title: Hookworm-related cutaneous larva migrans in patients living in an endemic community in Brazil: immunological patterns before and after ivermectin treatmen.
abstract: Hookworm-related cutaneous larva migrans (Hr-CLM) is caused by animal hookworm larvae migrating in the human epidermis where they elicit an inflammatory response. This study describes the immunological profile in Hr-CLM patients. In 77 Hr-CLM patients from Manaus, Brazil, peripheral eosinophils were counted, and serum concentrations of total immunoglobulin E (IgE) and selected cytokines were determined by ELISA before and after treatment with ivermectin. Controls included patients' household members (endemic controls), non-endemic Brazilian and Japanese individuals. Eosinophil counts and total IgE in Hr-CLM patients were higher than in controls and correlated with disease severity. Concentrations of interleukin (IL)-4, IL-5, IL-6, and IL-10 were higher in Hr-CLM patients than in endemic controls (p < 0.001) while no differences were detected for interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-1β, IL-2, or transforming growth factor (TGF)-β. Following ivermectin treatment, numbers of eosinophils and concentrations of IL-4, IL-5, and IL-10 decreased whereas IgE, IFN-γ, and TGF-β concentrations increased. The IL-5/IFN-γ ratio declined from 5.9 (interquartile range [IQR] 0.8-31.6) before to 0.1 (IQR 0.05-0.2; p = 0.001) after treatment. Thus, although an impact of other infections on the immune parameters determined cannot be excluded, Hr-CLM in endemic areas is associated with eosinophilia and elevated cytokine levels, particularly of IL-5 and IL-10, which decrease following ivermectin treatment.
authors.forename: R
authors.initials: R
authors.lastname: Shimogawara
authors.forename: N
authors.initials: N
authors.lastname: Hata
authors.forename: A
authors.initials: A
authors.lastname: Schuster
authors.forename: H
authors.initials: H
authors.lastname: Lesshafft
authors.forename: S
authors.initials: S
authors.lastname: Guedes de Oliveira
authors.forename: R
authors.initials: R
authors.lastname: Ignatius
authors.forename: N
authors.initials: N
authors.lastname: Akao
authors.forename: N
authors.initials: N
authors.lastname: Ohta
authors.forename: H
authors.initials: H
authors.lastname: Feldmeier
keywords: cutaneous larva migrans; cytokine; immunological profile; ivermectin; treatment