Síndrome inflamatorio de reconstitución inmunológica (SIRS) en la salud reproductiva / Immune reconstitution inflammatory syndrome (IRIS) in reproductive health

Resumen El embarazo es un proceso que genera grandes cambios inmunitarios en los cuales participan los linfocitos T con respuestas proinflamatorias (Th1/Th17) y antiinflamatorias (Th2/Treg), con la finalidad de mantener el óptimo estado y desarrollo fetal. En la infección por VIH estos ambientes inmunológicos son afectados directamente con el descenso de las células TCD4. El uso de antirretrovirales (ART) ha permitido que las mujeres que viven con VIH puedan disminuir de manera importante la posibilidad de infectar a sus productos con el virus. El embarazo, enfermedades autoinmunes y el uso de ART son factores conocidos para el desarrollo del síndrome inflamatorio de reconstitución inmunológica debido a la recuperación abrupta de la respuesta inmunitaria. En esta revisión describimos parte de estos cambios en el embarazo y puerperio sin patología añadida, además proponemos un posible comportamiento en los perfiles Th1/Th2 en mujeres que viven con VIH que reciben ART y cursan el primer año posparto.

Abstract Pregnancy is a process which generate great immunologic changes with participation of T lymphocytes with inflammatory (Th1/Th17) and anti-inflammatory response (Th2/Treg), with the purpose of maintain the optimum condition and fetal development. In HIV infection this immunological ambient are affected directly due the decrease of T CD4 cells. The use of antiretrovirals (ART) has allowed that women living with HIV can decrease the possibility to infect their newborns with the virus. The pregnancy, autoimmune diseases, and the use of ART are known factors for the progress of immune reconstitution inflammatory syndrome due to the abrupt recovery of immune response. In this review we describe some of these changes during the pregnancy and puerperium without any disease added, furthermore we propose a possible behavior of Th1/Th2 profile in women who live with HIV and receive ART during the first year of postpartum.

Psychological distress, anxiety, depression, stress level, and coping style in HIV-pregnant women in Mexico.

PURPOSE: To evaluate the presence of psychological distress (PD) and its association with the mental health and coping styles of pregnant women living with HIV (PWLWH). METHOD: An observational, cross-sectional descriptive study was performed. Seventy-three PWLWH were included. Patients responded to a psychometric battery for PD, depression, anxiety, stress, and coping style evaluation. The scales used in the study were: Goldberg's 30-item General Health Questionnaire (GHQ-30), State-Trait Anxiety Inventory (STAI), Zung Depression Self-Measurement Scale (ZDS), Nowack Stress Profile, Lazarus and Folkman's Coping Styles Questionnaire. RESULTS: PD was observed in 31.5% of the participants. PD-positive patients showed a higher probability of presenting traits of depression and anxiety and medium/high stress levels. Besides, they preferentially used emotion-focused coping styles. CONCLUSION: PD is associated with a higher probability of presenting anxiety and depression in PWLWH. Emotion-focused coping style could be a factor in decision-making associated with risk behaviors in PWLWH.

Transplacental transmission of cutaneous Leishmania mexicana strain in BALB/c mice.

The vertical transmission of leishmaniasis has been reported in species that cause visceral leishmaniasis. However, this condition has scarcely been documented in species that cause cutaneous leishmaniasis. The aim of this study was to determine experimentally whether L. mexicana is transmitted vertically. A control group of BALB/c mice and a group infected with L. mexicana were mated, the gestation was monitored, and females were killed before delivery. Four resorptions (P = 0.023) and eight fetal deaths (P = 0.010) were observed in the infected female group; furthermore, the offspring body weight of the infected group was lower than the body weight of the healthy group (P = 0.009). DNA amplification by polymerase chain reaction (PCR) revealed that all placentas and maternal spleens as well as 39 of 110 fetal spleens obtained from the offspring of infected mothers tested positive for Leishmania. In conclusion, L. mexicana is transmitted transplacentally and causes fetal death, resorption, and reduction in offspring body weight.

Effect of ambient temperature on the clinical manifestations of experimental diffuse cutaneous leishmaniasis in a rodent model.

Dermal species of Leishmania have a relatively broad temperature range for optimal growth in vitro, with temperature differences accompanied by a form change. This suggests that when the host is living in moderate temperatures (22°C), infection may proceed at temperatures lower than those that occur in tropical regions (32°C), and a different clinical expression of the disease due to a different parasitic form may result. The aim of this study was to investigate the effect of environmental temperature on the clinical expression of the disease. BALB/C mice infected with Leishmania mexicana were housed at 32°±2°C or 22°±1°C, and assessed for the development of inflammation and the presence of parasites in organs using PCR and immunohistology. The clinical expression of leishmaniasis at 32°C included inflammation at the site of inoculation with swelling of the nose and tail, whereas at 22°C, up to 50% of the infected mice developed dry exfoliative dermatitis with alopecia on the dorsum. In both cases, parasite colonization was confirmed in the skin, with parasites at more external locations at 22°C. Parasite visceralization was confirmed in all internal organs and glands in both cases based on PCR and immunohistology. In conclusion, the clinical expression of diffuse leishmaniasis by Leishmania mexicana in laboratory mice is modified by temperature, from nodular inflammation at 32°C, to dry exfoliative dermatitis and alopecia at 22°C, with parasite visceralization in both cases.