RESUMO
Our prospective hospital-based study examined frequency, clinical presentation and serological indicators of coeliac disease that correlated with intestinal biopsy among high-risk Sudanese children. From July 2001 to July 2002, 80 children aged 15 months-18 years presented with poor appetite, weight loss, pallor and proximal muscle wasting. We diagnosed coeliac disease in 18 (22.5%). Antigliadin antibodies (AGA-IgG, AGA-IgA or both) were high in 44; endomysial antibody retest was high in 30. Guardians of 12 children refused consent for biopsy. The other 18 were biopsied: 5 had total villous atrophy, 8 subtotal and 5 partial. All improved with gluten-free diet. Degree of villous atrophy did not correlate with diarrhoea duration or severity, anaemia severity or serological titres.
Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Anorexia/etiologia , Biópsia , Doença Celíaca/sangue , Doença Celíaca/complicações , Doença Celíaca/imunologia , Criança , Pré-Escolar , Diarreia/etiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Gliadina/imunologia , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Incidência , Lactente , Masculino , Programas de Rastreamento/métodos , Atrofia Muscular/etiologia , Palidez/etiologia , Vigilância da População , Estudos Prospectivos , Fatores de Risco , Estudos Soroepidemiológicos , Fatores Socioeconômicos , Sudão/epidemiologiaRESUMO
The immunological mechanisms underlying the susceptibility to disseminated visceral parasitism of mononuclear phagocytes in patients with kala-azar remain undefined. Resistance and susceptibility are correlated with distinct patterns of cytokine production in murine models of disseminated leishmanial disease. To assess lesional cytokine profiles in patients with kala-azar, bone marrow aspirates were analyzed using a quantitative reverse transcriptase PCR technique to amplify specific mRNA sequences of multiple Th1-, Th2-, and/or macrophage-associated cytokines. Transcript levels of IL-10 as well as IFN-gamma were significantly elevated in patients with active visceral leishmaniasis; IL-10 levels decreased markedly with resolution of disease. These findings suggest that IL-10, a potent, pleiotropic suppressor of all known microbicidal effector functions of macrophages, may contribute to the pathogenesis of kala-azar by inhibiting the cytokine-mediated activation of host macrophages that is necessary for the control of leishmanial infection.