Using rabbit erythrocyte-derived
neutral glycosphingolipids enriched for a
ceramide pentasaccharide as the
antigen, we detected elevated anti-galactosyl-alpha(1-3)galactose (anti-G alpha G) antibody levels in 76% of children with active
visceral leishmaniasis (
kala-azar [KA]) and in 42% of clinically cured patients with KA who had been treated about 5 years previously with
meglumine antimonate (30 mg/kg in a series of 15 daily
injections). The long-term persistence of elevated G alpha G
antibodies was also found in 56% of children living in the same geographic zone who, at the time of the initial clinical examination, had
fever and evident
splenomegaly with hyperglobulinemia but a negative bone marrow aspirate for leishmanial bodies. Five years after antimonate treatment, these clinically cured children with presumptive KA were studied serologically. Their mean G alpha G antibody values were slightly lower than those in patients with active KA but were still abnormal. Using different biochemical and immunological approaches, we found that elevated G alpha G
antibodies present in patients with KA bound specifically to
glycoconjugates with an alpha(1-3)-terminal
galactose residue. G alpha G
antibodies were mainly distributed between
immunoglobulin classes G and M in patients with active KA and in antimonate-treated patients with clinically cured KA. The possibility of the existence of remnant living parasites or the persistence of inserted G alpha G
epitopes in parasitized macrophages was proposed as a mechanism to explain the long-term persistence of abnormal G alpha G
antibodies in patients apparently cured of KA.