5 and Fig. 6D and F). Immune–endocrine

associations have not been sufficiently explored in human leishmaniasis. Herein, we found a reduction in plasma concentrations of DHEA-S, prolactin and testosterone, but not of cortisol and estradiol, in LCL patients. Plasma levels of cortisol, estradiol and prolactin correlated with at least one clinical marker. There is only one study addressing an immune–endocrine imbalance in human leishmaniasis (Gallindo-Sevilla et al., 2007); this study found lower serum levels of DHEA and cortisol in diffuse cutaneous leishmaniasis (DCL) patients compared with LCL patients or healthy volunteers. When DCL patients were excluded from the study, there was a statistically ABT-737 datasheet significant reduction of DHEA in LCL patients compared to age-matched controls. In our study, a decrease in levels of DHEA-S was observed together with reductions in levels of prolactin and testosterone. Concentrations of cortisol and estradiol were similar between LCL patients and NV. These results are consistent with other results described in the literature and indicate that infections do not lead to a

standard pattern in neuroendocrine alteration. In some cases, infection induces a reduction and in other cases, infection induces an increase in the same or different hormones. The endocrine imbalance observed during chronic infections could be the result of the activation of various neuroendocrine axes, such as the HPA axis (hypothalamus–pituitary–adrenal) and the HPG axis (hypothalamus–pituitary–gonads)

by the immune system (Besedovsky et al., 1986 and Webster et al., 2002). Some cytokines, especially IL-1, IL-6 and TNF-α, can act directly on the central EGFR inhibitor nervous system (CNS), resulting in the activation of neuroendocrine axes, mainly the HPA axis (Berkenbosch et al., 1987, Holsboer et al., 1988, Naitoh et al., 1988 and Sharp et al., 1989), and hormones can influence cytokine production (Besedovsky et al., 1986). Moreover, in some types of infections, the presence of microorganisms in the glands can affect hormone secretion (Reincke et al., 1998 and Corrêa-de-Santana et al., 2006). In LCL, parasites are present almost exclusively in the skin and draining lymph nodes (de Moura et al., 2005); therefore, the endocrine before imbalance seen in LCL is unlikely to be caused by the direct presence of the parasite but instead, may be due to the action of cytokines in the CNS or glands. Plasma concentrations of some hormones evaluated in this study correlated with clinical and/or immunological parameters. IFN-γ is the hallmark cytokine of a Th1 immune response and is strongly linked to protection against leishmaniasis. Cortisol showed a positive correlation with healing time and dose of Glucantime used in the treatment and a negative correlation with levels of IFN-γ. One of the major actions of glucocorticoids is to promote a shift from a Th1 to a Th2 cytokine response (Ramírez et al., 1996 and Ashwell et al., 2000).