Cell-mediated immunity in American visceral leishmaniasis: reversible immunosuppression during acute infection

Cell-mediated immunity was assessed in 14 Brazilian patients with acute untreated American visceral leishmaniasis (AVL) and in 11 healthy patients successfully treated 1 to 14 years previously. The diagnosis of AVL was established by demonstration of leishmania in bone marrow aspirates. The responsiveness of peripheral blood mononuclear cells to Leishmania chagasi antigens and phytohemagglutinin was studied in vitro. Soluble preparations of L. chagasi antigens were obtained from frozen-thawed promastigote cultures. L. chagasi antigen-stimulated lymphocytes from untreated AVL patients were unresponsiveness and incorporated a mean of 1.2 +/- 0.5 X 10(-3) cpm after a [3H]thymidine pulse. The cured AVL patients had 19.1 +/- 7.2 cpm, and 15 normal control subjects had 0.8 +/- 0.1 cpm. There were no differences in the response of controls and either untreated or cured AVL patients to phytohemagglutinin stimulation. Three of four untreated AVL patients responded to L. chagasi antigens when studied 2 to 4 weeks after therapy. The impaired response of lymphocytes from untreated AVL patients could not be attributed to either reduced numbers of circulating T cells or the inhibitory effect of monocytes or serum factors.