Influência da coinfecção por Trypanossoma cruzi na resposta imune e no desfecho clínico de pacientes com leishmaniose cutânea da área endêmica de Corte de Pedra.

Abstract

In several areas of Latin America, the geographic distribution of cutaneous leishmaniasis (CL) overlaps with areas of Chagas disease transmission ranging from 12 to 70% of patients with clinical symptoms of leishmaniasis. The aim of this study was to investigate whether coinfection with T. cruzi of patients with CL caused by Leishmania braziliensis is associated with clinical induction of leishmaniasis. A case-control study was carried out with one hundred and eighty sera from patients with CL caused by L. braziliensis, where chimeric proteins specific to Trypanosoma cruzi were used to detect coinfection with Chagas disease. We identified 20 patients with CL who were coinfected with T.cruzi, all of whom had higher anti-Leishmania antibody titers than patients infected with Leishmania alone. As for the production of cytokines, IL-6 was the one with the highest levels in the group of co-infected patients compared to the group with leishmaniasis alone. There was no statistical difference in the production of IFN-γ, TNF, IL-1β between patients coinfected with Leishmania braziliensis and T.cruzi. With regard to clinical outcome, fourteen (70%) of the co-infected patients failed antimonial therapy, and of patients with Leishmania infection alone, a total of sixty-two (42%) failed. These results indicate that co-infection can interfere with the immune response and influence the response to treatment of patients with CL caused by L. braziliensis.