FACTORS ASSOCIATED TO ADHERENCE TO DIFFERENT TREATMENT SCHEMES WITH MEGLUMINE ANTIMONIATE IN A CLINICAL TRIAL FOR CUTANEOUS LEISHMANIASIS

The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL), in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule); we observed 82.1% (vial return), 86.0% (monitoring card), 66.7% (Morisky test) and 86.0% (modified Morisky test) adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods

Is There Any Difference between the In Situ and Systemic IL-10 and IFN-γ Production when Clinical Forms of Cutaneous Sporotrichosis Are Compared?

Submitted by Sandra Infurna ([email protected]) on 2016-12-15T11:14:37Z No. of bitstreams: 1 fernanda_morgado_etal_IOC_2016.pdf: 4768094 bytes, checksum: 5ab755cd6bdf28be44e74b4620b05950 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2016-12-15T11:30:54Z (GMT) No. of bitstreams: 1 fernanda_morgado_etal_IOC_2016.pdf: 4768094 bytes, checksum: 5ab755cd6bdf28be44e74b4620b05950 (MD5)Made available in DSpace on 2016-12-15T11:30:54Z (GMT). No. of bitstreams: 1 fernanda_morgado_etal_IOC_2016.pdf: 4768094 bytes, checksum: 5ab755cd6bdf28be44e74b4620b05950 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ. Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Leishmaniose. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas. Serviço de Infectologia - VigLeish. Rio de Janeiro, RJ, Brasil / New University of Lisbon (UNL). Hygiene and Tropical Medicine Institute (IHMT). Lisboa, Portugal.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunoparasitologia. Rio de Janeiro, RJ. Brasil.Fungus of the Sporothrix schenckii complex can produce skin lesions in humans, commonly lymphocutaneous (LC) and fixed (F) forms of sporotrichosis. Some authors have suggested that clinical forms are influenced by differences in virulence and genetic profile of isolates. But little is known about the role of immune response in determining the clinical outcome of sporotrichosis. To verify the profile of systemic and in situ IFN-γ and IL-10 expression in sporotrichosis patients, and consequently to detect any difference between the two compartments and/or clinical presentation, we quantified the number of IFN-γ and IL-10 producer peripheral blood mononuclear cells stimulated with S. schenckii antigen (Ss-Ag) by Elispot, and quantified cytokines expression by in situ immunohistochemistry in the same patient. Three groups were formed: 1- LC (n = 9); 2- F (n = 10); 3- healthy individuals (n = 14). All sporotrichosis patients produced high amounts of systemic IFN- γ when compared to uninfected individuals. No differences were observed between LC and F groups. Regarding in situ IL-10 expression, a difference between LC and F groups was observed: LC lesions presented higher amounts of IL-10 than F lesions differently from systemic IL-10 which showed similarities. Our data suggests that LC lesions present higher IL-10 expression which could be related to regulatory mechanisms for compensating the tissue injury, however favoring fungal persistence in the lesions. Surprisingly, there were no differences in systemic and in situ IFN- γ expression between CL and F patients, although it was significantly higher expressed in these patients than in healthy individuals

<i>In situ</i> IFN-γ and IL-10 expression in lymphocutaneous and fixed lesions of sporothrichosis.

<p>The <i>in situ</i> IFN-γ and IL-10 expression was detected by immunohistochemistry. The arrows point positive areas (red/AEC– 3-amino-9-ethylcarbazole). The intensity of staining was scored in ten microscopic fields (200x magnification) as rare (at least 1 positive area / field), discrete (2–3 positive areas / field), moderate (4–5 positive areas / field) and intense (>5 positive areas / field). Scale bar = 10μm.</p

Clinical data of patients with lymphocutaneous (LC) and fixed (F) forms of sporothrichosis.

<p>Clinical data of patients with lymphocutaneous (LC) and fixed (F) forms of sporothrichosis.</p

<i>In situ</i> IL-10 expression in lymphocutaneous (LC) and fixed (F) forms of sporotrichosis.

<p><i>In situ</i> IL-10 expression in lymphocutaneous (LC) and fixed (F) forms of sporotrichosis.</p

<i>In situ</i> IFN-γ expression in lymphocutaneous (LC) and fixed (F) forms of sporotrichosis.

<p><i>In situ</i> IFN-γ expression in lymphocutaneous (LC) and fixed (F) forms of sporotrichosis.</p

Number of IFN-γ and IL-10 producer cells/2 x 10⁵ cells from peripheral blood.

<p>(A) Spontaneous IFN-γ producing cells and (B) IFN-γ producing cells after Ss-Ag stimulation. (C) Spontaneous IL-10 producing cells and (D) IL-10 producing cells after Ss-Ag stimulation. The spontaneous values were subtracted from total spots detected in stimulated cultures. LC—lymphocutaneous sporotrichosis; F- fixed form of sporotrichosis; * p-value = 0.013; **p-value = 0.026; ***p-value = 0.0001 (Mann-Whitney test).</p

Endemic Tegumentary Leishmaniasis in Brazil: Correlation between Level of Endemicity and Number of Cases of Mucosal Disease

The purpose of this study was to establish a correlation between the endemic level of tegumentary leishmaniasis in different regions of Brazil during 2002–2009 and the number of cases of mucosal or mucocutaneous leishmaniasis. The proportion of mucosal leishmaniasis was inversely correlated with prevalence of infection. In areas with a lower infection prevalence, the proportion of mucosal leishmaniasis increased (P < 0.05). The hypothesis of an Amazonian origin and dissemination through human migration is considered. Our results show that in regions with lower prevalence and endemically younger, the proportion of cases that evolve to the mucosal form is higher than in regions with higher prevalence and endemically older