Non-ulcerated or atypical cutaneous leishmaniasis caused by Leishmania (L.) infantum chagasi in the municipality of Amapala, Valle, Honduras: immunohistotopathological characterization of skin lesions

Author(s)

Carmen Maria Sandoval Pacheco

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2017-09-01

Examining board members

Marcia Dalastra Laurenti; Claudia Momo; Fredy Galvis Ovallos; Luiz Felipe Domingues Passero

• Advisor: Marcia Dalastra Laurenti

Abstract

In America, especially in South America, infection by Leishmania (L.) infantum chagasi causes subclinical manifestations and visceral leishmaniasis (VL), which when untreated is potentially fatal. In Central America, especially in Honduras, non-ulcerated or atypical cutaneous leishmaniasis and visceral leishmaniasis are caused by the same etiologic agent Leishmania (L.) infantum chagasi and occur in the same geographic region. Little is known about the profile of human infection by Leishmania (L.) infantum chagasi in Honduras, especially on the non-ulcerated or atypical form. In order to better understand the pathogenesis of the infection caused by this species of parasite in the municipality of Amapala (Valle) and Orocuina (Choluteca), Honduras, the present study aim the characterization of histopathological changes and cellular immune response in situ in lesions of patients with non-ulcerated or atypical cutaneous leishmaniasis. Twenty skin biopsies from patients with parasitological diagnosis confirmed by scraping of Giemsa-stained lesion and observed using an optical microscope. Histopathology, was evaluated by hematoxylin-eosin (HE) and the immunohistochemistry using the primary antibodies to macrophages (CD68), T lymphocytes (CD4, CD8), natural killer cells - NK (CD56), B lymphocytes CD20), nitric oxide synthase (NOS2) and interferon-gamma (IFN-y). Microscopically, the most significant histopathological changes were observed in the superficial and deep dermis, characterized by a predominantly lymphohistiocytic inflammatory infiltrate of variable intensities with diffuse arrangement and sometimes associated with the formation of epithelioid granulomas; the observation of suggestive forms of the parasite occurred in only 55 % of the cases. The immunohistochemical analysis of the lesions confirmed the presence of mononuclear cells in the inflammatory infiltrate characterized mainly by the presence of T-CD8+ lymphocytes, followed by T-CD4+, macrophages, B lymphocytes and NK cells. The high density of INF-y+ cells and the presence of iNOS, enzyme responsible for the production of nitric oxide, molecule with activity leishmanicide, in almost all of the macrophages in the inflammatory infiltrate, suggest an effective local immune response that collaborate to the control in the number of parasites and consequently the evolution of the lesion (AU)

• FAPESP's process: 15/01154-7 - Non-ulcerated or atypical cutaneous leishmaniasis caused by Leishmania infantum chagasi in Amapala municipality, Valle, Honduras: immune-histological characterization of the skin lesions
• Grantee: Carmen Maria Sandoval Pacheco
• Support Opportunities: Scholarships in Brazil - Master