Immunochemotherapy with interferon-gamma and multidrug therapy for multibacillary leprosy.

Treatment for multibacillary leprosy is presently performed with a multidrug therapy (MDT) scheme maintained for 2 years. Leprosy treatment however can benefit from the reduction of length. The lack of interferon-gamma (IFN-gamma) production by lepromatous leprosy (LL) patients' lymphocytes lead us to use this cytokine in the treatment of multibacillary leprosy associated with MDT in the treatment of multibacillary leprosy, and monitor several clinical and immunological parameters during the course of treatment. A total of 20 multibacillary leprosy patients were evaluated, 10 treated with MDT alone, and 10 treated with MDT + 10 daily doses of 2 x 10(6) international units (IU) of recombinant human IFN-gamma/m2 followed by 10 daily doses of 10(7) IU IFN-gamma/m2, intramuscularly, during the first 20 days of MDT. IFN-gamma was well tolerated and did not cause any increase in the rate of leprosy reactions development during treatment. Decrease of bacillary load, fall of anti-Mycobacterium leprae IgG serum antibodies, changes of histological pattern, as well as changes in lymphocyte proliferation assay in response to mitogens (PHA or PWM), M. leprae antigen or PPD was similar in both groups of patients. Among several soluble immunological markers measured before and 30 days after beginning of treatment, levels of soluble IL-2R receptor increased in patients treated with MDT plus IFN-gamma whereas decreased in patients treated with MDT alone. Soluble ICAM-1 levels decreased in the MDT group but did not change in the MDT + IFN-gamma treated patients. Soluble CD4 and soluble CD8 markers did not change significantly in either group of patients. Neopterin, a marker of macrophage activation, increased in all but one patient treated with MDT + IFN-gamma but in none treated with MDT alone, indicating that IFN-gamma was active in vivo. Our findings indicate that despite being able to promote macrophage activation in multibacillary leprosy patients a short course of systemically administered IFN-gamma is not able to change the clinical course of a long standing disease such as leprosy.

Serum interferon activity of patients with leishmaniasis

Serum from a significant proportion of 29 cutaneous and 12 mucocutaneous leishmaniasis patients exhibited interferon activity in a cytopathic assay: positive tests were obtained for 24.1% and 41.7% of the patients, respectively. Similar positive frequencies were observed in other parasitic diseases (schistosomiasis, 12.5%; toxoplasmosis, 20%; Chagas' disease, 16%; leprosy, 12.5%; tuberculosis, 30%). In contrast, none of the 44 serum samples from American visceral leishmaniasis (AVL) patients had interferon activity during the active stage of the disease. However, 13% of the samples obtained from patients recovered from AVL were positive

Serum interferon activity of patients with leishmaniasis.

Serum from a significant proportion of 29 cutaneous and 12 mucocutaneous leishmaniasis patients exhibited interferon activity in a cytopathic assay: positive tests were obtained for 24.1% and 41.7% of the patients, respectively. Similar positive frequencies were observed in other parasitic diseases (schistosomiasis, 12.5%; toxoplasmosis, 20%; Chagas' disease, 16%; leprosy, 12.5%; tuberculosis, 30%). In contrast, none of the 44 serum samples from American visceral leishmaniasis (AVL) patients had interferon activity during the active stage of the disease. However, 13% of the samples obtained from patients recovered from AVL were positive.

Disseminated cutaneous leishmaniasis in a field clinic in Bahia, Brazil: a report of eight cases.

Eight Bahian patients with cutaneous leishmaniasis who had 20 or more ulcerative lesions of short duration are described. Of five identifications of isolated parasites, four were Leishmania braziliensis braziliensis and one was L. mexicana amazonensis. All but one had positive Montenegro tests initially, and all did after treatment. All had circulating anti-leishmanial antibodies and five responded well to glucantime therapy suggesting a functioning immune response. This is quite different to the anergic hansenoid leishmaniasis seen with L. mexicana amazonensis infections in Brazil. Possible reasons for the occurrence of this type of leishmaniasis are briefly discussed.