American cutaneous leishmaniasis, lepromatous leprosy, and pulmonary tuberculosis coinfection with downregulation of the T-helper 1 cell response.
Cutaneous leishmaniasis, leprosy, and tuberculosis are caused by intracellular pathogens whose development depends on impaired cell-mediated immunity. We report an exceptional triple association of American cutaneous leishmaniasis, lepromatous leprosy, and pulmonary tuberculosis in a man with no recognized immunodeficiency. Normal immunological assessment of the interferon-gamma pathway does not support the hypothesis of a genetic defect in any of the genes involved in the T helper (Th)-1 cytokine cascade in this patient. Unresponsiveness to interleukin (IL)-12 of his T cells after stimulation with Leishmania guyanensis, Mycobacterium bovis bacille Calmette-Guérin, and Mycobacterium leprae antigens suggested the inability to mount an appropriate Th cell response to upregulate the IL-12 receptor expression.
Delobel
Pierre
P
Department of Infectious and Tropical Diseases, Purpan University Hospital, Toulouse, France. pierredelobel@yahoo.fr
Launois
Pascal
P
Djossou
Felix
F
Sainte-Marie
Dominique
D
Pradinaud
Roger
R
D000328:Adult; D000818:Animals; D001938:Brazil; D015536:Down-Regulation / Q000276:immunology*; D005616:French Guiana; D006801:Humans; D018334:Leishmania guyanensis / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015440:Leprosy, Lepromatous / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D009166:Mycobacterium leprae / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification; D013902:Radiography, Thoracic; D018123:Receptors, Interleukin / Q000096:biosynthesis; D053707:Receptors, Interleukin-12; D016176:T-Lymphocyte Subsets / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology*; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy
D018123:Receptors, Interleukin; D053707:Receptors, Interleukin-12