Correlation of circulating immune complexes and complement breakdown products with the severity of the disease in human schistosomiasis mansoni.

Circulating immune complexes and complements compounds were measured in serum and plasma from 66 patients with three different clinical forms of chronic schistosomiasis mansoni: intestinal, hepato-intestinal and hepatosplenic. Three different methods were used: the 125I-C1q-binding assay, conglutinin-binding assay (KgB) and Raji cell-binding assay. Approximately 25% of the patients were positive for circulating immune complexes as measured by the C1q and Raji assays. The levels of complexes increased significantly with the severity of the disease. 60% of the patients were positive for immune complexes as measured by the KgB-assay but the incidence of positive results was not clearly influenced by the stage of the disease. There was no significant correlation between immunoglobulin levels and immune complexes. The complement profile of these patients does not suggest a dramatic activation of the complement system. However, there was a progressive decrease in the plasma levels of C4 and an increase of C3d levels which correlated significantly with the severity of the disease.

Mother-child relationship in human schistosomiasis mansoni. I. Parasitic antigens and antibodies in milk.

Immunoglobulins, anti-Schistosoma mansoni antibodies, complement components and schistosome antigens were investigated in milk from mothers infected with S. mansoni. No significant differences of immunoglobulins or complement component levels were observed between infected and control mothers. Anti-S. mansoni antibodies were detected in the milk of 8 out of 25 infected mothers. A significant relationship was observed between serum and "4", were demonstrated in milk from infected patients by the double diffusion micromethod. The function of these immunologically active substances transmitted by milk from mother to child is discussed.

Immunological studies in human schistosomiasis. III. Immunoglobulin levels, antibodies, and delayed hypersensitivity.

Levels of IgG, IgE, IgM, and IgA were determined, specific antibodies were detected by the fluorescent antibody test, hemagglutination test, complement fixation test and immunoelectrophoresis, and intradermal tests for delayed hypersensitivity to Schistosoma mansoni antigens were performed in Brazilian patients with schistosomiasis mansoni. The results were compared according to the clinical forms of the disease. IgG levels and antibody titers increased progressively in the subclinical, hepatomegalic, and hepatosplenic forms and there was a statistical relationship between IgG levels and the intensity of responses to the four serological tests; Delayed hypersensitivity (DHS) was found more frequently in hepatosplenic patients and more particularly in those with splenomegaly. DHS also correlated with age, but not with sex or with skin color. The strongest DHS reactions were observed in patients 20 to 34 years old, and in those having the highest fecal egg output. IgG levels, antibody titers, and DHS responses decreased after splenectomy and portal filtration of the worms. No significant variation was observed between untreated subjects, patients who were splenectomized and a group not subject to reinfection for 4 yearsk0

Characteristics of the acquired immunodeficiency syndrome in Brazil.

The clinical and epidemiologic characteristics of the acquired immunodeficiency syndrome (AIDS) were studied in a tropical area of Brazil. During an 18-month period (July 1989-January 1991), 111 consecutive AIDS patients (102 men and nine women) were evaluated. Patients reported homosexual/bisexual activities (60%), intravenous drug use (19%), or both (6%), heterosexual activities (11%), blood transfusions (2%), and 2% belonged to an undetermined category. Weight loss, fever, oral thrush, and diarrhea were present in > or = 70% of the patients at presentation. An unexpected high frequency of hepatomegaly (49%) was detected, and found to be significantly associated with tuberculosis (P < 0.0001). Although the epidemiologic features of human immunodeficiency virus transmission were comparable to the United States/European pattern, the clinical spectrum of opportunistic infections more closely resembled that reported in Africa and Haiti, with a greater frequency of fungal and mycobacterial infections than Pneumocystis carinii pneumonia and viral infections.

Titres of antibodies to gut-derived antigens in patients with chronic schistosomiasis mansoni.

Serum titres of antibodies against six intestinal, one ubiquitous and one non-intestinal bacteria were determined in patients with severe hepatosplenic schistosomiasis mansoni, with light intestinal schistosomiasis and in normal subjects. No significant difference was observed among the three groups of subjects for levels of antibodies against two non-intestinal bacteria and four of the intestinal bacteria. Patients with hepatosplenic schistosomiasis had titres of antibodies against one strain of Pseudomonas aeruginosa and one strain of Escherichia coli lower than those observed in other groups of subjects. Despite the partial obliteration of the hepatic blood outflow and the elevated portal pressure, hepatic clearance of the portal blood is efficient in chronic human schistosomiasis, and unlike alcoholic liver cirrhosis, avoids excessive stimulation of the immune system by a gut-derived antigens.

The association between serum potassium at hospital admission and the case-fatality rate of leptospirosis in men.

Severe leptospirosis affects predominantly males and presents a high susceptibility to hypokalemic acute renal failure. As hypokalemia and hyperkalemia induce severe complications, it is important to evaluate if the initial serum potassium is an independent risk factor for death in leptospirosis. The medical records of 1016 patients hospitalized with the diagnosis of leptospirosis were reviewed. The analysis was restricted to 442, according to the following criteria: male, 18 years or older, information about death or hospital discharge and recorded values of serum potassium, serum creatinine and duration of symptoms at admission. Potassium values lower than 3.5 mEq/L (hypoK), 3.5-5 mEq/L (normoK) and above 5 mEq/L (hyperK) were detected in 180, 245 and 17 patients, respectively. The death rate increased with serum potassium: 11.1% in the hypoK, 14.7% in the normoK and 47.1% in the hyperK group (p = 0.002). In a logistic regression model (normoK as referent), including age, creatinine and duration of symptoms, hypoK was not associated with increased death rate (odds ratio (OR) = 0.80; p > 0.1). On the other hand, hyperK showed a significant association with increased risk of death (OR = 3.95, p = 0.021). In conclusion, in this sample of men with leptospirosis initial serum potassium was positively and independently correlated with the risk of in-hospital death.

Facial nerve palsy associated with leptospirosis.

This case report describes the findings of a 27-year-old black male from Bahia, Brazil, who developed facial palsy during the convalescence phase of leptospirosis. The patient recovered without neurological sequel. This work calls attention to a possible association between leptospirosis and facial palsy.

[Severe forms of leptospirosis: clinical, demographic and environmental aspects]. / Formas graves de leptospirose: aspectos clínicos, demográficos e ambientais.

Characteristics of 1,016 patients hospitalized with leptospirosis in the Hospital Couto Maia, Salvador, BA, Brazil, between 1993 and 1997 are described. Higher pluviometric precipitation was related to an increase in the number of hospitalizations during the following month. Males corresponded to 81.1% (824/1,016) of these; mean age was 35.7+/-15.4 years. Almost 94% (778/829) of the 829 patients with information about race were black or mulatto (mixed race). For ages 18 years or above, almost 93% had not completed high school level. The mean incubation period was estimated as 6.3+/-3.9 days. Average duration of symptoms was 6.1+/-2.4 days. Hemorrhagic events corresponded to 14.3% (145/1,016). The case-fatality rate among 1,009 patients that were not transferred was 14.2% (143/1,009). Renal failure was the attributable cause of death in 76.2% (109/143). The data indicate that leptospirosis is closely related to lower socioeconomic levels, and that higher pluviometric precipitation antecedes the outbreaks.

[High intensity signal in basal ganglia on T1 weighted images: case report in Manson's Schistosomiasis with portal systemic encephalopathy]. / Hiperintensidade de sinal em T1 dos núcleos da base. Relato de caso na encefalopatia portal sistêmica esquistossomótica.

We report a case of mansonic schistosomiasis with portal systemic encephalopathy associated with a high intensity signal in basal ganglia on TI weighted images due to deposition of manganese in tissues related with portal-systemic collateral vessels. A bibliographic review was done focusing the magnetic resonance findings. To the best of our knowledge, these signal changes have not yet been associated with Manson's schistosomiasis.