Leishmaniasis: A new method for confirming cure and detecting asymptomatic infection in patients receiving immunosuppressive treatment for autoimmune disease

PLoS Negl Trop Dis. 2021 Aug 2;15(8):e0009662. doi: 10.1371/journal.pntd.0009662. eCollection 2021 Aug.

Abstract

Visceral leishmaniasis (VL) in patients receiving immunosuppressant drugs for autoimmune disease has been on the rise. It is important-but difficult-to know when cure has been achieved in these patients since the withdrawal of immunosuppressants during antileishmania treatment is commonly required, and there is a risk of relapse when immunosuppression is restored. The prevalence of asymptomatic infection among those immunosuppressed for autoimmune disease is also uncertain. The present work describes how cytokine release assays can be used to confirm the cure of VL, and to determine the prevalence of asymptomatic infection, in such patients. After collection of blood from volunteers (n = 108), SLA-stimulation of peripheral blood mononuclear cell cultures and of whole blood was found to induce the production of different combinations of cytokines that served to confirm recovery from VL, and asymptomatic Leishmania infection. Indeed, cure was confirmed in 14 patients, all of whom showed a specific Th1 immune response against Leishmania, and the prevalence of asymptomatic infection was determined as 21.27%. Cytokine profiles could be used to manage VL in patients with autoimmune disease, and to identify and better protect those with asymptomatic infection who are at risk of developing this disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Protozoan / blood
  • Asymptomatic Infections
  • Autoimmune Diseases / drug therapy
  • Clinical Laboratory Techniques / methods*
  • Cytokines / metabolism*
  • Drug Monitoring / methods*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Leishmaniasis / diagnosis*
  • Leishmaniasis / epidemiology
  • Leukocytes, Mononuclear / immunology*
  • Middle Aged

Substances

  • Antibodies, Protozoan
  • Cytokines
  • Immunosuppressive Agents

Grants and funding

This study was funded by the Instituto de Salud Carlos III through two ISCIII-AES projects: PI18CIII/00028 and DTS16III10. EC was supported by a contract from RD16CIII/0003/0002 Red de Enfermedades Tropicales, Subprograma RETICS del Plan Estatal de I+D+I 2013–2016, co-funded by FEDER “Una manera de hacer Europa” funds. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.