Serum cytokine responses over the entire clinical-immunological spectrum of human leishmania (l.) infantum chagasi infection

The clinical-immunological spectrum of human Leishmania (L.) infantum chagasi infection in Amazonian Brazil was recently reviewed based on clinical, DTH, and IFAT (IgG) evaluations that identified five profiles: three asymptomatic (asymptomatic infection, AIsubclinical resistant infection, SRIand indeterminate initial infection, III) and two symptomatic (symptomatic infection, SIAmerican visceral leishmaniasis, AVLand subclinical oligosymptomatic infection, SOI). TNF-alpha, IL-4, IL-6, and IL-10 serum cytokines were analyzed using multiplexed Cytometric Bead Array in 161 samples from endemic areas in the Brazilian Amazon: SI [AVL] (21 cases), III (49), SRI (19), SOI (12), AI (36), and a control group [CG] (24). The highest IL-6 serumlevels were observed in the SI profile (AVL)higher IL-10 serum levels were observed in SI than in SOI or CG and in AI and III than in SOIhigher TNF-alpha serum levels were seen in SI than in CG. Positive correlations were found between IL-6 and IL-10 serum levels in the SI and III profiles and between IL-6 and TNF-alpha and between IL-4 and TNF-alpha in the III profile. These results provide strong evidence for associating IL-6 and IL-10 with the immunopathogenesis of AVL and help clarify the role of these cytokines in the infection spectrum.Instituto Evandro Chagas (Secretaria de Vigilancia em Saude, Ministerio da Saude, Brazil)Nucleo de Medicina Tropical (Universidade Federal do Para, Brazil)Laboratorio de Investigacao Medica (LIM)-50 (Hospital de Clinicas (HC)-Faculdade de Medicina (FM)-Universidade de Sao Paulo (USP), Brazil)Sao Paulo Research Foundation (FAPESP) [2006/56319-1]Parasitology Department, Evandro Chagas Institute, Surveillance Secretary of Health, Ministry of Health, Ananindeua, PA, BrazilAlbert Einstein Israelite Hospital, São Paulo, SP, BrazilDivision of Immunology, Federal University of São Paulo, São Paulo, SP, BrazilPathology Department, Medical School of São Paulo University, São Paulo, SP, BrazilTropical Medicine Nucleus, Federal University of Pará, Belém, PA, BrazilDivision of Immunology, Federal University of São Paulo, São Paulo, SP, BrazilFAPESP: 2006/56319-1Web of Scienc

Serum Cytokine Responses over the Entire Clinical-Immunological Spectrum of Human Leishmania (L.) infantum chagasi

The clinical-immunological spectrum of human Leishmania (L.) infantum chagasi infection in Amazonian Brazil was recently reviewed based on clinical, DTH, and IFAT (IgG) evaluations that identified five profiles: three asymptomatic (asymptomatic infection, AI; subclinical resistant infection, SRI; and indeterminate initial infection, III) and two symptomatic (symptomatic infection, SI; American visceral leishmaniasis, AVL; and subclinical oligosymptomatic infection, SOI). TNF-α, IL-4, IL-6, and IL-10 serum cytokines were analyzed using multiplexed Cytometric Bead Array in 161 samples from endemic areas in the Brazilian Amazon: SI [AVL] (21 cases), III (49), SRI (19), SOI (12), AI (36), and a control group [CG] (24). The highest IL-6 serum levels were observed in the SI profile (AVL); higher IL-10 serum levels were observed in SI than in SOI or CG and in AI and III than in SOI; higher TNF-α serum levels were seen in SI than in CG. Positive correlations were found between IL-6 and IL-10 serum levels in the SI and III profiles and between IL-6 and TNF-α and between IL-4 and TNF-α in the III profile. These results provide strong evidence for associating IL-6 and IL-10 with the immunopathogenesis of AVL and help clarify the role of these cytokines in the infection spectrum

Can domestic dogs be considered a good reservoir of Leishmania (L.) infantum chagasi in an endemic area of nonulcerated cutaneous leishmaniasis in Southern Honduras?

Dogs are considered to be the main domestic reservoir associated with the transmission of Leishmania (L.) infantum chagasi to humans in endemic areas of visceral leishmaniasis in America. However, little is known about the role of canines as a source of infection in endemic areas of nonulcerated cutaneous leishmaniasis (NUCL). Therefore, the objective of the present study was to investigate the role of dogs as a possible reservoir of the parasite in Southern Honduras. Dogs (n = 107) living with individuals affected by NUCL were clinically examined and biological material was collected for parasitological and immunological diagnosis. Most animals showed a healthy appearance and a few presented slight weight loss (64%), alopecia (7%), onychogryphosis (5%) and skin lesions (1%). The overall seroprevalence of Leishmania infection based on the DDP ® quick test and/or in-house ELISA serological test was 41%. The presence of the parasite’s DNA was confirmed in 94% of the dogs; however, the average parasite load in the buffy coat was low at 6.09 parasites/µL, ranging between 0.221 and 50.2. The skin of seropositive dogs examined by histopathology using paraffin sections stained by hematoxylin and immunohistochemistry did not show cutaneous lesions or parasite amastigotes. Based on the absence of parasites in the skin and the low parasite load detected in the buffy coat, it seems that the dog does not represent a good source of infection for the vector in the endemic area of NUCL transmission in Southern Honduras. Other domestic and/or wild animals should be investigated

ESTUDO EPIDEMIOLÓGICO DE PACIENTES COM LEISHMANIOSE TEGUMENTAR AMERICANA EM BURITICUPU, PRÉ-AMAZÔNIA MARANHENSE

A LTA constitui um sério problema de saúde pública; trata-se de uma doença endêmica no Brasil, tendo distribuição em todo território nacional, com maior casuística na Pré-Amazônia Maranhense. Causada por diferentes espécies de protozoários do gênero Leishmania Ross, 1903, esta doença caracteriza-se pelo comprometimento cutâneo e, dependendo da espécie de Leishmania e de fatores inerentes ao hospedeiro, podem ocorrer lesões mutilantes nas mucosas nasobucofaríngea. Foram atendidos 35 pacientes na cidade de Buriticupu, estado do Maranhão, dos quais a maioria era do gênero masculino (85,7%), apresentava um tempo de evolução da doença inferior a 2 meses (51,4%) e média de idade de 33,9±15,9 anos. Essas características indicam que, embora a busca ao serviço diagnóstico se dê na fase aguda, a doença continua a avançar nas regiões pesquisadas.Descritores:  Leishmaniose Tegumentar Americana; Epidemiologia; Leishmania.Abstract: Epidemiological study of patients with American Cutaneous Leishmaniasis in Buriticupu, pre-amazon region of Maranhão. ACL constitutes a serious public health problem; it is an endemic disease in Brazil, being distributed in all of the nation’s territory, with higher casuistic in the pre-amazon portion of Maranhão. Caused by many different protozoan species from the genus Leishmania Ross, 1903; this disease is characterized by its cutaneous compromises, and, depending on the species of Leishmania and on inherent host factors, there may occur mutilating lesions on the nasobuccopharingeal mucosae. 35 patients with ACL were assessed in the cities of São Luís and Buriticupu, state of Maranhão, from which the majority were males (85,7%), had a disease evolution time of below 2 months (51,4%) and a mean age of 33,9±15,9 years old. These characteristics indicate that, although the diagnostics made within the acute phase of the disease, it is still progressing in the locations researched.Descriptors: American Cutaneous Leishmaniasis; Epidemiology; Leishmania

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning