Protozoa are among the most important pathogens that can cause infections in immunocompromised hosts. These microorganisms particularly infect individuals with impaired cellular immunity, such as those with hematological neoplasias, renal or heart transplant patients, patients using high doses of corticosteroids, and patients with acquired immunodeficiency syndrome. The protozoa that most frequently cause disease in immunocompromised patients are Toxoplasma gondii, Trypanosoma cruzi, different Leishmania species, and Cryptosporidium parvum; the first two species cause severe acute meningoencephalitis and acute myocarditis, Leishmania sp. causes mucocutaneous or visceral disease, and Cryptosporidium can lead to chronic diarrhea with hepatobiliary involvement. Various serological, parasitological, histological and molecular methods for the diagnosis of these infections are currently available and early institution of specific therapy for each of these organisms is a basic measure to reduce the morbidity and mortality associated with these infections.

/pdf/some-aspects-of-protozoan-infections-in-immunocompromised-13grrrl24t.pdf

Some Aspects of Protozoan Infections in Immunocompromised Patients: A Review

Publisher Summary Trypanosoma cruzi (T. cruzi), the causative agent of Chagas disease, is a digenetic trypanosomatid, which circulates in the bloodstream of the vertebrate host as trypomastigotes and has an obligatory intracellular phase in which the parasite multiplies as amastigotes, which differentiate into trypomastigotes. From an immunological point of view, therefore, the parasite presents stages that are directly exposed to the effector elements of the immune response, such as antibodies and macrophages, as well as stages that are sequestrated within host cells. T. cruzi infection is characterized by an acute phase with large numbers of parasites and by a sub-patent chronic phase in which circulating and tissue stages are difficult to detect. The mechanisms involved in the resistance to the parasite and in the control of parasitism during the chronic phase are not known. Chagas disease is life-long and spontaneous cures do not occur. There is increasing evidence that auto-immune processes participate in the pathogenesis of the cardiac and digestive forms of the disease. These many obscure aspects and challenging problems explain the increasing use of T. cruzi as a model for the study of humoral and cellular immunity in both basic and applied immunology.

Immunity to Trypanosoma cruzi.

Presentation des connaissances actuelles concernant l'immunobiologie de la relation hote-parasite chez l'infection de la souris par Trypanosoma cruzi. L'etude porte sur les modifications subies par le systeme immunitaire de l'animal parasite et non pas sur les mecanismes de l'immunite

Immunobiology of Murine T Cruzi Infection: The Predominance of Parasite-nonspecific Responses and the Activation of TCRIT Cells

The contribution of T-cell subpopulations to immunopathology in murine Trypanosoma cruzi infection was studied by using in situ localization of lymphocytes and in vivo depletion of T-lymphocyte populations. CD8+ T cells were the major lymphocyte population in the inflamed hearts of C3H/HeSnJ mice infected with the Sylvio X10/4 clone of T. cruzi at all time points of the acute and chronic phases of the infection examined. Depletion of CD8+ and/or CD4+ T cells beginning on day 20 of the infection resulted in a moderate decrease in the inflammation and an increase in parasite burden in the hearts of mice at day 30 of infection. Longer-term depletion, beginning at day 20 and extending as long as 200 days of infection, resulted in an increased inflammatory response in the heart. A large proportion of the inflammatory cells in the hearts of anti-CD8- or anti-CD4- and anti-CD8-treated mice were Thy1+ and CD4- CD8-. At 200 days of infection, the increased inflammation was accompanied by an increase in the parasite load in the heart. These results show that T-cell subset depletion does not prevent the inflammatory response associated with acute and chronic T. cruzi infection. The increased parasite load in T-cell-depleted mice also demonstrates the participation of these T-cell subsets in regulation of parasite load throughout the course of the infection. The increased inflammatory response despite T-cell depletion and in association with increased numbers of tissue parasites suggests that intracellular parasites are a driving force behind the inflammatory response in chronic murine T. cruzi infection.

Depletion of T-cell subpopulations results in exacerbation of myocarditis and parasitism in experimental Chagas' disease.

The notion that the pathology of Chagas’ disease has an autoimmune component was initially based on the finding of circulating antibodies binding heart tissue antigens in patients and mice chronically infected with Trypanosoma cruzi. Later, T lymphocytes reactive with heart or nerve tissue antigens were found in chagasic mice and patients, extending the concept to include cell-mediated immunity. However, there is disagreement about whether the observed immunologic autoreactivities are triggered by T. cruzi epitopes and then affect host tissue antigens by virtue of molecular mimicry or are elicited by host antigens exposed to lymphocytes after tissue damage caused by the parasite. There is also disagreement about the relevance of immunologic autoreactivities to the pathogenesis of Chagas’ disease because of the lack of reproducibility of some key reports supporting the autoimmunity hypothesis, conflicting data from independent laboratories, conclusions invalidated by advances in our understanding of the immunologic mechanisms underlying cell lysis, and, last but not least, a lack of direct, incontrovertible evidence that cross-reacting antibodies or autoreactive cells mediate the typical pathologic changes associated with human Chagas’ disease. The data and views backing and questioning the autoimmunity hypothesis for Chagas’ disease are summarized in this review.

https://cmr.asm.org/content/cmr/12/2/210.full.pdf

Chagas’ Disease and the Autoimmunity Hypothesis

The effects of some immunosuppressive agents (gamma radiation, cyclophosphamide, Imuran and 6-mercaptopurine) administered, in the course of chronic Chagas's disease, to mice experimentally inoculated with different strains of Trypanosoma cruzi, have been studied Gamma radiation and cyclophosphamide could induce, in mice inoculated with the “CL” strain, a fresh acute phase with outbreaks of high parasitaemia and a high mortality rate, whereas no increase of parasitaemia has been observed in animals inoculated with strains “Y,” “Berenice” and “PNM” and similarly treated during the chronic phase Imuran and 6-mercaptopurine were not able to alter the course of experimental chronic Chagas's disease Some factors accounting for the differences observed in animals inoculated with different strains of T cruzi and submitted to immunosuppressive agents have been discussed

Z. Brener

Papers

The effects of some immunosuppressive agents in experimental chronic Chagas's disease☆