RESUMO
BACKGROUND: West Nile Disease (WND) is a zoonotic mosquito-borne infection involving viral pathogens, human and animal hosts, vectors and environment. Cooperation among medical, veterinary and entomological fields has been promoted by the Italian Public Health Authorities, and an integrated West Nile Virus (WNV) Surveillance Plan has been in force in Italy since 2016 to prevent the transmission risk of WND to humans through an early detection of viral circulation by animal and entomological surveillance. This managing model is unique in Europe. OBJECTIVES: This survey aimed at presenting the 'One Health' approach applied in 2016 to the first autochthonous human case of West Nile Neuroinvasive Disease (WNND) in Sicily (Southern Italy). METHODS: Serological (anti-WNV IgM and IgG ELISA, anti-WNV neutralizing antibodies) and molecular tests were conducted on blood, liquor and urine of a 38-year-old man with encephalitis and meningitis. Overall, 2704 adult culicides from 160 mosquito catches were morphologically identified. Female mosquitoes were analysed in pools for WNV RNA detection. Serological (anti-WNV IgM and IgG ELISA) and molecular analyses for WNV were carried out in 11 horses, 271 chickens and two dogs sampled in farms around the man's residence. RESULTS AND CONCLUSIONS: WNND was confirmed by serological analysis on patient's liquor and serum. Collected mosquito species included Culex pipiens (93.56%, CI95% 92.64%-94.49%), Aedes albopictus (5.25%, CI95% 4.41%-6.09%), Culex hortensis (0.59%, CI95% 0.30%-0.88%), Culiseta longiareolata (0.55%, CI95% 0.27%-0.83%) and Anopheles maculipennis s.l. (0.04%, CI95% -0.04% to 0.11%). Mosquito pools were negative for WNV RNA. Two dogs (100%) and two horses (18.18%, CI95% -4.61 to 40.97%) resulted positive for anti-WNV specific antibodies. The 'One Health' approach allowed to report the first human neuroinvasive WND in Sicily and to confirm the local circulation of WNV in animals of the same area where the clinical case occurred, defining the autochthonous origin of the infection.
Assuntos
Doenças do Cão , Doenças dos Cavalos , Saúde Única , Febre do Nilo Ocidental , Vírus do Nilo Ocidental , Animais , Galinhas , Cães , Feminino , Doenças dos Cavalos/epidemiologia , Cavalos , Humanos , Mosquitos Vetores , Febre do Nilo Ocidental/epidemiologia , Febre do Nilo Ocidental/veterináriaRESUMO
Many regions of the world are increasingly exposed to leptospirosis due to poverty, global warming and high urban density. Here, we report a molecular survey for pathogenic Leptospira spp. in rodents and two symptomatic human cases of leptospirosis in the city of Palermo, Italy. Four rodent species were captured in six areas of the city, and a molecular analysis for pathogenic Leptospira spp. on DNA from the kidney samples showed a different prevalence of leptospirosis in all the species of rodents. In addition, two human cases that occurred in May and October of 2009 in the city were also reported. A 67-year-old woman recovered after antibiotic treatment, whereas a 71-year-old woman did not survive. The weather during both of those times was notable for a violent cloudburst that caused street flooding. For the past several years, the incidence of leptospirosis has remained steady at 9 human cases every 10 years across the entire island of Sicily, with a population of almost 5 million inhabitants. The high prevalence of leptospirosis in rodents and the simultaneous presence of known risk factors, such as a mild/wet climate, street flooding and garbage accumulation, could explain the two cases of leptospirosis within the same city in the same year. This occurrence should raise awareness of this under-estimated zoonosis among public health authorities, especially given the potential fatality among elderly and immune-compromised individuals in urban settings in developed countries.
Assuntos
Clima , Leptospira/isolamento & purificação , Leptospirose/epidemiologia , Leptospirose/transmissão , Roedores/microbiologia , Idoso , Animais , Cidades , Mudança Climática , DNA Bacteriano/genética , Reservatórios de Doenças/microbiologia , Feminino , Humanos , Incidência , Itália/epidemiologia , Leptospira/genética , Leptospira/patogenicidade , Leptospirose/tratamento farmacológico , Leptospirose/microbiologia , Prevalência , Saúde Pública , Zoonoses/epidemiologia , Zoonoses/microbiologia , Zoonoses/transmissãoRESUMO
BACKGROUND: Imported cases of infections due to Dengue (DENV) and Chikungunya (CHIKV) viruses and, more recently, Zika virus (ZIKV) are commonly reported among travelers returning from endemic regions. In areas where potentially competent vectors are present, the risk of autochthonous transmission of these vector-borne pathogens is relatively high. Laboratory surveillance is crucial to rapidly detect imported cases in order to reduce the risk of transmission. This study describes the laboratory activity performed by the National Reference Laboratory for Arboviruses (NRLA) at the Italian National Institute of Health in the period from July 2014 to October 2015. METHODS: Samples from 180 patients visited/hospitalized with a suspected DENV/CHIKV/ZIKV infection were sent to the NRLA from several Italian Hospitals and from Regional Reference Laboratories for Arboviruses, in agreement with the National Plan on human surveillance of vector-borne diseases. Both serological (ELISA IgM test and Plaque Reduction Neutralization Test-PRNT) and molecular assays (Real Time PCR tests, RT-PCR plus nested PCR and sequencing of positive samples) were performed. RESULTS: DENV infection was the most frequently diagnosed (80 confirmed/probable cases), and all four genotypes were detected. However, an increase in imported CHIKV cases (41 confirmed/probable cases) was observed, along with the detection of the first ZIKV cases (4 confirmed cases), as a consequence of the recent spread of both CHIKV and ZIKV in the Americas. CONCLUSIONS: Main diagnostic issues highlighted in our study are sensitivity limitations of molecular tests, and the importance of PRNT to confirm serological results for differential diagnosis of Arboviruses. The continuous evaluation of diagnostic strategy, and the implementation of laboratories networks involved in surveillance activities is essential to ensure correct diagnosis, and to improve the preparedness for a rapid and proper identification of viral threats.
Assuntos
Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Vírus da Dengue/isolamento & purificação , Dengue/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Infecção por Zika virus/diagnóstico , Zika virus/isolamento & purificação , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/genética , Febre de Chikungunya/transmissão , Vírus Chikungunya/genética , Dengue/epidemiologia , Dengue/genética , Dengue/transmissão , Vírus da Dengue/genética , Surtos de Doenças/prevenção & controle , Feminino , Genótipo , Humanos , Itália/epidemiologia , Masculino , Vigilância da População , Saúde Pública , Viagem , Adulto Jovem , Zika virus/genética , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controle , Infecção por Zika virus/transmissãoRESUMO
BACKGROUND: Insulin resistance (IR), constitutes an important cardiovascular risk factor and can cause ischemic heart disease. It can lead to left ventricular dysfunction with a mechanism independent of ischemic heart disease and it is closely associated with impaired vascular function. The aim of our study was to explore the impact of IR on cardiac and vascular function, in patients with cardiovascular risk factors but angiographically undamaged coronary arteries. METHODS: We studied 32 patients (62.06±11.19years) with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, Doppler ultrasound of carotid arteries and laboratory tests. Exclusion criteria were coronary artery disease detected by coronary angiography, diabetes mellitus, creatinine above 1.5mg/dl, atrial fibrillation or malignant arrhythmias, left-ventricular hypertrophy, valvular heart disease, ejection fraction below 50%. The presence of insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Each patient underwent a complete echocardiographic examination including Global Longitudinal Strain assessment and carotid artery ultrasound scan including measurement of arterial stiffness. RESULTS: The patients were divided into two groups based on the median value of HOMA-IR, the first group for values <4.14 and, the second, for values ≥4.14. Ejection fraction and diastolic function did not significantly differ between the two groups, whether in patients with higher levels of HOMA-IR (≥4.14) we observed a Global Longitudinal Strain (GLS) that was significantly reduced (-16.50±1.37% vs. -20.73±1.84%, p=0.0015) vascular stiffness, measured in the carotid arteries as pulse wave velocity (PWV) (9.70±1.75m/s vs. 7.40±1.89m/s, p=0.00148) that was increased. At multivariate analysis HOMA-IR was an independent predictor of myocardial dysfunction (GLS: coefficient 0.1156, p<0.0001). CONCLUSION: Insulin resistance is associated with subclinical myocardial and vascular alterations in patients without significant coronary artery disease, measured as a reduction of Global Longitudinal Strain, and increased arterial stiffness. Our results underscore the importance of studying the interaction between ventricular function and vessels, in the perspective of more effective preventive and therapeutic interventions.
Assuntos
Doenças Cardiovasculares/epidemiologia , Resistência à Insulina/fisiologia , Idoso , Doenças Cardiovasculares/diagnóstico , Artérias Carótidas/diagnóstico por imagem , Angiografia Coronária/métodos , Ecocardiografia/métodos , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Fatores de Risco , Ultrassonografia Doppler/métodos , Rigidez Vascular/fisiologiaRESUMO
BACKGROUND: The pathophysiological hallmark of Rickettsia conorii (R. conorii) infection comprises infection of endothelial cells with perivascular infiltration of T-cells and macrophages. Although interferon (IFN)-γ-induced protein 10 (IP-10)/CXCL10 is induced during vascular inflammation, data on CXCL10 in R. conorii infection is scarce. METHODS: Serum CXCL10 was analyzed in two cohorts of southern European patients with R. conorii infection using multiplex cytokine assays. The mechanism of R. conorii-induced CXCL10 release was examined ex vivo using human whole blood interacting with endothelial cells. RESULTS: (i) At admission, R. conorii infected patients had excessively increased CXCL10 levels, similar in the Italian (n=32, â¼56-fold increase vs controls) and the Spanish cohort (n=38, â¼68-fold increase vs controls), followed by a marked decrease after recovery. The massive CXCL10 increase was selective since it was not accompanied with similar changes in other cytokines. (ii) Heat-inactivated R. conorii induced a marked CXCL10 increase when whole blood and endothelial cells were co-cultured. Even plasma obtained from R. conorii-exposed whole blood induced a marked CXCL10 release from endothelial cells, comparable to the levels found in serum of R. conorii-infected patients. Bacteria alone did not induce CXCL10 production in endothelial cells, macrophages or smooth muscle cells. CONCLUSIONS: We show a massive and selective serum CXCL10 response in R. conorii-infected patients, likely reflecting release from infected endothelial cells characterized by infiltrating T cells and monocytes. The CXCL10 response could contribute to T-cell infiltration within the infected organ, but the pathologic consequences of CXCL10 in clinical R. conorii infection remain to be defined.
Assuntos
Febre Botonosa/sangue , Quimiocina CXCL10/biossíntese , Células Endoteliais/metabolismo , Rickettsia conorii , Adulto , Idoso , Idoso de 80 Anos ou mais , Febre Botonosa/patologia , Estudos de Coortes , Células Endoteliais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Monócitos/patologia , Linfócitos T/metabolismo , Linfócitos T/patologiaRESUMO
Hypovitaminosis D is a worldwide disorder, with a high prevalence in the general population of both Western and developing countries. In HIV patients, several studies have linked vitamin D status with bone disease, neurocognitive impairment, depression, cardiovascular disease, high blood pressure, metabolic syndrome, type 2 diabetes mellitus, infections, autoimmune diseases like type 1 diabetes mellitus, and cancer. In this review, we focus on the most recent epidemiological and experimental data dealing with the relationship between vitamin D deficiency and HIV infection. We analysed the extent of the problem, pathogenic mechanisms, clinical implications, and potential benefits of vitamin D supplementation in HIV-infected subjects.
Assuntos
Doenças Ósseas , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Terapia Antirretroviral de Alta Atividade , Doenças Ósseas/complicações , Doenças Ósseas/epidemiologia , Infecções por HIV/tratamento farmacológico , Humanos , Prevalência , Fatores de RiscoRESUMO
UNLABELLED: Leishmaniasis clinical spectrum ranges from cryptic infection to fatal visceral leishmaniasis. Cryptic infection can be found in blood donors from areas endemic for leishmaniasis all over the world. Although leishmaniasis is a classic vector-borne disease, cases of transfusion transmitted leishmaniasis have been reported especially in nonendemic areas. Most of these cases regarded infants or children. This paper reviews the literature on this specific feature and the impact of leishmaniasis on transfusion medicine. Relevant literature was found through PubMed. The reference lists of selected articles identiï¬ed further sources. CONCLUSIONS: Blood donations by emigrants or travelers from endemic areas require special attention. Routine diagnostic methods should be implemented in blood banks to exclude donors that are positive for Leishmania, and individuals who suffered from visceral leishmaniasis should be prohibited from donating blood. The use of leukodepletion filters at the time of collection should be recommended in at-risk areas especially for high-risk recipients.
Assuntos
Sangue/microbiologia , Leishmaniose Visceral , Animais , Doadores de Sangue , Transfusão de Sangue , Humanos , Leishmania/patogenicidade , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/prevenção & controle , Leishmaniose Visceral/transmissão , Medicina TransfusionalRESUMO
Leishmaniasis is a vector-borne protozoan infection whose clinical spectrum ranges from asymptomatic infection to fatal visceral leishmaniasis. Over the last decades, an increase in imported leishmaniasis cases in developed, non-endemic countries, have been pointed-out from a review of the international literature. Among the possible causes are increasing international tourism, influx of immigrants from endemic regions and military operations. The main area for the acquisition of cutaneous leishmaniasis, especially for adventure travelers on long-term trips in highly-endemic forested areas, is represented from South America, whereas popular Mediterranean destinations are emerging as the main areas to acquire visceral variant. Leishmaniasis should be considered in the diagnostic assessment of patients presenting with a compatible clinical syndrome and a history of travel to an endemic area, even if this occurred several months or years before. Adventure travelers, researchers, military personnel, and other groups of travelers likely to be exposed to sand flies in endemic areas, should receive counseling regarding leishmaniasis and appropriate protective measures.
Assuntos
Leishmaniose , Viagem , Animais , Antiprotozoários/farmacologia , Emigrantes e Imigrantes , Humanos , Insetos Vetores/parasitologia , Leishmania , Leishmaniose/diagnóstico , Leishmaniose/tratamento farmacológico , Leishmaniose/epidemiologia , Leishmaniose/fisiopatologia , Leishmaniose/prevenção & controle , Região do Mediterrâneo , Militares , Psychodidae/parasitologia , América do SulRESUMO
AIMS: The aim of our study was to evaluate the relationship between insulin resistance and the detection of precocious echocardiographic signs of heart failure in patients with cardiovascular risk factors. METHODS: We enrolled 34 consecutive patients with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, and laboratory tests. Exclusion criteria were diabetes (fasting glucose greater than 126 mg/dl or treatment with insulin or oral hypoglycemic agents), coronary artery disease, creatinine above 1.5 mg/dl, left-ventricular hypertrophy, valvular heart disease, ejection fraction below 50%, atrial fibrillation, or other severe arrhythmia. The presence of insulin resistance was assessed by using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Ventricular function was investigated by echocardiography. RESULTS: Distinguishing patients with insulin resistance, based on the median value of HOMA-IR (<4.06 and >4.06), we observed that in the group with higher levels of HOMA-IR, there were echocardiographic signs of subclinical ventricular dysfunction statistically more frequent (E/A in group with HOMA <4.06: 1.159â+â0.33 vs. group with HOMA >4.06: 0.87â+â0.29, Pâ=â0.0136; E/E': 6.42â+â4 vs. 15.52â+â3.26, Pâ=â0.001; Tei index: 0.393â+â0.088 vs. 0.489â+â0.079, Pâ=â0.0029; S wave: 0112â+â0.015 vs. 0.114â+â0.027, Pâ=â0.0001; ejection fraction 59.11â+â4.75 vs. 58.88â+â6.81, Pâ=â0.9078). Grade II diastolic dysfunction was observed in 5 patients, grade I in 12 patients, and 17 patients had normal diastolic function. On multivariate analysis, HOMA-IR (Pâ=â0.0092), hypertension (Pâ=â0.0287), waist circumference (Pâ=â0.0009), high-density lipoprotein (Pâ=â0.0004), and fasting blood glucose (Pâ=â0.0003) were variables independently associated with diastolic dysfunction. On analysis of covariance, we found that the variables that influence diastolic dysfunction are HOMA-IR, waist circumference, BMI, and age, and that the only variable that influences Tei index is HOMA-IR. CONCLUSION: Insulin resistance is frequently associated with subclinical left-ventricular dysfunction. Patients with cardiovascular risk factors and increased HOMA-IR levels, although without diabetes mellitus, overt coronary artery disease, or hypertensive cardiomyopathy, may represent a target population for screening programs, recommended changes in lifestyle, and possibly the use of pharmacological interventions to prevent the onset of heart failure.
Assuntos
Insuficiência Cardíaca/etiologia , Resistência à Insulina , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Idoso , Doenças Assintomáticas , Biomarcadores/sangue , Glicemia/metabolismo , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Insulina/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Ultrassonografia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
BACKGROUND: Based on their essential role in concerting immunological and inflammatory responses we hypothesized that the homeostatic chemokines CCL19 and CCL21 may play a pathogenic role in rickettsiae infection. METHODS: Serum levels of CCL19 and CCL21 in patients with R. africae and R. conorii infection were analyzed by enzyme immunoassays. Lungs from R. conorii infected mice were examined for CCL19, CCL21 and CCR7 expression by immunohistochemistry. RESULTS: We found that patients with R. africae infection (n = 15) and in particular those with R. conorii infection (n = 16) had elevated serum levels of CCL19 on admission, with a decline during follow-up. While a similar pattern was seen for CCL21 in R. africae infection, patients with R. conorii infection showed persistently increased CCL21 levels during follow-up. In experimental R. conorii infection, we found strong immunostaining of CCL19 and CCL21 in the lungs, particularly in individuals that had received lethal doses. Immunofluorescence showed co-localization of CCR7 to endothelial cells, macrophages and fibroblasts within the lung tissue of R. conorii infected mice. CONCLUSIONS: Our findings suggest that the CCL19/CCL21/CCR7 axis is up-regulated during R. africae and in particular during R. conorii infection, which may potentially contribute to the pathogenesis of these disorders.
Assuntos
Quimiocina CCL19/sangue , Quimiocina CCL21/sangue , Infecções por Rickettsia/sangue , Rickettsia conorii/fisiologia , Adulto , Idoso , Animais , Quimiocina CCL19/genética , Quimiocina CCL21/genética , Feminino , Homeostase , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C3H , Pessoa de Meia-Idade , Receptores CCR7/sangue , Receptores CCR7/genética , Infecções por Rickettsia/genética , Infecções por Rickettsia/microbiologia , Regulação para Cima , Adulto JovemRESUMO
The pathophysiological hallmark of spotted fever group rickettsioses comprises vascular inflammation. Based on the emerging importance of the wingless (Wnt) pathways in inflammation and vascular biology, we hypothesized that Dickkopf-1 (DKK-1), as a major modulator of Wnt signaling, could be involved in the pathogenesis in rickettsial infections. Our major findings were: (i) While baseline concentration of DKK-1 in patients with R. conorii infection (nâ=â32) were not different from levels in controls (nâ=â24), DKK-1 rose significantly from presentation to first follow-up sample (median 7 days after baseline). (ii) In vitro experiments in human umbilical vein endothelial cells (HUVECs) showed that while heat-inactivated R. conorii enhanced the release of interleukin-6 (IL-6) and IL-8, it down-regulated the release of endothelial-derived DKK-1 in a time- and dose-dependent manner. (iii) Silencing of DKK-1 attenuated the release of IL-6, IL-8 and growth-related oncogene (GRO)α in R. conorii-exposed HUVECs, suggesting inflammatory effects of DKK-1. (iv) Silencing of DKK-1 attenuated the expression of tissue factor and enhanced the expression of thrombomodulin in R. conorii-exposed HUVECs suggesting pro-thrombotic effects of DKK-1. The capacity of R. conorii to down-regulate endothelial-derived DKK-1 and the ability of silencing DKK-1 to attenuate R. conorii-induced inflammation in endothelial cells could potentially reflect a novel mechanism by which R. conorii escapes the immune response at the site of infection.
Assuntos
Febre Botonosa/imunologia , Febre Botonosa/metabolismo , Células Endoteliais/microbiologia , Evasão da Resposta Imune , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Rickettsia conorii/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Febre Botonosa/genética , Estudos de Casos e Controles , Linhagem Celular , Citocinas/imunologia , Citocinas/metabolismo , Células Endoteliais/imunologia , Células Endoteliais/metabolismo , Feminino , Inativação Gênica , Células Endoteliais da Veia Umbilical Humana/imunologia , Células Endoteliais da Veia Umbilical Humana/metabolismo , Células Endoteliais da Veia Umbilical Humana/microbiologia , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/imunologia , Interleucina-6/metabolismo , Masculino , Pessoa de Meia-Idade , Rickettsia conorii/imunologia , Transdução de Sinais , Trombose/genética , Trombose/metabolismo , Proteínas Wnt/metabolismo , Adulto JovemRESUMO
OBJECTIVE: To determine possible prediction of regular menses with aging in anovulatory women with polycystic ovary syndrome (PCOS). DESIGN: Cohort. SETTING: Academic practice. PATIENT(S): A total of 54 anovulatory women with PCOS and 28 age- and weight-matched control subjects. INTERVENTION(S): Blood and ovarian ultrasound at baseline and after 5 years. MAJOR OUTCOME MEASURE(S): Serum antimüllerian hormone (AMH), gonadotropins, androgens, insulin sensitivity, and ovarian ultrasound. RESULT(S): After 5 years, there was a significant decrease in AMH in women with PCOS and control subjects (10 of 54 anovulatory women became ovulatory after 5 years). There was a significant negative correlation between baseline serum AMH and ovulatory function after 5 years. However, baseline serum AMH ≤ 4 ng/mL was associated with ovulatory function. CONCLUSION(S): Serum AMH may help predict ovulatory function with aging in anovulatory women with PCOS.
Assuntos
Envelhecimento/fisiologia , Hormônio Antimülleriano/sangue , Ovário/fisiologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/fisiopatologia , Adulto , Androgênios/sangue , Anovulação/sangue , Anovulação/fisiopatologia , Biomarcadores/sangue , Índice de Massa Corporal , Estudos de Coortes , Feminino , Gonadotropinas/sangue , Humanos , Resistência à Insulina/fisiologia , Pessoa de Meia-Idade , Ovário/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , UltrassonografiaRESUMO
The background of this article is as follows: Few data are available about the persistence of serum-specific IgG antibodies to L. infantum after acute VL. The objective of this article is to evaluate the persistence of antibodies against L. infantum in patients healed from acute VL, and the kinetic of the same antibodies observed in 2 cases of VL relapse and 2 cases of resistance to therapy. The methods which we used to obtain our objective are the following: 55 apparently immunocompetent, HIV-negative patients were examined for antibodies to L. infantum by IFAT over 14 years period, and we got the following results: Serum-specific IgG antibodies titers decrease slowly, but constantly. In the patients with a diagnosis of VL relapse, the kinetic of antibodies was characterized by an initial reduction, and a subsequent antibody levels rapidly increase, while in the patients with a clinical and parasitological diagnosis of VL not responding to specific therapy, we demonstrated persistent high level of antibodies to L. infantum. Finally, we conclude that specific antibodies to L. infantum might persist for many years, and decrease slowly, but steadily. The persistence of these specific antibodies is not related to poor therapeutic response or prognosis, but an acute increase in their levels might be a sentinel of a VL relapse, while persistence of high antibody levels could suggest a resistance to therapy.
Assuntos
Anticorpos Antiprotozoários/sangue , Leishmania infantum/imunologia , Leishmaniose Visceral/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Imunofluorescência , Humanos , Imunoglobulina G/sangue , Leishmaniose Visceral/imunologia , Masculino , Pessoa de Meia-Idade , Recidiva , Sicília , Fatores de Tempo , Adulto JovemRESUMO
Human rickettsial diseases comprise a variety of clinical entities caused by microorganisms belonging to the genera Rickettsia, Orientia, Ehrlichia, and Anaplasma. These microorganisms are characterized by a strictly intracellular location which has, for long, impaired their detailed study. In this paper, the critical steps taken by these microorganisms to play their pathogenic roles are discussed in detail on the basis of recent advances in our understanding of molecular Rickettsia-host interactions, preferential target cells, virulence mechanisms, three-dimensional structures of bacteria effector proteins, upstream signalling pathways and signal transduction systems, and modulation of gene expression. The roles of innate and adaptive immune responses are discussed, and potential new targets for therapies to block host-pathogen interactions and pathogen virulence mechanisms are considered.
Assuntos
Proteínas de Bactérias/imunologia , Infecções por Rickettsiaceae/imunologia , Rickettsieae/imunologia , Fatores de Virulência/imunologia , Imunidade Adaptativa , Animais , Artrópodes , Regulação da Expressão Gênica/imunologia , Especificidade de Hospedeiro , Interações Hospedeiro-Patógeno , Humanos , Imunidade Inata , Terapia de Alvo Molecular/tendências , Infecções por Rickettsiaceae/tratamento farmacológico , Infecções por Rickettsiaceae/genética , Infecções por Rickettsiaceae/metabolismo , Rickettsieae/patogenicidade , Transdução de SinaisRESUMO
To evaluate seroprevalence of B. henselae infection both in Sicilian children and healthy blood donors. Furthermore, circulation of Bartonella in the natural reservoir was also studied. Two hundred forty-three children, living in Sicily (Palermo), affected by various diseases, without clinical features suggesting B. henselae infection, together with 122 healthy blood donors were serologically investigated for IgG and IgM antibodies by indirect fluorescent antibody test (IFAT). One hundred twenty stray and 62 pet cats were also analyzed only for IgG. Among children 25.1% had IgG antibodies to B. henselae; 18.5% showed a titer 1:64, 2.4% 1:128, 2.4% 1:256, 0.8% 1:512, 0.4% 1:1024, and 0.4% 1:5120. Among healthy blood donors 11.4% had IgG class antibodies to B. henselae; 9.8% showed a titer 1:64 and 1.6% 1:128. All the human serum samples did not show positive results for B. henselae IgM class antibodies. Stray cats (68.3%) and pet cats (35.4%) also had IgG class antibodies to B. henselae. We demonstrated high frequency of serologic evidence of past B. henselae infection, in young Italian children, affected by various diseases, apparently free of any clinical features suggesting B. henselae infection. This observation is supported by high circulation of Bartonella in cats.
Assuntos
Anticorpos Antibacterianos/imunologia , Bartonella henselae/imunologia , Doadores de Sangue , Gatos/imunologia , Adolescente , Adulto , Animais , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/sangue , Antígenos de Bactérias/imunologia , Criança , Pré-Escolar , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Lactente , Masculino , Pessoa de Meia-Idade , Sicília/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Visceral leishmaniasis (VL) is a protozoan diseases caused in Europe by Leishmania (L.) infantum. Asymptomatic Leishmania infection is more frequent than clinically apparent disease. Among HIV infected patients the risk of clinical VL is increased due to immunosuppression, which can reactivate a latent infection. The aims of our study were to assess the prevalence of asymptomatic L. infantum infection in HIV infected patients and to study a possible correlation between Leishmania parasitemia and HIV infection markers. METHODS: One hundred and forty-five HIV infected patients were screened for the presence of anti-Leishmania antibodies and L. infantum DNA in peripheral blood. Statistical analysis was carried out by using a univariate regression analysis. RESULTS: Antibodies to L. infantum were detected in 1.4% of patients. L. infantum DNA was detected in 16.5% of patients. Significant association for PCR-Leishmania levels with plasma viral load was documented (p = 0.0001). CONCLUSION: In our area a considerable proportion of HIV infected patients are asymptomatic carriers of L. infantum infection. A relationship between high HIV viral load and high parasitemic burden, possibly related to a higher risk of developing symptomatic disease, is suggested. PCR could be used for periodic screening of HIV patients to individuate those with higher risk of reactivation of L. infantum infection.
Assuntos
Infecções por HIV/complicações , Leishmania infantum/isolamento & purificação , Leishmaniose Visceral/epidemiologia , Adulto , Idoso , Anticorpos Antiprotozoários/sangue , Portador Sadio , DNA de Protozoário/sangue , Feminino , Infecções por HIV/parasitologia , Humanos , Imunoglobulina G/sangue , Itália/epidemiologia , Leishmania infantum/imunologia , Masculino , Pessoa de Meia-Idade , Parasitemia/epidemiologia , Prevalência , Análise de Regressão , Adulto JovemRESUMO
The acute phase of Mediterranean spotted fever (MSF) is characterized by dramatic changes in cytokine production patterns, clearly indicating their role in the immunomodulation of the response against the microorganism, and the differences in cytokine production seem to influence the extent and severity of the disease. In this study, the single nucleotide polymorphisms (SNPs) of tumor necrosis factor alpha (TNF-alpha) -308G/A (rs1800629) and interleukin-10 (IL-10) -1087G/A (rs1800896), -824C/T (rs1800871), and -597C/A (rs1800872) and the gamma interferon (IFN-gamma) T/A SNP at position +874 (rs2430561) were typed in 80 Sicilian patients affected by MSF and in 288 control subjects matched for age, gender, and geographic origin. No significant differences in TNF-alpha -308G/A genotype frequencies were observed. The +874TT genotype, associated with an increased production of IFN-gamma, was found to be significantly less frequent in MSF patients than in the control group (odds ratio [OR], 0.18; 95% confidence interval [95% CI], 0.06 to 0.51; P corrected for the number of genotypes [Pc], 0.0021). In addition, when evaluating the IFN-gamma and IL-10 genotype interaction, a significant increase of +874AA/-597CA (OR, 5.31; 95% CI, 2.37 to 11.88; P(c), 0.0027) combined genotypes was observed. In conclusion, our data strongly suggest that finely genetically tuned cytokine production may play a crucial role in the regulation of the immune response against rickettsial infection, therefore influencing the disease outcomes, ranging from nonapparent or subclinical condition to overt or fatal disease.