RESUMO
Pediatric tuberculosis (TB) differs from adult TB in many features. To date, cytokine expression has not been studied in children with TB. The relative amounts of the various cytokines released at the site of infection may be important determinants of TB disease development and pathology. We determined cytokine transcripts in bronchoalveolar cells (BACs) recovered from 9 children presenting with TB and from 9 children with pulmonary diseases other than TB. An RT-PCR-based method was developed to quantify the mRNAs encoding six cytokines (IFN- gamma, IL-12, TNF- alpha, IL-10, IL-4, TGF- beta 1) known to play key roles in mycobacterial infections. Expression of mRNA encoding TGF- beta, TNF- alpha and IFN- gamma was statistically significantly higher in BACs from children with TB than in BACs from children with other pulmonary diseases; whereas the levels of mRNA transcription for TGF- beta is high, the levels of mRNA transcription for IFN- gamma and TNF- alpha remain low. All children had low levels of mRNA for IL-12(p40). IL-4 was barely detectable in all cases. Children with miliary TB had high levels of IL-10 transcripts and low levels of mRNA encoding TGF- beta. The immunosuppressive cytokines TGF- beta and IL-10, are overproduced in children with non-miliary TB and miliary TB respectively and are probably involved in the progression of the disease. These data suggest that Th1 responses are reduced in children with TB.
Assuntos
Líquido da Lavagem Broncoalveolar/imunologia , Citocinas/análise , Tuberculose Pulmonar/imunologia , Adolescente , Líquido da Lavagem Broncoalveolar/citologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Interferon gama/análise , Interleucina-10/análise , Interleucina-12/análise , Interleucina-4/análise , Masculino , RNA Mensageiro/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estatísticas não Paramétricas , Fator de Crescimento Transformador beta/análise , Tuberculose Pulmonar/patologia , Fator de Necrose Tumoral alfa/análiseRESUMO
A 15 1/2-year-old girl with disseminated lupus erythematosus presented with acute flank pain and hematuria during oral anticoagulant therapy for thrombophlebitis of the lower extremities. The intravenous pyelogram demonstrated multiple filling defects of the renal collecting system interpreted as pyelocalyceal submocosal hemorrhage. This benign complication disappeared following adjustment of the anticoagulant therapy. An identical appearance has been described in a case of aplastic anemia, Henoch-Schonlein purpupa, and in renal truma. Submocosal hemorrhage of the renal collecting system is to be differentiated from pyeloureteritis cystca, uroepithelial tumor, vascular impressions from collateral circulation and submucosal edema.