.lastname: Moll
authors.forename: R
authors.initials: R
authors.lastname: Gillitzer
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Torres
authors.forename: R
authors.initials: R
authors.lastname: Pérez-Montfort
authors.forename: J D
authors.initials: JD
authors.lastname: Domínguez
authors.forename: O
authors.initials: O
authors.lastname: Velasco-Castrejón
authors.forename: M
authors.initials: M
authors.lastname: Crippa
authors.forename: I
authors.initials: I
authors.lastname: Becker
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use; D000818:Animals; D000963:Antimetabolites / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D016516:CD4-CD8 Ratio / Q000187:drug effects; D004359:Drug Therapy, Combination; D006801:Humans; D007371:Interferon-gamma / Q000627:therapeutic use*; D007694:Killer Cells, Natural / Q000187:drug effects / Q000276:immunology; D007801:Langerhans Cells / Q000187:drug effects* / Q000276:immunology / Q000469:parasitology; D007894:Leishmania mexicana; D016774:Leishmaniasis, Diffuse Cutaneous / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D010419:Pentamidine / Q000627:therapeutic use*; D011994:Recombinant Proteins; D016897:Respiratory Burst / Q000187:drug effects / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000963:Antimetabolites; D000981:Antiprotozoal Agents; D011994:Recombinant Proteins; D000493:Allopurinol; D010419:Pentamidine; D007371:Interferon-gamma