Clinical and Immunological Features of Human Leishmania (L.) infantum-Infection, Novel Insights Honduras, Central America.

Wilfredo Sosa-Ochoa,Carlos Eduardo Pereira Corbett,Luis Fernando Chaves,Fernando Tobias Silveira,Carmen Maria Sandoval Pacheco,Vania Lúcia Ribeiro Da Matta,Concepción Zúniga,Gabriela Venicia Araujo Flores,Marcia Dalastra Laurenti

doi:10.3390/pathogens9070554

Abstract

Leishmania (Leishmania) infantum is the etiological agent of both American visceral leishmaniasis (AVL) and non-ulcerated cutaneous leishmaniasis (NUCL) in Honduras. Although AVL is the most severe clinical form of infection, recent studies have shown that human immune response to parasite infection can result in a clinical-immunological spectrum. The overall prevalence rate of infection and clinical-immunological profiles of the L. (L.) infantum infection in Amapala municipality, South Honduras was determined. We examined 576 individuals with diagnosis based on combined ELISA (IgG/IgM) and DTH assays. We also used genus-specific kDNA PCR and Hsp70 PCR-RFLP for NUCL cases. Clinical evaluation found 82% asymptomatic and 18% symptomatic individuals. All symptomatic cases (n = 104) showing NUCL were positive for parasites. We identified L. (L.) infantum species in 100% of the skin lesion scrapings and in 90% of the blood samples from NUCL cases studied. A total of 320 asymptomatic individuals were exposed (ELISA+ and/or DTH+), providing an overall L. (L.) infantum prevalence of 73.6%. Clinical, parasitological, and immunological evaluations suggest seven infection profiles, three asymptomatic and four symptomatic. This represents the first report on clinical and immunological features of human L. (L.) infantum-infection in Amapala municipality, Honduras.

Highlights

Leishmaniases have a broad clinical and immunological spectrum of manifestations depending on Leishmania species, host immune responses, and possibly insect vector saliva factors [1]
non-ulcerated cutaneous leishmaniasis (NUCL) is clinically characterized by non-ulcerated skin lesions, which most frequently are few and small in size, with chronic evolution, affecting the skin in the form of painless papules, nodules, and erythematous plaques surrounded by a hypopigmented halo [12,13]
Skin lesions compatible with NUCL were identified in 104 individuals

Summary

Introduction

Leishmaniases have a broad clinical and immunological spectrum of manifestations depending on Leishmania species, host immune responses, and possibly insect vector saliva factors [1]. (L.) infantum-infections have shown atypical manifestations in humans, causing frequently non-ulcerated cutaneous leishmaniasis (NUCL) in adolescents and young adults, and sometimes causing AVL in children under ten years [7,8,9,10]. NUCL is clinically characterized by non-ulcerated skin lesions, which most frequently are few and small in size, with chronic evolution, affecting the skin in the form of painless papules, nodules, and erythematous plaques surrounded by a hypopigmented halo [12,13]. (L.) infantum in the same geographic area suggests that host immunity factors may be involved in determining these different clinical forms of disease [15,16] The co-occurrence of AVL and NUCL caused by L. (L.) infantum in the same geographic area suggests that host immunity factors may be involved in determining these different clinical forms of disease [15,16]

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