Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features.
BACKGROUND
The relationship between severe clinical manifestations of visceral leishmaniasis (VL) and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil).


METHODS
We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão.


RESULTS
Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ) levels, although their interleukin 10 (IL-10) levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2) and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL.


CONCLUSIONS
Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity.
Departamento de Medicina III, Centro de Ciências da Saúde, Universidade Federal do Maranhão, São LuísMA.
Mônica Elinor Alves
ME
Gama
Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São PauloSP.
Cláudia Maria de Castro
CM
Gomes
Instituto Evandro Chagas, Ananideua, BelémPará
Fernando Tobias
FT
Silveira
Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São PauloSP.
Márcia Dalastra
MD
Laurenti
Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal do Maranhão, São LuísMA.
Eloisa da Graça
Eda G
Gonçalves
Departamento de Patologia, Centro de Ciências da Saúde, Universidade Federal do Maranhão, São LuísMA.
Antônio Rafael da
AR
Silva
Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São PauloSP.
Carlos Eduardo Pereira
CE
Corbett
D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood*; D016753:Interleukin-10 / Q000097:blood*; D007376:Interleukin-2 / Q000097:blood*; D007898:Leishmaniasis, Visceral / Q000097:blood / Q000276:immunology*; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index
D015415:Biomarkers; D007376:Interleukin-2; D016753:Interleukin-10; D007371:Interferon-gamma