title: Immune response to Leishmania antigens in an AIDS patient with mucocutaneous leishmaniasis as a manifestation of immune reconstitution inflammatory syndrome (IRIS): a case report.
abstract: BACKGROUND
  After the onset of HAART, some HIV-infected individuals under treatment present a exacerbated inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary leishmaniasis have been described in association with IRIS. Moreover, the immunopathogenesis of IRIS in association with Leishmania is unclear.
  
  
  METHODS
  The present study reports on a 29-year-old HIV-infected individual who developed mucocutaneous leishmaniasis associated with immune reconstitution inflammatory syndrome (IRIS) five months following highly active antiretroviral therapy (HAART). Severe lesions resulted in the partial destruction of the nasal septum, with improvement observed 15 days after treatment with Amphotericin B and corticosteroids. The immune response of this patient was evaluated before and after the lesions healed. IRIS was diagnosed in association with high levels of TNF-α and IL-6. Decreased production of IFN-γ and a low IFN-γ/IL-10 ratio were also observed in response to Leishmania antigens. After receiving anti-leishmanial treatment, the individual's specific Th1 immune response was restored.
  
  
  CONCLUSIONS
  The results suggest that the production of inflammatory cytokines by unstimulated T-lymphocytes could contribute to occurrence of leishmaniasis associated with IRIS.
authors: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil. lualeandro1@hotmail.com.
authors: Luana
authors: L
authors: Gois
authors: Hospital Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil. rbadaro884@gmail.com.
authors: Roberto
authors: R
authors: Badaró
authors: Department of Medicine, University of California, San Diego, USA. rschooley@ucsd.edu.
authors: Robert
authors: R
authors: Schooley
authors: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil. grassi@bahia.fiocruz.br.
authors: Maria Fernanda Rios
authors: MF
authors: Grassi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D000953:Antigens, Protozoan / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active; D003937:Diagnosis, Differential; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications / Q000175:diagnosis*; D007891:Leishmania / Q000276:immunology; D007897:Leishmaniasis, Mucocutaneous / Q000150:complications / Q000175:diagnosis*; D008297:Male
chemical_list: D000953:Antigens, Protozoan
references: Am J Trop Med Hyg. 2009 Oct;81(4):559-64
references: 19815866
references: J Immunol. 1985 Dec;135(6):4144-8
references: 4067312
references: AIDS Res Ther. 2007 May 08;4:9
references: 17488505
references: Am J Respir Crit Care Med. 2008 Nov 15;178(10):1083-9
references: 18755923
references: Infect Immun. 2005 Dec;73(12):7853-9
references: 16299275
references: Science. 1997 Jul 4;277(5322):112-6
references: 9204894
references: AIDS. 2003 Jun 13;17(9):1411-3
references: 12799572
references: J Infect Dis. 1996 Feb;173(2):321-9
references: 8568292
references: Medicine (Baltimore). 2002 May;81(3):213-27
references: 11997718
references: N Engl J Med. 1998 Mar 26;338(13):853-60
references: 9516219
references: Expert Rev Anti Infect Ther. 2010 Apr;8(4):419-33
references: 20377337
references: J Invest Dermatol. 2013 Jun;133(6):1533-40
references: 23321919
references: N Engl J Med. 1993 Feb 4;328(5):327-35
references: 8093551
references: Br J Dermatol. 2009 Feb;160(2):311-8
references: 19187345
references: Curr Protoc Cytom. 2004 Feb;Chapter 9:Unit 9.11
references: 18770808
references: AIDS Res Ther. 2008 Apr 29;5:9
references: 18442415
references: Nat Rev Microbiol. 2012 Feb;10(2):150-6
references: 22230950
references: HIV Med. 2002 Jan;3(1):21-7
references: 12059947
references: Blood. 2010 Nov 11;116(19):3818-27
references: 20660788
references: J Infect Dis. 2005 Nov 15;192(10):1819-22
references: 16235183
references: Clin Vaccine Immunol. 2011 Oct;18(10):1765-9
references: 21832098
references: Cell Immunol. 2012 Oct;279(2):180-6
references: 23246680
references: J Clin Microbiol. 2011 Nov;49(11):3892-904
references: 22042830
references: Int J Dermatol. 2008 Dec;47(12):1263-70
references: 19126013
references: J Infect Dis. 2012 Dec 1;206(11):1715-23
references: 23002445
references: BMC Infect Dis. 2011;11:43
references: 21299909
references: AIDS. 1999 Oct 1;13(14):1857-62
references: 10513643
references: Am J Respir Crit Care Med. 2012 Aug 15;186(4):369-77
references: 22700860
references: Clin Infect Dis. 2009 Jan 1;48(1):101-7
references: 19025493
references: Trans R Soc Trop Med Hyg. 2011 Aug;105(8):438-44
references: 21723576
references: Acta Trop. 2003 Jan;85(1):39-49
references: 12505182