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Comparative histological and immunohistochemical changes of dry type cutaneous leishmaniasis after administration of meglumine antimoniate, imiquimod or combination therapy.
Arch Iran Med. 2011 Jul; 14(4):238-43.AI

Abstract

BACKGROUND

This study compared histological and immunohistochemical changes of cutaneous leishmaniasis treated with meglumine antimoniate, imiquimod, and the combination of both therapies.

METHODS

Single blind clinicopathological studies of fifteen patients with old world cutaneous leishmaniasis in Kerman, Iran were included. A total of four patients received a combination of imiquimod (5% cream) and intra-lesional meglumine antimoniate weekly for four weeks. Monotherapy with imiquimod was given to seven patients and four patients were treated with meglumine antimoniate intralesionally. Histological confirmation was performed before and during therapy. Semi-quantitative histological parameters such as numbers of mixed inflammatory cells (cells/mm(2)) and percentages of Langerhans cells (CD1a+), T-cells (CD3+), B-cells (CD20+), and macrophages (CD68+) were calculated immunohistochemically in the dermis and adjacent epidermis.

RESULTS

Topical imiquimod significantly reduced mean histiocytic cellular aggregation size (P<0.05). Meglumine antimoniate reduced parasite load and infected activated histiocytes in the dermis (P<0.05). Meglumine antimoniate therapy decreased epidermal CD3+ lymphocytes but increased them in the dermis, within the granulomas (P<0.05). During topical application of imiquimod a depletion of CD1a+ dendritic cells in the epidermis (P<0.05) and slight predominance of dendritic cells in the dermis were observed. Combined therapy and imiquimod monotherapy decreased CD68+ macrophages in the dermis (P<0.05).

CONCLUSION

Meglumine antimoniate decreases parasite load with considerable effect on up-regulation of T-cells, which demonstrates that meglumine antimoniate works as parasitocidal and immunomodulator, which could be a first line of treatment. Imiquimod accentuates the host immune response and reduces granuloma size which could be effective immunomodulator for combination therapy. Monotherapy of imiquimod is less effective than the two other regimens in decreasing parasite load, inflammation and congestion at the inoculated site.

Authors+Show Affiliations

Dermatology Department, Afzalipour Medical School, Kerman University of Medical Science, Kerman, Iran. meymandi_s@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21726098

Citation

Shamsi Meymandi, Simin, et al. "Comparative Histological and Immunohistochemical Changes of Dry Type Cutaneous Leishmaniasis After Administration of Meglumine Antimoniate, Imiquimod or Combination Therapy." Archives of Iranian Medicine, vol. 14, no. 4, 2011, pp. 238-43.
Shamsi Meymandi S, Javadi A, Dabiri S, et al. Comparative histological and immunohistochemical changes of dry type cutaneous leishmaniasis after administration of meglumine antimoniate, imiquimod or combination therapy. Arch Iran Med. 2011;14(4):238-43.
Shamsi Meymandi, S., Javadi, A., Dabiri, S., Shamsi Meymandi, M., & Nadji, M. (2011). Comparative histological and immunohistochemical changes of dry type cutaneous leishmaniasis after administration of meglumine antimoniate, imiquimod or combination therapy. Archives of Iranian Medicine, 14(4), 238-43. https://doi.org/0011144/AIM.003
Shamsi Meymandi S, et al. Comparative Histological and Immunohistochemical Changes of Dry Type Cutaneous Leishmaniasis After Administration of Meglumine Antimoniate, Imiquimod or Combination Therapy. Arch Iran Med. 2011;14(4):238-43. PubMed PMID: 21726098.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative histological and immunohistochemical changes of dry type cutaneous leishmaniasis after administration of meglumine antimoniate, imiquimod or combination therapy. AU - Shamsi Meymandi,Simin, AU - Javadi,Abdolreza, AU - Dabiri,Shahriar, AU - Shamsi Meymandi,Manzumeh, AU - Nadji,Mehrdad, PY - 2011/7/6/entrez PY - 2011/7/6/pubmed PY - 2012/3/3/medline SP - 238 EP - 43 JF - Archives of Iranian medicine JO - Arch Iran Med VL - 14 IS - 4 N2 - BACKGROUND: This study compared histological and immunohistochemical changes of cutaneous leishmaniasis treated with meglumine antimoniate, imiquimod, and the combination of both therapies. METHODS: Single blind clinicopathological studies of fifteen patients with old world cutaneous leishmaniasis in Kerman, Iran were included. A total of four patients received a combination of imiquimod (5% cream) and intra-lesional meglumine antimoniate weekly for four weeks. Monotherapy with imiquimod was given to seven patients and four patients were treated with meglumine antimoniate intralesionally. Histological confirmation was performed before and during therapy. Semi-quantitative histological parameters such as numbers of mixed inflammatory cells (cells/mm(2)) and percentages of Langerhans cells (CD1a+), T-cells (CD3+), B-cells (CD20+), and macrophages (CD68+) were calculated immunohistochemically in the dermis and adjacent epidermis. RESULTS: Topical imiquimod significantly reduced mean histiocytic cellular aggregation size (P<0.05). Meglumine antimoniate reduced parasite load and infected activated histiocytes in the dermis (P<0.05). Meglumine antimoniate therapy decreased epidermal CD3+ lymphocytes but increased them in the dermis, within the granulomas (P<0.05). During topical application of imiquimod a depletion of CD1a+ dendritic cells in the epidermis (P<0.05) and slight predominance of dendritic cells in the dermis were observed. Combined therapy and imiquimod monotherapy decreased CD68+ macrophages in the dermis (P<0.05). CONCLUSION: Meglumine antimoniate decreases parasite load with considerable effect on up-regulation of T-cells, which demonstrates that meglumine antimoniate works as parasitocidal and immunomodulator, which could be a first line of treatment. Imiquimod accentuates the host immune response and reduces granuloma size which could be effective immunomodulator for combination therapy. Monotherapy of imiquimod is less effective than the two other regimens in decreasing parasite load, inflammation and congestion at the inoculated site. SN - 1735-3947 UR - https://www.unboundmedicine.com/medline/citation/21726098/Comparative_histological_and_immunohistochemical_changes_of_dry_type_cutaneous_leishmaniasis_after_administration_of_meglumine_antimoniate_imiquimod_or_combination_therapy_ L2 - http://www.ams.ac.ir/AIM/NEWPUB/11/14/4/003.pdf DB - PRIME DP - Unbound Medicine ER -