Cellular and humoral immune responses of a patient with American cutaneous leishmaniasis and AIDS.

The lymphocyte responsiveness to leishmanial antigens and its influence on the course of cutaneous leishmaniasis was studied in a patient with AIDS-associated American cutaneous leishmaniasis caused by Leishmania braziliensis. The patient had cutaneous disseminated erythematous papules or nodules and mucosal lesions as well as moniliasis and weight loss. The patient had a poor delayed-type hypersensitivity to leishmanial antigens, showing 3 mm of induration. The cellular immune responses were studied in vitro by lymphocyte proliferative assays induced by leishmanial antigens and concanavalin A. The T cell phenotypes were analysed by flow cytometry. The peripheral blood mononuclear cells before proliferation showed an inversion of the CD4/CD8 ratio (0.28:1). The lymphoproliferative responses to antigen and mitogen were very low (indices < 2.5). The blast-like cell phenotypes after antigen stimulation in culture were: CD3+ 44.8%, CD4+ 7.53% and CD8+ 17.45%. In AIDS patients the decrease in the pool of CD4+ cells, and consequent diminution of the CD4/CD8 ratio, produced by HIV infection provokes a generalized immune depression. The patient's disseminated clinical picture was probably related to the inability of his T cell-mediated immune responses to control the spread of Leishmania infection.

[Amelanotic melanoma. Study of 18 cases]. / Melanoma amelanótico. Estudo de 18 casos.

The authors analyze a retrospective study of 18 cases of amelanotic melanoma, coming from 7 Departments of Dermatopathology, and 3 from private clinics in Brazil, during the period from 1980 through 1987. Nine of the 18 patients were men, and seven were women; 14 of the 18 were caucasian and 2 were blacks. Their average combined age was 56 years, varying from 24 years to 86 years. The average size of the lesions was 2.7 cm. and the location was: extremities = 7, thoracic wall = 5, upper limb = 2, and lower limb = 2. Only 2 cases included in this analyses, didn't have any other additional information about color, age, sex and location. The authors found that amelanotic melanoma is rare, in accordance with the literature. They point out, that the rarity or the lack of the melanic pigment within the tumors cells, makes the clinical diagnosis much more complex.

Zoster. / Zoster

E feita a revisao geral do assunto, comparando-se os resultados universalmente conhecidos com aqueles obtidos em 197 pacientes do Hospital dos Servidores do Estado - RJ. Assim, foi constatada a maior incidencia nos individuos leucodermicos, bem como, proporcionalmente, durante a puberdade. Acreditam os autores que o zoster seja menos frequente do que se pensa nas regioes tropicais, isoladamente ou associado a neoplasias