In vitro sensitivity of paired Leishmania (Viannia) braziliensis samples isolated before meglumine antimoniate treatment and after treatment failure or reactivation of cutaneous leishmaniasis.

This study evaluated the in vitro sensitivity of paired Leishmania braziliensis samples isolated from the same patient before pentavalent antimonial treatment (Sample A) and after treatment failure or cutaneous leishmaniasis reactivation (Sample B) in patients undergoing intralesional administration or injections (5 mgSb(V)/kg/d) of meglumine antimoniate. Fourteen samples from 7 patients were studied. After 24 h of drug exposure, 50% lethal dose (LD50) values for promastigotes ranged from 0.37 mg/mL to 5.86 mg/mL for samples obtained before treatment (A) and 0.89 mg/mL to 7.80 mg/mL for samples obtained after treatment (B). After 48 h, LD50 values ranged from 0.37 mg/mL to 5.75 mg/mL and 0.70 mg/mL to 7.68 mg/mL for A and B samples, respectively. After 48 h, LD50 values for amastigotes ranged from 11.7 to 44.3 µg/mL for A samples and 13.7 to 52.7 µg/mL for B samples. Of 7 patients, 1 discontinued treatment and 6 were cured after retreatment with amphotericin B (4 cases) or meglumine antimoniate (2 cases). Overall the B samples had higher LD50 values than A samples; however the difference was not significant. These results do not support the hypothesis that low-dose and intralesional treatments induce selection of resistant parasites in vitro and suggest that other factors may influence therapeutic outcome in patients with poor response to initial treatment.

Intralesional meglumine antimoniate for treatment of cutaneous leishmaniasis patients with contraindication to systemic therapy from Rio de Janeiro (2000 to 2006).

We evaluated the effectiveness and safety of intralesional meglumine antimoniate (MA) in 24 not submitted to previous treatment patients with cutaneous leishmaniasis (CL) and with contraindication to systemic therapy. Each treatment consisted of one to four intralesional applications of MA at 15-day intervals. Patients' age ranged from 3 to 90 years; fourteen were females. Intralesional treatment in the absence of any relevant toxicity was successful in 20 (83.3%) patients. Three patients required additional treatment with amphotericin B and one required systemic MA. None of the patients developed mucosal lesions when followed up to 60 months. Intralesional MA is an effective and less toxic alternative treatment of patients with CL and contraindication to systemic therapy.

Evaluation of Genetic Polymorphism of Leishmania (V.) braziliensis Isolates Obtained from the Same Patient before and after Therapeutic Failure or Reactivation of Cutaneous Lesions.

The aim of this study was to investigate genetic polymorphism in Leishmania braziliensis population previously typed through isoenzyme electrophoresis, isolated from the same patient in two different moments: (A) before the beginning of treatment and (B) after treatment failure to meglumine antimoniate or reactivation after successful initial treatment. Fifteen pairs of isolates were assessed using the polymorphic molecular marker LSSP-PCR and following the phenetic analysis. The genetic profiles of the 30 samples were grouped in four clusters. Only two patients presented total identity in the A and B isolates. Most isolates presented similarity coefficients varying from 0.63 to 0.91. In this group of patients genetic polymorphisms could be observed indicating low similarity between the pairs of isolates. The results demonstrate the existence of genetic polymorphism between the samples isolated before treatment and after reactivation or treatment failure, suggesting a possible differentiation of the structure of the original parasite population which could be involved in the mechanisms of resistance to treatment or reactivation of lesions in the ATL. This phenomenon is important, although other factors also could be involved in this context and are discussed in this paper.

Evaluation of Leishmania (Leishmania) chagasi strains isolated from dogs originating from two visceral leishmaniasis-endemic areas in Brazil using multilocus enzyme electrophoresis / Avaliação de amostras de Leishmania (Leishmania) chagasi isoladas de cães oriundos de duas áreas endêmicas de leishmaniose visceral no Brasil através da eletroforese de isoenzimas

INTRODUCTION: Domestic dogs are the most important reservoir in the peridomestic transmission cycle of Leishmania (Leishmania) chagasi. The genetic variability of subpopulations of this parasite circulating in dogs has not been thoroughly analyzed in Brazil, even though this knowledge has important implications in the clinical-epidemiological context. METHODS: The objective of this study was to evaluate and compare the phenotypic variability of 153 L. chagasi strains isolated from dogs originating from the municipalities of Rio de Janeiro (n = 57) and Belo Horizonte (n = 96), where the disease is endemic. Strains isolated only from intact skin were selected and analyzed by multilocus enzyme electrophoresis using nine enzyme systems (6PG, GPI, NH1 and NH2, G6P, PGM, MDH, ME, and IDHNADP). RESULTS: The electrophoretic profile was identical for all isolates analyzed and was the same as that of the L. chagasi reference strain (MHOM/BR/74/PP75). Phenetic analysis showed a similarity index of one for all strains, with the isolates sharing 100 percent of the characteristics analyzed. CONCLUSIONS: The results demonstrate that the L. chagasi populations circulating in dogs from Rio de Janeiro and Belo Horizonte belong to a single zymodeme.

INTRODUÇÃO: Cães domésticos são considerados os reservatórios mais importantes no ciclo peridoméstico de transmissão de Leishmania (Leishmania) chagasi. No entanto, a variabilidade genética de sub-populações que circulam neste hospedeiro é ainda pouco explorada no Brasil, sendo tal conhecimento de grande importância no contexto clínico-epidemiológico. MÉTODOS: O objetivo deste estudo foi avaliar e comparar a variabilidade fenotípica de 153 amostras de L. chagasi isoladas de cães oriundos dos municípios do Rio de Janeiro (n = 57) e Belo Horizonte (n = 96), onde a doença é endêmica. Foram selecionadas somente amostras isoladas de pele íntegra e analisadas por eletroforese de isoenzimas (MLEE) empregando nove sistemas enzimáticos (6PG, GPI, NH1 e NH2, G6P, PGM, MDH, ME, IDHNADP). RESULTADOS: Todas as amostras analisadas apresentaram perfil eletroforético idêntico entre si e com a amostra de L. chagasi utilizada como referência neste estudo (MHOM/BR/74/PP75). A análise fenética demonstrou índice de similaridade igual a um para todas as amostras, revelando um compartilhamento de 100 por cento dos caracteres avaliados. CONCLUSÕES: A partir desses resultados, podemos inferir que as populações de L. chagasi que estão circulando nos cães do Rio de Janeiro e Belo Horizonte podem ser agrupadas em um único zimodema.

Evaluation of Leishmania (Leishmania) chagasi strains isolated from dogs originating from two visceral leishmaniasis-endemic areas in Brazil using multilocus enzyme electrophoresis.

INTRODUCTION: Domestic dogs are the most important reservoir in the peridomestic transmission cycle of Leishmania (Leishmania) chagasi. The genetic variability of subpopulations of this parasite circulating in dogs has not been thoroughly analyzed in Brazil, even though this knowledge has important implications in the clinical-epidemiological context. METHODS: The objective of this study was to evaluate and compare the phenotypic variability of 153 L. chagasi strains isolated from dogs originating from the municipalities of Rio de Janeiro (n = 57) and Belo Horizonte (n = 96), where the disease is endemic. Strains isolated only from intact skin were selected and analyzed by multilocus enzyme electrophoresis using nine enzyme systems (6PG, GPI, NH1 and NH2, G6P, PGM, MDH, ME, and IDHNADP). RESULTS: The electrophoretic profile was identical for all isolates analyzed and was the same as that of the L. chagasi reference strain (MHOM/BR/74/PP75). Phenetic analysis showed a similarity index of one for all strains, with the isolates sharing 100% of the characteristics analyzed. CONCLUSIONS: The results demonstrate that the L. chagasi populations circulating in dogs from Rio de Janeiro and Belo Horizonte belong to a single zymodeme.

American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report.

This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4 mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.

American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report / Leishmaniose cutânea americana causada pela Leishmania (Viannia) braziliensis resistente ao antimoniato de meglumina e com boa resposta terapêutica à pentamidina: relato de um caso

Relatamos um caso de um militar brasileiro com leishmaniose cutânea, cuja lesão reativou após dois tratamentos sistêmicos com antimoniato de meglumina. Foi tratado com anfotericina B, mas precisou interromper por intolerância à medicação. Após isolamento de Leishmania sp, seis infiltrações intralesionais de antimoniato de meglumina foram realizadas, sem resposta. Promastigotas de Leishmania sp. foram novamente isoladas. Foi submetido a tratamento intramuscular com pentamidina (4mg/kg). Parasitas da primeira e segunda biópsias foram identificados como Leishmania (Viannia) braziliensis; os da primeira biópsia eram mais sensíveis ao antimoniato de meglumina in vitro do que os da segunda biópsia. A lesão não reativou.

This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.

Variabilidade genética e sensibilidade ao antimonial in vitro de amostras de Leishmania sp. isoladas de pacientes com LTA / Genetic variability and sensitivity to antimony in vitro Leishmania sp. isolated from patients with LTA

O fármaco de primeira escolha para o tratamento das leishmanioses é o antimônio pentavalente e apesar de seus efeitos tóxicos, ainda se mostra a mais efetiva entre as drogas disponíveis. A leishmaniose tegumentar americana (LTA) apresenta-se como uma doença infecciosa com diferentes formas clínicas. A resposta ao tratamento com antimoniais pentavalentes é variável e pode resultar em cura clínica, falha terapêutica ou reativação da doença após resposta favorável inicial. O objetivo deste estudo foi verificar a variabilidade genotípica e a sensibilidade ao antimonial pentavalente in vitro de amostras de Leishmania sp. obtidas de pacientes com LTA. Na primeira etapa um “screening” inicial foi realizado em amostras de pacientes com evoluções clínicas típicas e atípicas da LTA no estado do Rio de Janeiro. Foram detectados nove genótipos sem associação com a evolução clínica da LTA...

Um novo estudo comparando pares de isolados antes do tratamento (A) e após o insucesso terapêutico ou reativação das lesões cutâneas (B) de um mesmo paciente, através da técnica de LSSP-PCR, detectou polimorfismo genético na maioria das amostras pareadas (A e B). Sete destes pares foram expostos a diferentes concentrações de antimônio pentavalente in vitro. Sob as condições do nosso estudo, formas promastigota e amastigota (A e B) foram sensíveis ao glucantime in vitro, no entanto os valores de IC50 obtidos com formas promastigotas foram muito variáveis. Nas formas amastigotas, as amostras B apresentaram valores de IC50 mais elevados que as amostras A, em quatro dos sete pacientes avaliados. Estes resultados sugerem que as amostras isoladas destes quatro pacientes após falha terapêutica ou reativação são mais resistentes in vitro ao antimônio pentavalente. No entanto, todos os pacientes curaram após retratamento final. Dentro da complexa relação parasitohospedeiro, os resultados apresentados neste estudo sugerem que fatores tanto do parasito como do hospedeiro exerçam papel semelhante na evolução favorável ou não da LTA...

[Serological evaluation for detection of anti-Leishmania antibodies in dogs and cats in the district of Santa Rita de Cássia, municipality of Barra Mansa, State of Rio de Janeiro]. / Avaliação sorológica para detecção de anticorpos anti-Leishmania em cães e gatos no bairro de Santa Rita de Cássia, Município de Barra Mansa, Estado do Rio de Janeiro.

From a canine case of american cutaneous leishmaniasis in the locality of Santa Rita de Cássia, municipality of Barra Mansa, Rio de Janeiro, a serological survey was performed on 177 dogs and 43 cats. Evaluation of the canine serum samples showed that 10% had a positive reaction in the indirect immunofluorescence test and 10.7% in the enzyme-linked immunosorbent assay. Among the feline serum samples tested, none of the animals had a positive reaction in the indirect immunofluorescence test and only one (2.4%) showed a positive reaction in the enzyme-linked immunosorbent assay. The detection of an autochthonous case of Leishmania braziliensis in Barra Mansa gives warning that a focus of american cutaneous leishmaniasis is possibly becoming established in this region.

Avaliação sorológica para detecção de anticorpos anti-Leishmania em cães e gatos no bairro de Santa Rita de Cássia, Município de Barra Mansa, Estado do Rio de Janeiro / Serological evaluation for detection of anti-Leishmania antibodies in dogs and cats in the district of Santa Rita de Cássia, municipality of Barra Mansa, State of Rio de Janeiro

A partir de um caso canino de leishmaniose tegumentar americana na localidade de Santa Rita de Cássia, município de Barra Mansa, Rio de Janeiro, foi realizado um inquérito sorológico em 177 cães e 43 gatos. Na avaliação das amostras de soros caninos, 10 por cento foram positivos na reação de imunofluorescência indireta e 10,7 por cento no ensaio imunoenzimático. Entre as amostras de soros felinos testados, nenhum animal foi positivo na reação de imunofluorescência indireta e apenas um (2,4 por cento) felino apresentou reação positiva ao ensaio imunoenzimático. A detecção de Leishmania braziliensis, autóctone em Barra Mansa, faz um alerta para a instalação de um possível foco de leishmaniose tegumentar americana nessa região.

From a canine case of american cutaneous leishmaniasis in the locality of Santa Rita de Cássia, municipality of Barra Mansa, Rio de Janeiro, a serological survey was performed on 177 dogs and 43 cats. Evaluation of the canine serum samples showed that 10 percent had a positive reaction in the indirect immunofluorescence test and 10.7 percent in the enzyme-linked immunosorbent assay. Among the feline serum samples tested, none of the animals had a positive reaction in the indirect immunofluorescence test and only one (2.4 percent) showed a positive reaction in the enzyme-linked immunosorbent assay. The detection of an autochthonous case of Leishmania braziliensis in Barra Mansa gives warning that a focus of american cutaneous leishmaniasis is possibly becoming established in this region.

Relato de infecção natural de morcegos por flagelados tripanosomatideos em diferentes municípios do Estado do Rio de Janeiro / Report on natural infection of bats by trypanosomatid flagellates in different municipalities in the State of Rio de Janeiro

Este trabalho objetivou avaliar a infecção natural de morcegos por tripanosomatídeos. Foram examinados, por hemocultura, 86 exemplares de diferentes gêneros, sendo 22 (25,58 por cento) amostras isoladas de Desmodus rotundus e Lonchorhina aurita. Os resultados obtidos contribuem para o conhecimento da ocorrência de tripanosomatídeos em morcegos no Estado do Rio de Janeiro.

This study aimed to evaluate natural infection of bats by trypanosomatids. Using blood culturing, 86 specimens from different genera were examined, and 22 samples (25.58 percent) of Desmodus rotundus and Lonchorhina aurita were isolated. These results contribute towards knowledge of the occurrence of trypanosomatids in bats in the State of Rio de Janeiro.

[Report on natural infection of bats by trypanosomatid flagellates in different municipalities in the State of Rio de Janeiro]. / Relato de infecção natural de morcegos por flagelados tripanosomatideos em diferentes municípios do Estado do Rio de Janeiro.

This study aimed to evaluate natural infection of bats by trypanosomatids. Using blood culturing, 86 specimens from different genera were examined, and 22 samples (25.58%) of Desmodus rotundus and Lonchorhina aurita were isolated. These results contribute towards knowledge of the occurrence of trypanosomatids in bats in the State of Rio de Janeiro.

Post mortem parasitological evaluation of dogs seroreactive for Leishmania from Rio de Janeiro, Brazil.

A parasitological study was conducted on 66 dogs seroreactive for Leishmania captured as a control measure of visceral leishmaniasis in the State of Rio de Janeiro, Brazil. Biological samples from different anatomical sites were collected during autopsy of the animals and cultured on biphasic medium (NNN/Schneider). The Leishmania isolates were characterized by isoenzyme electrophoresis. Leishmania was isolated from 80.3% of the animals: 12 animals with Leishmania (Viannia) braziliensis isolated exclusively from cutaneous lesions, 39 with L. (L.) chagasi isolated from different sites in the same animal, and 2 with simultaneous isolation of L. (V.) braziliensis from cutaneous lesions and L. (L.) chagasi from different sites. Isolation in culture revealed the absence of Leishmania parasites in 13 animals. The results obtained confirm the existence of mixed infections in dogs in Rio de Janeiro and indicate the need to complement the investigation of seroreactive dogs using methods for the parasitological diagnosis and identification of Leishmania species.

Axenic promastigote forms of Leishmania (Viannia) lainsoni as an alternative source for Leishmania antigen production.

The present study demonstrates that axenic cultures of Leishmania (Viannia) lainsoni produce larger cell masses in NNN-LIT medium, as well as higher amounts of total proteins in cell extracts, than Leishmania (Leishmania) amazonensis. Antigenicity of L. (V.) lainsoni whole promastigotes is similar to that of L. (L.) amazonensis, as demonstrated by an indirect immunofluorescence diagnostic test using sera from human patients and dogs infected with visceral leishmaniasis. Infectivity of the L. (V.) lainsoni strain used in the present work was demonstrated by the detection by transmission-electron microscopy of tissue amastigotes in skin lesion samples from an experimentally infected hamster. Incubation of lesion fragments in NNN-LIT medium allowed us to obtain promastigote forms, which could be cultivated successfully in vitro. lsoenzyme analysis of such promastigotes confirmed the parasite strain as L. (V.) lainsoni, as compared to other Leishmania reference strains. Our data indicate that L. (V.) lainsoni is a useful alternative source for antigen production as well for use in assays that depend on large cell volumes of Leishmania spp. parasites.

Differential interferon- gamma production characterizes the cytokine responses to Leishmania and Mycobacterium leprae antigens in concomitant mucocutaneous leishmaniasis and lepromatous leprosy.

BACKGROUND: Tegumentary leishmaniasis and leprosy display similar spectra of disease phenotypes, which are dependent on cell-mediated immunity to specific antigens. Diffuse cutaneous leishmaniasis and lepromatous leprosy represent the anergic end of the spectrum, whereas mucocutaneous leishmaniasis and tuberculoid leprosy are associated with marked antigen-specific cellular immune response. METHODS: We characterized and compared the cell-mediated response to Leishmania and Mycobacterium leprae antigens in a patient with an intriguing association of mucocutaneous leishmaniasis with lepromatous leprosy, which are at opposite ends of the immunopathological spectra of these diseases. This was done by performance of skin tests and by assessment of the cell proliferation and cytokine production of peripheral blood mononuclear cells (PBMCs). RESULTS: Strong skin-test reactions and PBMC proliferation were observed in response to Leishmania antigens but not to M. leprae antigens. The stimulation of PBMCs with Leishmania and M. leprae antigens induced comparable levels of tumor necrosis factor- alpha , interleukin-5, and interleukin-10. However, the interferon- gamma response to Leishmania antigens was remarkably high, and that to M. leprae antigens was almost nil. CONCLUSIONS: We found that concomitant leprosy and tegumentary leishmaniasis can produce opposite polar forms associated, respectively, with absent or exaggerated cell-mediated immune responses to each pathogen. This suggests that independent mechanisms influence the clinical outcome of each infection. Moreover, interferon- gamma appears to play a major role in the clinical expression of these intracellular infections.

Caracterização morfológica e bioquímica de protozoários tripanosomatídeos do gênero Endotrypanum (Kinetoplastida: Trypanosomatidae) isolados de flebotomíneos (Díptera: Psychodiae) e preguiças (Endeata: Xenarthra) da Região Amazônica / Morphologic characterization and biochemist of protozoários Trypanosomatid of Endotrypanum the isolated sort of psychodidaes and sloths of the Amazon region

Parasitos tripanosomatídeos do gênero Endotrypanum são freqüentemente encontrados no interior de hemácias de preguiças de dois dedos (gênero Choloepus) e de três dedos (gênero Bradypus), apresentando-se nas formas epi- ou tripomastigotas. Entretanto, no tubo digestivo dos insetos vetores (gênero Lutzomyia) e em cultura axênica, estes parasitos se transformam em formas promastigotas. Neste trabalho nós caracterizamos bioquimicamente e morfologicamente algumas amostras de Endotrypanum isolados na região Amazônica. De 27 tripanosomatídeos originalmente isolados de flebotomíneos, somente 6 amostras (IM4565, IM4570, IM4668, IM4670, IM4671 e IM4758) apresentaram perfil isoenzimático similar à amostras referência do gênero Endotrypanum (A9, 5725, 6159 e 11602), como demonstrado por eletroforese em gel de agarose a 1 (por cento) com os seguintes sistemas enzimáticos: ACON, G6PDH, GPI, HK, IDHNAD, IDHNADP, 6PGDH, MDH, ME, NH1 e NH2. As amostras IM4758 e IM4565 foram isoladas de Lutzomyia shannoni, que têm sido incriminadas como o principal vetor de Endotrypanum. Outras duas amostras (IM4781 e IM4886) foram isoladas do sangue de duas preguiças de dois dedos. Destes 8 novos isolados de Endotrypanum, cinco amostras, assim como duas cepas de referência de Endotrypanum, não foram infectivas, como esperado, para macrófagos peritoneais murinos in vitro. A observação de esfregaços sangüíneos de preguiça por microscopia óptica revelou flagelados tripanosmatídeos no interior de hemácias. Em uma preguiça, puderam ser observadas formas intraeritrocíticas e formas tripomastigotas livres, sugerindo a ocorrência de infecção mista por diferentes tripanosomatídeos. Nenhum parasita intraeritrocítico pôde ser detectado por microscopia eletrônica de transmissão (TEM). Além do mais, nenhum parasita intracellular pôde ser observado, por microscopia óptica, nos tecidos de uma preguiça infectada. A análise por TEM de formas promastigotas de cultura revelou a presença de partículas semelhantes a vírus (VLPs) somente no citoplasma da de referência A9.