Severe combined immunodeficiency in Brazil: management, prognosis, and BCG-associated complications.

BACKGROUND: Severe combined immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency. The objectives of this study were to analyze the diagnosis, treatment, and prognosis of SCID in Brazil and to document the impact of BCG vaccine. METHODS: We actively searched for cases by contacting all Brazilian referral centers. RESULTS: We contacted 23 centers and 70 patients from 65 families. Patients were born between 1996 and 2011, and 49 (70%) were male. More than half (39) of the diagnoses were made after 2006. Mean age at diagnosis declined from 9.7 to 6.1 months (P = .058) before and after 2000, respectively, and mean delay in diagnosis decreased from 7.9 to 4.2 months (P = .009). Most patients (60/70) were vaccinated with BCG before the diagnosis, 39 of 60 (65%) had complications related to BCG vaccine, and the complication was disseminated in 29 of 39 (74.3%). Less than half of the patients (30, 42.9%) underwent hematopoietic stem cell transplantation (HSCT). Half of the patients died (35, 50%), and 23 of these patients had not undergone HSCT. Disseminated BCG was the cause of death, either alone or in association with other causes, in 9 of 31 cases (29%, no data for 4 cases). CONCLUSIONS: In Brazil, diagnosis of SCID has improved over the last decade, both in terms of the number of cases and age at diagnosis, although a much higher number of cases had been expected. Mortality is higher than in developed countries. Complications of BCG vaccine are an important warning sign for the presence of SCID and account for significant morbidity during disease progression.

Mycoflora and occurrence of aflatoxin B(1) and fumonisin B(1) during storage of Brazilian sorghum.

The present study is a 1-year follow up of the mycoflora of 140 samples of Brazilian freshly harvested (10) and stored (130) sorghum, the levels of aflatoxin and fumonisin contamination detected in the grains, and the prevailing abiotic factors (grain moisture content, water activity, temperature, relative humidity, and mean rainfall) at the time of sampling. The results show a predominance of the genera Phoma (57.1%), Aspergillus (42.7%), Fusarium (25.0%), and Rhizopus (21.4%) and the presence of nine other filamentous fungi. Fusarium, Aspergillus, and Penicillium, the three most important genera in terms of toxicity, presented numbers of colony forming units per gram of sorghum (CFU/g) that varied from 1 x 10(3) to 36 x 10(3), from 1 x 10(3) to 295 x 10(3), and from 1 x 10(3) to 20 x 10(3) CFU/g, respectively. The species most frequently found were Aspergillus flavus and Fusarium moniliforme. Of the total samples analyzed, 12.8% were contaminated with aflatoxin B(1) (concentration mean = 7-33 microg/kg) and 74.2% with fumonisin B(1) (concentration mean = 0.11-0.15 microg/g). This paper is the first report of the natural occurrence of aflatoxins and fumonisins in sorghum grain from Brazil.

Acute effect of aflatoxin B1 on different inbred mouse strains II.

The acute effects of Aflatoxin B1(AFB1) were evaluated on C57B1/6, CBA/J, and Balb/c mice challenged with a single intraperitoneal dose of the mycotoxin (60 mg/Kg animal weight). 90 mice per strain were divided into three groups of 30 animals each: the intoxicated group and control groups I and II. Intoxicated mice were injected intraperitoneally with AFB1 dissolved in corn oil, while control I mice received corn oil only (0.01 ml/g) by the same route. Lots of 10 animals from the intoxicated and control groups were sacrificed 24, 72 and 168 hours after challenge. Control mice II remained untreated and were used as standards of normality for biochemical (hepatic and renal function) and hematological evaluation. AFB1 was detected in the liver of C57B1/6 and CBA/J mice 24 hours (1.46 and 0.75 ng/g, respectively), 72 hours (2.30 and 0.08 ng/g, respectively), and 168 hours (2.18 and 0.25 ng/g, respectively) after challenge. The mycotoxin was also observed in the liver of B10A mice (6.20 ng/g) 72 hours post-injection. The most evident histological lesions were observed 168 hours after treatment in C57B1/6 and B10A mice. Serum levels of alkaline phosphatase in intoxicated C57B1/6 and B10A mice were significantly higher than those of control I and II animals. The histopathologic lesions and biochemical changes were very discrete in Balb/c and CBA/J mice. It is included that strains C57B1/6 and B10A are more susceptible than strains CBA/J and Balb/c to the acute effects of AFB1. Such difference probably reflects each strain's ability to biotransform and eliminate AFB1 and its metabolites.