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How I Treat... Leishmaniasis Using Immunosuppressive Drugs
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Before addressing the use of immunosuppressive drugs in leishmaniosis, the altered immunity that causes this disease should be reminded. An homogeneous pattern of the immune response to Leishmania cannot be defined because there are very significant differences that are related to the parasite species and the infected animal, as evidenced by the weak humoral response in skin infections and high antibody titers with the visceral involvement, or the existence of dogs that are naturally resistant to the disease and do not even get to suffer it or resolve it spontaneously; however, the involvement of cellular and humoral immune mechanisms it is a common feature throughout the course of the disease.
The immune response to infection by Leishmania can be broken down into three sections: The primary response at the entry point, Th1 response and Th 2 response. The latter two are predominantly cell responses directed by the T helper lymphocytes and represent two evolutionary types: Th 1 is associated with increased specific lymphoproliferation with moderate or low levels of immunoglobulins and a favorable progression, and Th2 is associated with a diminished specific lymphoproliferation, very high levels of immunoglobulins and a clinical course. Progression towards one or the other type of response appears to be strongly influenced by the type of cytokines released in the earliest stages of infection. It was found that the in vivo depletion of IFN-gamma with monoclonal antibodies blocks the Th1 response and promotes de Th2, while the absence of IL-4 favours the Th1 or that IL-12 causes the Th1 response. […]
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