title: Increase of NK cells and proinflammatory monocytes are associated with the clinical improvement of diffuse cutaneous leishmaniasis after immunochemotherapy with BCG/Leishmania antigens.
abstract: Diffuse cutaneous leishmaniasis (DCL) is characterized by disseminated lesions and the absence of a specific cellular immune response. Here, the immunochemotherapy outcome of a patient with DCL from Amazonian Brazil infected with Leishmania (Leishmania) amazonensis is presented. After several unsuccessful chemotherapy treatment regimens and many relapses, a monthly immunotherapy scheme of L. amazonensis PH8 plus L. (Viannia) braziliensis M2903 monovalent vaccines associated with Bacillus Calmette-Guerin (BCG) was established, one round of which also included an M2903 vaccine associated with intermittent antimonial treatment. Temporary healing of all lesions was achieved, although Leishmania skin tests were negative and interferon gamma was not detected in mononuclear cell cultures stimulated with Leishmania antigens. The frequencies of CD16 (+)CD56(+) NK cells (approximately 2x) and CD14 (+)CD16(+) proinflammatory monocytes (approximately 8x) increased in peripheral blood, and CD56 (+) lymphocytes were found infiltrating the lesions. An association between the increase of the frequency of innate immune system cells and the healing of lesions is shown, suggesting that this protocol of immunotherapy reduced the parasite load and activated NK cells and monocytes.
authors.affiliation: Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiás Hospital de Doenças Tropicais Anuar Auad, Goiás, Brazil. ledicepereira@gmail.com
authors.forename: Ledice I A
authors.initials: LI
authors.lastname: Pereira
authors.forename: Miriam L
authors.initials: ML
authors.lastname: Dorta
authors.forename: Ana Joaquina C S
authors.initials: AJ
authors.lastname: Pereira
authors.forename: Rosidete P
authors.initials: RP
authors.lastname: Bastos
authors.forename: Milton A P
authors.initials: MA
authors.lastname: Oliveira
authors.forename: Sebastião A
authors.initials: SA
authors.lastname: Pinto
authors.forename: Hélio
authors.initials: H
authors.lastname: Galdino
authors.forename: Wilson
authors.initials: W
authors.lastname: Mayrink
authors.forename: Warly
authors.initials: W
authors.lastname: Barcelos
authors.forename: Vicente P C P
authors.initials: VP
authors.lastname: Toledo
authors.forename: Gloria Maria C A
authors.initials: GM
authors.lastname: Lima
authors.forename: Fátima
authors.initials: F
authors.lastname: Ribeiro-Dias
mesh_terms: D000818:Animals; D000942:Antigens, Bacterial / Q000627:therapeutic use; D000953:Antigens, Protozoan / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000627:therapeutic use*; D001681:Biological Assay; D006801:Humans; D007167:Immunotherapy; D007694:Killer Cells, Natural; D007894:Leishmania mexicana / Q000276:immunology / Q000302:isolation & purification*; D054332:Leishmaniasis Vaccines / Q000627:therapeutic use*; D016774:Leishmaniasis, Diffuse Cutaneous / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D009000:Monocytes; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial; D000953:Antigens, Protozoan; D000981:Antiprotozoal Agents; D001500:BCG Vaccine; D054332:Leishmaniasis Vaccines