Serologic profile in hepatitis B virus and hepatitis C virus in a Brazilian liver transplant waiting list.

UNLABELLED: Chronic viral hepatitis is currently the most common indication for liver transplantation (OLT). Knowing the serological profile of patients on the liver transplant waiting list (LTWL) is essential to manage prophylactic and therapeutic strategies pre- and post-OLT. The aim of this study was to determine the hepatitis B virus (HBV) and hepatitis C virus (HCV) serological profile on the LTWL. METHODS: Serological data were collected from 44 candidates included on the LTWL from May 2003 to November 2004. HBV and HCV serological profiles were performed by microenzyme immunoassay. RESULTS: Twenty-eight patients (66.7%) lacked HBV serological markers. Anti-HBs was detected in 9.5% and was positive for HBsAg, anti-HBc, IgM anti-HBc, or HbeAg in 4.8% of patients, probably related to reactivation of chronic infection. In 7.1% of patients, the markers demonstrated serological cure of infection. In HCV patients, 41.5% were positive. There was HBV and HCV co-infection in 12.2% of patients. CONCLUSION: HBV infection in 21.4% of the patients corroborates the need to use more efficient protocols for prophylactic and therapeutic management pre- and post-OLT. The high prevalence of HCV infection reinforces the need to follow adequate protocols to avoid related complications and guarantee rational and universal use of more efficient drugs.

Immunomodulatory activities associated with beta-glucan derived from Saccharomyces cerevisiae.

In this study we investigated the effect of beta-glucan derived from Saccharomyces cerevisiae on fungicidal activity, cytokine production and natural killer activity. Spleen and peritoneal cells from female C57BL/6 mice, previously injected (24 or 48 h) with 20 or 100 microg of glucan by i.p. route, were assayed. In vivo beta-glucan administration primed spleen cells for a higher production of IL-12 and TNF-alpha when S. aureus was used as a stimulus. In addition, beta-glucan increased NK spleen cells activity against YAC target cells. Some immunomodulatory activities not yet described for beta-glucan were observed in this work.

The use of glucan as immunostimulant in the treatment of paracoccidioidomycosis.

A group of 10 patients, nine of them seriously infected with Paracoccidioides brasiliensis (G1), received glucan (beta-1,3 polyglucose) as an immunostimulant intravenously once a week for one month, followed by monthly doses (10 mg) over an 11-month period, together with a specific anti-fungal agent as an immunostimulant. A second group of eight moderately infected patients (G2) was treated with only the anti-fungal agent. Among the patients in G1, there was only one case of relapse compared with five in G2. Values for the erythrocyte sedimentation rate (ESR) showed a significant difference (P < 0.001) post-treatment in G1 patients, when compared with the pretreatment levels. There was also a significant reduction (P < 0.001) in the level of serum antibodies to P. brasiliensis in the G1 patients in post-treatment examinations. The phytohemagglutinin (PHA) skin test showed a positive reaction among the patients in G1 (P < 0.01) post-treatment and there was a tendency towards an increase in the number of CD4+ T lymphocytes in both groups after treatment. The serum level of tumor necrosis factor (TNF) proved to be significantly higher (P < 0.02) in the G1 patients during treatment. In the G1 patients, the correlation between ESR and TNF tended to be negative whereas that between ESR and serum antibodies was positive. The present results indicate that the patients who received glucan, in spite of being more seriously ill, had a stronger and more favorable response to therapy.

Neurocysticercosis: treatment with albendazole and dextrochloropheniramine.

We evaluated the use of albendazole in combination with dextrochloropheniramine for the treatment of neurocysticercosis. Forty patients were treated from September 1984 to December 1987; each was diagnosed on the basis of clinical, epidemiological, cerebrospinal fluid and tomographic data. Patients were divided into 3 groups according to the albendazole treatment schedule. Group I received 10-15 mg/kg albendazole daily; group II received 15-25 mg/kg/d; group III received 15-30 mg/kg/d. Each patient also received simultaneously 18 mg/d of dextrochloropheniramine. Clinical improvement was observed in 4 patients in group I (50.0%), 10 patients in group II (83.3%) and 18 patients in group III (94.7%). Three patients in group II, and one in group III, died. Group III patients showed a significant improvement in quality of life compared to the other 2 groups. Side effects were insignificant in all groups. The combination of albendazole and dextrochloropheniramine seems to be a promising treatment for neurocysticercosis, especially at the doses used for group III, i.e. 15 mg/kg/d of albendazole for 21 d followed by 20-30 mg/kg/d for 30 d after a one-week interval, in combination with 18 mg/d of dextrochloropheniramine.

Liver dysfunction in patients bitten by Crotalus Durissus terrificus (Laurenti, 1768) snakes in Botucatu (State of São Paulo, Brazil).

Thirty-two patients bitten by venomous snakes sixteen by Bothrops spp. and sixteen by Crotalus durissus terrificus were studied. The group comprised thirty males and two females, aged eight to sixty-three years (mean 33 +/- 15). Bromsulphalein tests were increased in the majority of patients bitten by Crotalus durissus terrificus. The correlation coefficient of Spearman was positive between bromsulphalein tests and alanine aminotransferase levels, and between alanine aminotransferase and aspartate aminotransferase levels only in the Crotalus group. The only patient who died was bitten by Crotalus durissus terrificus and showed hydropic degeneration and mitochondrial injury in the liver. It was concluded that the hepatic damage might have been caused by at least two possible mechanisms: venom effect on liver mitochondria and cytokine effects on hepatocyte, specially interleukin-6.

The malarial impact on the nutritional status of Amazonian adult subjects.

The anthropometric (body weight, height, upper arm circumference, triceps and subescapular skinfolds; Quetelet index and arm muscle circumference) and blood biochemistry (proteins and lipids) parameters were evaluated in 93 males and 27 females, 17-72 years old voluntaries living in the malarial endemic area of Humaita city (southwest Amazon). According to their malarial history they were assembled in four different groups: G1--controls without malarial history (n:30); G2--controls with malarial history but without actual manifestation of the disease (n:40); G3--patients with Plasmodium vivax (n:19) and G4--patients with Plasmodium falciparum (n:31). The malarial status was stablished by clinical and laboratory findings. The overall data of anthropometry and blood biochemistry discriminated the groups differently. The anthropometric data were low sensitive and contrasted only the two extremes (G1 > G4) whereas the biochemistry differentiated two big groups, the healthy (G1 + G2) and the patients (G3 + G4). The nutritional status of the P. falciparum patients was highly depressed for most of the studied indices but none was sensitive enough to differentiate this group from the P. vivax group (G3). On the other hand the two healthy groups could be differentiated through the levels of ceruloplasmin (G1 < G2) and alpha nitrogen (G1 > G2). Thus it seems that the malaria-malnourishment state exists and the results could be framed either as a consequence of nutrient sink and/or the infection stress both motivated by the parasite.

[Plasmodium falciparum infection and pregnancy. Case reports]. / Infecção pelo Plasmodium falciparum e gravidez. Relato de casos.

In 1982 and 1985, an infant and a pregnant woman in the second trimester of her third pregnancy were respectively observed in Humaitá County, State of Amazonas, Brazil. Both had been diagnosed as having Plasmodium falciparum malaria. The infant was a boy born in the State of Amazonas with malaria since the 10th day of life and was examined at one month of age. His mother was 19 years old, was born in the State of Amazonas and had shown primary malarial infection on the day of the delivery of this child, her second. The pregnant woman was 22 years old, was born in the State of Amazonas, had two children respectively aged 8 and 6 years and had suffered three previous bouts of malaria, the first in 1983 and the last in March 1985. Both the infant and the pregnant woman were treated with clindamycin and evolved satisfactorily to clinical and parasitic cure. The infant probably presented with congenital malaria in view of the short period of incubation, which may have been due to the fact that he did not receive maternal antibodies.

[Seroprevalence of measles antibodies in a pediatric population from Botucatu, São Paulo State, Brazil]. / Soroprevalência de anticorpos contra o sarampo de uma determinada população infantil de Botucatu, SP.

A study of the seroprevalence of measles antibodies was conducted in a population of children residing in Botucatu, SP, in order to asses their immunological status whether induced by natural infection or by vaccination. A total of 101 children were studied, all of which had been vaccinated against measles. The laboratory tests used to determine the presence of antibodies in the collected blood samples were hemagglutination inhibition (HI) and immunoenzymatic assay (ELISA). HI results showed that 92.1% of the samples presented antibodies against measles. Samples with titers <1:4 when studied by HI were retested by ELISA in the same laboratory and only two continued to be negative for measles antibodies. Thus, measles antibodies were present in 98% of the serum samples from the children studied.

A retrospective study of 40 victims of crotalus snake bites. Analysis of the hepatic necrosis observed in one patient.

Forty patients with a diagnosis of snake bite were studied at the Infectious and Parasitic Disease Service of the Faculty of Medicine of Botucatu. Thirty were males and 10 females, ranging in age from 16 to 70 years. All were farm laborers and 35 of them were bitten in the lower limbs. Two of the 9 patients seen more than 6 hours after the bite died. The low mortality rate (5%) observed could be explained by the early care provided, by the use of appropriate doses of anti-crotalus serum, parenteral hydration, urine alkalinization with sodium bicarbonate and induction of osmotic diuresis with a mannitol solution. Anatomopathological examination of one of the patients who died revealed extensive hepatic necrosis. The authors discuss the possibility of the effect of a factor of snake venom in the genesis of hepatic necrosis and in the increased transaminase levels.

Isoniazid acetylating phenotype in patients with paracoccidioidomycosis and its relationship with serum sulfadoxin levels, glucose-6-phosphate dehydrogenase and glutathione reductase activities.

The authors evaluated the isoniazid acetylating phenotype and measured hematocrit, hemoglobin, glucose-6-phosphate dehydrogenase and glutathione reductase activities plus serum sulfadoxin levels in 39 patients with paracoccidioidomycosis (33 males and 6 females) aged 17 to 58 years. Twenty one (53.84%) of the patients presented a slow acetylating phenotype and 18(46.16%) a fast acetylating phenotype. Glucose-6-phosphate-dehydrogenase (G6PD) activity was decreased in 5(23.80%) slow acetylators and in 4(22.22%) fast acetylators. Glutathione reductase activity was decreased in 14(66.66%) slow acetylators and in 12(66.66%) fast acetylators. Serum levels of free and total sulfadoxin were higher in slow acetylator (p less than 0.02). Analysis of the results permitted us to conclude that serum sulfadoxin levels are related to the acetylator phenotype. Furthermore, sulfadoxin levels were always above 50 micrograms/ml, a value considered therapeutic. Glutathione reductase deficiency observed in 66% of patients may be related to the intestinal malabsorption of nutrients, among them riboflavin, a FAD precursor vitamin, in patients with paracoceidioidomycosis.