ABSTRACT
La hidatidosis o equinococosis quística es una enfermedad zoonótica que tiene presentaciones clínicas muy heterogéneas. Los quistes sintomáticos y complicados habitualmente son resueltos mediante cirugía siguiendo las reglas de la WHO-IWGE. Sin embargo, en las formas transicionales (CE3) los criterios terapéuticos continúan en discusión. Asimismo, en quistes asintomáticos y en pacientes con alto riesgo quirúrgico, la opción del tratamiento médico con benzoimidazólicos y su combinación con la estrategia de vigilar y esperar puede ser una alternativa terapéutica segura. Se presenta un caso de hidatidosis hepática CE3b con características clínico-evolutivas excepcionales y alto riesgo quirúrgico en que se adoptó un manejo de vigilancia clínica y tratamiento con albendazol. Se analizan los beneficios y riesgos de esta terapéutica.
Cystic echinococcosis is a zoonotic disease with very heterogeneous clinical presentations. The possibility of symptomatic hepatic cysts be solved by surgery is the conduct of election. However, in asymptomatic cysts and in patients with high surgical risk, medical treatment with benzimidazolic combined with the strategy of watch and wait, may be an option to take into account. In the present work, we take as an example a case of hepatic hydatid disease with high surgical risk and analyze the potential benefits of establishing such therapeutic conduct and monitoring.
A hidatidose ou equinococose cística é uma doença zoonótica com apresentações clínicas muito heterogêneas heterogêneas. Os cistos sintomáticos e complicados de maneira geral são tratados por cirurgia de acordo com as indicações da WHO- IWGE. No entanto, nos casos de formas transicionais (CE3) os critérios terapêuticos continuam em discussão. Nos cistos assintomáticos e em pacientes com alto risco cirúrgico a opção do tratamento médico com benzoimidazolicos e sua combinação com a estratégia de vigilar e esperar, pode ser uma alternativa terapêutica segura. Apresenta-se um caso de hidatidose hepática CE3b, com características clínico-evolutivas excepcionais e alto risco cirúrgico, no qual utilizou- se um manejo de vigilância clínica e tratamento com albendazol. Os benefícios e os riscos desta terapêutica são analisados.
Subject(s)
Humans , Echinococcosis, Hepatic/therapy , Surveillance in DisastersABSTRACT
Antigenic preparations from Sporothrix schenckii usually involve materials from mixed cultures of yeast and mycelia presenting cross-reactions with other deep mycoses. We have standardized pure yeast phase with high viability of the cells suitable to obtain specific excretion-secretion products without somatic contaminations. These excretion-secretion products were highly immunogenic and did not produce noticeable cross-reactions in either double immunodiffusion or Western blot. The antigenic preparation consists mainly of proteins with molecular weights between 40 and 70 kDa, some of them with proteolytic activity in mild acidic conditions. We also observed cathepsin-like activity at two days of culture and chymotrypsin-like activity at four days of culture consistent with the change in concentration of different secreted proteins. The proteases were able to cleave different subclasses of human IgG suggesting a sequential production of antigens and molecules that could interact and interfere with the immune response of the host.
Subject(s)
Antigens, Fungal/biosynthesis , Cathepsins/biosynthesis , Chymotrypsin/biosynthesis , Fungal Proteins/biosynthesis , Immunoglobulin G/immunology , Sporothrix/metabolism , Animals , Antibodies, Antinuclear/immunology , Electrophoresis, Polyacrylamide Gel , Humans , Immunoblotting , Immunodiffusion , Molecular Weight , RabbitsABSTRACT
Antigenic preparations from Sporothrix schenckii usually involve materials from mixed cultures of yeast and mycelia presenting cross-reactions with other deep mycoses. We have standardized pure yeast phase with high viability of the cells suitable to obtain specific excretion-secretion products without somatic contaminations. These excretion-secretion products were highly immunogenic and did not produce noticeable cross-reactions in either double immunodiffusion or Western blot. The antigenic preparation consists mainly of proteins with molecular weights between 40 and 70 kDa, some of them with proteolytic activity in mild acidic conditions. We also observed cathepsin-like activity at two days of culture and chymotrypsin-like activity at four days of culture consistent with the change in concentration of different secreted proteins. The proteases were able to cleave different subclasses of human IgG suggesting a sequential production of antigens and molecules that could interact and interfere with the immune response of the host.
As preparações antigênicas de Sporothrix schenckii provêm geralmente de cultivos mistos de leveduras e micélios e apresentam reações cruzadas com outras micoses profundas. Foi padronizada a obtenção da fase leveduriforme pura, com alto índice de células viáveis, o que permite, por sua vez, obter produtos específicos da excreção-secreção sem contaminantes somáticos. Estes produtos da excreção-secreção são altamente imunogênicos, e não apresentam reações cruzadas visíveis em dupla difusão e sem Western blot. O preparado antigênico consiste principalmente em proteínas com peso molecular entre 40 e 70 kDa, sendo que algumas apresentam atividade proteolítica em meios levemente ácidos. Foi observada atividade do tipo catepsina em produtos da excreção-secreção obtidos a partir de leveduras de dois dias de cultivo, e atividade do tipo quimiotripsina aos quatro dias de cultivo, consistente com a mudança de concentração de proteínas secretadas. As proteases puderam clivar diferentes subclasses de IgG humanas, o que sugere uma produção seqüencial de antígenos e moléculas que podem interagir com a resposta imune do hospedeiro.
Subject(s)
Animals , Humans , Rabbits , Antigens, Fungal/biosynthesis , Cathepsins/biosynthesis , Chymotrypsin/biosynthesis , Fungal Proteins/biosynthesis , Immunoglobulin G/immunology , Sporothrix/metabolism , Antibodies, Antinuclear/immunology , Electrophoresis, Polyacrylamide Gel , Immunoblotting , Immunodiffusion , Molecular WeightABSTRACT
The asteroid body in Sporotrichosis (AB) is a characteristic structure that allows diagnosis in lymphangitic presentations and whose generation and composition is not fully understood. Our study focused on the biological relationship between the yeast and host elements present in the AB. Indirect immunofluorescence showed that on ABs obtained from naturally infected individuals there were antigenically related IgG and IgM molecules in the spikes of the radiated crowns. However, there were differences in the pattern of distribution for each immunoglobulin isotypes. The yeast cells located at the center of the ABs were viable, as shown by the generation of germ tubes and conidial formation after 36-48 hours of incubation at 22 degrees C. The central yeast could divide and proliferate even in the ABs that had been pre-treated with specific anti-Sporothrix schenckii serum and fresh complement. The data suggests that AB in sporotrichosis might be a resistance structure which uses the host immune molecules to the advantage of the yeast.
Subject(s)
Microbial Viability , Sporotrichosis/immunology , Sporotrichosis/pathology , Yeasts/immunology , Yeasts/physiology , Antibodies, Fungal/analysis , Fluorescent Antibody Technique, Indirect , Humans , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Lymphatic Vessels/chemistry , Lymphatic Vessels/pathology , Skin/chemistry , Skin/pathologyABSTRACT
La estrongiloidiasis es una parasitosis intestinal de distribución mundial, más frecuente en regiones tropicales, templadas y húmedas. Generalmente paucisintomática, puede producir ocasionalmente cuadros intestinales severos, tiene la particularidad de perpetuarse por autoinfección y puede producir hiperinfección en pacientes inmunocomprometidos por diseminación masiva y sistémica de larvas.Presentamos el primer caso en Uruguay de hiperinfección por Strongyloides stercoralis, en una paciente de 18 años, VIH positiva, que no recibía tratamiento antirretroviral y que comenzó tres meses antes del ingreso con fiebre y gran repercusión general. Al ingreso presentaba mal estado general e insuficiencia respiratoria con estertores subcrepitantes diseminados, por lo que con el diagnóstico presuntivo de pneumocistosis fue tratada con trimetoprim-sulfametoxazol, hidrocortisona y ventilación no invasiva. Posteriormente el estudio microscópico directo del lavado bronquiolo alveolar mostró larvas filariformes identificadas como de Strongyloides stercoralis. Con el diagnóstico de estrongiloidiasis se comenzó tratamiento con ivermectina al cuarto día de internación, pero la paciente falleció en las horas siguientes.La prevalencia de estrongiloidiasis en Uruguay es muy baja. Sin embargo, dado que la frecuencia de geo-helmintiasis está creciendo notablemente en muchas áreas del país, no se debe subestimar el riesgo que implica esta parasitosis para los inmunocomprometidos. Frente a antecedentes clínicos y epidemiológicos compatibles en estos pacientes, la estrongiloidiasis debe ser descartada con metodologías adecuadas.
Subject(s)
Strongyloidiasis , Strongyloides stercoralis , Strongylida InfectionsSubject(s)
Ascaris lumbricoides , Cestoda , Communicable Disease Control , Enterobius , Helminthiasis , Hymenolepis , Strongyloides stercoralis , Taeniasis , Trichuris , Health Education , SanitationABSTRACT
Cyclospora cayetanensis (Ortega, Gilman & Sterling, 1994), es el agente emergente de la ciclosporiasis, nueva afección diarreica descrita como aguda y autolimitada, de dos a seis semanas de duración en inmunocompetentes y diarrea crónica intermitente en pacientes con sida. Esta afección y su agente han sido notificados recientemente en Uruguay, afectando a viajeros provenientes de áreas reconocidamente endémicas para este nuevo protozoario coccidio entérico. En la presente comunicación se examina la totalidad de la casuística conocida en el país, y se concluye que C. cayetanensis es en Uruguay un agente de diarrea del viajero, sin registro de ocurrencia autóctona hasta la fecha.
Summary Cyclospora cayetanensis (Ortega, Gilman, and Sterling, 1994) is the emergent agent of cyclosporiasis, a new acute and self-limited diarrhoeal disease. It lasts from two to six weeks when affects immunocompetent individuals and it causes chronic intermittent diarrhea in AIDS patients. This disease and its etiologic agent have been recently reported in Uruguay, affecting travellers coming from previously known endemic areas. In the present work, the whole number of cases in the country is reported. We conclude that C. cayetanensis is an agent of the traveller's diarrhoea in Uruguay, without occurrence of native cases so far.
Résumé Cyclospora cayetanensis Ortega, Gilman& Sterling, 1994), c'est l'agent émergent de la cyclosporiasis, nouvelle mala-die diarrhéique décrite comme aigue et auto-limitée, de deux à six semaines de durée en immunocompétentes et diarrhée chronique intermittente chez des patients avec Sida. Cette affection et son agent ont été récemment décrits en Uruguay et elle atteint des voyageurs qui viennent d'endroits reconnus comme endémiques pour ce nouveau protozoaire coccidien entérique. Dans cette étude, on examine toute la casuistique connue dans le pays, et on conclut que C. Cayetanensis est en Uruguay un agent de diarrhée du voyageur, n'ayant pas de registre autochtone jusqu'à présent.
Subject(s)
Cyclosporiasis , Diarrhea , Cyclospora , Travel-Related IllnessABSTRACT
The last national survey on seroprevalence of T. cruzi human infection in Uruguay, showed a 3,4 percent in adults from endemic areas. Since 1983, antivectorial actions of the control program have been carried out continually. In consequence, household infestation by Triatoma infestan, the main vector of T. cruzi in Uruguay, decreased in all endemic areas and was completely eliminated in some of them. The objectives of the present work are to evaluate the new seroepidemiological situation. A representive sampling of rural and urban population was undertaken, to include six and twelve year-old schoolchildren from three departments: Artigas, Rivera and Tacuarembo. The whole sample included 4,722 school children, evaluated by the indirect inmunofluorescense (IFI) test for Chagasïdisease. The seroprevalence of T. cruzi infection in the six year-old group was 0,3 percent in Artigas, 0,6 percent in Rivera and 1,0 percent in Tacuarembo. The seropositive children with seropositive mothers support the possible congenital transmission
Subject(s)
Humans , Male , Female , Chagas Disease/epidemiology , Trypanosoma cruzi/pathogenicity , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Seroepidemiologic Studies , Uruguay/epidemiology , Vector Control of DiseasesABSTRACT
Guia de tratamiento de la enfermedad hidática.
Subject(s)
Echinococcosis/therapy , Reference BooksABSTRACT
This paper describes population structure, spatial distribution and habitat selection of wild and peridomestic populations of Triatoma rubrovaria (Blanchard, 1843). Field studies were carried out at Las Piedras and La Bolsa in the Northern Department of Artigas, Uruguay. A semicircular sampling area, divided in seven or eight triangular sectors was sequentially examined from October 1990 to November 1991. At Las Piedras (typical wild habitat) 1063 T. rubrovaria bugs were collected from 84 of the rocky outcroops ("pedregales"). Abundance varied by season peaking in October-November (spring). Throughout the year, most of the population was made up of third, fourth and fifth instar nymphs; adults were found from October to March. In the peridomestic environment of La Bolsa, however T. rubrovaria was less common and showed a more irregular instar distribution. Colonized ecotopes, were those close to houses. In both sites T. rubrovaria was mainly associated with the geckonid Homonota uruguayensis and the cockroach Blaptica dubia.
Subject(s)
Animals , Male , Female , Triatoma , Population Density , Sampling Studies , Seasons , UruguayABSTRACT
En una localidad con poblacion rural dispersa ("La Bolsa", 3ª seccional, dpto. de Artigas, Uruguay) se estudio, en ambitos peridomiciliarios, el perfil alimentario de T. rubrovaria (triatomineo silvestre y potencial vector secundario de colonizacion intradomiciliaria), utilizandose la tecnica de doble difusion en agar, enfrentando contenido promesenterico frente a un panel de 13 sueros. Se pudo detectar en 120 insectos 251 identificaciones de fuente hematofagica con alimentacion predominante en mamiferos (73 per cent), pero marcado eclectismo alimentario (mamiferos, aves, reptiles y cucarachas), incluyendo hematofagia sobre seres humanos en un 8 per cent de las identificaciones totales....
Subject(s)
Humans , Chagas Disease/prevention & control , Disease Vectors/classification , Triatoma/parasitology , Insect Vectors , UruguayABSTRACT
La meningoencefalitis chagásica se observaba, hasta hace poco tiempo, casi exclusivamenete en las formas congénitas de la enfermedad y en las formas agudas en menores de 4 años. Estando la infección controlada por mecanismos inmunes, el aumento de los pacientes con distintas causas de inmunodepresión, ha permitido ver manifestaciones neurológicas de la enfermedad de Chagas, ya sea por reactivaciones de infecciones latentes o en el curso de la infección aguda. El SIDA es una nueva causa de inmunodepresión en la que puede desarrollarse esta complicación de la que hay pocos casos documentados en la literatura
