Correlation between local immune response and clinical course in cutaneous leishmaniasis due to L. braziliensis: A systematic review
DOI:
https://doi.org/10.5281/zenodo.17795810Keywords:
Leishmania braziliensis, Cutaneous leishmaniasis, Immunopathology, Cytotoxicity, Inflammasomes, Systematic reviewAbstract
Background: Cutaneous leishmaniasis (CL) caused by Leishmania (Viannia) braziliensis presents a variable clinical spectrum, from localized ulcers to destructive mucosal forms. Antimonial treatment failure is a growing problem. Unlike other models, pathology in L. braziliensis CL appears driven by an exacerbated inflammatory response rather than immunodeficiency.
Objective: To systematically analyze recent scientific evidence on the correlation between local immune-response profiles (in the lesion) and clinical course (healing, failure, chronicity) in patients with L. braziliensis CL.
Methods: A systematic review followed PRISMA 2020. Original observational studies published 2016–2024 were searched in PubMed, Scopus, LILACS and Web of Science. Studies evaluating immunologic markers directly in human lesions and correlating them with clinical outcomes were included. Quality was assessed with the Newcastle–Ottawa Scale.
Results: Of 526 records identified, 24 met inclusion criteria. Synthesis showed therapeutic failure and chronicity consistently associated with an exacerbated cytotoxic response (high Granzyme B, NKG2D and lytic-pathway gene expression), NLRP3 inflammasome activation and sustained IL-1β production. An immunosenescence signature (senescent T and NK cells) was identified in chronic lesions. Healing was characterized by early regulation of inflammation, not by a greater proinflammatory response.
Conclusions: Immunopathology in L. braziliensis CL is driven by a dysregulated, senescent Th1/cytotoxic response, not by a Th2 response. These findings suggest host-directed therapies that modulate inflammation may be essential adjuvants to improve prognosis.
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Copyright (c) 2025 Djean Carlos de Mello dos Santos, Paulo Roberto de Souza Filho, Carlos André Jales Rocha, Ivaniza Leão Santana da Silva Costa, Luiz Henrique Lira Fernandes, Mateus Silva Fernandes, João Lucas Viginotti Souza, Andrea Paola Britos Gómez (Autor/a)
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