Detection of Leishmania (Viannia) braziliensis in vascular endothelium lesions of patients with localized cutaneous leishmaniasis

In the present study, we examined the cutaneous lesions of 8 patients with cutaneous leishmaniasis, from regions situated near the rivers Chama-Mocoties, in Merida state, Venezuela. The lesions of the patients were diagnosed on the basis of clinical, parasitological and immmunological examinations. The Polymerase Chain Reaction (PCR) assay showed infection by Leishmania (Viannia) braziliensis in cutaneous lesions samples. Histopathology of skin biopsy specimens showed inflammatory infiltrates of mononuclear and polymorphonuclear leukocytes. Granulomatous reactions and amastigotes were observed in the dermis. The histological sections of the cutaneous lesions in one patient (No. 5), showed alterations in the integrity of dermal blood vessels, leishmanial antigens on the superficial endothelium and free parasites in the capillary lumen and inside mononuclear cells. The Leishmania amastigotes also were detected in the cytoplasm of neutrophils in Giemsa-stained imprints. The skin biopsies examined using immunofluorescence (IFI) and immunoperoxidase assay (PAP), show amastigotes and antigenic material adsorbed on the vecinity of the walls of dermal microvessels. Based on these results, we concluded that in the cutaneous lesions it is possible to show the presence of intra and extracellular parasites, attached to wall of the dermal blood vessels and free, in the capillary lumen. The circulating parasites in peripheral blood may allow the possibility of developing secondary infections as well as the propagation of the infection in endemic areas of leishmaniasis, where the parasite circulates between domestic and wild reservoirs, vector insects and humans living in those areas.     

Presence of parasite DNA in clinically unaffected nasal mucosa during cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis

Objectives

We aimed to detect Leishmania DNA carriage in nasal mucosa of individuals with cutaneous leishmaniasis (CL) caused by Leishmania (Viannia) braziliensis.

PCR-based diagnosis of acute and chronic cutaneous leishmaniasis caused by Leishmania (Viannia)

We evaluated PCR methods for diagnosis of acute and chronic cutaneous leishmaniasis (CL) in an area of Colombia where Leishmania (Viannia) is endemic. The PCR method specifically amplified whole linearized minicircle kinetoplast DNA (kDNA) of the Leishmania subgenus Viannia from biopsy lysates. PCR products were detected in agarose gels. For 255 acute cases, this PCR method had greater sensitivity (75.7%) than each conventional method, i.e., microscopic examination of Giemsa-stained lesion scraping (46.7%), biopsy culture (55.3%), aspirate culture (46.3%), and the conventional methods combined (70.2%). Among 44 cases of chronic CL, amplification of biopsy DNA was more sensitive (45.5%) than the individual (4.5 to 27.7%) and combined (27.3%) conventional methods. The detection of kDNA in biopsies from chronic lesions was enhanced by a chemiluminescent dot blot hybridization, which produced a sensitivity of 65.8% when alone and 90.9% when in combination with DNA extraction of biopsy lysates (P < 0.001). Three biopsies from 84 skin lesions of other etiologies were falsely positive by PCR (specificity, 96.4%). PCR detected kDNA more frequently in biopsies (detection level, 83.9%) than in aspirates (74.7%) from 103 cases of acute CL. Among aspirates from 53 chronic cases of CL, the alternative methods, DNA extraction and hybridization, increased sensitivity from 41.5 to 56.6% (P > 0.05). This enhanced PCR method in chronic biopsies was so much more sensitive than conventional methods that it should be considered the preferred diagnostic method for chronic CL. These findings support the appropriate incorporation of PCR into diagnostic strategies for cutaneous leishmaniasis.     

Effect of intralesional treatment with emetine hydrochloride on Leishmania (Viannia) braziliensis in hamsters

The therapeutic effect of the emetine hydrochloride alkaloid administered intralesionally was compared with that of standard parenteral treatment with Glucantime in outbred male hamsters experimentally infected with 4 x 10(3) amastigotes of Leishmania (Viannia) braziliensis. Both chemotherapeutic agents reduced significantly (P < 0.01) the average lesion sizes in experimental animals in comparison with those untreated. The alkaloid infiltration was found to be as effective as the antimonial injection for clinical resolution. The ultrastructural effects on the Leishmania parasites exposed to emetine were observed mainly in the inner cytoplasm, which appeared disorganized, pycnotic and with loss of morphological definition; however, any known emetine hydrochloride action mechanism factor could not be directly related with ultrastructure effects detected on leishmanial parasites. Smears, conventional histopathology, culture in NNN medium and indirect immunoperoxidase method showed viable amastigotes in nodules and/or scars of all the evaluated hamsters 75 to 230 days after the end of treatment. These findings suggest that measurement of the size of cutaneous leishmania lesions does not appear to be a valid criterion for evaluating the efficiency of chemotherapy in experimental LT. Detection of leishmania parasites in the lesion scars, supports the hypothesis that man could be considered as an domestic reservoir.     

Development of Leishmania (Viannia) braziliensis and Leishmania (Leishmania) amazonensis in the sand fly Lutzomyia migonei (Diptera: Psychodidae)

Development of Leishmania braziliensis (Vianna) and Leishmania amazonensis (Lainson and Shaw) in the sand fly Lutzomyia migonei (Fran?a) was compared by studying the parasite microhabitats in the alimentary tract, the sequence of parasite morphological changes leading to the metacyclogenesis process, and the parasite transmission to the vertebrate susceptible host. Although the infections by the 2 Leishmania species were initiated with the same number of amastigotes, Le. amazonensis developed a higher population. Infections with Le. braziliensis were typically peripylarian and those with Le. amazonensis suprapylarian but with an unusual invasion of an organ other than the gut, the Malpighian tubules. The life cycle of the 2 parasites within the sand fly vector included the development of all promastigote forms: procyclics, haptomonads, nectomonads, paramastigotes and infective metacyclics, the last of which are uniquely adapted for transmission to the vertebrate hosts. Appearance of metacyclics coincided with the presence of large number of procyclics and haptomonads, low numbers of nectomonads and the appearance of paramastigotes. In both type of infections, there was a high mortality of the promastigotes inside the bloodmeal during digestion but once infection became established metacyclic forms appeared. Although the numbers of metacyclics that developed in sand flies were low for both parasites they were able to transmit the infection to vertebrates, a key event in the vector competence. We suggest that L. migonei is a true biological host and a possible vector of the 2 Leishmania species, which coexist in extensive geographic areas.     

Immunopathological characterization of human cutaneous leishmaniasis lesions caused by Leishmania (Viannia) spp. in Amazonian Brazil

Parasitology Research - American cutaneous leishmaniasis (ACL) is a chronic infectious disease caused by different protozoan species of Leishmania, and it is endemic in both tropical and...     

Leishmania (Viannia) species identification on clinical samples from cutaneous leishmaniasis patients in Peru: assessment of a molecular stepwise approach

We present an algorithm based on three PCR assays for Leishmania (Viannia) species identification and assessed its performance using 70 specimens from Peruvian patients. The succession of the assayed targets can be ordered according to species prevalence. Sequential progression through the algorithm reduced the number of samples here studied by approximately 30% after each step.     

Human american cutaneous leishmaniasis (Leishmania b. braziliensis) in Brazil: lymphoproliferative responses and influence of therapy.

The host defence to Leishmania parasites is believed to depend on cell-mediated immune responses. Three groups of inhabitants from an endemic area in Rio de Janeiro were studied: Group I consisted of 28 patients with cutaneous lesions, Group II of 28 healthy persons (without ulcers) but with positive Montenegro skin tests (MST) and Group III of 29 healthy persons with negative MST. The peripheral blood lymphocyte proliferative responses induced by leishmanial-antigens (Leishmania b. braziliensis lymphoproliferative response) as well as by Concanavalin A (Con A-lymphoproliferative response), both measured by 3H-thymidine incorporation were tested in each group. The results showed that: The Leishmania b. braziliensis lymphoproliferative response (L.b.b.-LPR) in healthy persons with positive MST (Group II) was higher than in patients prior to therapy (Group I); A significantly higher L.b.b.-LPR was found in patients and healthy persons with positive MST as compared to Group III (negative MST); The L.b.b.-LPR of Group I (patients) increased during antimonial therapy--this might possibly be related to the destruction of parasites; The levels of L.b.b.-LPR after therapy became similar to the ones before therapy; All individuals from the three groups had a positive Con A-lymphoproliferative response (Con A-LPR); All patients who had a histopathological picture of granulomatous reaction also had a positive L.b.b.-LPR; A poor response to antimonial therapy observed in six patients was associated with a low L.b.b.-LPR.     

Cutaneous leishmaniasis of man due to Leishmania (Viannia) naiffi Lainson and Shaw, 1989

Until recently mammalian hosts of Leishmania (Viannia) naiffi Lainson & Shaw, 1989 have been limited to armadillos, Dasypus novemcinctus, in Amazonian Brazil. Past evidence for human cutaneous leishmaniasis due to this parasite is reviewed, and a recent infection in man reported, with identification of the parasite by isoenzyme profiles and a specific monoclonal antibody. The role of some phlebotomine sandfly species as vectors is discussed.     

Proteins Selected in Leishmania (Viannia) braziliensis by an Immunoproteomic Approach with Potential Serodiagnosis Applications for Tegumentary Leishmaniasis

The serodiagnosis of human tegumentary leishmaniasis (TL) presents some problems, such as the low level of antileishmanial antibodies found in most of the patients, as well as the cross-reactivity in subjects infected by other trypanosomatids. In the present study, an immunoproteomic approach was performed aimed at identification of antigens in total extracts of stationary-phase promastigote and amastigote-like forms of Leishmania (Viannia) braziliensis using sera from TL patients. With the purpose of reducing the cross-reactivity of the identified proteins, spots recognized by sera from TL patients, as well as those recognized by antibodies present in sera from noninfected patients living in areas where TL is endemic and sera from Chagas disease patients, were discarded. Two Leishmania hypothetical proteins and 18 proteins with known functions were identified as antigenic. The study was extended with some of them to validate the results of the immunoscreening. The coding regions of five of the characterized antigens (enolase, tryparedoxin peroxidase, eukaryotic initiation factor 5a, β-tubulin, and one of the hypothetical proteins) were cloned in a prokaryotic expression vector, and the corresponding recombinant proteins were purified and evaluated for the serodiagnosis of TL. The antigens presented sensitivity and specificity values ranging from 95.4 to 100% and 82.5 to 100%, respectively. As a comparative antigen, a preparation of Leishmania extract showed sensitivity and specificity values of 65.1 and 57.5%, respectively. The present study has enabled the identification of proteins able to be employed for the serodiagnosis of TL.     

Confirmation of Leishmania infantum MON-24, agent of cutaneous leishmaniasis in southern France

Leishmania infantum MON-24, an agent causing cutaneous leishmaniasis, has only been reported once in Southern France. The authors report an additional case which confirms the presence of this zymodeme as agent of cutaneous leishmaniasis in this area. Treatment with a single course of liposomal amphotericine B did not show convincing efficacy.     

Genetic polymorphism and molecular epidemiology of Leishmania (Viannia) braziliensis from different hosts and geographic areas in Brazil

Numerical zymotaxonomy and variability of the internal transcribed spacers (ITS) between the small and large subunits of the rRNA genes were used to examine strain variation and relationships in natural populations of Leishmania (Viannia) braziliensis. A total of 101 strains from distinct hosts and Brazilian geographic regions were assigned to 15 zymodemes clustered in two major genetic groups. The great number of isolates (48.5%) placed in zymodeme IOC/Z-27 were collected on the Atlantic coast. The high molecular diversity found in populations in the Amazon Basin was related to the great number of sandfly vector(s) in that region. The results of the restriction fragment length polymorphism analysis of the ITS depicted considerable intraspecific variation. Genotypic groups A, B, and C contained 39, 40, and 22 isolates, which were divided into 16, 10, and 15 genotypes, respectively. The genetic polymorphism observed demonstrates the degree of diversity of L. (V.) braziliensis strains from different regions where they are endemic. The results reinforce the clonal theory for Leishmania parasites showing the genetic diversity of this pathogen and an association of L. (V.) braziliensis genotypes with specific transmission cycles, probably reflecting an adaptation of different clones to the vector species involved.     

A vaccine composed of a hypothetical protein and the eukaryotic initiation factor 5a from Leishmania braziliensis cross-protection against Leishmania amazonensis infection

In the present study, two proteins cloned from Leishmania braziliensis species, a hypothetical protein (LbHyp) and the eukaryotic initiation factor 5a (EiF5a), were evaluated to protect BALB/c mice against L. amazonensis infection. The animals were immunized with the antigens, either separately or in combination, using saponin as an immune adjuvant in both cases. Spleen cells from vaccinated and later infected mice produced significantly higher levels of protein and parasite-specific IFN-γ, IL-12, and GM-CSF, in addition to low levels of IL-4 and IL-10. Evaluating the parasite load by means of a limiting dilution technique and quantitative Real-Time PCR, vaccinated animals presented significant reductions in the parasite load in both infected tissues and organs, as well as lower footpad swelling, when compared to the control (saline and saponin) groups. The best results regarding the protection of the animals were achieved when the combined vaccine was administered into the animals. Protection was associated with an IFN-γ production against parasite antigens, which was mediated by both CD4⁺ and CD8⁺ T cells and correlated with antileishmanial nitrite production. In conclusion, data from the present study show that this polyprotein vaccine, which combines two L. braziliensis proteins, can induce protection against L. amazonensis infection.     

Salivary gland homogenates from wild‐caught sand flies Lutzomyia flaviscutellata and Lutzomyia (Psychodopygus) complexus showed inhibitory effects on Leishmania (Leishmania) amazonensis and Leishmania (Viannia) braziliensis infection in BALB/c mice

During the natural transmission of Leishmania parasites, the infected sand fly female regurgitates promastigotes into the host's skin together with its saliva. It has been reported that vector saliva contains immunomodulatory molecules that facilitate the establishment of infection. Thus, the main objective of this study was to evaluate the specificity of Lutzomyia (Lu.) flaviscutellata and Lu. (Psychodopygus) complexus salivas on the infectivity of Leishmania (L.) (Leishmania) amazonensis and L. (Viannia) braziliensis, respectively. BALB/c mice were inoculated into the skin of hind footpad with L. (L.) amazonensis and L. (V.) braziliensis promastigotes in the absence or presence of Lu. flaviscutellata and Lu. (P.) complexus salivary gland homogenates (SGHs). The evolution of the infection was evaluated by lesion size, histopathological analysis and determination of the parasite load in the skin biopsies collected from the site of infection at 4 and 8 weeks PI. The lesion size and the parasite load of both groups of mice infected in the presence of SGHs were smaller than the control groups. The histopathological features showed that the inflammatory reaction was less prominent in the groups of mice infected in the presence of both SGHs when compared to the control group. The results showed that the presence of SGHs of Lu. flaviscutellata and Lu. (P.) complexus led to induction of processes that were disadvantageous to parasite establishment during infection by L. (L.) amazonensis and L. (V.) braziliensis. An inhibitory effect on Leishmania infection could be observed in both groups inoculated with SGHs, especially when the SGH from Lu. (P.) complexus was used.     

A new enzymatic variant of Leishmania infantum Nicolle, 1908, agent of cutaneous leishmaniasis in northern Algeria

For the first time, the pathogenic agent of cutaneous leishmaniasis in the North of Algeria has been identified as Leishmania infantum s.1. The parasite was found to be a newly discovered enzymatic variant (zymodeme 24) differing by two electromorphs from a variant isolated in France (zymodeme 11) from the same type of lesion. Until now, the dermotropic zymodemes of Algeria and France have not been seen in cases of visceral leishmaniasis of the Mediterranean Basin.     

Comparative Evaluation of Lesion Development,Tissue Damage,and Cytokine Expression in Golden Hamsters (Mesocricetus auratus) Infected by Inocula with Different Leishmania (Viannia) braziliensis Concentrations

The golden hamster (Mesocricetus auratus) is a susceptible model to Leishmania (Viannia) spp.; however, available studies employ different infection protocols, which account for clinical and pathological presentation differences. Herein, L. (V.) braziliensis preparations were standardized to contain 10⁴, 10⁵, or 10⁶ parasites to determine an optimal inoculum that ensured cutaneous lesions without causing a disseminated infection in hamsters. Lesion development was followed for 105 days by size measurements, and skin, draining lymph node, spleen, and sera were investigated to check parasite load, spleen visceralization, cytokine expression, histopathological changes, and anti-Leishmania IgG levels. The lesion emergence time was inversely proportional to the parasite concentration in the inocula. Animals infected by 10⁴ parasites presented nodular lesions, while those infected with 10⁶ parasites often exhibited ulcerated lesions. The differences in the final lesion sizes were observed between 10⁴ and 10⁵ inocula or 10⁴ and 10⁶ inocula. High IFNG expression, anti-Leishmania IgG levels, and parasite load occurred independently of the inoculum used. A mild inflammatory skin involvement was observed in animals infected with 10⁴ parasites, while extensive tissue damage and parasite spleen visceralization occurred with 10⁵ and 10⁶ parasites. These results indicate that inocula with different concentrations of parasites generate differences in the time of lesion emergence, clinical presentation, and systemic commitment, despite high and similar IFNG expression and parasite load. This suggests that a modulation in the immune response to different parasite numbers occurs in an early phase of the infection, which could dictate the establishment and magnitude of the chronic phase of the disease.