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Immune response to Leishmania antigens in an AIDS patient with mucocutaneous leishmaniasis as a manifestation of immune reconstitution inflammatory syndrome (IRIS): a case report.

AbstractBACKGROUND:
After the onset of HAART, some HIV-infected individuals under treatment present a exacerbated inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary leishmaniasis have been described in association with IRIS. Moreover, the immunopathogenesis of IRIS in association with Leishmania is unclear.
CASE PRESENTATION:
The present study reports on a 29-year-old HIV-infected individual who developed mucocutaneous leishmaniasis associated with immune reconstitution inflammatory syndrome (IRIS) five months following highly active antiretroviral therapy (HAART). Severe lesions resulted in the partial destruction of the nasal septum, with improvement observed 15 days after treatment with Amphotericin B and corticosteroids. The immune response of this patient was evaluated before and after the lesions healed. IRIS was diagnosed in association with high levels of TNF-α and IL-6. Decreased production of IFN-γ and a low IFN-γ/IL-10 ratio were also observed in response to Leishmania antigens. After receiving anti-leishmanial treatment, the individual's specific Th1 immune response was restored.
CONCLUSION:
The results suggest that the production of inflammatory cytokines by unstimulated T-lymphocytes could contribute to occurrence of leishmaniasis associated with IRIS.
AuthorsLuana Gois, Roberto Badaró, Robert Schooley, Maria Fernanda Rios Grassi
JournalBMC infectious diseases (BMC Infect Dis) Vol. 15 Pg. 38 (Feb 03 2015) ISSN: 1471-2334 [Electronic] England
PMID25645330 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Antigens, Protozoan
Topics
  • AIDS-Related Opportunistic Infections (complications, diagnosis)
  • Adult
  • Antigens, Protozoan (blood)
  • Antiretroviral Therapy, Highly Active
  • Diagnosis, Differential
  • Humans
  • Immune Reconstitution Inflammatory Syndrome (complications, diagnosis)
  • Leishmania (immunology)
  • Leishmaniasis, Mucocutaneous (complications, diagnosis)
  • Male

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