Diversidade clínica e tratamento da leishmaniose visceral
Palavras-chave:
leishmaniose visceral, diversidade clínica, resposta terapêutica, Leishmania infantum
Resumo
A leishmaniose visceral (LV) é causada por protozoários do gênero Leishmania, sendo as duas principais espécies: Leismania (Leishmania) donovani e Leishmania (Leishmania) infantum, as quais tem ocorrência geográfica diversa e estão relacionadas com diversidade de manifestações clinicas e de resposta terapêutica. Notadamente, a LV que ocorre, principalmente, na Índia Sudão, Sudão do Sul, Bangladesh e Etiópia é causada pela espécie L. donovani, enquanto nas Américas e em algumas regiões da África e Europa, a espécie causadora é a L. infantum. A LV causada pela L. (L.) donovani tem um espectro clínico variando de comprometimento visceral à lesão cutânea que ocorre após um episódio de LV, que é a leishmaniose dérmica pós-kalazar (PKDL), manifestações esta que não é muito frequente na LV causada pela L. infantum. Ademais, a resposta terapêutica é divergente entre essas espécies, visto que na LV causada por L. donovani há pobre resposta ao antimonial pentavalente, configurando um padrão de resistência elevado, enquanto que na LV causada pela L. infantum essa informação não é muito clara. Neste artigo abordamos a diversidade clínica e a resposta terapêutica da LV causada principalmente por L. infantum, que é de ocorrência nas Américas.Referências
1. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Manual de vigilância e controle da leishmaniose visceral. Brasília (DF): Ministério da Saúde; 2014. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_vigilancia_controle_leishmaniose_visceral_1edicao.pdf
2. World Health Organization. Control of the leishmaniasis: report of a meeting of theWHO Expert Committee on the Control of Leishmaniases. Geneva: World Health Organization; 2010. Disponível em: http://www.who.int/iris/handle/10665/44412
3. Argaw D, Mulugeta A, Herrero M, Nombela N, Teklu T, Tefera T et al. Risk factors for visceral Leishmaniasis among residents and migrants in Kafta-Humera, Ethiopia. PLoS Negl Trop Dis. 2013;7(11):e2543. http://dx.doi.org/10.1371/journal.pntd.0002543
4. Cerf BJ, Jones TC, Badaro R, Sampaio D, Teixeira R, Johnson WD Jr.. Malnutrition as a risk factor for severe visceral leishmaniasis. J Infect Dis. 1987;156(6):1030-3.
5. Mengesha B, Endris M, Takele Y, Mekonnen K, Tadesse T, Feleke A et al. Prevalence of malnutrition and associated risk factors among adult visceral leishmaniasis patients in Northwest Ethiopia: a cross sectional study. BMC Res Notes. 2014;7:75. http://dx.doi.org/10.1186/1756-0500-7-75
6. de Araújo VE, Pinheiro LC, Almeida MC, de Menezes FC, Morais MH, Reis IA et al. Relative risk of visceral leishmaniasis in Brazil: a spatial analysis in urban area. PLoS Negl Trop Dis. 2013;7(11):e2540. http://dx.doi.org/10.1371/journal.pntd.0002540
7. Badaró R, Jones TC, Lorenço R, Cerf BJ, Sampaio D, Carvalho EM et al. A prospective study of visceral leishmaniasis in an endemic area of Brazil. J Infect Dis. 1986;154(4):639-49.
8. Silveira FT, Lainson R, Crescente JA, de Souza AA, Campos MB, Gomes CM et al. A prospective study on the dynamics of the clinical and immunological evolution of human Leishmania (L.) infantum chagasi infection in the Brazilian Amazon region. Trans R Soc Trop Med Hyg. 2010;104(8):529-35. http://dx.doi.org/10.1016/j.trstmh.2010.05.002
9. Crescente JA, Silveira FT, Lainson R, Gomes CM, Laurenti MD, Corbett CE. A cross-sectional study on the clinical and immunological spectrum of human Leishmania (L.) infantum chagasi infection in the Brazilian Amazon region. Trans R Soc Trop Med Hyg. 2009;103(12):1250-6. http://dx.doi.org/10.1016/j.trstmh.2009.06.010
10. Ibarra-Meneses AV, Carrillo E, Sánchez C, García-Martínez J, López Lacomba D, San Martin JV et al. Interleukin-2 as a marker for detecting asymptomatic individuals in areas where Leishmania infantum is endemic. Clin Microbiol Infect. 2016;22(8):739.e1-4. http://dx.doi.org/10.1016/j.cmi.2016.05.021
11. van Griensven J, Diro E. Visceral leishmaniasis. Infect Dis Clin North Am. 2012;26(2):309-22. http://dx.doi.org/10.1016/j.idc.2012.03.005
12. Saporito L, Giammanco GM, De Grazia S, Colomba C. Visceral leishmaniasis: host-parasite interactions and clinical presentation in the immunocompetent and in the immunocompromised host. Int J Infect Dis. 2013;17(8):e572-6. http://dx.doi.org/10.1016/j.ijid.2012.12.024
13. Goto H, Prianti Md. Immunoactivation and immunopathogeny during active visceral leishmaniasis. Rev Inst Med Trop Sao Paulo. 2009;51(5):241-6. http://dx.doi.org/10.1590/S0036-46652009000500002
14. Lindoso JAL, Goto H. Leishmaniose visceral. In: Lopes AC. Tratado de Clínica Médica. 3 ed. Rio de Janeiro (RJ): Roca; 2016.
15. Zijlstra EE, Musa AM, Khalil EA, el-Hassan IM, el-Hassan AM. Post-kala-azar dermal leishmaniasis. Lancet Infec Dis 2003;3(2):87-98. https://doi.org/10.1016/S1473-3099(03)00517-6
16. Zijlstra EE. PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses. PLoS Neg Trop Dis. 2014;8(11):e3258. https://doi.org/10.1371/journal.pntd.0003258
17. Iddawela D, Vithana SMP, Atapattu D, Wijekoon L. Clinical and epidemiological characteristics of cutaneous leishmaniasis in Sri Lanka. BMC Infect Dis. 2018;18(1):108. https://doi.org/10.1186/s12879-018-2999-7
18. Belli A, García D, Palacios X, Rodriguez B, Valle S, Videa E et al. Widespread atypical cutaneous Leishmaniasis caused by Leishmania(L.) chagasi in Nicaragua. Am J Trop Med Hyg. 1999;61(3):380-5.
19. Araujo Flores GV, Sandoval Pacheco CM, Tomokane TY, Sosa Ochoa W, Zúniga Valeriano C, Castro Gomes CM et al. Evaluation of regulatory immune response in skin lesions of patients affected by nonulcerated or atypical cutaneous leishmaniasis in Honduras, Central America. Mediators Inflamm. 2018;2018:3487591. https://doi.org/10.1155/2018/3487591
20. Lyra MR, Pimentel MIF, Madeira MF, Antonio LF, Lyra JP, Fagundes A et al. Firt report of cutaneous leishmaniasis caused by Leishmania (Leishmania) infantum chagasi in an urban area of Rio de Janeiro, Brazil. Rev Inst Med Trop Sao Paulo. 2015;57(5):451-4. https://doi.org/10.1590/S0036-46652015000500016
21. Lindoso JAL, Moreira CHV, Celeste BJ, Oyafuso LKM, Folegatti PM, Zijlstra EE. Para-kala-azar dermal leishmaniasis in a patient in Brazil: a case report. Rev Soc Bras Med Trop. 2018;51(1):105-7. http://dx.doi.org/10.1590/0037-8682-0487-2016
22. Lindoso JA, Cota GF, da Cruz AM, Goto H, Maia-Elkhoury AN, Romero GA et al. Visceral leishmaniasis and HIV coinfection in Latin America. PLoS Negl Trop Dis. 2014;8(9):e3136. https://doi.org/10.1371/journal.pntd.0003136
23. Monge-Maillo B, Norman FF, Cruz I, Alvar J, López-Vélez R. Visceral leishmaniasis and HIV coinfection in the Mediterranean region. PLoS Negl Trop Dis. 2014;8(8):e3021. https://doi.org/10.1371/journal.pntd.0003021
24. Lindoso JA, Cunha MA, Queiroz IT, Moreira CH. Leishmaniasis-HIV coinfection: current challenges. HIV AIDS (Auckl). 2016;8:147-156. https://doi.org/10.2147/HIV.S93789
25. Alvar J, Aparicio P, Aseffa A, Den Boer M, Cañavate C, Dedet JP et al. The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev. 2008;21(2):334-59. https://doi.org/10.1128/CMR.00061-07
26. Madalosso G, Fortaleza CM, Ribeiro AF, Cruz LL, Nogueira PA, Lindoso JA. American visceral leishmaniasis: factors associated with lethality in the state of São Paulo, Brazil. J Trop Med. 2012; 2012:281572. https://doi.org/10.1155/2012/281572
27. Belo VS, Struchiner CJ, Barbosa DS, Nascimento BWL, Horta MAP, da Silva ES et al. Risk factors for adverse prognosis and death in American visceral leishmaniasis: a meta-analysis. PLoS Negl Trop Dis. 2014;8(7):e2982. https://doi.org/10.1371/journal.pntd.0002982
28. Costa DL, Rocha RL, Chaves EB, Batista VG, Costa HL, Costa CH. Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software. Rev Soc Bras Med Trop. 2016;49(6):728-40. https://doi.org/10.1590/0037-8682-0258-2016
29. Cota GF, de Sousa MR, Rabello A. Predictors of visceral leishmaniasis relapse in HIV-infected patients: a systematic review. PLoS Negl Trop Dis. 2011;5(6):e1153. https://doi.org/10.1371/journal.pntd.0001153
30. Romero GAS, Costa DL, Costa CHN, de Almeida RP, de Melo EV, de Carvalho SFG et al; Collaborative LVBrasil Group. Efficacy and safety of available treatments for visceral leishmaniasis in Brazil: A multicenter, randomized, open label trial. PLoS Negl Trop Dis. 2017;11(6):e0005706. https://doi.org/10.1371/journal.pntd.0005706
31. Cota GF, de Sousa MR, de Mendonça AL, Patrocinio A, Assunção LS, de Faria SR et al. Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil. PLoS Negl Trop Dis. 2014;8(4):e2816. http://dx.doi.org/10.1371/journal.pntd.0002816
32. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Manual de recomendações para diagnóstico, tratamento e acompanhamento de pacientes com a coinfecçãoLeishmania-HIV. Brasília (DF): Editora do Ministério da Saúde; 2011. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_pacientes_leishmania.pdf
33. Petri e Silva SC, Palace-Berl F, Tavares LC, Soares SR, Lindoso JA. Effects of nitro-heterocyclic derivatives against Leishmania (Leishmania) infantum promastigotes and intracellular amastigotes. Exp Parasitol. 2016;163:68-75. https://doi.org/10.1016/j.exppara.2016.01.007
34. da Costa-Silva TA, Galisteo AJ Jr, Lindoso JA, Barbosa LR, Tempone AG. Nanoliposomal buparvaquone immunomodulates Leishmania infantum-infected macrophages and is highly effective in a murine model. Antimicrob Agents Chemother. 2017;61(4):e02297-16. https://doi.org/10.1128/AAC.02297-16
2. World Health Organization. Control of the leishmaniasis: report of a meeting of theWHO Expert Committee on the Control of Leishmaniases. Geneva: World Health Organization; 2010. Disponível em: http://www.who.int/iris/handle/10665/44412
3. Argaw D, Mulugeta A, Herrero M, Nombela N, Teklu T, Tefera T et al. Risk factors for visceral Leishmaniasis among residents and migrants in Kafta-Humera, Ethiopia. PLoS Negl Trop Dis. 2013;7(11):e2543. http://dx.doi.org/10.1371/journal.pntd.0002543
4. Cerf BJ, Jones TC, Badaro R, Sampaio D, Teixeira R, Johnson WD Jr.. Malnutrition as a risk factor for severe visceral leishmaniasis. J Infect Dis. 1987;156(6):1030-3.
5. Mengesha B, Endris M, Takele Y, Mekonnen K, Tadesse T, Feleke A et al. Prevalence of malnutrition and associated risk factors among adult visceral leishmaniasis patients in Northwest Ethiopia: a cross sectional study. BMC Res Notes. 2014;7:75. http://dx.doi.org/10.1186/1756-0500-7-75
6. de Araújo VE, Pinheiro LC, Almeida MC, de Menezes FC, Morais MH, Reis IA et al. Relative risk of visceral leishmaniasis in Brazil: a spatial analysis in urban area. PLoS Negl Trop Dis. 2013;7(11):e2540. http://dx.doi.org/10.1371/journal.pntd.0002540
7. Badaró R, Jones TC, Lorenço R, Cerf BJ, Sampaio D, Carvalho EM et al. A prospective study of visceral leishmaniasis in an endemic area of Brazil. J Infect Dis. 1986;154(4):639-49.
8. Silveira FT, Lainson R, Crescente JA, de Souza AA, Campos MB, Gomes CM et al. A prospective study on the dynamics of the clinical and immunological evolution of human Leishmania (L.) infantum chagasi infection in the Brazilian Amazon region. Trans R Soc Trop Med Hyg. 2010;104(8):529-35. http://dx.doi.org/10.1016/j.trstmh.2010.05.002
9. Crescente JA, Silveira FT, Lainson R, Gomes CM, Laurenti MD, Corbett CE. A cross-sectional study on the clinical and immunological spectrum of human Leishmania (L.) infantum chagasi infection in the Brazilian Amazon region. Trans R Soc Trop Med Hyg. 2009;103(12):1250-6. http://dx.doi.org/10.1016/j.trstmh.2009.06.010
10. Ibarra-Meneses AV, Carrillo E, Sánchez C, García-Martínez J, López Lacomba D, San Martin JV et al. Interleukin-2 as a marker for detecting asymptomatic individuals in areas where Leishmania infantum is endemic. Clin Microbiol Infect. 2016;22(8):739.e1-4. http://dx.doi.org/10.1016/j.cmi.2016.05.021
11. van Griensven J, Diro E. Visceral leishmaniasis. Infect Dis Clin North Am. 2012;26(2):309-22. http://dx.doi.org/10.1016/j.idc.2012.03.005
12. Saporito L, Giammanco GM, De Grazia S, Colomba C. Visceral leishmaniasis: host-parasite interactions and clinical presentation in the immunocompetent and in the immunocompromised host. Int J Infect Dis. 2013;17(8):e572-6. http://dx.doi.org/10.1016/j.ijid.2012.12.024
13. Goto H, Prianti Md. Immunoactivation and immunopathogeny during active visceral leishmaniasis. Rev Inst Med Trop Sao Paulo. 2009;51(5):241-6. http://dx.doi.org/10.1590/S0036-46652009000500002
14. Lindoso JAL, Goto H. Leishmaniose visceral. In: Lopes AC. Tratado de Clínica Médica. 3 ed. Rio de Janeiro (RJ): Roca; 2016.
15. Zijlstra EE, Musa AM, Khalil EA, el-Hassan IM, el-Hassan AM. Post-kala-azar dermal leishmaniasis. Lancet Infec Dis 2003;3(2):87-98. https://doi.org/10.1016/S1473-3099(03)00517-6
16. Zijlstra EE. PKDL and other dermal lesions in HIV co-infected patients with Leishmaniasis: review of clinical presentation in relation to immune responses. PLoS Neg Trop Dis. 2014;8(11):e3258. https://doi.org/10.1371/journal.pntd.0003258
17. Iddawela D, Vithana SMP, Atapattu D, Wijekoon L. Clinical and epidemiological characteristics of cutaneous leishmaniasis in Sri Lanka. BMC Infect Dis. 2018;18(1):108. https://doi.org/10.1186/s12879-018-2999-7
18. Belli A, García D, Palacios X, Rodriguez B, Valle S, Videa E et al. Widespread atypical cutaneous Leishmaniasis caused by Leishmania(L.) chagasi in Nicaragua. Am J Trop Med Hyg. 1999;61(3):380-5.
19. Araujo Flores GV, Sandoval Pacheco CM, Tomokane TY, Sosa Ochoa W, Zúniga Valeriano C, Castro Gomes CM et al. Evaluation of regulatory immune response in skin lesions of patients affected by nonulcerated or atypical cutaneous leishmaniasis in Honduras, Central America. Mediators Inflamm. 2018;2018:3487591. https://doi.org/10.1155/2018/3487591
20. Lyra MR, Pimentel MIF, Madeira MF, Antonio LF, Lyra JP, Fagundes A et al. Firt report of cutaneous leishmaniasis caused by Leishmania (Leishmania) infantum chagasi in an urban area of Rio de Janeiro, Brazil. Rev Inst Med Trop Sao Paulo. 2015;57(5):451-4. https://doi.org/10.1590/S0036-46652015000500016
21. Lindoso JAL, Moreira CHV, Celeste BJ, Oyafuso LKM, Folegatti PM, Zijlstra EE. Para-kala-azar dermal leishmaniasis in a patient in Brazil: a case report. Rev Soc Bras Med Trop. 2018;51(1):105-7. http://dx.doi.org/10.1590/0037-8682-0487-2016
22. Lindoso JA, Cota GF, da Cruz AM, Goto H, Maia-Elkhoury AN, Romero GA et al. Visceral leishmaniasis and HIV coinfection in Latin America. PLoS Negl Trop Dis. 2014;8(9):e3136. https://doi.org/10.1371/journal.pntd.0003136
23. Monge-Maillo B, Norman FF, Cruz I, Alvar J, López-Vélez R. Visceral leishmaniasis and HIV coinfection in the Mediterranean region. PLoS Negl Trop Dis. 2014;8(8):e3021. https://doi.org/10.1371/journal.pntd.0003021
24. Lindoso JA, Cunha MA, Queiroz IT, Moreira CH. Leishmaniasis-HIV coinfection: current challenges. HIV AIDS (Auckl). 2016;8:147-156. https://doi.org/10.2147/HIV.S93789
25. Alvar J, Aparicio P, Aseffa A, Den Boer M, Cañavate C, Dedet JP et al. The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev. 2008;21(2):334-59. https://doi.org/10.1128/CMR.00061-07
26. Madalosso G, Fortaleza CM, Ribeiro AF, Cruz LL, Nogueira PA, Lindoso JA. American visceral leishmaniasis: factors associated with lethality in the state of São Paulo, Brazil. J Trop Med. 2012; 2012:281572. https://doi.org/10.1155/2012/281572
27. Belo VS, Struchiner CJ, Barbosa DS, Nascimento BWL, Horta MAP, da Silva ES et al. Risk factors for adverse prognosis and death in American visceral leishmaniasis: a meta-analysis. PLoS Negl Trop Dis. 2014;8(7):e2982. https://doi.org/10.1371/journal.pntd.0002982
28. Costa DL, Rocha RL, Chaves EB, Batista VG, Costa HL, Costa CH. Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software. Rev Soc Bras Med Trop. 2016;49(6):728-40. https://doi.org/10.1590/0037-8682-0258-2016
29. Cota GF, de Sousa MR, Rabello A. Predictors of visceral leishmaniasis relapse in HIV-infected patients: a systematic review. PLoS Negl Trop Dis. 2011;5(6):e1153. https://doi.org/10.1371/journal.pntd.0001153
30. Romero GAS, Costa DL, Costa CHN, de Almeida RP, de Melo EV, de Carvalho SFG et al; Collaborative LVBrasil Group. Efficacy and safety of available treatments for visceral leishmaniasis in Brazil: A multicenter, randomized, open label trial. PLoS Negl Trop Dis. 2017;11(6):e0005706. https://doi.org/10.1371/journal.pntd.0005706
31. Cota GF, de Sousa MR, de Mendonça AL, Patrocinio A, Assunção LS, de Faria SR et al. Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil. PLoS Negl Trop Dis. 2014;8(4):e2816. http://dx.doi.org/10.1371/journal.pntd.0002816
32. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Manual de recomendações para diagnóstico, tratamento e acompanhamento de pacientes com a coinfecçãoLeishmania-HIV. Brasília (DF): Editora do Ministério da Saúde; 2011. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_pacientes_leishmania.pdf
33. Petri e Silva SC, Palace-Berl F, Tavares LC, Soares SR, Lindoso JA. Effects of nitro-heterocyclic derivatives against Leishmania (Leishmania) infantum promastigotes and intracellular amastigotes. Exp Parasitol. 2016;163:68-75. https://doi.org/10.1016/j.exppara.2016.01.007
34. da Costa-Silva TA, Galisteo AJ Jr, Lindoso JA, Barbosa LR, Tempone AG. Nanoliposomal buparvaquone immunomodulates Leishmania infantum-infected macrophages and is highly effective in a murine model. Antimicrob Agents Chemother. 2017;61(4):e02297-16. https://doi.org/10.1128/AAC.02297-16
Publicado
2018-03-29
Como Citar
LINDOSO, J. A. L. (2018). Diversidade clínica e tratamento da leishmaniose visceral. Revista Do Instituto Adolfo Lutz, 77, 1-8. Recuperado de https://periodicoshomolog.saude.sp.gov.br/index.php/RIAL/article/view/34199
Edição
Seção
RESUMO EXPANDIDO DO SIMPÓSIO INTERNACIONAL - "LEISHAMANIOSE VISCERAL
