المستخلص:
This study was carried on 145 patients infected with leishmaniasis including; 75 with CL, 70 with VL, attending Al - Karama Teaching Hospital, Central Public Health Laboratory and Central Pediatric Teaching Hospital, during the period October 2013 to February 2014 were enrolled in this study, in addition to 30 healthy control collected from the National Center for blood donation for the same age groups for a group of patients. No clinical autoimmune manifestations such as arthralgia or cutaneous vasculitis were reported in any patients. Based on direct skin smear examination and serum samples analysis, the patients were distributed into two clinical groups : 30 patients suffering from cutaneous leishmaniasis and 30 patients suffering from visceral leishmaniasis patients.The presented study aimed to confirmation of diagnosis cutaneous leishmaniasis depending on direct skin smear and visceral leishmaniasis based on indirect immunofluorescent assay test IFAT, then investigate the association of IgG autoantibodies against some antigens, especially : nuclear antigens, like : ds - DNA, nucleosome, histones, SmD1, PCNA, ribosomal P0, SS - A/Ro60kD, SS - A/Ro52kD, SS - B/La, CENP - B, Scl70, U1 - snRNP, AMA M2, Jo1, PM - Scl, Mi - 2, Ku and against cardiolipin, in order to correlate the types of diseases presentation (cutaneous or visceral) with the presence of these autoantibodies in a sample of Iraqi patients.The study was reached to the following results : 1. The direct microscopically examination of skin smear in CL patients, showed positive results in 30 cases (40.0%) compared to 45 cases (60.0%) negative results, and was a significant difference at the level of (P?0.05).2. The anti - leishmanial antibodies by Indirect immunofluorescent assay test in VL patients, showed positive results in 30 cases (42.9%) compared to 45 cases (57.1%) negative results, and was a highly significant difference at the level of (P? 0.01).3. The age groups most affected in CL were 16 to 40 years, with high significant differences at the level of (P? 0.01) were observed when compared with the other age groups. As for patients with VL, who aged between 3 months to 9 years, they showed variable significant differences between age groups in female while there were no significant differences in male at the level of (P?0.01). The majority of patients were aged 3 to 4 years and they represent 9 (30.0%). The study result showed 16 CL patients (53.3%) have only one lesion, while 11 patients (36.7%) have 2 to 9 lesions and only 3 cases (10%) have ? 10 lesions in different sites of their bodies. There were elevated high significant differences at the level of (P?0.01) when compared between the groups. And 21 cases (70%) have infected for ? two months, and the remaining 9 cases get their infection for > 2 months duration. There were increased high significant differences observed at the level of (P?0.01) when compared between the groups. Dry lesions recorded superiority in 20 (66.7%) of the CL cases, and other 10 (33.3%) have been diagnosed as a wet lesions. There were elevated high significant differences observed at the level of (P?0.01) when compared between the two types of the lesion. And The upper limbs were the dominant site of lesions in the CL cases, 15 (39.4%) of the cases had their lesions in one or both hands, followed by the lower limbs in 11 (29.0%) cases and the less frequent site of infection was the face in only 4 (10.5%) cases and 8 (21.0%) cases common lesions. The results showed obvious high significant differences at (P? 0.01) between the groups.4. For the tests of the autoantibodies, the anti - ds - DNA antibody was positive only in one patients (3.3%) with CL of the total (30) patients, while tests of the rest 29 (96.7%) were negative, while in VL of the total (30) patients, 9 patients (30.3%) were positive and 21 (70.0%) were negative. The anti - ds - DNA in leishmaniasis patients were highly significant at the level of (P?0.01) when compared between the study groups. As for the anti - nucleosomes antibodies, it was positive in 5 patients (16.7%) and negative in 25 (83.3%) among patients in CL, while in VL patients, 16 patients (% 53.3) registered positive and 14 (46.7%) their result werenegative, the anti - nucleosomes antibodies in leishmaniasis patients were highly significant at the level of (P?0.01) when compared between the groups study. No score was recorded for anti - SmD1antibodies in CL patients, no one was positive 0 (0.0%) and all the 30 patients (100.0%) gave negative result for this antibody, while in patients with VL, the result showed 4 patients (13.3%) gave positive and 26 patients (86.7%) were negative, the anti - SmD1antibodies in leishmaniasis patients was significantly different at the level of (P?0.05) when compared between the groups. While the anti - SSA/Ro60kD and anti - SSA/Ro52kD, in VL patients, 9 patients (30.0%) scored positive results and 21 of the patients (70.0%) were tested negative for anti - SS - A/Ro60kD, but 7 patients (23.3%) were positive and 23 of the patients (76.7%) were tested negative for anti - SS - A/Ro52kD. While in patients with CL, no one scored positive (0.00%) and 30 of the patients (100.0%) were negative for anti - SS - A/Ro60kD, whereas one patient (3.3%) gave a positive result and 29 of the patients (96.7%) were negative for anti - SS - A/Ro52kD. About anti - SS - B/La we found that 19 of the patients (63.3%) were scored positive result for this antibody in addition to 11 patients (36.7%) who were negative in VL patients and 4 of the patients (13.3%) have those antibodies and 26 of the patients (86.7%) haven’t these antibodies in CL patients respectively. The anti - SS - A/Ro60kD, anti - SS - A/Ro52kD and anti - SS - B/La in leishmaniasis patients were highly significantly different at the level of (P?0.01), when compared between studied groups.5. VL cases showed a significantly different distribution of anti - nuclear antibodies (ANA) in compare with CL cases, especially; in Anti - Ku antibodies 24 (80%), anti - Mi - 2 antibodies 21 (70%) and anti - SS - B/La antibodies 19 (63.3%) respectively.6. The results of anti - nuclear antibodies level in patients with leishmaniasis like; anti - ds DNA, anti - nucleosome, anti - SmD1, anti - PCNA, anti - SS - A/RO 60, anti - SS - A/RO 52, anti - CNP - B were in high significantly different at the level of (P?0.01) and level (P?0.05) when compared between the groups, while the other autoantibodies like; anti - histone, anti - ribosomal P0, anti - Sc170, anti - U1 - snRNP, anti - AMA M2, anti - J0 - 1 and anti - PM - Sc1 showed no significant differences (P?0.01) between the investigated groups.7. The mean value of anti - cardiolipin IgG antibodies was increased substantially with highly significantly differences (P?0.01) in VL patients as compared with control group (8.123 vs. 1.959), also as compared with CL patients (8.123 vs. 2.402).
اسم المشرف:
انوار ادريس سليمان العساف
اسم المؤلف:
مرتضى قيس علي العامري
