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Varicella Zoster Virus–Specific Immune Response after Treatment with Sodium Stibogluconate for Cutaneous Leishmaniasis

Sodium stibogluconate has been associated with the reactivation of varicella zoster virus (VZV) in otherwise healthy adults who receive the drug as treatment for cutaneous leishmaniasis. Ten patients receiving daily sodium stibogluconate underwent phlebotomy at baseline and at day 10. Flow cytometry–based immunophenotyping, VZV-specific IgG levels, and lymphocyte proliferative responses and intracellular cytokine secretion to VZV, cytomegalovirus, tetanus toxoid, superantigen, and mitogens were performed at both time points. The absolute number of total leukocytes, total lymphocytes, and lymphocyte subsets decreased overall without predilection for any particular subset of lymphocytes, such that the percentage of the total lymphocyte population for each lymphocyte subset did not change significantly (except for a marginal increase in percentage of cytotoxic T cells). Antibodies to VZV were measured in seven patients before and after treatment, and did not change. Lymphocyte proliferative responses to VZV and other antigens and mitogens did not change from baseline. The mechanism for the increased rate of VZV reactivation after treatment with sodium stibogluconate remains undefined.

Received October 10, 2007. Accepted for publication January 4, 2008.

Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Department of the Army or the U.S. Department of Defense.

^* Address correspondence to Glenn Wortmann, Ward 63, Infectious Diseases Clinic, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307-5001. E-mail: Glenn.Wortmann{at}na.amedd.army.mil

Authors’ addresses: In-Kyu Yoon, Allergy and Immunology Division, Walter Reed Army Medical Center, Washington, DC 20307-5100. Josephine Cox and Anais Valencia-Micolta, Walter Reed Army Institute of Research, Rockville, MD 20847. Yaling Zhou, Yvonne Lukes, and Brian Reinhardt, Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, DC 20307-5100. Glenn Wortmann, Ward 63, Infectious Diseases Clinic, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307-5001, Telephone: 202-782-6740, Fax: 202-782-3765, E-mail: Glenn.Wortmann{at}na.amedd.army.mil.