title: A case of conventional treatment failure in visceral leishmaniasis: leukocyte distribution and cytokine expression in splenic compartments.
abstract: BACKGROUND
  In this paper we study the distribution of leukocyte populations and of cytokine-producing cells in the spleen of a patient with visceral leishmaniasis resistant to clinical treatment. It is the first attempt to compare the distribution of leukocyte populations and cytokine-producing cells in the splenic compartments of a patient with visceral leishmaniasis with those observed in patients without the disease.
  
  
  METHODS
  A 25-year-old male, farmer, was hospitalized on several occasions with diagnosis of visceral leishmaniasis and received all recommended treatments for the disease with only transient improvement followed by relapse. He was eventually subjected to splenectomy in order to control the effects of hypersplenism and to potentially overcome infection. After surgery and combined chemotherapy, the disease evolved to cure. In comparison with the spleens of the other two patients without visceral leishmaniasis, an increase was observed in the CD4/CD8 ratio and in the number of IL-10- and FoxP3-producing cells, while the number of IL-17-producing cells was lower in the spleen of the patient with visceral leishmaniasis.
  
  
  CONCLUSIONS
  This report confirms previous data on changes in the CD4/CD8 ratio in the spleens of patients with visceral leishmaniasis. Additionally the data presented herein suggests that splenic FoxP3- and IL-17-producing cells are involved in the chronicity of visceral leishmaniasis.
authors.affiliation: Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz, Salvador, BA, Brazil. wluis@bahia.fiocruz.br.
authors.forename: Washington L C
authors.initials: WL
authors.lastname: Dos-Santos
authors.forename: Carla
authors.initials: C
authors.lastname: Pagliari
authors.forename: Lina G
authors.initials: LG
authors.lastname: Santos
authors.forename: Valter A
authors.initials: VA
authors.lastname: Almeida
authors.forename: Thiago L V
authors.initials: TL
authors.lastname: e Silva
authors.forename: João de J
authors.initials: Jde J
authors.lastname: Coutinho
authors.forename: Tulio
authors.initials: T
authors.lastname: Souza
authors.forename: Maria I S
authors.initials: MI
authors.lastname: Duarte
authors.forename: Luiz A R
authors.initials: LA
authors.lastname: de Freitas
authors.forename: Carlos H N
authors.initials: CH
authors.lastname: Costa
mesh_terms: D000328:Adult; D016207:Cytokines / Q000235:genetics* / Q000276:immunology; D006801:Humans; D018314:Leishmania infantum / Q000502:physiology; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000235:genetics / Q000276:immunology / Q000628:therapy*; D007958:Leukocyte Count; D007962:Leukocytes / Q000166:cytology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000166:cytology / Q000276:immunology*; D017211:Treatment Failure
chemical_list: D016207:Cytokines