RESUMO
Neutralizing potency of humoral immune responses induced by prior infection or vaccination is vital for protecting of individuals and population against severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). However, the emergence of viral variants that can evade neutralization by vaccine- or infection-induced immunity is a significant public health threat and requires continuous monitoring. Here, we have developed a novel scalable chemiluminescence-based assay for assessing SARS-CoV-2-induced cytopathic effect to quantify the neutralizing activity of antisera. The assay leverages the correlation between host cell viability and ATP levels in culture to measure the cytopathic effect on target cells induced by clinically isolated, replication-competent, authentic SARS-CoV-2. With this assay, we demonstrate that the recently arisen Omicron subvariants BQ.1.1 and XBB.1 display a significant decrease in sensitivity to neutralization by antibodies elicited from breakthrough infections with Omicron BA.5 and from receipt of three doses of mRNA vaccines. Thus, this scalable neutralizing assay provides a useful platform to assess the potency of acquired humoral immunity against newly emerging SARS-CoV-2 variants. IMPORTANCE The ongoing global pandemic of SARS-CoV-2 has emphasized the importance of neutralizing immunity in protecting individuals and populations against severe respiratory illness. In light of the emergence of viral variants with the potential to evade immunity, continuous monitoring is imperative. A virus plaque reduction neutralization test (PRNT) is a "gold standard" assay for analyzing neutralizing activity for authentic viruses that form plaques, like influenza virus, dengue virus, and SARS-CoV-2. However, this method is labor intensive and is not efficient for performing large-scale neutralization assays on patient specimens. The assay system established in this study allows for the detection of a patient's neutralizing activity by simply adding an ATP detection reagent, providing a simple evaluation system for neutralizing activity of antisera as an alternative to the plaque reduction method. Our extended analysis of the Omicron subvariants highlights their increasing capability to evade neutralization by both vaccine- and infection-induced humoral immunity.
Assuntos
Infecções Irruptivas , COVID-19 , Humanos , Luminescência , COVID-19/prevenção & controle , SARS-CoV-2/genética , Vacinação , Soros Imunes , Trifosfato de Adenosina , Anticorpos Neutralizantes , Anticorpos AntiviraisRESUMO
BACKGROUND: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regardless of the initiation of antiretroviral therapy (ART) in some patients with HIV-1 infection. In the present study, we examined the clinical characteristics of HIV-1-infected patients with high levels of plasma IFN-γ. METHODS: The study subjects were patients infected with HIV-1 who were either naïve to ART with CD4+ cell count > 200 cells/µL (n = 12), or had achieved viral suppression after ART for over a year (n = 188). The levels of plasma IFN-γ and interleukin-6 (IL-6) were measured by the enzyme-linked immunosorbent assay. Patients were divided into high IFN-γ and low IFN-γ groups based on a cutoff level of 5 pg/mL. RESULTS: The high IFN-γ group included 41 patients (21%). Compared to the patients on ART with low IFN-γ levels, those on ART in the high IFN-γ group were more likely to be younger than 50 years of age (P = 0.0051) and less likely to have dyslipidemia (P = 0.0476) or to be on a protease inhibitor (P = 0.0449). There was no significant difference between groups in the median increase of CD4+ cell counts from the initiation of ART for up to 3 years. However, after 4 years, the increase in CD4+ cell counts was significantly lower in the high IFN-γ group compared with that in the low IFN-γ group. There were no such significant differences between patients with low and high (> 2 pg/mL) levels of plasma IL-6. CONCLUSION: We concluded that HIV-1-infected patients with high levels of circulating IFN-γ did not have a higher rate of comorbidities related to immune activation. However, they exhibited lower CD4+ cell count recovery after 4 years of being on ART. This deficit could be a consequence of persistent immune activation.
Assuntos
Antirretrovirais/uso terapêutico , Farmacorresistência Viral/genética , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Interferon gama/sangue , Adulto , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/patologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Soropositividade para HIV/sangue , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/epidemiologia , HIV-1/classificação , HIV-1/isolamento & purificação , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , RNA Viral/análise , RNA Viral/genéticaRESUMO
OBJECTIVE: To investigate clinical and laboratory features of giant cell arteritis (GCA). METHOD: We included 24 patients (6 men, 18 women; mean age 69.8 years) in this study. GCA was diagnosed based on the American College of Rheumatology 1990 classification criteria. RESULTS: Mean serum C-reactive protein was 9.03 mg/dl. GCA was classified into three types: classic temporal arteritis type (cranial GCA, nine patients); large-vessel type, affecting the aorta and its major branches without temporal arteries (12 patients); generalized type, affecting both temporal arteries and large vessels (three patients). Swelling and tenderness of temporal arteries were recognized in temporal arteritis and generalized arteritis. Ten of these patients also had histopathologic findings of arteritis, including giant cells in biopsy specimens. Examination of HLA-class 1 expression showed that one patient with cranial GCA, three with generalized GCA, and seven with large-vessel GCA were positive for HLA-A24, and four patients with large-vessel GCA were positive for HLA-B39. One patient with cranial GCA, one with generalized GCA, and six with large-vessel GCA were positive for HLA-B52. Nine patients were positive for anti-phospholipid antibodies (seven for anti-cardiolipin antibody immunoglobulin G, seven for anti-cardiolipin ß2-glycoprotein-1 antibody, one for lupus anticoagulant). CONCLUSION: Our study demonstrated that HLA-class 1 expression in GCA resembles that in Takayasu arteritis, suggesting that these two arteritis types share the same genetic background. In contrast, the difference in the prevalence of anti-phospholipid antibodies in GCA and Takayasu arteritis patients shows a difference in the characteristic aspects of these two arteritis types.
Assuntos
Arterite de Células Gigantes/classificação , Arterite de Células Gigantes/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antifosfolipídeos/sangue , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Arterite de Células Gigantes/genética , Arterite de Células Gigantes/patologia , Antígenos de Histocompatibilidade Classe I/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Arterite de TakayasuRESUMO
We report a patient with Japanese minor ß thalassemia and HIV-1 infection. The patient showed prolonged anemia, which was originally attributed to chronic parvovirus B19 infection. Twelve years later, the patient presented with exacerbation of microcytic anemia following cessation of anti-retroviral therapy; the exacerbation resolved when anti-retroviral therapy was resumed. Sequencing of the ß globin gene revealed heterozygosity for a four-nucleotides deletion at codon 41/42 and minor ß thalassemia was confirmed. Because HIV-1-infected patients frequently show anemia due to nutritional deficiencies, opportunistic infections, AIDS-related malignancies, drug treatment and a direct effect of HIV-1 on the bone marrow, it is likely to overlook other causes of anemia. Thalassemia should be considered in the differential diagnosis of anemia even in HIV-1 infected patients, when microcytic anemia without iron deficiency is observed. Our case suggested that active HIV infection may have worsened ß thalassemia, and early introduction of anti-retroviral therapy is beneficial for the recovery of anemia.
Assuntos
Antirretrovirais/administração & dosagem , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , HIV-1/isolamento & purificação , Talassemia beta/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do PacienteRESUMO
We present herein a case report of a 59-year-old patient with HIV-1 infection who developed a CMV-induced pseudotumor of the duodenum. The patient presented with oral pain and dysphagia. Physical examination revealed oral thrush. An EIA and a Western blot assay for antibodies to HIV were positive. His CD4-positive lymphocyte count was initially 49/microL with an HIV viral load of 2.6 x 10(5) copies/mL. Cytomegalovirus (CMV) reactivation was detected with the CMV antigenemia assay. He had CMV retinitis in both eyes with unilateral blurring. An endoscopic study revealed candida esophagitis, and a tumor-like lesion with an irregular ulcer at the papilla of Vater. Histological and immunohistochemical studies revealed a CMV-induced pseudotumor and severely inflamed duodenal mucosa with infiltration of CMV-positive cells. The patient was treated with oral valganciclovir and fluconazole for three weeks. As the oral thrush and retinitis showed improvement, he began antiretroviral therapy (ART), consisting of raltegravir and TDF/ FTC. One month later the patient's CD4-positive cells increased to 130/microL and the level of HIV-RNA decreased to 160 copies/mL, The CMV retinitis had transiently worsened because of an ART-induced inflammatory response, immune reconstitution inflammatory syndrome (IRIS). Six months after the ART initiation, an endoscopic study revealed that the esophagitis and the lesion at the papilla had improved. Biopsy showed no CMV-positive cells in the epithelium. The patient was now in a relatively healthy condition. CMV-induced pseudotumors of the duodenum are rare, and sometimes resemble malignancy. However, because this tomor responds to medical treatment physicians treating severely immunocompromised patients should be aware of its presentation and treatment.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , Ampola Hepatopancreática , Colangite/patologia , Infecções por Citomegalovirus/patologia , Infecções por HIV/complicações , HIV-1 , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This report describes a 50-year-old woman with coexisting Basedow's disease and adult-onset Still's disease (AOSD) that relapsed simultaneously. She was diagnosed with Basedow's disease in 1999, and treatment with antithyroid agents was started. However, the treatment was soon stopped because of severe side effects. A partial thyroidectomy was performed and the thyroid function stayed well-controlled after the surgery. In August 2007, she was admitted to our hospital with fever, a sore throat, skin rashes, arthritis and leukocytosis, and was diagnosed with AOSD. At the same time, her laboratory data revealed decreased serum TSH and elevated serum free T4, suggesting a relapse of Basedow's disease. After initiation of steroid pulse therapy accompanied by oral prednisolone, both diseases improved significantly. Prednisolone was gradually reduced, and the disease activity remained in remission. Immediately after prednisolone reached 3 mg/day in November 2009, both diseases relapsed. Prednisolone was increased to 30 mg/day, and the diseases became well-controlled again. In this case, Basedow's disease was aggravated when AOSD was in the active stage. Literature searches revealed five previously reported cases with coexisting Basedow's disease and AOSD. In four of the six cases, including our case, both diseases were activated simultaneously. AOSD in the active stage is known to cause hypercytokinemia and immunological derangement. Our case indicated that the pathogenesis of AOSD might lead to relapse of coexisting Basedow's disease.
Assuntos
Doença de Graves/complicações , Doença de Still de Início Tardio/complicações , Feminino , Doença de Graves/tratamento farmacológico , Humanos , Metilprednisolona/administração & dosagem , Prednisolona/administração & dosagem , Pulsoterapia , Recidiva , Doença de Still de Início Tardio/tratamento farmacológico , Doença de Still de Início Tardio/imunologia , Resultado do TratamentoRESUMO
A 79-year-old man was diagnosed with relapsing polychondritis, from symptoms of bilateral auricular deformity and pigmentation, polyarthralgia, and audiovestibular damage, and from histological examination of the left auricular cartilage. The left auricular cartilage biopsy specimen revealed cartilage destruction with infiltration of plasmacytes expressing IgG4. This case suggests that IgG4 may be involved in the pathogenesis and etiology of relapsing polychondritis.
Assuntos
Adenocarcinoma/complicações , Doenças Autoimunes/imunologia , Imunoglobulina G/imunologia , Neoplasias Pulmonares/complicações , Policondrite Recidivante/imunologia , Adenocarcinoma/diagnóstico por imagem , Idoso , Doenças Autoimunes/complicações , Doenças Autoimunes/patologia , Biópsia , Orelha Externa/patologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Plasmócitos/imunologia , Plasmócitos/patologia , Policondrite Recidivante/complicações , Policondrite Recidivante/patologia , RadiografiaRESUMO
A 46-year-old female with a past history of ulcerative colitis (UC) was diagnosed with subacute thyroiditis (SAT), which improved with prednisolone (PSL) treatment (60 mg/day). The dose of PSL was gradually decreased, however upper back and neck pain and chest discomfort developed. The patient was diagnosed with Takayasu's arteritis (TA) based on wall thickening and luminal narrowing of the left common carotid artery and the left subclavian artery. The result of human leukocyte antigen typing analysis was A24 and B52 positive. These findings suggested that common genetic factors may be important for the etiology of TA, UC and SAT. This is the first report of TA that developed following UC and SAT.
Assuntos
Colite Ulcerativa/sangue , Antígeno HLA-A24/sangue , Antígeno HLA-B52/sangue , Arterite de Takayasu/sangue , Tireoidite Subaguda/sangue , Biomarcadores/sangue , Colite Ulcerativa/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/etiologia , Tireoidite Subaguda/diagnósticoRESUMO
A 58-year-old woman was diagnosed with Churg-Strauss syndrome (CSS) based on the symptoms of bronchial asthma, eosinophilia, mononeuritis multiplex and histological examination of the right sural nerve. Prior to treatment, the serum interleukin (IL)-5 level was high, and rearrangement of the T cell receptor (TCR) gene was identified. This is the first report of TCR gene rearrangement in a patient with CSS. The expanded T cell clone may be responsible for the overproduction of IL-5. Further studies are warranted to disclose a prevalence of TCR gene rearrangement in CSS patients and its pathophysiological roles in the development of this disease.
Assuntos
Síndrome de Churg-Strauss/genética , Rearranjo Gênico da Cadeia beta dos Receptores de Antígenos dos Linfócitos T/genética , Genes Codificadores da Cadeia beta de Receptores de Linfócitos T , Interleucina-5/sangue , Síndrome de Churg-Strauss/sangue , Síndrome de Churg-Strauss/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Nervo Sural/patologiaRESUMO
We report a 29-year-old woman with a 2.5 year history of mixed connective tissue disease (MCTD) who developed idiopathic portal hypertension (IPH) and thrombocytopenia as a result of hypersplenism. She had recurrent esophagogastric variceal rupture. Hematological examination also revealed low levels of protein C activity. The liver biopsy specimen showed non-specific mild inflammation and no thrombi. However, portal vein thrombosis developed after splenectomy. This was a rare case of severe complications of IPH accompanying MCTD and protein C deficiency.
Assuntos
Doença Mista do Tecido Conjuntivo/complicações , Doença Mista do Tecido Conjuntivo/diagnóstico , Deficiência de Proteína C/complicações , Deficiência de Proteína C/diagnóstico , Adulto , Feminino , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Pancitopenia/complicações , Pancitopenia/diagnóstico , Esplenomegalia/complicações , Esplenomegalia/diagnóstico , Hipertensão Portal não Cirrótica IdiopáticaRESUMO
OBJECTIVE: To investigate the clinical characteristics of patients with Churg-Strauss syndrome (CSS), including symptoms, blood chemistry and immunological findings. PATIENTS AND METHODS: We retrospectively investigated the records of 11 patients (six female and five male) with CSS admitted to our hospital from September 2003 to October 2009. RESULTS: Eight patients had preceding symptoms including bronchial asthma and allergic rhinitis. Seven patients showed eosinophilia. Nine patients had mononeuritis multiplex. Positive findings of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) were found in five patients. Neither clinical manifestations nor laboratory findings were correlated with positivity for MPO-ANCA. However, the MPO-ANCA-positive group showed a higher level of blood urea nitrogen and proteinuria than those negative for MPO-ANCA. Ten patients recovered after starting steroid or immunosuppressive therapy, although one patient died of unknown etiology. CONCLUSION: Although general assessments based on various factors such as medical history, clinical manifestation and laboratory studies are indispensable in CSS, MPO-ANCA might be useful as a predictor of renal dysfunction in patients with CSS.
Assuntos
Síndrome de Churg-Strauss , Adulto , Idoso , Anticorpos Anticitoplasma de Neutrófilos/sangue , Asma/imunologia , Nitrogênio da Ureia Sanguínea , Síndrome de Churg-Strauss/sangue , Síndrome de Churg-Strauss/tratamento farmacológico , Síndrome de Churg-Strauss/imunologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Japão , Masculino , Pessoa de Meia-Idade , Peroxidase/imunologia , Proteinúria/imunologia , Estudos Retrospectivos , Rinite Alérgica Perene/imunologia , Rinite Alérgica Sazonal/imunologia , Esteroides/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To clarify the clinical usefulness of cerebrospinal fluid (CSF) interleukin-6 (IL-6) measurement in patients with neuropsychiatric systemic lupus erythematosus (NPSLE), we studied CSF IL-6 levels in patients with NPSLE and analyzed the association between CSF IL-6 levels and other clinical findings of NPSLE. PATIENTS AND METHODS: We retrospectively analyzed records of 37 patients (33 females and four males) with NPSLE admitted to our hospital between January 2003 and December 2008. RESULTS: All patients showed neuropsychiatric symptoms. Fourteen patients showed abnormalities in brain magnetic resonance imaging (MRI) and 12 patients had abnormal findings in electroencephalography (EEG). Increased CSF cell counts and elevated levels of CSF IL-6 were found in 11 and 30 patients, respectively. Elevated levels of CSF IL-6 were not statistically correlated with specific abnormalities in the blood analysis, in increased CSF cell counts, and in abnormalities in the brain MRI and EEG. In addition, a group of NPSLE patients positive for antiphospholipid antibodies (aPL) showed lower CSF IL-6 than the patients negative for aPL. CONCLUSION: These results indicated that CSF IL-6 might be useful in diagnosis of NPSLE. However, general assessments of patients based on various factors (clinical manifestations, imaging findings and CSF examinations) are also required.
Assuntos
Interleucina-6/líquido cefalorraquidiano , Vasculite Associada ao Lúpus do Sistema Nervoso Central/líquido cefalorraquidiano , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We herein report a case study of an HIV-1-infected 64-year-old Japanese man who presented, with an abdominal aortic aneurysm due to non-typhoidal Salmonella. He was admitted with a 7-day history of intermittent left back pain. A culture of a blood specimen yielded gram-negative bacilli, which were identified as non-typhoidal Salmonella. Computed tomography showed an abdominal aortic aneurysm due to the non-typhoidal Salmonella infection. Since such a complication is frequently fatal, its management, especially the timing of surgery, is difficult. Further studies are needed to determine the optimal treatment strategy, however, early diagnosis and prompt careful treatment can reduce mortality.
Assuntos
Aneurisma Infectado/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Infecções por HIV/diagnóstico , HIV-1 , Infecções por Salmonella/diagnóstico , Salmonella , Aneurisma Infectado/complicações , Aneurisma Infectado/terapia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/terapia , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Salmonella/complicações , Infecções por Salmonella/terapiaRESUMO
A 63-year-old-man was diagnosed in March 2002 with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis because of mononeuritis multiplex, interstitial pneumonia and a positive finding for myeloperoxidase (MPO)-ANCA. Although treated with prednisolone and oral cyclophosphamide, he suffered repeated remission and deterioration of his conditon, which was complicated by hypertrophic pachymeningitis and sinusitis. In July 2006, he was diagnosed with an exacerbation of ANCA-associated vasculitis because of pyrexia, general malaise, numbness in his face and legs, and elevated serum CRP level. Steroid pulse therapy was thus initiated and the patient's clinical symptoms improved. However, serum CRP levels elevated again (5.18 mg/dl) in September 2006. We began administration of rituximab (500 mg/bodyx4 times) in November 2006 and his symptom and laboratory data significantly improved. The dose of prednisolone was slowly decreased without suffering a relapse. Rituximab has been administered every one year, and good disease control has been achieved. Diagnosis of Wegener's granulomatosis was made from the findings of a nodular lesion in the left lung. Rituximab should be considered for patients with refractory ANCA-associated vasculitis.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Anticorpos Anticitoplasma de Neutrófilos/sangue , Anticorpos Monoclonais Murinos , Biomarcadores/sangue , Proteína C-Reativa , Ciclofosfamida/administração & dosagem , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Recidiva , Rituximab , Resultado do TratamentoRESUMO
We report a 24-year-old male with systemic lupus erythematosus (SLE) who developed influenza virus B-associated hemophagocytic syndrome and cardiac tamponade. Although the patient's general condition improved after steroid pulse therapy and pericardiocentesis, pericardial effusion re-accumulated. Colchicine and aspirin were administered, together with prednisolone, after which no further relapses occurred. This was a rare case of severe influenza-associated hemophagocytic syndrome and steroid-resistant pericardial effusion in an SLE patient.
Assuntos
Vírus da Influenza B , Influenza Humana/complicações , Lúpus Eritematoso Sistêmico/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Pericardite/complicações , Anti-Inflamatórios/uso terapêutico , Aspirina/uso terapêutico , Colchicina/uso terapêutico , Quimioterapia Combinada , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/virologia , Linfo-Histiocitose Hemofagocítica/patologia , Masculino , Pericardite/diagnóstico por imagem , Pericardite/tratamento farmacológico , Prednisolona/uso terapêutico , Ultrassonografia , Adulto JovemRESUMO
The appearance of tumor necrosis factor blockers changes the treatment goal of rheumatoid arthritis (RA) to include not only the inhibition of bone destruction, but also the induction of remission. We, herein, report two cases with RA that showed a prolonged remission after the discontinuation of etanercept. The two cases were 27 and 38 years of age, and their disease durations were 6 and 14 months, respectively. Their disease activity score 28 (DAS28) before treatment were 4.43 and 5.07, respectively. Case two was resistant to infliximab as determined by previous treatment with this therapy. Both cases showed a dramatic clinical response and discontinued etanercept in the 15th month and the 14th month after the start of treatment, respectively. No exacerbation of arthritis was evident after the discontinuation of etanercept as supported by the maintenance of DAS28 at less than 2.6. Moreover, after the discontinuation of etanercept, radiographic progression was not evident and decreased modified Sharp scores were observed for at least 1 year in both cases. These findings indicate that clinical and radiographic remission is possible in some patients with RA after the discontinuation of etanercept.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Imunoglobulina G/administração & dosagem , Receptores do Fator de Necrose Tumoral/administração & dosagem , Adulto , Esquema de Medicação , Etanercepte , Feminino , Humanos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Western blot (WB) is the most widely accepted confirmatory assay for detecting antibodies to the human immunodeficiency virus 1 (HIV-1). We report the case of an HIV-1 patient whose WB was negative for over two years. A 41-year-old Japanese man with Pneumocystis pneumonia (PCP) and pulmonary tuberculosis referred in March 2005 was found to have positive HIV-1 ELISA and HIV RNA PCR, but HIV-1 WB with only two bands, at gp160 and p18, and no WB HIV-2 band. The CD4 count was 37/microL, and total immunoglobulin, IgG, IgM, and IgG subclasses were normal. The man was treated for PCP and pulmonary tuberculosis, then underwent antiretroviral therapy. He had taken short-terms steroids to treat a drug allergy and immune reconstitution syndrome. Six months later, his serological ELISA tests for HIV-1 and HIV DNA PCR were negative and WB showed no positive band. The CD4 count recovered gradually, and exceeded 350/microL two years later, but WB remained negative. Lymphoproliferative assays and interferon y expression against HIV-pl7, p24, and p41 were studied and compared to those of other HIV-1 infected patients. Our patient showed no response to p17 or p24 and only a weak response to p41. Other patients showed a response to HIV-antigens, but patients with antiretroviral therapy or with histories of steroid use responded more weakly than those with neither. These findings show that HIV-specific lymphocytes decline with antiretroviral therapy and steroid treatment within early HIV infection. It is therefore important to interpret negative serological tests carefully in patients such as ours.
Assuntos
Western Blotting , Infecções por HIV/imunologia , HIV-1/imunologia , Adulto , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 51-year-old woman was admitted to our hospital because of systemic jaundice, general fatigue in August 24, 2007. She was diagnosed with systemic lupus erythematosus (SLE) as a result of a discoid rash, photosensitivity, lymphocytopenia, elevated serum anti ds-DNA antibody and a positive test for antinuclear antibody. Her laboratory data revealed severe liver dysfunction, suggesting autoimmune hepatitis (AIH). She was also diagnosed with thrombotic thrombocytic purpura (TTP) because of thrombocytopenia, hemolytic anemia, renal dysfunction and decreased ADAM-TS13 activity. The patient was treated by methylprednisolone pulse therapy, fresh frozen plasma infusion and ursodeoxycholic acid. Her symptoms and laboratory data rapidly improved and a liver biopsy was carried out. Interface hepatitis and lymphocyte infiltration were observed in the specimen. A diagnosis of definite AIH was made from her International AIH group score of 20 points. AIH and TTP are rare complications of SLE. The prevalence of the complication of SLE and AIH has been reported as 1.7 approximately 2.7%, and that of SLE and TTP as 1 approximately 4%. We reported here a rare case of SLE complicated with AIH and TTP.
Assuntos
Hepatite Autoimune/complicações , Lúpus Eritematoso Sistêmico/complicações , Púrpura Trombocitopênica Trombótica/complicações , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Abstract Human herpes virus 8 (HHV-8) is known to be reactivated in immunocompromised situations and it is associated with Kaposi's sarcoma (KS) and some hematological diseases. The aim of this study was to analyze the effect of HHV-8 on HIV-1 infection, especially on thrombocytopenia complicated with HIV infection. The HHV-8 DNA load was determined by a quantitative real-time PCR, using leukocytes from 125 HIV-1-infected individuals. HHV-8 DNA was detected in 37 individuals. The increased HIV-1 load and reduced percentage of CD4-positive T cells were significantly associated with the presence of HHV-8. The prevalence and load for HHV-8 are higher in patients with KS than in patients without KS, but the difference is not significant. The increased HHV-8 DNA load was significantly correlated with thrombocytopenia, and platelet counts were significantly lower in individuals with HHV-8 than in individuals without HHV-8. We also obtained the negative correlations between changes in platelet counts and changes in HHV-8 DNA loads. The association between thrombocytopenia and HHV-8 has never been reported previously, apart from some case reports of Castleman's disease and KS. Various cytokines or chemokines are produced by HHV-8-infected cells, some of which have been reported to inhibit hematopoiesis. This may be one of the mechanisms by which HHV-8 infection induces thrombocytopenia. These results indicate that HHV-8 DNA in leukocytes may provide useful information for the assessment of the clinical appearance of HIV-1 infection.
Assuntos
DNA Viral/isolamento & purificação , Infecções por HIV/complicações , Infecções por Herpesviridae/virologia , Herpesvirus Humano 8/isolamento & purificação , Leucócitos/virologia , Trombocitopenia/complicações , Carga Viral , Adulto , Idoso , DNA Viral/análise , Feminino , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Infecções por Herpesviridae/complicações , Humanos , Leucócitos/química , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Reação em Cadeia da Polimerase/métodosRESUMO
A 62-year-old male was admitted to a local hospital due to a clouding of consciousness in October 2006. On admission, his renal function was observed to have severely deteriorated, which is thought to cause disturbance of consciousness. Laboratory data showed blood urea nitrogen to be 160 mg/dl and the serum creatinine level was 25 mg/dl and, as a result, continuous hemodiafiltration (CHDF) was started. Although his general condition improved, his renal function did not recover. Therefore, regular hemodialysis was started in December 2006. The cause of renal dysfunction was uncertain, because MPO-ANCA was negative, and a renal biopsy could not be done due to the lack of a clear corticomedullary border in his kidneys. In January 2008, he was diagnosed to have microscopic polyangiitis (MPA) because of hemoptysis, elevated serum CRP levels and a positive finding for MPO-ANCA (408.0 EU). An alveolar hemorrhage was also ascertained in a broncoscopic examination. Steroid pulse therapy and intravenous pulse therapy of cyclophosphamide were thus started. The patient's clinical symptoms thereafter significantly improved and his MPO-ANCA level became normalized. This is a rare case characterized by a late appearance of MPO-ANCA, which occurred after more than one year after the onset of renal failure in MPA.