Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report.
Severe mucocutaneous (MCL) and diffuse (DCL) forms of American cutaneous leishmaniasis (ACL) are infrequent in Venezuela. Chemotherapy produces only transitory remission in DCL, and occasional treatment failures are observed in MCL. We have evaluated therapy with an experimental vaccine in patients with severe leishmaniasis. Four patients with MCL and 3 with early DCL were treated with monthly intradermal injections of a vaccine containing promastigotes of Leishmania (Viannia) braziliensis killed by pasteurization and viable Bacillus Calmette- Guerin. Clinical and immunological responses were evaluated. Integrity of protein constituents in extracts of pasteurized promastigotes was evaluated by gel electrophoresis. Complete remission of lesions occurred after 5-9 injections in patients with MCL or 7-10 injections in patients with early DCL. DCL patients developed positive skin reactions, average size 18.7 mm. All have been free of active lesions for at least 10 months. Adverse effects of the vaccine were limited to local reactivity to BCG at the injection sites and fever in 2 patients. Extracts of pasteurized and fresh promastigotes did not reveal differences in the integrity of protein components detectable by gel electrophoresis. Immunotherapy with this modified vaccine offers an effective, safe option for the treatment of patients who do not respond to immunotherapy with vaccine containing autoclaved parasites or to chemotherapy.
Convit
Jacinto
J
Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela. jconvi@telcel.net.ve
Ulrich
Marian
M
Polegre
María Argelia
MA
Avila
Angela
A
Rodríguez
Noris
N
Mazzedo
Maria Ilina
MI
Blanco
Belkis
B
D000328:Adult; D000818:Animals; D001500:BCG Vaccine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004591:Electrophoresis, Polyacrylamide Gel; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007892:Leishmania braziliensis / Q000276:immunology*; D016774:Leishmaniasis, Diffuse Cutaneous / Q000276:immunology / Q000628:therapy*; D007897:Leishmaniasis, Mucocutaneous / Q000276:immunology / Q000628:therapy*; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D016052:Protozoan Vaccines / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014687:Venezuela
D001500:BCG Vaccine; D016052:Protozoan Vaccines