Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features

Author(s)

Alves Gama, Monica Elinor ^[1] ; de Castro Gomes, Claudia Maria ^[2] ; Silveira, Fernando Tobias ^{[3, 4]} ; Laurenti, Marcia Dalastra ^[2] ; Goncalves, Eloisa da Graca ^[5] ; da Silva, Antonio Rafael ^[5] ; Pereira Corbett, Carlos Eduardo ^[2]

Affiliation

^[1] Univ Fed Maranhao, Ctr Ciencias Saude, Dept Med 3, Sao Luis, MA - Brazil

^[2] Univ Sao Paulo, Fac Med, Dept Patol, Sao Paulo - Brazil

^[3] Fed Univ Para, Nucleo Med Trop, BR-66059 Belem, Para - Brazil

^[4] Inst Evandro Chagas, Belem, Para - Brazil

^[5] Univ Fed Maranhao, Ctr Ciencias Saude, Dept Patol, Sao Luis, MA - Brazil

• Document type: Journal article
• Source: Revista da Sociedade Brasileira de Medicina Tropical; v. 46, n. 6, p. 741-745, NOV-DEC 2013.
• Web of Science Citations: 7

Abstract

Introduction The relationship between severe clinical manifestations of visceral leishmaniasis (VL) and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil). Methods We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão. Results Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ) levels, although their interleukin 10 (IL-10) levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2) and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL. Conclusions Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity. (AU)

• FAPESP's process: 06/56319-1 - Leishmaniasis in Brazil: clinical and immunopathogenetic aspects of the human and experimental disease
• Grantee: Carlos Eduardo Pereira Corbett
• Support Opportunities: Research Projects - Thematic Grants