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Treatment of two patients with diffuse cutaneous leishmaniasis caused by Leishmania mexicana modifies the immunohistological profile but not the disease outcome

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Two patients with diffuse cutaneous leishmaniasis caused by Leishmania mexicana were treated with two leishmanicidal drugs (pentamidine and allopurinol) combined with recombinant interferon-γ restoring Th-1 favouring conditions in the patients. Parasites decreased dramatically in the lesions and macrophages diminished concomitantly, while IL-12-producing Langerhans cells and interferon-γ– producing NK and CD8 + lymphocytes increased in a reciprocal manner. The CD4+/CD8 + ratio in the peripheral blood normalized. During exogenous administration of interferon-γ the parasites' capacity to inhibit the oxidative burst of the patients' monocytes was abolished. Even though Th-1-favouring conditions were restored, both patients relapsed two months after therapy was discontinued. We conclude that the tendency to develop a disease-promoting Th-2 response in DCL patients is unaffected by, and independent of, parasite numbers. Even though intensive treatment in DCL patients induced Th-1 disease restricting conditions, the disease-promoting immunomodulation of few persistent Leishmania sufficed to revert the immune response.

Keywords: Langerhans cells; Leishmania mexicana; NK and CD8+ lymphocytes; diffuse cutaneous leishmaniasis; immunocytochemistry; monocytes; respiratory burst

Document Type: Research Article


Affiliations: 1: Departamento de Medicina Experimental, Facultad de Medicina, UNAM, Mexico 2: Instituto Nacional de Cancerología, Secretaría de Salud, Mexico 3: Zentrum für Infektionsforschung, Universität Würzburg, Germany 4: Klinik für Hautkrankheiten, Universität Würzburg, Germany 5: Departamento de Biología Tisular y Celular, UNAM, Mexico 6: Departamento de Bioquímica, Instituto de Fisiología Celular, UNAM, Mexico

Publication date: December 1, 1999


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