[Persistent neutrophilic meningitis in a patient with the acquired immunodeficiency syndrome]. / Meningite neutrofílica persistente em paciente com síndrome de imunodeficiência adquirida.

Persistent neutrophilic meningitis is rarely found and it is characterized by predominance of the number of neutrophils in samples of C SF (cerebrospinal fluid) from the patient after seven days of treatment. The above patient in HIV positive; he has developed fever and mental disorder for 4 months and has presented neutrophilic pleocytosis in analysis of CSF for more than 5 months. Since the beginning or the treatment he has taken antituberculous drugs and corticosteroids. For 3 months, the serologic evaluation, smears and cultures were negative. On the 60th day in hospital, the investigation of acid-fast bacilli in CSF was positive and culture confirmed the presence of Mycobacterium tuberculosis resistant to isoniazid. Several factors that may have caused this uncommon development were discussed: the disturbance of cell-mediated immunity, mainly in release of IL 8 and TNF, the simultaneous use of medicines that could alter the CSF concentration of antituberculous drugs, and the increasing number of multiresistant strains.

Circulating antigens levels in different clinical forms of the Schistosoma mansoni infection.

With the aim to evaluate the circulating cathodic antigen (CCA) levels in relation to the different clinical phases of Schistosoma sp. infection a sandwich ELISA using monoclonal antibody 5H11 was performed. The sera of three groups of 25 Brazilian patients with acute, intestinal and hepatosplenic forms of S. mansoni infection were tested and compared to a non-infected control group. Patients and control groups were matched for age and sex and the number of eggs per gram of feces was equally distributed among the three patient groups. Sensitivity of 100%, 72%, 52% of the assay was observed for the intestinal, hepatosplenic and acute toxemic groups respectively. The specificity was 100%. Intestinal and hepatosplenic groups presented CCA levels significantly higher in comparison to those observed for acute patients (F-ratio = 2,524; p = 0.000 and F-ratio = 6,314; p = 0.015 respectively). There was no significant difference of CCA serum levels between hepatosplenic and intestinal groups (F-ratio = 1,026; p = 0.316).

Meningite neutrofílica persistente em paciente com síndrome de imunodeficiência adquirida / Persistent neutrophilic meningitis in a patient with the acquired immunodeficiency syndrome

A meningite neutrofílica persistente é raramente diagnosticada e é caracterizada pelo predomínio neutrofílico na contagem diferencial do número de leucócitos nas amostras de líquido cefalorraquidiano retiradas após sete dias de tratamento adequado. O paciente aqui descrito é soropositivo para o HIV, apresentou febre e confusão mental durante 4 meses e pleocitose neutrofílica na análise liquórica por mais 5 meses. Foi tratado desde o início com tuberculostáticos. Durante três meses as reações imunológicas, as culturas e as pesquisas diretas foram negativas. No sexagésimo dia de internação, a pesquisa de bacilo álcool-ácido resistente (BAAR) no líquor foi positiva e a cultura confirmou a presença de Mycobacterium tuberculosis resistente à isoniazida. Vários fatores podem provocar esta evolução incomum. O comprometimento da imunidade celular, principalmente na liberação de citocinas pró-inflamatórias como a IL 8 e o FNT. O uso concomitante de medicações que poderiam alterar a concentração liquórica dos tuberculostáticos e o aparecimento crescente de cepas multirresistentes foram discutidos.

Persistent neutrophilic meningitis is rarely found and it is characterized by predominance of the number of neutrophils in samples of C SF (cerebrospinal fluid) from the patient after seven days of treatment. The above patient in HIV positive; he has developed fever and mental disorder for 4 months and has presented neutrophilic pleocytosis in analysis of CSF for more than 5 months. Since the beginning or the treatment he has taken antituberculous drugs and corticosteroids. For 3 months, the serologic evaluation, smears and cultures were negative. On the 60th day in hospital, the investigation of acid-fast bacilli in CSF was positive and culture confirmed the presence of Mycobacterium tuberculosis resistant to isoniazid. Several factors that may have caused this uncommon development were discussed: the disturbance of cell-mediated immunity, mainly in release of IL 8 and TNF, the simultaneous use of medicines that could alter the CSF concentration of antituberculous drugs, and the increasing number of multiresistant strains.

Figado gorduroso agudo idiopatico da gravidez. Estudo clinico-patologico de tres casos. / Idiopathic acute fatty liver of pregnancy. Clinico-pathological study of 3 cases

Os autores relatam tres casos de figado gorduroso agudo idiopatico da gravidez, estudados do ponto de vista clinico e anatomo-patologico: duas pacientes sobreviveram, tendo havido involucao da hepatopatia comprovada por puncao-biopsia percutanea, e uma terceira evoluiu para o obito, para o qual concorreu a coexistencia de descolamento prematuro da placenta. Chamam a atencao para a possibilidade da ocorrencia de nova gravidez nao complicada (caso I) bem como para o risco de hipoglicemia grave (casos I e II) capaz de determinar importante sequela neurologica (caso II) e a exigir a monitorizacao e o controle rigoroso dos niveis de glicose sanguinea

Hepatopatia em receptores de transplante renal. / Hepatopathy in renal transplantation recipients

Treze dentre 55 pacientes em hemodialise (23,6%) foram submetidos a biopsia hepaticas antes e apos transplante renal e acompanhados, em media, por 18,3 meses, por serem HBaAg positivo (12 pacientes, 21,8%) e/ou terem disfuncao hepatica. A simples persistencia do HBsAg no soro se acompanhava, com frequencia, de biopsias normais ou com alteracoes inespecificas. Entretanto, quatro pacientes HBsAg positivos apresentaram hepatopatia fatal algum tempo apos o transplante: dois com cirrose comprovada, um com necrose submacica e outro, que se tornara etilista inveterado, com provavel cirrose. Um quinto paciente HBaAg positivo evoluiu para hepatite cronica ativa apos rejeicao do transplante. Embora a persistencia do HBsAg no soro indique sempre mau prognostico apos o transplante, parece ser a principal causa de hepatopatia em nosso grupo de renais cronicos e associa-se, por vezes, a disfuncao hepatica intensa e ate fatal