RESUMO
An American cutaneous leishmaniasis outbreak, with cases clustering during 1993 in Tartagal city, Salta, was reported. The outbreak involved 102 individuals, 43.1% of them with multiple ulcers. Age (mean: 33 years old) and sex distribution of cases (74.5% males), as well as working activity (70 forest-related), support the hypothesis of classical forest transmission leishmaniasis, despite the fact that the place of permanent residence was in periurban Tartagal. Moreover, during July, sandflies were only collected from one of the 'deforestation areas'. Lutzomyia intermedia was the single species of the 491 phlebotomines captured, reinforcing the vector incrimination of this species. Most infections must have been acquired during the fall (April to June), a pattern consistent with previous sandfly population dynamics data. Based on the epidemiological and entomological results, it was advised not to do any vector-targeted periurban control measures during July. Further studies should be done to assess if the high rate of multiple lesions was due to parasite factors or to infective vector density factors.
Assuntos
Surtos de Doenças , Leishmaniose Cutânea/epidemiologia , Adolescente , Adulto , Idoso , Animais , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Insetos Vetores , Leishmaniose Cutânea/transmissão , Masculino , Pessoa de Meia-Idade , Psychodidae , Estações do AnoRESUMO
The occurrence of leishmaniasis patients carrying a double infection with Trypanosoma cruzi has been suspected but not proved. In this study, we analyzed sera of leishmaniasis patients from a region endemic for both parasites by using immunoblotting with epimastigotes and a purified antigen specific for T. cruzi (Ag 163B6). Seven of 12 patients showed a pattern of bands characteristic of chagasic patients reacting with antigens with molecular weights of 131, 125, 116, 111, 51-45, and 43 kD, and positive reactivity with Ag 163B6. Xenodiagnosis for T. cruzi was carried out in all patients; this technique has a positivity rate of 50% in chronic chagasic patients. The presence of T. cruzi trypomastigotes was shown in the blood of three, thus confirming the existence of a double infection in humans. Since the two parasites possess cross-reacting antigens, it may be assumed that previous infection with one of the parasites may affect the course of subsequent infection with the other. Nevertheless, T. cruzi infection did not prevent the appearance of typical leishmaniasis lesions. Therefore, antigenic cross-reactivity is unable to induce a sterilizing immune response against Leishmania.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/complicações , Leishmania/imunologia , Leishmaniose/complicações , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Idoso , Animais , Antígenos de Protozoários/imunologia , Doença de Chagas/diagnóstico , Doença de Chagas/imunologia , Reações Cruzadas , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Immunoblotting , Leishmaniose/diagnóstico , Leishmaniose/imunologia , Masculino , Pessoa de Meia-Idade , Triatoma/parasitologia , Trypanosoma cruzi/isolamento & purificaçãoRESUMO
In many regions of South America there are overlapping endemic areas for American Trypanosomiasis (Chagas' disease) and Leishmaniasis. T. cruzi and Leishmania spp, the causative agents of these parasitoses belong to the Trypanosomatidae family and share various antigens that cause cross-reactivity in serological diagnosis when complex antigenic mixtures are used. We studied patients who sought medical attention because of cutaneous or mucocutaneous lesions typical of leishmaniasis infection. These patients were from the province of Salta where Trypanosomiasis and Leishmaniasis are endemic diseases. Sixty-two patients gave a positive Montenegro skin test and, of these, 53 (85, 48%) showed the presence of amastigotes in Giemsa stained smears of dermal scrapings. Seven patients were not included because they were negative for both assays. We analyzed the leishmaniasic sera against homologous antigens to study the immune response and against complex heterologous antigens from T. cruzi to evaluate cross-reactivity phenomena. We also tested these sera against specific antigens for diagnosis of Chagas' disease in order to search for mixed infections. When complex antigens from leishmania were used, the sera showed an unusually strong antibody response 100% positive by IFA, 88.7% by ELISA and 80.6% by immunoblotting. Furthermore, significant cross-reactivity was found when conventional antigens for the serodiagnosis of Chagas' disease were used: 74.19% by IHA, 91.93% by IFA, and 76.80% by ELISA. We have previously purified by immunoaffinity, using a monoclonal antibody, an antigen termed Ag163B6 which is not present in L. mexicana. This antigen has shown the ability to specifically differentiate sera of chronic chagasic patients from those of leishmaniasic patients in ELISA. Furthermore, recent studies from our laboratory by immunoblotting, have demonstrated that chronic chagasic patients exhibit a specific reactivity pattern against T. cruzi epimastigotes that can be distinguished from those presented by leishmaniasic patients in spite of cross-reactive antigens. According to the results obtained in these assays, we classified the patients in two groups: 1) Patients with evidence of T. cruzi infection, those who tested positive in at least one assay: 2) Patients with no evidence of T. cruzi infection who were negative for both assays. More than 50% (32/62) of the patients showed strong evidence of mixed infection with T. cruzi. On the other hand, high cross-reactivity between these two parasitoses was shown in the second group without any evidence of T. cruzi infection since 18 out of 30 were positive in at least two conventional serological reactions. This implies that they would be misdiagnosed as chagasics if conventional reactions were used. These results emphasize the importance of the use of defined antigens and appropriate techniques for the differential diagnosis of these parasitoses, which is more important in areas endemic for both of them.