American Journal of Clinical Dermatology

, Volume 3, Issue 8, pp 557–570 | Cite as

Vaccination Against Cutaneous Leishmaniasis

Current Status
Review Article

Abstract

The different cutaneous leishmaniases are distinct in their etiology, epidemiology, transmission, and geographical distribution. In most instances cutaneous leishmaniasis is limited to one or a few skin ulcers that develop at the site where the parasites were deposited during the bite of the sandfly vector. Lesions typically heal spontaneously after several months but some lesions can be large and follow a chronic, more severe course.

Protective immunity is usually acquired following cutaneous infection with Leishmania spp., so prevention of disease through prophylactic immunization appears to be feasible. Since vaccination with live, virulent parasites is associated with an unacceptable rate of adverse events, attention has turned to the use of killed or attenuated parasite vaccines and defined subunit vaccines. Whole parasite vaccines have the advantage of delivering multiple antigenic epitopes that may be necessary for initiation of a broad-based immune response. Persistent or repeated immune-stimulation by parasite antigens and/or sustained expression of interleukin-12 appear to be critical elements in the development of durable immunity.

A number of purified or recombinant antigens, when co-administered with a vaccine adjuvant, appear promising as vaccine candidates against cutaneous leishmaniasis. The sustained expression of recombinant Leishmania antigens by vaccination with DNA is an attractive approach because it mimics the persistent antigenic stimulation of subclinical infection. Effective vaccine-induced immunity must generate an antigen-specific memory T cell population that, upon exposure to the infecting parasite, rapidly produces a type 1 effector T cell response that leads to interferon-γ-mediated activation of infected macrophages to kill the intracellular parasites. This parasite-directed recall response must be prompt and of sufficient magnitude to overcome the subversive effect that the intracellular infection has on macrophage effector function. It is unlikely that vaccination against cutaneous leishmaniasis would induce sterile immunity, but a small number of parasites are likely to persist subclinically.

Keywords

Visceral Leishmaniasis Cutaneous Leishmaniasis Virulent Parasite Parasite Challenge Metacyclic Promastigotes 

Notes

Acknowledgments

This work was supported by a Merit Review Grant from the US Department of Veterans Affairs, and by funding from the National Institutes of Health (AI 48823). The author has no conflicts of interest that are directly relevant to the contents of this manuscript. The author thanks Sunil Ahuja, Seema Ahuja, Greg Anstead, and David Sacks for helpful discussions, and Lydia Melby for help with library research.

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Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Department of Veterans Affairs Medical Center, Medical ServiceSouth Texas Veterans Health Care SystemSan AntonioUSA
  2. 2.Departments of Medicine and Microbiology, Division of Infectious DiseasesThe University of Texas Health Science CenterSan AntonioUSA

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