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• Rev. Soc. Bras. Med. Trop. 18 (4) • Dec 1985 • https://doi.org/10.1590/S0037-86821985000400004   copy

The use of different concentrations of leishmanial antigen in skin testing to evaluate delayed hypersensitivity in american cutaneous leishmaniasis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Three concentrations of Leishmania mexicana amazonensis sonicated whole promastigote antigen (30, 9.6 and 3 ug N in 0.1 ml) wereprepared and 0.1 ml of each inoculated intradermally intopatients who live in one endemic leishmaniasis region in Brazil. Patients were divided into groups with active cutaneous leishmaniasis (ACL), healed cutaneous leishmaniasis (HCL), mucosal leishmaniasis (ML), and Controls (C). Skin reactions were recorded by measuring induration 48 hours after inoculation. Skin tests using 9.6 ugN/0.1 mlyielded the best diagnostic resultssince 97% of 30 patients with active lesions (cutaneous or mucosal) and 83% with HCL showed reactions of 5 mm orgreater as compared with 4% Controls. Tests using 30ug N/O. 1 ml causedan unacceptable levei of skin reactions with necrosis (10% of ACL patients tested and 17% of HCL, respectively). Tests using 3 ug N/O. 1 ml were less sensitive since only 87% of patients with active lesions and 68% with HCL had reactions of 5mm orgreater. The 3 ug N/O. 1 ml dose was utilized to ask the questions whether skin delayed hypersensitivity decreased with time after the initial lesion and whether mucosal involvement is associated with enhaced hypersensitivity to leishmanial antigen. Decreased delayed hypersensitivity was noted only in those patients who had an initial lesion more than 30 years ago. The mean induration of the reaction in 10 patients with ML was 11.3 mm ± 7.15, in 41 patients with HCL, 9.27 mm ± 6.78 and in 20patients with ACL 10. 7 mm ± 6.10 mm. The percent of patients with 5 mm orgreater induration was ML 80%, HCL 71%, ACL 90%. Thus, we could not confirm an association between enhanced delayed hypersensitivity and mucosal involvement in leishmaniasis.

Skin test comparison; Antigen concentrations; Clinical forms; American mucocutaneous leishmaniasis

ARTICLES

The use of different concentrations of leishmanial antigen in skin testing to evaluate delayed hypersensitivity in american cutaneous leishmaniasis

César A. Cuba CubaI; Philip D. MarsdenI; Air C. BarrettoI; Thomas C. JonesII; Frank RichardsII

IFaculdade de Ciências da Saúde. Núcleo de Medicina Tropical. Universidade de Brasília. Brasília, Brazil

IIComell University Medical College, New York, USA

ABSTRACT

Three concentrations of Leishmania mexicana amazonensis sonicated whole promastigote antigen (30, 9.6 and 3 ug N in 0.1 ml) wereprepared and 0.1 ml of each inoculated intradermally intopatients who live in one endemic leishmaniasis region in Brazil. Patients were divided into groups with active cutaneous leishmaniasis (ACL), healed cutaneous leishmaniasis (HCL), mucosal leishmaniasis (ML), and Controls (C). Skin reactions were recorded by measuring induration 48 hours after inoculation.

Skin tests using 9.6 ugN/0.1 mlyielded the best diagnostic resultssince 97% of 30 patients with active lesions (cutaneous or mucosal) and 83% with HCL showed reactions of 5 mm orgreater as compared with 4% Controls. Tests using 30ug N/O. 1 ml causedan unacceptable levei of skin reactions with necrosis (10% of ACL patients tested and 17% of HCL, respectively). Tests using 3 ug N/O. 1 ml were less sensitive since only 87% of patients with active lesions and 68% with HCL had reactions of 5mm orgreater.

The 3 ug N/O. 1 ml dose was utilized to ask the questions whether skin delayed hypersensitivity decreased with time after the initial lesion and whether mucosal involvement is associated with enhaced hypersensitivity to leishmanial antigen. Decreased delayed hypersensitivity was noted only in those patients who had an initial lesion more than 30 years ago. The mean induration of the reaction in 10 patients with ML was 11.3 mm ± 7.15, in 41 patients with HCL, 9.27 mm ± 6.78 and in 20patients with ACL 10. 7 mm ± 6.10 mm. The percent of patients with 5 mm orgreater induration was ML 80%, HCL 71%, ACL 90%. Thus, we could not confirm an association between enhanced delayed hypersensitivity and mucosal involvement in leishmaniasis.

Keywords: Skin test comparison. Antigen concentrations. Clinical forms. American mucocutaneous leishmaniasis.

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Recebido para publicação em 26/9/84.

* This work was supported by NIH Grant AI 16282 and by the Conselho Nacional de Pesquisas (CNPq, PIDE V 403682/82), the Brazilian Ministry of Health (SUCAM) and UNDP/WORLD BANK/WHO Special programme for research and Training in Tropical Disease (TDR).

  • 1. Ashton DL, Thorley AP. Leishmaniasis in Central Brazil. Results of a Montenegro skin test survey among Amerindians in the Xingu National Park. Transactions of the Royal Society of Tropical Medicine and Hygiene 64: 671, 1970.
  • 2. Azulay RD, Salgado U. Surto epidêmico da leishmaniose tegumentar em pára-quedistas do Exército no Amazonas. Medicina Cutânea 1: 347, 1966.
  • 3. Barbosa W. Souza MCM, Rassi DM, Oliveira RL, Mota L. Investigação sobre imunologia da leishmaniose tegumentar americana. 1. Intradermorreação concomitante com antígenos de Leptomonas pessoai e L. braziliensis Revista de Patologia Tropical 1: 377-383, 1972.
  • 4. Barretto AC, Cuba CAC, Marsden PD, Vexenat JA, De Belder M. Características epidemiológicas de leishmaniose tegumentar americana em uma região endêmica do Estado da Bahia, Brasil. I. Leishmaniose humana. Boletim Oficina Sanitaria Panamericana 90: 415-424 1981.
  • 5. Bittencourt AL, Andrade ZA. Aspectos immunopatológicos na leishmaniose cutaneomucosa. Hospital 71: 975-984, 1967.
  • 6. Bray RS. Leishmaniasis. In: Houba V (ed)Immunological investigation of Tropical parasitic diseases. Churchill Livingstone, New York. p. 66-74, 1980.
  • 7. Cuba CA. Leishmaniose tegumentar em area endêmica do Estado da Bahia. Caracterização e classificação de Leishmania no homem e cão doméstico e aspectos comportamentais de L. braziliensis braziliensis Tese de Doutoramento. Universidade Federal de Minas Gerais. Belo Horizonte-MG. Brasil. 1983.
  • 8. Fonseca JM, Lacaz CS, Machado PA. Inquérito imunoalérgico na Amazônia. Resultados preliminares. Revista do Instituto de Medicina Tropical de São Paulo 15: 409-416, 1973.
  • 9. Furtado TA. Critérios para o diagnóstico da Leishmaniose Tegumentar Americana. Anais Brasileiros de Dermatologia 55: 81-86, 1980.
  • 10. Goa A. A microbiuret method for protein determination of total protein in cerebrospinal íluid. Scandinavian Journal of Clinical Investigation 5: 218-223. 1953.
  • 11. Heyneman D. Immunology of Leishmaniasis. Bulletin of the World Health Organization 44: 499-514. 1971.
  • 12. Martins AV. Barreto MP, Brener Z, Pellegrino J. Observações preliminares sobre um foco de leishmaniose tegumentar americana em Minas Gerais. Revista Brasileira de Malariologia e Doenças Tropicais 8: 577-581, 1956.
  • 13. Marsden PD, Nonata RR. Mucocutaneous Leishmaniasis. A review of clinical aspects. Revista da Sociedade Brasileira de Medicina Tropical 6: 309-326, 1975.
  • 14. Marzochi MCA, Coutinho SG, Sabroza PC, Souza WI. Reação de imunofluorescência indireta e intradermorreação para leishmaniose tegumentar americana em moradores na área de Jacarepaguá, Rio de Janeiro. Estudo comparativo dos resultados em 1974 e 1978. Revista do Instituto de Medicina Tropical de São Paulo 22: 149-155, 1980.
  • 15. Mayrink W, Melo MN, Da Costa CA, Magalhães SA, Dias PA, Coelho M, Araújo MV, Williams FG, Figueiredo UP, Batista SM. Intradermorreação de Montenegro na leishmaniose tegumentar americana após terapeutica antimonial. Revista do Instituto de Medicina Tropical de São Paulo 18: 182-185, 1976.
  • 16. Melo MN, Mayrink W, Da Costa CA, Magalhães PA, Dias M, Williams P, Araújo FG, Coelho MV, Batista SM. Padronização do antígeno de Montenegro. Rçvista do Instituto de Medicina Tropical de São Paulo 19: 161-164, 1977.
  • 17. Menezes JA. Leishmaniose tegumentar no Estado do Rio de Janeiro, Tese de Mestrado, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 1976.
  • 18. Montenegro J. Cutaneous reactions in leishmaniasis. Archives ofDermatology and Syphilis 13: 187-194,1926.
  • 19. Pampaglione S, Manson Bahr PEC, La Placa M, Borgatti MA, Micheloni F. Studies on Mediterranean Leishmaniasis. IV. The Leishmanin skin test in cutaneous Leishmaniasis. Transactions of the Rnyal Society of Tropical Medicine and Hygiene 70: 62-65, 1976.
  • 20. Pellegrino J, Pereira LH, Furtado TA. Mucocutaneous leishmaniasis intradermal test with a promastigote suspension and a crude extract from Leishmania braziliensis. Revista do Instituto de Medicina Tropical de São Paulo 19: 393-396, 1977.
  • 21. Pessoa SB, Pestana BR. A intradermorreação de Montenegro nas campanhas sanitárias contra a leishmaniose. São Paulo Médico. 15: 133-151, 1940.
  • 22. Pessoa SB, Cardoso FA. Nota sobre a imunidade cruzada na leishmaniose tegumentar e na moléstia de Chagas. O Hospital 21: 187-193, 1942.
  • 23. Pessoa SB, Barreto MP. Leishmaniose tegumentar americana. Imprensa Nacional, Rio, 1948.
  • 24. Rotberg A. Contribuição para o estudo da alergia na leishmaniose tegumentar americana. Tese, Universidade de São Paulo, São Paulo, 1951.
  • 25. Ridley DS. A histological classification of cutaneous leishmaniasis and its geographical expression. Transactions of the Royal Society of Tropical Medicine and Hygiene 74: 515-521, 1980.
  • 26. Sabroza PC, Wagner MS, Sobrero N. Inquérito epidemiológico de leishmaniose tegumentar americana em Jacarepaguá, Rio de Janeiro. In: Resumo do XI Congresso da Sociedade Brasileira de Medicina Tropical, Rio de Janeiro, 1975.
  • 27. Shaw JJ, Lainson R. Leishmaniasis in Brazil. X. Some Observations on intradermal reactions to different trypanosomatid antigens of patients suffering from cutaneous and mucocutaneous leishmaniasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 69: 323-335, 1975.
  • 28. Wagener EH. A skin reaction to extracts of Leishmania tropica and Leishmania infantum University of Califórnia Publications in Zoology. 20: 473-488, 1923.

Publication Dates

  • Publication in this collection
    07 June 2013
  • Date of issue
    Dec 1985

History

  • Accepted
    26 Sept 1984
  • Received
    26 Sept 1984
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