Neutrophil–lymphocyte ratio,platelet–lymphocyte ratio and mean platelet volume in Japanese patients with psoriasis and psoriatic arthritis: Response to therapy with biologics

Recent studies indicate the presence of systemic inflammation in psoriatic patients, and this inflammatory status is significantly associated with a range of comorbidities. The aim of this study was to evaluate the clinical significance of novel inflammatory biomarkers, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and mean platelet volume (MPV) in Japanese patients with plaque‐type psoriasis (PsV) and psoriatic arthritis (PsA). One hundred and eighty‐six patients with PsV and 50 patients with PsA treated with biologics, including infliximab, adalimumab and ustekinumab, were retrospectively analyzed before and after treatment. At baseline, NLR and PLR, as well as C‐reactive protein (CRP), were significantly higher in PsA patients than those in PsV patients, and a significant correlation was found between NLR and PLR. In PsV patients, the NLR‐high and PLR‐high subgroups exhibited significantly higher Psoriasis Area and Severity Index scores compared with the NLR‐low and PLR‐low subgroups, respectively, and the NLR‐high subgroup also showed higher CRP levels. MPV value was negatively associated with the presence of arthritis, but its association with inflammation was less clear than that of NLR or PLR. After treatment of the patients with biologics for up to 12 months, NLR and PLR decreased promptly in parallel with a decrease of CRP, irrespective of the type of biologics used. Altogether, these results indicate that both NLR and PLR may be useful markers to evaluate systemic inflammation in psoriatic patients. They may serve as simple, convenient and cost‐effective biomarkers to monitor the disease course after systemic therapy.     

Neutrophil/platelet to lymphocyte ratio in monitoring of response to TNF‐α inhibitors in psoriatic patients

Neutrophil or platelet to lymphocyte ratio (NLR and PLR) has been proposed to be used as prognostic purposes in a variety of diseases. The aim of this study was to evaluate the usefulness of these ratios in monitoring of response to TNF‐α‐inhibitors in psoriatic patients. Eighty psoriatic patients were included and treated with TNF‐α‐inhibitors for 12 months based on drug protocol. Hematologic indices, including NLR and PLR values were assessed before and after treatment. Data on psoriasis area and severity index (PASI), smoking behavior, alcohol intake habit, nail abnormality, body mass index (BMI), joint involvement, and disease duration were also recorded. PASI scores were improved significantly after one‐year treatment (P = .000). Furthermore, this type of treatment significantly reduced the NLR and PLR (P = .000). These changes were in accordance with PASI scores. Patients with BMI greater than 24.9 had higher, but non‐significant NLR and PLR than normal or lean individuals. Cigarette smokers and alcohol consumers had lower NLR and PLR values than other individuals (P < .05). There was no significant association between NLR and PLR and joint or nail involvement. Although NLR and PLR will not be helpful in primary diagnosis of inflammatory diseases, they could be accounted as monitoring tools in management of psoriasis or globally indicators of inflammation.     

司库奇尤单抗治疗中重度斑块型银屑病患者中NLR与PASI值相关性分析

目的：分析司库奇尤单抗治疗中重度斑块型银屑病时中性粒细胞和淋巴细胞比值(NLR)与PASI值的相关性。方法：2017年4月1日至7月31日中重度斑块型银屑病患者每周皮下注射司库奇尤单抗，治疗4次，随后每4周1次,治疗11次。结果：司库奇尤单抗共治疗中重度斑块型患者22例，PASI评分由治疗前的22.28分下降至2.31分，NLR下降值同PASI下降值具有相关性（r12周=0.504，r24周=0.604，r36周=0.470，r48周=0.454；均P<0.05）。结论：司库奇尤单抗治疗银屑病有效，NLR下降值与PASI下降值呈正相关。     

中性粒细胞与淋巴细胞比值联合超敏C-反应蛋白在寻常型银屑病合并多囊卵巢综合征中的诊断价值

目的探讨中性粒细胞和淋巴细胞比值(NLR)联合超敏C反应蛋白(hs-CRP)在寻常型银屑病(Psoriasis vulgaris,PV)合并多囊卵巢综合征(PCOS)中的诊断价值。方法回顾性纳入本院妇产科住院的31例PV合并PCOS的患者、76例皮肤科门诊PV患者和55例体检中心正常体检人群作为研究对象,记录所有研究对象血常规指标及hs-CRP水平。比较3组研究对象血常规指标和hs-CRP水平的差异,有统计学意义的变量与PV合并PCOS患者的病程、睾酮水平及LH/FSH采用Spearman相关性分析,并采用Logistic回归分析PV合并PCOS的独立变量,利用受试者操作曲线探讨NLR联合hs-CRP在PV合并PCOS中的诊断价值。结果PV合并PCOS患者血NLR、hs-CRP较PV患者显著升高(均P<0.05),PV患者血NLR、hs-CRP较正常对照组显著升高(均P<0.05)。Logistic回归分析结果显示NLR、hs-CRP是PV合并PCOS的独立相关变量(P<0.05)。受试者工作特征(ROC)曲线显示NLR联合hsCRP对PV合并PCOS有良好的诊断价值,其敏感度为94.8%,特异性为75.6%。结论PV患者应常规检测NLR和hs-CRP水平,NLR和hs-CRP联合检测对PV合并PCOS有良好的诊断价值。     

寻常型银屑病与血脂代谢异常相关性分析

目的通过分析相关临床资料,探讨寻常型银屑病患者伴血脂代谢异常之间的相关性。方法收集2017年12月至2018年5月在我院门诊及住院治疗的143例寻常型银屑病患者作为观察组,选取同期健康体检的人员143例作为对照组。收集两组人员的一般资料,检测血脂指标、炎性指数。结果观察组体重指数(BMI)、中性粒细胞与淋巴细胞比值(NLR)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)高于对照组,高密度脂蛋白胆固醇(HDL-C)水平低于对照组(P<0.05)。结论NLR水平可反映寻常型银屑病的炎症程度,患者肥胖、脂代谢紊乱、炎症程度与寻常型银屑病密切相关。     

成人过敏性紫癜胃肠道出血与中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值的关系

目的 探讨中性粒细胞/淋巴细胞比值(NLR)及血小板/淋巴细胞比值(PLR)与成人过敏性紫癜胃肠道出血的关系.方法 对115例成人过敏性紫癜的血常规指标、C反应蛋白、血细胞沉降率进行回顾性分析,计算NLR及PLR,并与100例健康人的指标比较.用logistic回归分析确定与成人过敏性紫癜胃肠道出血相关的变量,用受试者工作特征曲线确定变量的预测效能.结果 成人过敏性紫癜患者的NLR、PLR较健康对照组升高(均P＜ 0.05),有胃肠道出血的过敏性紫癜患者NLR、PLR、CRP水平明显高于无出血的患者(均P＜0.05).logistic回归分析显示,NLR是成人过敏性紫癜胃肠道出血的独立危险因素(P＜0.05).ROC曲线显示,NLR截点值为3.24时,预测过敏性紫癜胃肠道出血的效能最高,其敏感度为85.1％,特异性为71.3％.结论 成人过敏性紫癜患者的NLR、PLR明显升高,尤其是伴有胃肠道出血时.NLR是成人过敏性紫癜胃肠道出血的潜在预测因子.     

Skin disorders in Korean patients infected with human immunodeficiency virus and their association with a CD4 lymphocyte count: a preliminary study

Background Dermatological disorders are quite common in human immunodeficiency virus (HIV)‐infected patients. However, cutaneous findings in Korean HIV‐infected patients have not been properly investigated. Objective To investigate the spectrum of dermatological disorders in Korean HIV‐infected individuals according to a CD4 lymphocyte count. Methods A retrospective clinical study was carried out from June 2002 to January 2008. We comprehensively collected information regarding HIV‐associated skin problems, laboratory data and the history of highly active antiretroviral therapy (HAART). Results Ninety‐nine HIV‐seropositive patients (mean age: 39.6 ± 11.3 years, males: 94.9%) were included in this study. Of them, 55 patients (55.6%) presented with at least one skin problem. The four most common dermatological disorders were eosinophilic pustular folliculitis (18.6%), symptomatic syphilis (comprising of primary and secondary syphilis) (17.1%), seborrhoeic dermatitis (17.1%) and condyloma acuminatum (12.8%). The group with a CD4 lymphocyte count < 200 × 10⁶ cells/L showed a significantly higher prevalence of Kaposi sarcoma compared with the group with a CD4 lymphocyte count > 200 × 10⁶ cells/L (P = 0.014). Condyloma was more prevalent in the group with a CD4 count > 200 × 10⁶ cells/L (P = 0.022). The patients treated with HAART had a lower prevalence of neurosyphilis compared with the non‐treated group (P = 0.018). Conclusions Diverse dermatological conditions were demonstrated in Korean HIV‐infected patients. Kaposi sarcoma was associated with a low CD4 lymphocyte count, but condyloma was associated with a high CD4 lymphocyte count. The prevalence of syphilis in our study was higher than that of Western countries. HAART seemed to be associated with the low prevalence of neurosyphilis.     

Evaluation of hematological parameters in patients using systemic isotretinoin with diagnosis of acne vulgaris

Objectives

Oral isotretinoin is the most effective treatment option in patients with acne. However, it can cause various hematologic and biochemical abnormalities. This study aimed to evaluate hematologic abnormalities during oral isotretinoin treatment in patients with acne.

Material and Methods

In this cross-sectional study, the hematologic and inflammatory parameters of 138 patients with acne using 0.3-1 mg/kg/day oral isotretinoin for at least 6 months were retrospectively analyzed.

Results

In the study, the female-to-male ratio was 2.83, and the mean age of the patients was 23.1 ± 5.8 years. At the third and sixth months of isotretinoin treatment, there was a statistically significant decrease in the neutrophil count compared to the pre-treatment values (p = 0.003 and p = 0.032, respectively). The platelet count showed the most statistically significant increase (p < 0.001) at the first month of treatment. The most statistically significant decrease in the neutrophil-to-lymphocyte ratio (NLR) was observed at the third month of treatment (p < 0.001). No significant changes were observed in hemoglobin, hematocrit, white blood cell count, mean corpuscular volume, and mean platelet volume.

Conclusions

There was a decrease in neutrophils and NLR and an increase in platelets during isotretinoin treatment, and these changes were usually mild. However, it would be appropriate to monitor blood counts during treatment in patients with neutropenia or thrombocytosis.     

The Effects of Systemic Psoriasis Therapies on the C-Reactive Protein and the Neutrophil-Lymphocyte Ratio

BackgroundCurrently, no generally accepted laboratory marker for monitorizing the disease activity and therapy response of psoriasis is known.ObjectiveThe aim of the study is to evaluate the effects of systemic therapies on C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) in psoriasis.MethodsOne hundred patients with psoriasis treated with narrow band ultraviolet B, acitretin, cyclosporine, methotrexate, adalimumab, etanercept, and ustekinumab were prospectively evaluated. At baseline and at week 12, CRP, NLR, and Psoriasis Area and Severity Index (PASI) were evaluated.ResultsA statistically significant decrease was observed in PASI scores, CRP, and NLR values from the baseline to the 12-week visit (p=0.001, p=0.001, p=0.001, respectively). The reduction in PASI scores and NLR values was positively correlated (r=0.460, p=0.001). The comparisons between treatment groups revealed that the median decrease in NLR values was statistically higher in the adalimumab group than in the methotrexate group (p=0.007). And the median decrease in PASI scores was significantly higher in the adalimumab group compared with the methotrexate and acitretin therapy group (p=0.007, p=0.042, respectively).ConclusionIn the present study, systemic therapy of psoriasis was demonstrated to decrease the levels of CRP and NLR, which are known to be indicators of systemic inflammation and cardiovascular comorbidities.     

TLR9在初发和复发尖锐湿疣皮损及外周血T细胞亚群中的表达

目的检测初发和复发尖锐湿疣(CA)患者皮损及外周血T细胞亚群中TLR9的表达情况,并探讨TLR9在HPV感染和CA复发机制中的作用。方法分别选用30例初发CA和27例复发CA患者皮损,并以28例正常人皮肤石蜡切片作为正常对照组。采用双色免疫荧光抗体染色流式细胞术检测入选者外周血T细胞中TLR9的表达。结果初发CA组和复发CA组皮损颗粒层和棘层TLR9表达(1.38±0.72和2.06±0.84)和外周血CD3+CD4+T细胞内TLR9表达[(11.4±3.2)%和(14.6±2.4)%]显著高于正常对照组[0.97±0.43和(6.2±2.1)%];另外,复发CA患者外周血CD3+CD4+T细胞内TLR9的表达也显著高于初发CA组;以上差异均有统计学意义(P均<0.05)。但是该两组患者的外周血CD3+CD8+T细胞内TLR9的表达与正常对照组差异不显著(P>0.05)。结论 CA皮损及外周血CD3+CD4+T细胞内TLR9表达上调可能是HPV病毒感染的识别受体,并参与机体的抗HPV免疫应答。TLR9可能在CA复发机制中发挥着重要的作用。     

珠海市HIV/AIDS初治病人123例流行病学及临床特征分析

目的观察珠海市HIV/AIDS初治病例的流行病学和临床特征,为本地区艾滋病防治提供依据。方法回顾性分析2005年1月-2011年12月本院收治的123例HIV/AIDS初治病例的临床资料。结果 HIV/AIDS初治病例中男:女1.93:1,20～50岁年龄组占91.05%;感染途径以性传播为主,其中异性间性传播47.97%,同性间性传播11.38%;常见临床症状为发热、腹泻和淋巴结肿大等,常见机会性感染有口腔真菌感染、肺孢子菌肺炎、结核病和带状疱疹等;CD4+淋巴细胞<100个/μL占47.15%,100～200个/μL占28.46%,200～350个/μL占23.58%,>350个/μL占0.81%。结论珠海市HIV/AIDS初治病例男性多于女性,以青壮年为主,感染途径以性传播为主。临床医生应加强对艾滋病的筛查及宣教工作,做到早发现和早治疗,遏制艾滋病蔓延。     

司库奇尤单抗治疗中重度斑块状银屑病20例临床观察

 目的: 观察司库奇尤单抗注射液治疗中重度斑块状银屑病的临床疗效及安全性。方法:纳入20例中重度斑块状银屑病患者,给予司库奇尤单抗注射液皮下注射治疗,300 mg/次,分别于第0、1、2、3、4周注射1次,随后每4周1次,于第4、8、12周时记录患者银屑病皮损面积和严重度指数（PASI）、中性粒细胞和淋巴细胞比值（NLR）,观察药物不良反应。结果:20例患者治疗4 周时,PASI均值为2.52±0.91,6例达PASI 90,2例达PASI 100;8周时,PASI均值为0.99±0.55,8例达PASI 90,5例达PASI 100;12周时,PASI均值为0.13±0.16,10例达PASI 90,7例达PASI 100。患者治疗前、治疗后4、8、12周NLR水平分别为2.42±0.08、2.17±0.05、2.14±0.03和2.12±0.03,第4周NLR水平明显低于治疗前,差异有统计学意义(t=11.66,P<0.01),但与第8周和12周比较差异无统计学意义(t值分别为1.78、1.79,P值分别为0.083、0.081)。患者治疗前NLR和PASI评分呈正相关(r＝0.88,P<0.01),治疗后NLR下降值和PASI下降值明显相关(4周、8周、12周时r值分别为0.93、0.97、0.98,P值均<0.05)。所有患者均未发生严重不良反应。结论:司库奇尤单抗注射液治疗中重度斑块状银屑病起效迅速,疗效明显,不良反应较少且轻微,是中重度斑块状银屑病患者新的治疗选择。     

Cutaneous leishmaniasis in Multan,Pakistan

Background Cutaneous leishmaniasis (CL) is endemic in certain areas of Pakistan. This study was carried out to determine the incidence and clinical pattern of the disease in Pakistan. Methods CL patients presenting in the out-patient clinic of the Department of Dermatology, Nishtar Hospital, Multan from January 1995 to June 1997 were included in the study. The patients were diagnosed clinically and confirmed by laboratory demonstration of the parasite in a Giemsa-stained smear from the lesion. All important clinical details were recorded on specially designed forms. Results Three hundred and five patients with 681 lesions were seen during 30 months. All the lesions were of the dry type. Most of the lesions (97%) were present on exposed areas of the body. One hundred and thirty-four (44%) patients had one and 75 (24%) had two lesions. Eight five per cent of the sufferers were less than 30 years of age. The disease was slightly more preponderant in males (60%). Most cases presented during winter. Conclusions Lack of wet type lesions may be due to complete absence of Leishmania major in this area. This is in contrast to other areas of Pakistan where both dry and wet types of CL are present.     

长期抗病毒治疗的艾滋病患者CD4^+/CD8^+比值影响因素分析

目的探讨艾滋病患者抗病毒治疗后影响CD4^+/CD8^+比值恢复的因素。方法回顾性分析455例患者的基线及随访资料,观察期60个月,对60个月时CD4^+ T细胞数大于350/μL的患者,用Logistic回归分析影响其CD4^+/CD8^+比值恢复的影响因素,同时分析基线CD4^+/CD8^+、CD4^+T细胞数的差异。结果治疗60个月,影响CD4^+ T细胞数大于350/μL的患者CD4^+/CD8^+比值恢复的独立危险因素为年龄、基线CD4^+ T细胞数小于100/μL、基线CD8^+ T细胞数。CD4^+ T细胞数大于350/μL组,与CD4^+ T细胞数小于350/μL组,基线CD4^+/CD8^+比值比较差异有统计学意义(P=0.00),基线CD4^+ T细胞数比较差异有统计学意义(P=0.00)。结论抗病毒治疗可改善CD4^+/CD8^+比值,治疗时间越早,长期治疗后免疫功能恢复情况越好。但高龄、低CD4^+ T细胞数、高CD8^+ T细胞数是长期治疗的HIV/AIDS患者免疫功能重建的影响因素。     

A high neutrophil to lymphocyte ratio prior to BRAF inhibitor treatment is a predictor of poor progression-free survival in patients with metastatic melanoma

Background

Some studies have shown that a high neutrophil/lymphocyte ratio (NLR) ≥4 before initiating ipilimumab treatment is an independent prognostic indicator of poor survival in patients with metastatic melanoma (MM).

Objectives

To determine whether the NLR before starting BRAF inhibitor (BRAFi) treatment in patients with (MM) is associated with progression-free survival (PFS).

Materials & methods

This retrospective study included 49 patients consecutively receiving BRAFi for MM between July 2012 and December 2014. Cox proportional hazards regression was used to analyse the relationship between NLR and other factors, such as lactate dehydrogenase (LDH), performance status, BRAFi as firstor second-line therapy, and corticosteroid intake with PFS. The NLR before starting BRAFi was significantly associated with PFS based on univariate analysis and multivariate analysis adjusted for potential confounding factors, such as LDH activity, ulceration, performance status, first-line therapy, and corticosteroid intake. A high NLR (continuous variable) was associated with short PFS (HR: 1.35; 95% CI: 1.07-1.70; p = 0.01), and NLR ≥4 was associated with shorter PFS (HR: 3.24; 95% CI: 1.30-8.12; p = 0.01). Corticosteroid intake was not associated with short PFS based on multivariate analysis.

Conclusion

An NLR > 4, before starting BRAFi treatment, is an independent prognostic indicator of poor progression-free survival.

     

Hematological parameters in patients with acnes

Objective

To compare complete blood count (CBC) parameters and inflammatory factors in the patients with different grade of acne vulgaris and healthy controls.

Methods

A total of 20 patients were enrolled in this study. Patients were divided into mild group and moderate-to-severe group based on the acne severity, and compared to controls. Inflammatory factors (TNF-α, IL-6, IL-8, and IL1-α) detected by ELISA and complete blood count parameters (MPV, NLR, dNLR, PLR, LMR, and SII) obtained by routine blood tests were compared among the three group.

Results

All CBC parameters were not significantly elevated in patients with acne compared to healthy controls. However, the present studies have found that the inflammatory factors in acne patients were significantly elevated relative to healthy controls, and increase with the acne grade.

Conclusions

Inflammatory factors are convenient parameters to show inflammatory response to acne vulgaris, and may be a new clinical method for judging the acne grades of objectively. Considering the use of antibiotic, we believe that this metric worth further study.     

Japanese real‐world study of sequential nivolumab and ipilimumab treament in melanoma

To describe the treatment patterns of nivolumab and ipilimumab in Japan, a retrospective observational study was conducted in melanoma patients who received nivolumab and ipilimumab sequentially. Patients who received nivolumab and ipilimumab in combination were excluded from this study. Efficacy was evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST) in terms of the overall response rate (ORR), progression‐free survival (PFS), and disease control rate (DCR). Overall survival (OS) was also evaluated. Safety was assessed by the Common Terminology Criteria for Adverse Events (CTCAE). The treatment for all 68 patients enrolled involved switching from nivolumab to ipilimumab in 61 patients and switching from ipilimumab to nivolumab in seven patients. Switching occurred because of progressive disease in 55 patients and adverse events in eight patients. The median number of ipilimumab doses was three. Ipilimumab treatment achieved an ORR and DCR of 4.9% and 21.3%, respectively, and the median OS from start of ipilimumab was 7.0 months. During the study period, no new safety signals were noted. Independent factors which were indicative of poor prognosis for PFS were high neutrophil‐to‐lymphocyte ratio (NLR) and high C‐reactive protein (CRP) levels before ipilimumab treatment. An evaluation over a washout period indicated that no significant relationship existed with efficacy or safety. For the sequential administration of nivolumab and ipilimumab in Japanese melanoma patients, switch from nivolumab to ipilimumab was common, and the major reason for switching was progressive disease. The major prognostic factors for ipilimumab PFS after nivolumab were NLR and CRP before ipilimumab treatment.     

Prolonged BCG treatment of melanoma: does it suppress the immune capacity?

The immunological status of seven patients with disseminated melanoma during BCG scarification was followed. As parameters, the total peripheral blood leukocyte and lymphocyte counts, serum immunoglobulin levels, natural ABO blood group antibodies, lymphocyte responses in vitro to PHA and PPD, and skin reactivity against PPD and candidin were followed during a period of 2-36 months. The EAC-rosette-forming cells increased and the E-rosette-forming cells decreased during prolonged BCG therapy. The skin reactions and lymphocyte responses showed in most patients conversion from negative to positive or augmentation at the start of the therapy. Later on, however, the values in most patients dropped before disseminated disease became clinically apparent. In the only surviving patient the values first increased, remained high, and after 100 weeks treatment decreased. After 140 weeks'treatment immunological parameters are similar to pre-treatment levels. The possibility that prolonged intensive BCG treatment might eventually suppress the immune system, and thus result in an enhanced risk of dissemination of the disease, is discussed.     

Immunological effects of stress in psoriasis

Background Psychological stress causes phenotypic changes in circulating lymphocytes and is regarded as an important trigger of the Th1‐polarized inflammatory skin disease psoriasis. Objective To study the effects of psychological stress on immunological parameters, i.e. membrane molecules relevant to the pathophysiology of psoriasis, especially cutaneous lymphocyte‐associated antigens (CLA) involved in T and natural killer (NK) cells homing in on the skin. Methods The severity of psoriasis was assessed in patients using the Psoriasis Area and Severity Index. Patients with psoriasis (n = 15) and healthy volunteers (n = 15) were exposed to brief psychological stress in the laboratory. In vitro analyses were conducted 1 h before, immediately following and 1 h after stress exposure. Peripheral T‐ and NK‐cell subsets including CD8+ T lymphocytes, CLA+ lymphocytes and lymphocyte function‐associated antigen type 1 (LFA‐1)+ lymphocytes were analysed by flow cytometry. Results We found a significant stress‐induced increase of CD3+ T lymphocytes in patients with psoriasis only. Analyses of T‐cell subsets revealed that this increase was observable for cytotoxic CD8+ T lymphocytes and CLA+ CD3+ lymphocytes. The total number of circulating NK cells (CD16+, CD56+) increased immediately after stress in both groups whereas only patients with psoriasis showed a significant increase in CLA+ NK cells. Conclusions A higher stress‐induced increase of CLA+ T and CLA+ NK cells in the circulation of patients with psoriasis might point to an increased ability of T and NK cells in the presence of psoriasis to home in on the skin during mental stress. Further studies are needed to verify these relationships in more detail and to investigate the time point at which these cells accumulate within lesional skin, and whether or not psychotherapy improves the quality of life of patients with psoriasis and influences stress‐dependent parameters.     

LEISHMANIASIS RECIDIVA CUTIS IN AMERICAN CUTANEOUS LEISHMANIASIS

Background. Leishmaniasis recidiva cutis (LRC) consists of active lesions around or inside the scar of classical cutaneous leishmaniasis (CL). In the literature it is considered as an hyperergic form of CL because the patients show a strong response to intradermal testing with leishmania antigen and, histologically, the parasites are scarce or absent; a well-organized granuloma is always observed. Methods. Three patients from Bahia (Brazil) with LRC were evaluated by clinical examination, biopsies, skin tests with leishmania antigen, serology, and culture. In addition, a specific lymphocyte blastogenesis test was done and the species of leishmania characterized. Results. The disease was caused by both L. amazonensis and L braziliensis and serological titers varied from 1/16 to 1/64. The patients presented histologic and immunologic aspects different from those referred to in the literature. From four biopsies obtained only two presented a granulomatous reaction and parasites varied from absent to a parasite index 3. In one patient an absence of T cell response to leishmania antigen was observed in the first evaluation with restoration of the response after cure. In the other two, the degree of the specific proliferative response was lower than that usually observed in patients with classical CL. Conclusions. These findings indicate that New World LRC can not be considered a hyperergic form of CL. With respect to its clinical aspects and response to treatment, LRC must be considered as an entity different from the classical CL.