Atypical mucocutaneous leishmaniasis caused by Leishmania braziliensis in an acquired immunodeficiency syndrome patient: T-cell responses and remission of lesions associated with antigen immunotherapy.

An atypical case of acquired immunodeficiency syndrome-associated mucocutaneous lesions due to Leishmania braziliensis is described. Many vacuolated macrophages laden with amastigote forms of the parasite were found in the lesions. Leishmanin skin test and serology for leishmaniasis were both negative. The patient was resistant to therapy with conventional drugs (antimonial and amphotericin B). Interestingly, remission of lesions was achieved after an alternative combined therapy of antimonial associated with immunotherapy (whole promastigote antigens). Peripheral blood mononuclear cells were separated and stimulated in vitro with Leishmania antigens to test the lymphoproliferative responses (LPR). Before the combined immunochemotherapy, the LPR to leishmanial antigens was negligible (stimulation index - SI=1.4). After the first course of combined therapy it became positive (SI=4.17). The antigen responding cells were predominantly T-cells (47.5%) most of them with CD8+ phenotype (33%). Very low CD4+ cells (2.2%) percentages were detected. The increased T-cell responsiveness to leishmanial antigens after combined therapy was accompanied by interferon-g (IFN-g) production as observed in the cell culture supernatants. In this patient, healing of the leishmaniasis lesions was associated with the induction of a specific T-cell immune response, characterized by the production of IFN-g and the predominance of the CD8+ phenotype among the Leishmania-reactive T-cells.

Quadro espirografico na fase assintomatica da asma bronquica. / Spirometric study in asymptomatic period of bronchial asthma

O estudo espirografico de 67 asmaticos totalmente assintomaticos e com o exame fisico normal, atendidos consecutivamente e sem carater de selecao, a nao ser exclusao de doencas concomitantes, mostrou que a obstrucao persistia em 76,1%. Dos l3 com espirograma normal, 9 revelaram resposta significativa apos broncodilatacao. Reforca-se, assim, a impressao de que ha na asma um exame do tonus broncomotor independente de fatores desencadeantes. Em 49,2% a obstrucao esteve presente ao longo de toda a expiracao e em apenas 26,8% so na parte final. A reducao da capacidade vital ocorreu em apenas 11,9%, sempre aliada a obstrucao. A prova broncodialtadora revelou melhora da obstrucao em 68,6% dos casos, e, no grupo todo, o aumento foi significativo em todos os parametros estudados (p < 0,05). No nivel de significancia de 5%, nao houve diferenca entre asmaticos nao-fumantes e asmaticos fumantes ou exfumantes, quer nos resultados pre-broncodilatacao, quer na resposta broncodilatadora, a excecao unica da capacidade vital forcada, em que houve aumento significativamente maior entre fumantes e ex-fumantes (p < 0,05)