Forma mucosa da Leishmaniose Tegumentar Americana : estudo histopatológico e imuno-histoquímoco de casos do Hospital Universitário de Brasília

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

The American Integumentary Leishmaniasis (AIL) is a parasitic endemic disease, mainly in the Center-West region. Leishmania is a parasite that through its secreted and not secreted antigens trigger, respectively, a predominantly cellular immune response (innate and acquired) and to a lesser extent humoral. In the innate response, complement system, neutrophils, macrophages and natural killer cells work in an initial response. In this initial response, there is production of cytokines (IL-12, INF-γ and TNF-α) that activate T CD4+ and T CD8+ cells for acquired cellular immune response. The IL-12 action differentiates CD4 T cell to Th1 response and production of INF-γ, activation of macrophages and resolution of the disease. While the IL-4 has reverse effect directing to Th2 response with decreased activation of macrophages, this reaction prevents tissue damage and allows the persistence of the parasite. In this study, we have described patients with the mucosal form of AIL, they were treated in the University Hospital of Brasilia, analyzing epidemiological, clinical and laboratory data and correlating with the histopathologic features and the following immunohistochemical antibodies: CD45RO, CD4, CD8, CD20, CD15, CD68 and Bcl-2. Most common profile of patients: male, mean age 50 years, from Center-West region, with complaint of nasal obstruction and injury of nasal mucosa infiltrated with septum ulceration and perforation detected in the otorhinolaryngologic examination. Most of them with laboratory tests (indirect immunofluorescence, inoculation in hamster, smear, culture and Montenegro Skin Test) compatible with the disease, and in 44.44% of the cases it was possible the identification of Leishmania by some auxiliary method. In histopathology, in general, there was an inflammatory infiltrate lynphohistioplasmocitary sometimes accompanied by a granulomatous reaction with or without necrosis. The histopathological grades found were: ECR (exudative cellular reaction), ENR (exudative necrotic reaction), NEGR (necrotic-exudative granulomatous reaction) and EGR (exudative granulomatous reaction), the first one was the most frequent (66.67%) These classes are statistically significant (p <0.05) different when compared to each other with the amount of positive cells in immunohistochemistry, except between ENR and EGR classes (p>0.05). This study attested the applicability and practicality of the program UnBVision in quantitative analysis of cells in immunohistochemical reactions. In immunohistochemistry, the T cells were predominant on B cells, confirming that the disease as more cellular immune response than humoral, and in T cells, prevailed the CD4+ T on CD8+ T cells, except in only one instance case EGR. There was considerable expression of Bcl-2 in inflammatory infiltrate. In groups with previous contact with pentavalent antimony and presence of granulomas or Leishmania the histopathologic method were not statistically significant (p>0.05) to explain the difference in the number of positive cells for all markers used in the study. In further studies, the use of immunohistochemistry to identify the cytokines and markers pro and antiapoptosis can contribute to better explanations of the immunopathology of disease.

ASSUNTO(S)

imuno-histoquímica macrófago macrophage linfócitos t citokines histopathology immunohistochemistry citocina leishmaniasis t cell histopatologia ciencias da saude leishmaniose

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