Manual de vigilância e controle da Leishmaniose Visceral (Portuguese Edition)
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Findings of a previous study showed that the presence of the deletion allele is associated with a resistance to HIV infection and that it confers protection against asthma, rheumatoid arthritis, multiple sclerosis and renal graft rejection Renal transplant recipients who are homozygous for a deletion have a significantly higher survival rate than recipients heterozygous or homozygous for the wild-type allele The CCR5 receptor is involved in directing the immune response towards a Th1, thus affecting the development of infectious diseases. As the various clinical forms of ACL depend on the host immune response, the CCR5 receptor may play a role in the development of the various forms of the disease.
The diagnosis consisted of a search for parasites in the lesion and also a Montenegro skin test. An aliquot of 20 ml peripheral blood was collected from all the patients and controls. The control group comprised healthy individuals.
The inclusion criterion was being exposed to the same environmental risks as the ACL patients, i. Blood relatives were excluded to reduce the likelihood of obtaining biased data. The study included patients who had been diagnosed positive for ACL and whose lesions did not return in the first 2 years subsequent to treatment. Blood relatives were not included in the study. The ACL patient group was divided into groups according to the clinical form of ACL, the results of laboratory tests and the clinical history Fig.
Composition of the patient groups and subgroups with American cutaneous leishmaniasis ACL. Group 1 comprised individuals who had presented with cutaneous lesions and showed no signs of a recurrence of the disease. This group was subdivided into group 1A consisting of 77 individuals who had received a positive parasitological diagnosis and group 1B consisting of 11 individuals who only had a positive Montenegro skin test. Group 2 included individuals who had mucosal lesions.
This group was subdivided into group 2A composed of seven individuals with mucosal lesions who had previously had cutaneous lesions with a positive laboratory diagnosis parasitological or the Montenegro skin test and group 2B composed of three individuals who had mucosal lesions, without a previous history of cutaneous lesions.
Group 3 consisted of individuals who had cutaneous lesions which returned subsequent to treatment. This group was subdivided into group 3A, comprising seven individuals who had positive laboratory diagnoses parasitological or the Montenegro skin test and whose lesions had returned in the same location, as well as group 3B, comprising six individuals who had positive laboratory diagnoses parasitological or the Montenegro skin test and whose lesions had returned in a different location.
Group 4 consisted of all the individuals with a recurrence of the lesion groups 2A and 3A. Recurrence was regarded as the appearance of a new lesion in the same location as the previous cutaneous lesion group 3A or in the mucosa group 2A subsequent to 2 years of treatment. This group comprised 14 individuals.
The peripheral blood samples were placed in tubes containing EDTA anticoagulant at a concentration of 1. Primers CCR5. All DNA amplification reactions were performed in parallel with negative controls to detect the possibility of contamination. The and base pair products were analyzed by electrophoresis on a 2. All individuals were informed of the purpose of the study. The variables of age, gender and ethnicity were analyzed Table I in the patients with ACL patient group and the healthy subjects control group.
The patients were 47 years old on average and the controls were 31 years old on average. The populations examined showed no significant deviation from the Hardy-Weinberg equilibrium. Confidence interval CI , 0.
Human visceral leishmaniasis and relationship with vector and canine control measures
The comparison of the frequency of the genotypes between the ACL patients who showed no recurrence of the lesion subsequent to treatment group 1A and the other groups revealed no difference in the genotype distribution Table III. The analysis of the genotypes of the control group versus the patient groups and subgroups showed that only the group of individuals who had cutaneous lesions with a positive laboratory diagnosis and whose lesions returned in a different location Group 3B presented with a different distribution than the control group.
OR, odds ratio. In the last 20 years the incidence of ACL has increased in all the states of Brazil 3. This increase was primarily attributable to behavioral and environmental changes, including invasions in primary forests, deforestation, massive migration from rural to urban areas and rapid and unplanned urbanization 3. Therefore, due to the increase in the number of cases and the wide spectrum of clinical and immunopathological manifestations of ACL, the aim of the present study was to evaluate the potential effect of the chemokine receptor CCR5 in the varying forms of ACL.
In the present study, the patients were older than the controls. The ACL patients were 47 years old on average while the controls were 31 years old on average. The age range of the patients was as expected as the ACL occurs more frequently in older patients It was observed that the majority of the patients were male.
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These results were expected as males more commonly conduct leisure activities, including hunting and fishing, that involve the risk of contracting ACL Thus, the control group comprised a higher proportion of males to the remaining paired data. Therefore, it was expected that the populations most affected by the virus would have a higher degree of gene deletion, however, mutations of this gene may have occurred in fatal generalized epidemics that occurred in Europe and not due to the HIV virus.
Prior to HIV, the bubonic plague would have affected the mutation. A recent study has demonstrated that smallpox may also have affected the mutation since the smallpox virus uses the CCR5 and CXCR4 as receptors to enter cells This allele has not been reported in China, Japan or native African populations There were no individuals with the homozygous recessive genotype in the present study.
Challenges in the Therapy of Visceral Leishmaniasis in Brazil: A Public Health Perspective
Thus, the chance of identifying a homozygous deleted individual is extremely small and consistent with the genotypes observed in this population. These results corroborated the results of another study which also identified no differences in the frequency of these alleles among its study groups The recurrence of cutaneous lesions may be due to an immune deficiency of the host or infection by parasitic subspecies capable of inducing immunosuppression in the host There was also no difference in the allele frequency between the subgroup of the individuals who presented with cutaneous lesions and had a positive parasitological diagnosis with no signs of recurrence of the disease within a period of at least 2 years group 1A and the other patient subgroups.
This showed that there was no correlation between the alleles and the various groups of ACL patients that were studied. This result was in contrast with a study that observed that the heterozygous patients only had cutaneous lesions However, due to the small number of patients in each subgroup, more studies are required to elucidate the role of CCR5 in the pathogenesis of ACL, enabling advances in therapeutic treatments and new prophylactic strategies for the disease. Parasitology, Editora Guanabara Koogan. Rio de Janeiro: pp.
Rev Soc Bras Trop Med. In Portuguese. Rev Bras Epidemiol.
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[Full text] Visceral leishmaniasis and HIV coinfection: current perspectives | HIV
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