RESUMO
Con el objetivo de describir las características clínico-epidemiológicas de la paracoccidioidomicosis, se realizó un estudio descriptivo de los casos diagnosticados por el Servicio de Microbiología Clínica del hospital de adultos Dr. Julio C. Perrando, de la ciudad de Resistencia (Chaco, Argentina). Entre 2011 y 2014 se detectaron 46 casos. En 2013 y 2014 se constató un incremento de la tasa de incidencia de alrededor de 4 veces con respecto a los anos anteriores. La forma crónica fue la predominante, con una media de edad de los pacientes de 53 anos. Del total de ellos, a 39 se les realizaron pruebas serológicas. En 15 de 39 casos, las pruebas serológicas fueron la única herramienta diagnóstica, mientras que en 4 de estos casos con diagnóstico microbiológico, la prueba resultó no reactiva. La inclusión de la paracoccidioidomicosis en el diagnóstico diferencial de pacientes de áreas endémicas que presentan un síndrome infeccioso inespecífico y la aplicación de las herramientas diagnósticas disponibles contribuyen al diagnóstico oportuno, así como a disminuir las secuelas de esta afección y su impacto socioeconómico.
In order to describe the clinical and epidemiological characteristics of paracoccidioidomycosis, a descriptive study of all the cases diagnosed by the Clinical Microbiology Service at Dr. Julio C. Perrando hospital in the city of Resistencia (Chaco Province, Argentina) was conducted. Between 2011 and 2014, 46 cases were detected. In the period 2013-2014, an almost 4-fold increase in the incidence rate was detected. The chronic form of the disease was predominant with an average age of 53 years. Serological tests in 39 out of 46 patients were performed. In 15 of 39 patients, serological tests were the only diagnostic tool while in 4 patients with a microbiological diagnosis serological tests were non-reactive. In patients from endemic areas with non-specific infectious syndrome it is important to include paracoccidioidomycosis in the differential diagnosis and to apply all available diagnostic tools to reach a timely diagnosis and to reduce the long-term sequelae and their socio-economic impact.
Assuntos
Paracoccidioidomicose/epidemiologia , Testes Sorológicos/métodos , Paracoccidioidomicose/diagnóstico , Incidência , Doenças Endêmicas/estatística & dados numéricosRESUMO
In order to describe the clinical and epidemiological characteristics of paracoccidioidomycosis, a descriptive study of all the cases diagnosed by the Clinical Microbiology Service at Dr. Julio C. Perrando hospital in the city of Resistencia (Chaco Province, Argentina) was conducted. Between 2011 and 2014, 46 cases were detected. In the period 2013-2014, an almost 4-fold increase in the incidence rate was detected. The chronic form of the disease was predominant with an average age of 53 years. Serological tests in 39 out of 46 patients were performed. In 15 of 39 patients, serological tests were the only diagnostic tool while in 4 patients with a microbiological diagnosis serological tests were non-reactive. In patients from endemic areas with non-specific infectious syndrome it is important to include paracoccidioidomycosis in the differential diagnosis and to apply all available diagnostic tools to reach a timely diagnosis and to reduce the long-term sequelae and their socio-economic impact.
Assuntos
Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/epidemiologia , Adulto , Idoso , Argentina/epidemiologia , Feminino , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Presentamos un paciente de sexo masculino de 54 años con una asociación poco frecuente de tres entidades: paracoccidioidomicosis, SIDA y tuberculosis...
Assuntos
Humanos , Masculino , Síndrome da Imunodeficiência Adquirida , Paracoccidioidomicose , Tuberculose , Anorexia , Tosse , Febre , Redução de PesoRESUMO
Activating and inhibitory killer immunoglobulin-like receptors (KIR) and their ligands HLA-Bw4 (loci A and B) were studied by way of establishing whether they can contribute to protection against HIV-1 infection in highly exposed and persistently seronegative (HESN) patients. Twenty-three HIV-1 serodiscordant heterosexual couples, 100 HIV-1(+) patients and 200 healthy individuals were included in this retrospective case-control study. HLA typing was performed by means of PCR followed by sequence-specific oligonucleotide probe reverse hybridization. KIR3DL1 and KIR3DS1 were studied by PCR sequence-specific primers. The frequency of KIR3DS1(3DS1/3DL1)-Bw4 combination was significantly higher in HESN patients versus the discordant couples (P = 0·0003) and HIV-1(+) patients (P = 0·0001). Conversely, the KIR3DL1/KIR3DL1 homozygosity was significantly decreased in HESN patients versus the discordant couples (P = 0·00003), and HIV-1(+) patients (P = 0·00066). The frequency of HLA-A*32 and HLA-B*44 was higher in HESN versus their discordant couples (P = 0·009; P = 0·049), and HIV-1(+) patients (P = 0·00002; P = 0·0001). This had greater significance in combination with KIR3DS1 (3DS1/3DL1). KIR3DS1(3DS1/3DL1) could have a greater effect on protection against HIV-1 infection in HESN patients when bound to a specific HLA allele, in this case HLA-A*32 and HLA-B*44, both Bw4 alleles. The differences probably arise both in the HLA alleles and in the subtypes of KIR receptors depending on the ethnic group studied.
Assuntos
Predisposição Genética para Doença/genética , Infecções por HIV/genética , Antígenos HLA-B/genética , Receptores KIR/genética , Adulto , Alelos , Argentina , Epitopos , Feminino , Genótipo , Antígenos HLA-A/genética , Heterossexualidade , Humanos , MasculinoRESUMO
UNLABELLED: A total of 220 individuals were included in this study, 112 HIV-seronegative healthy individuals and 108 HIV-1-infected patients involving: 18 AIDS patients with Toxoplasmic encephalitis (AIDS-TE), 49 AIDS patients without TE, and 41 asymptomatic patients, were genotyping for DR and DQ loci by molecular biology techniques. Fisher's Exact test was used for statistical analysis. HLA-DQB*0402 and DRB1*08 alleles were associated with a high risk to develop opportunistic infections with neurological involvement, mainly Toxoplasma encephalitis in relationship with subjects healthy (OR = 20.43; Pc = 7.0 x 10(-6) and OR = 11; Pc = 2.6 x 10(-4), respectively); in relationship with AIDS no TE (OR = 6.98; Pc = 0.028 and OR = 4.85; P = 0.012, Pc = 0.14) and with patients in asymptomatic stage (OR = 61.50, Pc = 8.4 x 10(-6) and OR = 19.38; Pc = 3.9 x 10(-4)), respectively. CONCLUSIONS: It was concluded that the presence of HLA-DQB*0402 and DRB1*08 alleles in HIV-1-positive patients could be considered risk factors for developing neurological opportunistic infections, mainly Toxoplasmic encephalitis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/genética , Encefalite/genética , Antígenos HLA-DQ/genética , Antígenos HLA-DR/genética , Toxoplasmose Cerebral/genética , Infecções Oportunistas Relacionadas com a AIDS/complicações , Argentina/epidemiologia , Estudos de Casos e Controles , Encefalite/complicações , Frequência do Gene , Predisposição Genética para Doença , HIV-1 , Antígenos HLA-DQ/classificação , Cadeias beta de HLA-DQ , Antígenos HLA-DR/classificação , Humanos , Fenótipo , Toxoplasmose Cerebral/complicaçõesRESUMO
The pathogenesis of infections clearly involves immunoregulatory host factors and products of Major Histocompatibility Complex (MHC) genes class II which present antigenic peptides to the T-cell receptor on CD4+ cells which in turn increase the production of specific antibodies and cytotoxic T lymphocytes. The objective of this study was to determine the frequency of the different alleles of HLA class II DQ and DR in HIV-1 infected patients of Caucasians with Guaraní and Toba genetic backgrounds in an effort to determine the prevalence of certain alleles which could signify a factor of susceptibility to or protection against HIV-1 infection. A total of 54 HIV-1 positive patients and 46 healthy control subjects participated in the HLA-DQB1 study while 54 HIV-1 (+) patients and 57 healthy controls were analyzed for HLA-DRB1. Both HLA-DQB1 and HLA-DRB1 genotyping were performed using PCR and sequence-specific reverse hybridization oligonucleotide probe and analyzed with the LiPA Key Typing System and LiPA software. HLA-DQB1*0203(P = 0.041) and DRB1*01(P = 0.05) exhibited a decreased frequency in HIV-1 (+) patients while HLA-DRB1*13 (P = 0.017) was observed more frequently. Several studies have reported different findings, depending on the populations analyzed. Our data show that there are HLA class II alleles associated with susceptibility or resistance to HIV-1 infection and that these differ among ethnic groups. We believe that our results differ from the other Caucasians populations due to the ethnic variability of Chaco inhabitants resulting from mixing between Caucasians and South American natives (Guaraníes and Tobas).
Assuntos
Alelos , Predisposição Genética para Doença , Infecções por HIV/genética , HIV-1 , Antígenos HLA-DQ/genética , Antígenos HLA-DR/genética , Argentina , Frequência do Gene , Infecções por HIV/imunologia , Humanos , Imunidade InataRESUMO
The pathogenesis of infections clearly involves immunoregulatory host factors and products of Major Histocompatibility Complex (MHC) genes class II which present antigenic peptides to the T-cell receptor on CD4+ cells which in turn increase the production of specific antibodies and cytotoxic T lymphocytes. The objective of this study was to determine the frequency of the different alleles of HLA class II DQ and DR in HIV-1 infected patients of Caucasians with Guarani and Toba genetic backgrounds in an effort to determine the prevalence of certain alleles which could signify a factor of susceptibility to or protection against HIV-1 infection. A total of 54 HIV-1 positive patients and 46 healthy control subjects participated in the HLA-DQB1 study while 54 HIV-1 (+) patients and 57 healthy controls were analyzed for HLA-DRB1. Both HLA-DQB1 and HLA-DRB1 genotyping were performed using PCR and sequence-specific reverse hybridization oligonucleotide probe and analyzed with the LiPA Key Typing System and LiPA software. HLA-DQB1*0203(P = 0.041) and DRB1*01(P = 0.05) exhibited a decreased frequency in HIV-1 (+) patients while HLA-DRB1*13 (P = 0.017) was observed more frequently. Several studies have reported different findings, depending on the populations analyzed. Our data show that there are HLA class II alleles associated with susceptibility or resistance to HIV-1 infection and that these differ among ethnic groups. We believe that our results differ from the other Caucasians populations due to the ethnic variability of Chaco inhabitants resulting from mixing between Caucasians and South American natives (Guaranies and Tobas) (AU)#S#a
Assuntos
Humanos , Alelos , Predisposição Genética para Doença , Infecções por HIV , HIV-1 , Antígenos HLA-D , Argentina , Frequência do Gene , Infecções por HIV , Antígenos HLA-DQ , Antígenos HLA-DR , Imunidade InataRESUMO
Los individuos con alto riesgo a la infección por el virus HIV-1, portadores de una variante polimórfica del gen del receptor para b quimioquinas CCR-5 son resistentes a la infección por HIV-1. La mutación de CCR-5 es una deleción de 32 pares de bases dentro del gen resultando en una proteína truncada que no se expresa en la superficie. El genotipo homocigota está asociado a resistencia de la infección. Este alelo se encuentra más comúnmente en la población caucásica y no fue hallado en africanos o japoneses. El genotipo heterocigota disminuiría la entrada y replicación del HIV-1 a linfocitos T CD4 y macrófagos, asociándose de esta manera a una lenta progresión a SIDA. Con el objetivo de establecer la frecuencia del alelo mutado en individuos HIV-1(-) y HIV-1(+), en la población chaqueña, caucásica y con influencia hispana y guaraní, se estudiaron 118 individuos HIV-1(-) y 80 HIV-1(+). Una porción del gen CCR-5 fue amplificado por la técnica PCR, a partir de DNA genómico obtenido por el método de Salting out. Se observó en población HIV-1(-) un 2.5 por ciento del genotipo homocigota y 15.3 por ciento heterocigota, estos datos coinciden con los comunicados para otras poblaciones caucásicas. En la población HIV-1(+) no se halló el genotipo homocigota coincidiendo con otras publicaciones y la proporción de pacientes con la forma heterocigota fue de 2.5 por ciento, cifra menor a las reportadas por otros autores.
Assuntos
Humanos , Alelos , Frequência do Gene , Infecções por HIV/genética , HIV-1/genética , Mutação , Receptores CCR5/genética , Argentina , Genótipo , Heterozigoto , Infecções por HIV/imunologia , HIV-1/imunologia , HomozigotoRESUMO
La asociación Chagas-SIDA ha sido ampliamente comunicada en la bibliografia en especial en su localización cardíaca y cerebral. Se presenta un paciente de sexo masculino de 36 años afectado de SIDA, con serología reactiva para Chagas y hepatopatía crónica con un recuento de CD4 de 31. Durante la internación desarrolla un cuadro clínico compatible con peritonitis espontánea que revela la presencia de numerosas formas tripomastigotas de T. cruzi en el líquido ascítico. Esta forma clínica de reactivación chagásica no ha sido previamente descrita en la literatura.
Assuntos
Humanos , Masculino , Adulto , Síndrome da Imunodeficiência Adquirida , Doença de Chagas/complicações , Peritonite/etiologia , Ascite/parasitologia , Trypanosoma cruzi/isolamento & purificaçãoRESUMO
Es conocido que en la etiopatogenia del Síndrome de Inmunodeficiencia Adquirida (SIDA) no sólo interviene el efecto citopático del virus sobre la población CD4, sino que también se activan otros complejos mecanismos entre ellos los de tipo autoinmune. El objetivo del trabajo fue estudiar en 88 pacientes HIV (+) (49 asintomáticos y 39 sintomáticos) los anticuerpos anticitoplasma de los neutrófilos (ANCA), a fin de correlacionarlos con algunos de los cuadros clínicos más frecuentes. Se utilizó la técnica de inmunofluorescencia indirecta (IFI) sobre improntas de polimorfonucleares (PMN). Se observó que la presencia de ANCA fue más frecuente en el grupo de enfermos (53,8 por ciento) respecto de los portadores asintomáticos (4,1 por ciento). Dentro del grupo ANCA (+) se observó correlación con infección pulmonar (95,9 por ciento), siendo la tuberculosis (TBC), la causa más frecuente de ésta. Cuando se comparó la presencia de ANCA en el grupo TBC(+) HIV(+) con el grupo TBC(+) HIV(-), se observó que los ANCA positivos se asociaban al primer grupo en forma significativa. Se cree que la presencia de estos anticuerpos puede estar relacionada con mecanismos de tipo autoinmune determinados por la expresión inadecuada de ciertas proteínas blanco tales como la mieloperoxidasa o proteinasa 3. La presencia importante de ANCA en pacientes HIV sintomáticos con infección pulmonar por Mycobacterium tuberculosis y no asi en pacientes HIV(+) asintomáticos o en pacientes con TBC pulmonar sin infección con HIV, parecería indicar que ni el virus per se, ni la infección pulmonar serían los responsables directos de la producción de estos anticuerpos.
Assuntos
Humanos , Anticorpos Anticitoplasma de Neutrófilos/fisiologia , Infecções por HIV/sangue , Infecções por HIV/fisiopatologia , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Infecções Oportunistas Relacionadas com a AIDS , Técnica Indireta de Fluorescência para AnticorpoRESUMO
Del analisis de situacion de la Provincia y de un area programatica de un Centro de Salud de Resistencia, se propone un programa de atencion con los elementos con que se cuenta en este momento para reducir niveles de desnutricion, mejorar controles de menores de una año y de embarazadas adolescentes, buena cobertura de vacunas e incentivar la participacion comunitaria , todo a travez de la APS
Assuntos
Humanos , Gravidez , Lactente , Pré-Escolar , Masculino , Feminino , Serviços de Saúde da Criança , Centros Comunitários de Saúde/organização & administração , Serviços de Saúde Comunitária/normas , Serviços de Saúde Materna , ArgentinaRESUMO
Diagnostico de situacion del Hospital Pediatrico Castelan de Resistencia, particularmente de la guardia externa y propuesta de reestructuracion de la misma