[Frequency of pulmonary and extrapulmonary tuberculosis in a reference hospital in Córdoba province, 1991-2003]. / Frecuencia de tuberculosis pulmonar y extrapulmonar en un hospital de referencia de la provincia de Córdoba, 1991-2003.

Tuberculosis continues to be a serious problem of public health causing nearly three million deaths per year all over the world. Despite technologic improvements in the diagnostic methods, it is not possible to control the disease in the absence of surveillance and treatment follow-up programs supervising the ending of treatments, and definitive cure of patients. The frequency of pulmonary and extrapulmonary tuberculosis, and simultaneous pulmonary and extrapulmonary tuberculosis localization among patients assisted at Tránsito Cáceres de Allende Hospital during thirteen years (1991-2003), was determined. The benefit of inoculating the specimens on Stonebrink medium for the best recuperation of Mycobacterium bovis was herein observed, and the contribution of Ziehl Neelsen staining in extrapulmonary materials was tested as well. Out of 790 cases of tuberculosis diagnosed, 723 were pulmonary, and 48 were extrapulmonary localization (pleural 31, renal 7, ganglionar 5, meningeal 2, genital 1, pericardial 1 and digestive 1), and 19 patients presented both, pulmonary and extrapulmonary tuberculosis. Out of the 723 pulmonary cases, 9 were caused by M. bovis. All M. bovis isolates grew on Stonebrink medium, and only one grew also on Lowenstein Jensen. Smear microscopy using Ziehl Neelsen staining resulted positive in 4 extrapulmonary specimens.

T cell response to myelin basic protein in the context of the multiple sclerosis-associated HLA-DR15 haplotype: peptide binding, immunodominance and effector functions of T cells.

In this study, we evaluated the role of the two functional HLA-DR heterodimers, DR2a (DR alpha paired with the beta chain encoded by DRB5*0101) and DR2b (DR alpha paired with the beta chain encoded by DRB1*1501), that are coexpressed in the multiple sclerosis (MS)-associated haplotype HLA-DR15 Dw2, in presenting myelin basic protein (MBP) peptides to MBP-specific T cell lines (TCL). Our results show that both HLA-DR molecules serve as restriction elements for HLA-DR15-restricted TCL. Slightly higher numbers of TCL use DR2a as restriction element, and the epitopes contained in the immunodominant C-terminal region (131-159) are uniquely restricted by DR2a. The immunodominant middle epitope (81-99) is recognized in the context of both DR2a and DR2b, but this specificity strongly dominates the DR2b-restricted T cell response. Overall, immunodominance in the MBP-specific T cell response correlated well with peptide binding to DR2a or DR2b, demonstrating that the affinity of MHC-peptide interactions is important for shaping the T cell response to this autoantigen. Furthermore, we show that binding of the middle MBP peptide to HLA-DR15 molecules prevents cleavage by cathepsin D, a protease abundantly found in endosomal processing compartments, and thus contributes to its immunodominance. Surprisingly, the restriction element employed by MBP-specific T cell clones influenced the effector function (i.e., cytotoxic activity) of T cells irrespective of their peptide fine specificity.

Frecuencia de tuberculosis pulmonar y extrapulmonar en un hospital de referencia de la provincia de Córdoba, 1991-2003 / [Frequency of pulmonary and extrapulmonary tuberculosis in a reference hospital in Córdoba province, 1991-2003]

Tuberculosis continues to be a serious problem of public health causing nearly three million deaths per year all over the world. Despite technologic improvements in the diagnostic methods, it is not possible to control the disease in the absence of surveillance and treatment follow-up programs supervising the ending of treatments, and definitive cure of patients. The frequency of pulmonary and extrapulmonary tuberculosis, and simultaneous pulmonary and extrapulmonary tuberculosis localization among patients assisted at Tránsito Cáceres de Allende Hospital during thirteen years (1991-2003), was determined. The benefit of inoculating the specimens on Stonebrink medium for the best recuperation of Mycobacterium bovis was herein observed, and the contribution of Ziehl Neelsen staining in extrapulmonary materials was tested as well. Out of 790 cases of tuberculosis diagnosed, 723 were pulmonary, and 48 were extrapulmonary localization (pleural 31, renal 7, ganglionar 5, meningeal 2, genital 1, pericardial 1 and digestive 1), and 19 patients presented both, pulmonary and extrapulmonary tuberculosis. Out of the 723 pulmonary cases, 9 were caused by M. bovis. All M. bovis isolates grew on Stonebrink medium, and only one grew also on Lowenstein Jensen. Smear microscopy using Ziehl Neelsen staining resulted positive in 4 extrapulmonary specimens.