Influence of sex hormones on the immune response to leishmaniasis.

The differences in morbidity and mortality patterns and life expectancy between the sexes are well established in different infectious and parasitic conditions, such as in leishmaniases, in which biological, genetic, sexual and hormonal variations can modulate the immune response indicating greater infectivity, prevalence and clinical severity in men. In this regard, in seeking the understanding of factors related to protection and susceptibility to infection, this review aimed to discuss the influence of sex hormones on the immune response to leishmaniases. In the literature, sex hormone variations promote differences in the innate, humoral and cell-mediated immune response, leading to greater susceptibility, mortality and complications in males. Epidemiological estimates confirm these results, showing a predominance of the disease, in its different clinical forms, in men and suggesting that sexual variations influence immunomodulatory mechanisms since the prevalence of cases comprises the post-puberty and adulthood period. In this perspective, the action of sex hormones has been investigated in different clinical models, highlighting the potential of testosterone in immunosuppression, given its association with greater susceptibility and poor control of parasite load and the induction of cell apoptosis and attenuation of pro-inflammatory signalling pathways. Therefore, hormonal variations influence the immune response among males and females against leishmaniases, in which androgens may present immunosuppressive potential, while steroids present immunomodulatory characteristics.

Causes and consequences of higher Leishmania infantum burden in patients with kala-azar: a study of 625 patients.

BACKGROUND: An infected host's Leishmania infantum load in blood is considered to be an estimate of his or her total parasite burden. Therefore, the measurement of blood parasite burden is important in the identification of factors involved in parasite control. METHODS: Quantitative polymerase chain reaction was performed on blood samples from 625 patients with kala-azar consecutively admitted to a reference hospital in Teresina, Brazil. Primers were used to amplify a segment of kDNA using the TaqMan system. Non-parametric statistical tests were applied. RESULTS: The median blood parasite burden was 499.2 amastigote equivalents (AE)/ml. Children <1 year old (yo) had a high parasite burden, which dropped sharply after the first year of life (192.8, AE/ml at 1 < 2 yo) and remained lower until adolescence. Following adolescence, the parasite burden increased with age, peaking among elderly individuals. Men had a higher parasite burden than women. HIV-infected patients had a much higher parasite burden than non-infected patients. The parasite burden of children under 5 years with acute moderate to severe malnourishment (weight-for-age and body mass index z-scores <-2) was almost three times greater than that of better-nourished children. The parasite burden identified in deceased patients was more than twice that of surviving patients; those with a higher risk of death, sepsis, pneumonia and jaundice also had increased parasite burdens. All of these differences were statistically significant at P-values <0.05. CONCLUSIONS: These data indicate that the parasite burden in patients with kala-azar was associated with age- and gender-associated factors and with HIV infection status. Acute malnutrition could be either a cause or a consequence of a higher parasite burden. An individual's parasite burden influences his or her clinical profile, disease severity and mortality risk. The best explanation for the presence of a higher parasite burden in individuals with these immunoregulatory conditions and severe disease is the occurrence of acquired immunosuppression followed by heightened innate immunity.

Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil.

INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

Lateral Flow Assay for Interleukin 6: A Technological and Scientific Prospection of a 10-Year Survey.

BACKGROUND: Interleukin-6 (IL-6) is a multifunctional cytokine that plays a crucial role not only in the immune system but also in numerous biological processes. Elevated IL-6 levels have been observed in many types of cancer and inflammatory diseases. Among the techniques that have been used to quantify IL-6, a Lateral Flow Assay (LFA) is one of the most promising. OBJECTIVE: The objective of this study was to perform a technological and scientific exploration of the development of an LFA for IL-6. METHOD: The Instituto Nacional de Propriedade Industrial-INPI (Brazil), European Patent Office - Espacenet, and United States Patent and Trademark Office-USPTO were used for the technological prospection to consider all the patents regarding an LFA for IL-6 detection. For the scientific investigation, the following periodic databases were used: Web of Science, Science Direct, PubMed, and Scielo, and were monitored from 2007 to May 2017. RESULTS: We found no patents based on the searched keywords, and a limited number of scientific articles were found. Therefore, the development of an LFA sensor for the detection of IL-6 appears to be innovative with significant biotechnological importance, creating a technology transfer to promote economic and industrial growth. CONCLUSION: The development of lateral flow immunosensors for IL-6 is innovative, as we could not find patents describing such a biosensor. Scientific prospection reported two lateral flow immunosensors. However, the test for IL-6 cannot be completed without using some kind of equipment for detection, such as the one we propose in future developments.

Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil

Abstract INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

Severe Kala-azar and seric level of IL-6: case reports / Calazar grave e níveis séricos de IL-6: relato de casos

Introduction: IL-6 is a cytokine that participates in the systemic inflammatory process in Kala-azar, its plasma levels are high during active disease and especially in patients with severe clinical condition. Case reports: Three patients from different age groups, clinical score of severe disease and different plasma levels of IL-6 were reported. Conclusion: The results suggest that only the clinical severity score does not present sensitivity to classify, among critically ill patients, those with imminent risk of death. The IL-6 concentration seems to allow this differentiation, considering that the only fatal case, HBV/Leishmania coinfection, presented an expressively higher plasma level.

Introdução: IL-6 é uma citocina que participa do processo inflamatório sistêmico no calazar. Seus níveis plasmáticos estão elevados durante doença ativa e, principalmente, em pacientes com quadro clínico grave. Relato de casos: foram reportados três pacientes em diferentes faixas etárias, escore clínico de doença grave e diferentes níveis plasmáticos de IL-6. Conclusão: os resultados sugerem que apenas o escore clínico não apresenta sensibilidade para classificar, entre os doentes graves, aquele com risco iminente de óbito. A concentração de IL-6 parece permitir essa diferenciação, considerando que o único caso fatal, coinfecção HBV/Leishmania, mostrou nível plasmático expressivamente mais elevado.