CLINICAL AND IMMUNOPATHOLOGICAL ASPECTS OF DISSEMINATED CUTANEOUS LEISHMANIASIS
CLINICAL AND IMMUNOPATHOLOGICAL ASPECTS OF DISSEMINATED CUTANEOUS LEISHMANIASIS
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DOI：
10.1016/0001-706x(94)90103-1
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发表时间：
1994-04-01
期刊：
影响因子：
2.7
通讯作者：
MARSDEN, P
中科院分区：
文献类型：
--
作者：
CARVALHO, EM;BARRAL, A;MARSDEN, P
描述了来自巴西巴伊亚的8例播散性皮肤利什曼病患者的临床病理和免疫学结果。这种情况不同于无反应性弥漫性皮肤利什曼病（DCL）和经典的美国皮肤利什曼病（ACL）。这些患者的病变数量范围为75至800个，其特征为丘疹和痤疮样病变，伴有少数溃疡，而不是DCL的主要特征结节。另一方面，播散性皮肤利什曼病患者粘膜疾病的高发病率（38%）使得这种疾病的粘膜受累率高于ACL。L. amazonensis和L.巴西人（2例）是患者的致病因子，其中感染因子具有特征。播散性皮肤利什曼病的抗体滴度高于ACL，抗体滴度最高的患者有粘膜病变。在ACL中未观察到的细胞免疫抑制，如CD4+细胞减少和缺乏对利什曼抗原的T细胞应答，在几例播散性皮肤利什曼病患者中观察到，但治疗后这些异常恢复。尽管有大量的病变，治疗反应良好，在一段时间内比ACL观察到的病变消失的6例。在两个治疗失败的病人中，致病因子是L。亚马逊河。在这些患者中，溃疡病变占优势，并检测到高滴度的抗体。
The clinico-pathological and immunological findings in eight patients from Bahia, Brazil with disseminated cutaneous leishmaniasis are described. This condition differs from anergic diffuse cutaneous leishmaniasis (DCL) and from classical American cutaneous leishmaniasis (ACL). The number of lesions in these patients ranged from 75 to 800 and were characterized by papules and an acneiform type of lesion with a few ulcers rather than nodules that are the main characteristic of DCL. On the other hand the high incidence of mucosal disease (38%) in patients with disseminated cutaneous leishmaniasis make the prevalence of mucosal involvement in this condition higher than that observed in ACL. L. amazonensis (live cases) and L. braziliensis (two cases) were the causal agents in the patients where the infecting agent was characterized. Antibody titers in disseminated cutaneous leishmaniasis were higher than those observed in ACL and patients with the highest antibody titers had mucosal envolvement. Abnormalities in cellular immunity that are not observed in ACL such as decrease in CD4+ cells and absence of T cell response to leishmania antigen were observed in several patients with disseminated cutaneous leishmaniasis but restoration of these abnormalities occurred after treatment. In spite of the great number of lesions, the therapeutic response was good in six patients with disappearance of the lesions in a period shorter than that observed in ACL. In the two patients that presented therapeutic failure the causal agent was L. amazonensis. In such patients there was a predominance of ulcerated lesions, and a high titer of antibody was detected.