Miltefosine enhances phagocytosis but decreases nitric oxide production by peritoneal macrophages of C57BL/6 mice.

Miltefosine is an anticancer drug currently used to treat visceral and cutaneous leishmaniasis, also presents a broad-spectrum of fungicidal and antiamoebae activities. It acts on the metabolism of phospholipids and glycoproteins of the membrane of parasites. Our study aimed to evaluate the effects of miltefosine (0.4 to 50.0 µg/mL) on the phagocytosis and nitric oxide production by macrophages of C57BL/6 mice to clarify the immunomodulatory effects of the drug on macrophages of C57BL/6, strain mice that is biased to Th1 response. Peritoneal macrophages were in vitro treated with miltefosine and phagocytosis of sensitized or nonsensitized Saccharomyces cerevisiae was assessed. NO production was evaluated by Griess reaction. In the concentration of 1.6 µg/mL and 50.0 µg/mL, miltefosine increased phagocytosis of non-opsonized S. cerevisiae in 59.7% and 214.3%, respectively. For phagocytosis through opsonin receptors, miltefosine (50.0 µg/mL) increased the phagocytic index in 208.6% (p=0.04, paired t test). Miltefosine (50.0 µg/mL) decreased in 39.3% NO production by macrophages. However, treatment with miltefosine (50.0 µg/mL) after infection of macrophages with Leishmania amazonensis increased NO production in 73.4% (p=0.01, Wilcoxon test). Our data showed that, besides the antimicrobial effect of miltefosine, the drug showed immunomodulatory effects on macrophages of C57BL/6 mice, improving phagocytosis and decreasing NO production, but was able to increase NO production when macrophages were previously infected with L. amazonensis. These results suggest that miltefosine may favor the better evolution of infectious diseases by improving the innate immune response of macrophages.

Risk factors for Leishmania chagasi infection in an endemic area in Raposa, State of Maranhão, Brazil / Fatores associados à infecção por Leishmania chagasi em uma área endêmica em Raposa, Estado do Maranhão, Brasil

INTRODUCTION: Infection with Leishmania chagasi is the most common clinical presentation for visceral leishmaniaisis in endemic areas. The municipality of Raposa is an endemic area in State of Maranhão, Brazil, and have had registration cases of visceral leishmaniasis disease. For this reason, a cross- sectional study was conducted to evaluate the risk factors for infection with L. chagasi detected by Montenegro skin test. METHODS: The sample comprised 96 percent of the inhabitants of the villages of Maresia, Pantoja, and Marisol located in the municipality of Raposa, corresponding to 1,359 subjects. Data were collected using a questionnaire. Univariate and multivariate logistic regression models were applied to evaluate the association between the variables studied and infection of L. chagasi. RESULTS: The variables associated with infection upon nonadjusted analysis were a straw roof, mud walls, floors of beaten earth, presence of sand flies inside or outside of the dwelling, and bathing outdoors. Adjusted analysis showed that the presence of sand flies inside/outside the dwelling was a risk factor, and age younger than 10 years was a protective factor against asymptomatic infection. CONCLUSIONS: The results highlight the extent to which precarious living conditions of the population strengthen the epidemiological chain of visceral leishmaniasis.

INTRODUÇÃO: A infecção por Leishmania chagasi é a apresentação clínica mais comum de laishmaniose visceral em áreas endêmicas. O município de Raposa é área endêmica no Estado do Maranhão, tendo registrado casos da doença. Por isso, realizou-se um estudo transversal, com o objetivo de estudar os fatores de risco para infecção por L. chagasi detectada pelo teste intradérmico de Montenegro. MÉTODOS: O estudo envolveu 96 por cento dos moradores das localidades de Maresia, Pantoja e Marisol do município da Raposa, totalizando 1.359 indivíduos. O levantamento dos dados foi realizado utilizando um questionário. Para verificar a associação entre as variáveis estudadas e a infecção por L. chagasi, foram utilizados os modelos de regressão logística uni e multivariada. RESULTADOS: Na análise não ajustada, as variáveis associadas à infecção foram: cobertura da casa de palha, paredes de taipa, piso de chão batido, a presença de flebotomíneos dentro ou fora do domicílio e o local do banho fora de casa. Na análise ajustada, a presença de flebotomíneos dentro ou fora do domicílio foi considerada fator de risco e a idade menor que 10 anos revelou-se como fator de proteção para a infecção assintomática. CONCLUSÕES: Evidenciou-se também, o quanto a precariedade das condições de vida da população contribui para o fortalecimento da cadeia epidemiológica da doença.

Risk factors for Leishmania chagasi infection in an endemic area in Raposa, State of Maranhão, Brazil.

INTRODUCTION: Infection with Leishmania chagasi is the most common clinical presentation for visceral leishmaniaisis in endemic areas. The municipality of Raposa is an endemic area in State of Maranhão, Brazil, and have had registration cases of visceral leishmaniasis disease. For this reason, a cross-sectional study was conducted to evaluate the risk factors for infection with L. chagasi detected by Montenegro skin test. METHODS: The sample comprised 96% of the inhabitants of the villages of Maresia, Pantoja, and Marisol located in the municipality of Raposa, corresponding to 1,359 subjects. Data were collected using a questionnaire. Univariate and multivariate logistic regression models were applied to evaluate the association between the variables studied and infection of L. chagasi. RESULTS: The variables associated with infection upon nonadjusted analysis were a straw roof, mud walls, floors of beaten earth, presence of sand flies inside or outside of the dwelling, and bathing outdoors. Adjusted analysis showed that the presence of sand flies inside/outside the dwelling was a risk factor, and age younger than 10 years was a protective factor against asymptomatic infection. CONCLUSIONS: The results highlight the extent to which precarious living conditions of the population strengthen the epidemiological chain of visceral leishmaniasis.