Dados do Trabalho

Título

INTERPLAY OF OBESITY AND DIABETES IN LEISHMANIASIS: CLINICAL AND IMMUNOLOGICAL INSIGHTS

Introdução

Obesity and diabetes mellitus (DM) affect susceptibility to infectious diseases like leishmaniasis, a global health threat with varied clinical outcomes shaped by host immunity, presenting complex challenges for public health strategies.

Objetivo (s)

This review aimed to systematically gather data on the impact of obesity and diabetes on the clinical presentation and immunological response in patients affected by leishmaniasis.

Material e Métodos

The electronic databases PubMed, Scopus, SciELO, BVS, and Google Scholar were searched for articles published between 2004 and 2024. The search utilized the descriptors: "leishmaniasis" AND “obesity”, “hypertriglyceridemia”, “dyslipidemia”, “diabetes”, and “insulin resistance”. Inclusion criteria were original research on human subjects, case studies, and English articles published in indexed journals. Grey literature was excluded. Titles and abstracts of the identified articles were screened, followed by a full-text review of selected articles. The methodological quality assessment of the studies was conducted by two reviewers independently.

Resultados e Conclusão

The search yielded 37,042 studies: 213 from PubMed, 597 from Scopus, 3 from SciELO, 200 from BVS, and 36,029 from Google Scholar. After title and abstract screening, 115 studies were selected. Following duplicate removal and inclusion criteria application, 11 articles were reviewed. In obesity, findings indicated that patients with visceral leishmaniasis (VL) experienced more clinical complications and had a higher parasitic burden. In cutaneous leishmaniasis (CL), obese patients, particularly women in endemic areas, had higher incidence rates. Obese CL patients had ulcers above the waist with longer healing times, increased IFN-γ and IL-15 production, decreased eotaxin, and similar leptin levels compared to patients with normal BMI. On the other hand, in DM, the following observations were made: CL patients exhibited atypical, treatment-refractory lesions and other clinical complications. DM-CL infected with L. amazonensis, L. tropica e L. braziliensis had lower CD8+ T cell frequency but higher levels of IFN-γ (lower in L. tropica), TNF-α, IL-1β,TGF-β, IL-4, total protein, ALT, AST, NO, GSH, phosphorylated NF-kB, IL-10, high plasma LTB4, IL-6, and neutrophil infiltrates. Obesity and DM worsen immune dysfunction, clinical complications in VL and CL. Understanding these interactions is vital for improving management and interventions in patients with leishmaniasis and obesity or diabetes comorbidities.

Palavras Chave

dyslipidemia; insulin resistance; Leishmania