Parasitology Department, Evandro Chagas Institute (Surveillance Secretary of Health, Ministry of Health), Avenida Almirante Barroso, 492, 66090-000, Belém, PA, Brazil.
Trans R Soc Trop Med Hyg. 2010 Aug;104(8):529-35. doi: 10.1016/j.trstmh.2010.05.002. Epub 2010 Jun 9.
This prospective study was carried out from October 2003 to December 2005 and involved a cohort of 946 individuals of both genders, aged 1-89 years, from an endemic area for American visceral leishmaniasis (AVL), in Pará State, Brazil. The aim of the study was to analyze the dynamics of the clinical and immunological evolution of human Leishmania (L.) infantum chagasi infection represented by the following clinical-immunological profiles: asymptomatic infection (AI); symptomatic infection (SI=AVL); subclinical oligosymptomatic infection (SOI); subclinical resistant infection (SRI); and indeterminate initial infection (III). Infection diagnosis was determined by the indirect fluorescent antibody test and leishmanin skin test. In total, 231 cases of infection were diagnosed: the AI profile was the most frequent (73.2%), followed by SRI (12.1%), III (9.9%), SI (2.6%) and SOI (2.2%). The major conclusion regarding evolution dynamics was that the III profile plays a pivotal role from which the cases evolve to either the resistant, SRI and AI, or susceptible, SOI and SI, profiles; only one of the 23 III cases evolved to SI, while most evolved to either SRI (nine cases) or SOI (five cases) and eight cases remained as III.
本前瞻性研究于 2003 年 10 月至 2005 年 12 月在巴西帕拉州一个美洲内脏利什曼病（AVL）流行地区进行，共纳入了 946 名 1-89 岁的男女个体。研究目的是分析人类利什曼原虫（L.）婴儿 Chagasi 感染的临床和免疫演变动态，其代表了以下临床-免疫谱：无症状感染（AI）；症状性感染（SI=AVL）；亚临床寡症状感染（SOI）；亚临床抵抗性感染（SRI）；和初始感染不确定（III）。感染诊断通过间接荧光抗体试验和利什曼菌素皮肤试验确定。共诊断出 231 例感染：AI 谱最常见（73.2%），其次是 SRI（12.1%）、III（9.9%）、SI（2.6%）和 SOI（2.2%）。关于进化动态的主要结论是，III 谱起着关键作用，从 III 谱发展为抵抗性 SRI 和 AI，或易感性 SOI 和 SI 谱；23 例 III 中仅有一例发展为 SI，而大多数发展为 SRI（9 例）或 SOI（5 例），8 例仍为 III。
