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Revista Paraense de Medicina

Print version ISSN 0101-5907


SILVEIRA, Fernando T. et al. Revisiting the Pathogenesis of the American Tegumenyary Leishmaniasis in Amazonian, with emphasis to the disease due to Leishmania (V.) braziliensis and Leishmania (L.) amazonensis. Rev. Para. Med. [online]. 2008, vol.22, n.1, pp.9-20. ISSN 0101-5907.

SUMMARY The pathogenesis of American tegumentary leishmaniasis (ATL) was reviewed in the light of more recent features of clinical, histopathological and immunopathological spectrum of disease caused by Leishmania (V.) braziliensis and Leishmania (L.) amazonensis. This review has shown a dichotomy in the interaction between these two species of Leishmania with the human cellular immune response; while L. (V.) braziliensis shows a clear tendency to direct infection, from the localized cutaneous leishmaniasis (LCL) in the center of the clinical-immunological spectrum of disease, to the hyperactive immunologic pole represented by mucocutaneous leishmaniasis (MCL), which shows exacerbated hypersensitivity reaction and CD4 Th1-type immune response, L. (L.) amazonensis shows the opposite, directing infection to the hypoactive immunologic pole consisted by anergic diffuse cutaneous leishmaniasis (ADCL), associated with a marked inhibition of hypersensitivity reaction and CD4 Th2-type immune response. Between the central LCL and the two polar MCL and ADCL forms the infection may present an intermediary phase, borderline disseminated cutaneous leishmaniasis (BDCL), which shows partial inhibition of hypersensitivity reaction and a mixed CD4 Th1 plus Th2 immune response. These are probably the main immunological mechanisms regarding the immune response dichotomy that modulates the pathogenesis of ATL caused by these Leishmania parasites.

Keywords : American tegumentary leishmaniasis; Pathogenesis; Leishmania (Viannia) braziliensis; Leishmania (Leishmania) amazonensis; Amazon region; Brasil.

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