Proteção do recém-nascido contra o tétano pela imunização ativa da gestante com antitoxina tetânica: estudo original de 1953 / Protection of newborn infants against tetanus by active immunization of the pregnant women with tetanus antitoxin: the 1953 original study

OBJETIVO: Determinar, em cobaias prenhes e em gestantes, a produção de antitoxina tetânica induzida pela aplicação da anatoxina tetânica e estudar a sua passagem para o recém-nascido. MÉTODOS: Na primeira fase, em estudo experimental, cobaias prenhes foram vacinadas com duas doses de toxóide tetânico em um intervalo de 15 dias, seguida da dosagem de anticorpos na cobaia imunizada, na prole ao nascer e 15 dias após o nascimento. Outro grupo de animais previamente vacinado recebeu uma dose de reforço 30 dias antes do parto, medindo-se o nível de anticorpos na cobaia e na prole. Na segunda fase, em ensaio clínico, as gestantes humanas foram vacinadas com três injeções de anatoxina tetânica, com um intervalo de 30 dias, em qualquer período da gravidez, medindo-se, a seguir, a antitoxina tetânica. Nos recém-nascidos, os anticorpos foram medidos ao nascer e aos 15 dias de vida. RESULTADOS: O título de antitoxina no sangue da prole de cobaias vacinadas com anatoxina tetânica foi elevado ao nascimento e aos 15 dias de vida. A dose de reforço provocou elevação do título basal. Nas gestantes, a aplicação de três doses de toxóide antitetânico conferiu imunidade a 95% dos recém-nascidos estudados. Os recém-nascidos de mães vacinadas apresentaram títulos elevados de antitoxina que persistiram por mais de 15 dias de vida. CONCLUSÕES: A vacinação durante a gestação foi acompanhada de títulos protetores de antitoxina contra o tétano tanto nos filhotes de cobaias quanto nos recém-nascidos humanos.

OBJECTIVE: To measure, in pregnant guinea pigs and women, the production of tetanus antitoxin, induced by vaccination with tetanus toxin, and to study the transmission of these antibodies to the offspring. METHODS: In an experimental design, pregnant guinea pigs were vaccinated with two doses of tetanus toxoid with a 15-day interval followed by determination of antibodies in the immunized guinea pig, in the offspring at birth and after 15 days of life. One group of guinea pigs received a booster dose of tetanus toxoid 30 days before delivery and the immunization status of dam and offspring was also studied. In a clinical trial, pregnant women were vaccinated in any period of gestation with three doses of tetanus toxoid with a 30-day interval; the antibody levels were measured in the mother and in the newborn infant at birth and at the 15th day of life. RESULTS: The antibody levels of guinea pigs offspring immunized with tetanus toxoid during gestation were elevated at birth and at the 15th day of life. These levels were elevated by the booster dose 30 days prior to delivery. In pregnant women, the immunization with three doses of tetanus toxoid was followed by immunity in 95% of the studied infants studied. The newborn infants of vaccinated women presented elevated levels of antibodies at birth and at 15th day of life. CONCLUSIONS: Vaccination during gestation was followed by protective levels of antibodies in guinea pigs and in newborn infants.

Cerebral aspergillosis due to Aspergillus fumigatus in AIDS patient: first culture-proven case reported in Brazil.

Cerebral aspergillosis is a rare cause of brain expansive lesion in AIDS patients. We report the first culture-proven case of brain abscess due to Aspergillus fumigatus in a Brazilian AIDS patient. The patient, a 26 year-old male with human immunodeficiency virus (HIV) infection and history of pulmonary tuberculosis and cerebral toxoplasmosis, had fever, cough, dyspnea, and two episodes of seizures. The brain computerized tomography (CT) showed a bi-parietal and parasagittal hypodense lesion with peripheral enhancement, and significant mass effect. There was started anti-Toxoplasma treatment. Three weeks later, the patient presented mental confusion, and a new brain CT evidenced increase in the lesion. He underwent brain biopsy, draining 10 mL of purulent material. The direct mycological examination revealed septated and hyaline hyphae. There was started amphotericin B deoxycholate. The culture of the material demonstrated presence of the Aspergillus fumigatus. The following two months, the patient was submitted to three surgeries, with insertion of drainage catheter and administration of amphotericin B intralesional. Three months after hospital admission, his neurological condition suffered discrete changes. However, he died due to intrahospital pneumonia. Brain abscess caused by Aspergillus fumigatus must be considered in the differential diagnosis of the brain expansive lesions in AIDS patients in Brazil.

Cerebral aspergillosis due to Aspergillus fumigatus in AIDS patient: first culture - proven case reported in Brazil

La aspergilosis cerebral es una causa rara de lesión expansiva cerebral en pacientes con SIDA. Presentamos el primer reporte de un absceso cerebral causado por Aspergillus fumigatus en un paciente brasileño con SIDA. El paciente, de 26 años de edad, presentaba antecedentes de infección por el virus de la inmunodeficiencia humana (VIH), tuberculosis pulmonar y toxoplasmosis cerebral. Manifestó fiebre, tos, disnea y dos episódios de convulsiones. La tomografía computadorizada (TC) demostró una lesión hipodensa parasagital y bi-parietal con realce periférico e importante efecto de masa. Se inició tratamiento anti-Toxoplasma. Tres semanas después, el paciente evidenció confusión mental y una nueva TC de cráneo mostró aumento de la lesión. Se realizó biopsia cerebral con drenaje de 10 mL de material purulento. El examen micológico directo reveló hifas hialinas septadas. Se inició anfotericina B deoxicolato. La cultura del material demostró presencia de Aspergillus fumigatus. En los siguientes dos meses el paciente fue sometido a otras tres cirugías, insertándose un catéter de drenaje y administrándose anfotericina B intralesional. Tres meses después de la admisión hospitalaria, la condición neurológica del paciente sufrió discretos cambios. Sin embargo, falleció debido a neumonia intrahospitalaria. Aunque muy raros, los abscesos cerebrales causados por Aspergillus fumigatus deben ser considerados en el diagnóstico diferencial de las lesiones expansivas cerebrales en pacientes con SIDA.

Immunoprecipitation techniques and Elisa in the detection of anti-Fonsecaea pedrosoi antibodies in chromoblastomycosis

Chromoblastomycosis (CBM) is a chronic subcutaneous infection caused by several dematiaceous fungi. The most commonly etiological agent found in Brazil is Fonsecaea pedrosoi, which appears as thick walled, brownish colored cells with transverse and longitudinal division in the lesions, called "muriform cells". This disease is found worldwide but countries like Madagascar and Brazil have highest incidence. Diagnosis is made by clinical, direct and histopathologic examination and culture of specimens. Serological tests have been used to identify specific antibodies against Fonsecaea pedrosoi antigens, as well as immunotechniques have been used for CBM serological identification and diagnosis. In the present study double immunodiffusion (DID), counterimmunoelectrophoresis (CIE) and immunoenzymatic test (ELISA) have been used to evaluate humoral immune response in patients with CBM caused by F. pedrosoi. Metabolic antigen was used for immunoprecipitation tests (DID and CIE) while somatic antigen for ELISA. Our results demonstrated 53 percent sensitivity and 96 percent specificity for DID, while CIE presented 68 percent sensitivity and 90.5 percent specificity. ELISA demonstrated 78 percent sensibility and 83 percent specificity. Serological tests can be a useful tool to study different aspects of CBM, such as helping differential diagnosis, when culture of the pathogenic agent is impossible.

Fonsecaea pedrosoi cerebral phaeohyphomycosis ("chromoblastomycosis"): first human culture-proven case reported in Brazil.

Cerebral phaeohyphomycosis ("chromoblastomycosis") is a rare intracranial lesion. We report the first human culture-proven case of brain abscesses due to Fonsecaea pedrosoi in Brazil. The patient, a 28 year-old immunocompetent white male, had ocular manifestations and a hypertensive intracranial syndrome. Magnetic resonance imaging (MRI) of the brain revealed a main tumoral mass involving the right temporo-occipital area and another smaller apparently healed lesion at the left occipital lobe. A cerebral biopsy was performed and the pathological report was cerebral chromoblastomycosis. The main lesion was enucleated surgically and culture of the necrotic and suppurative mass grew a fungus identified as Fonsecaea pedrosoi. The patient had received a knife wound sixteen years prior to his hospitalization and, more recently, manifested a pulmonary granulomatous lesion in the right lung with a single non-pigmented form of a fungus present. It was speculated that the fungus might have gained entrance to the host through the skin lesion, although a primary respiratory lesion was not excluded. The patient was discharged from the hospital still with ocular manifestations and on antimycotic therapy and was followed for eight months without disease recurrence. Few months after he had complications of the previous neuro-surgery and died. A complete autopsy was performed and no residual fungal disease was found.

Fonsecaea pedrosoi cerebral phaeohyphomycosis ("chromoblastomycosis"): first human culture-proven case reported in Brazil

Cerebral phaeohyphomycosis ("chromoblastomycosis") is a rare intracranial lesion. We report the first human culture-proven case of brain abscesses due to Fonsecaea pedrosoi in Brazil. The patient, a 28 year-old immunocompetent white male, had ocular manifestations and a hypertensive intracranial syndrome. Magnetic resonance imaging (MRI) of the brain revealed a main tumoral mass involving the right temporo-occipital area and another smaller apparently healed lesion at the left occipital lobe. A cerebral biopsy was performed and the pathological report was cerebral chromoblastomycosis. The main lesion was enucleated surgically and culture of the necrotic and suppurative mass grew a fungus identified as Fonsecaea pedrosoi. The patient had received a knife wound sixteen years prior to his hospitalization and, more recently, manifested a pulmonary granulomatous lesion in the right lung with a single non-pigmented form of a fungus present. It was speculated that the fungus might have gained entrance to the host through the skin lesion, although a primary respiratory lesion was not excluded. The patient was discharged from the hospital still with ocular manifestations and on antimycotic therapy and was followed for eight months without disease recurrence. Few months after he had complications of the previous neuro-surgery and died. A complete autopsy was performed and no residual fungal disease was found

Células fúngicas permanecem viáveis por até dozes dias em lesões de cromomicose tratadas pela criocirurgia com nitrogênio líquido / Fungal cells remain viable for up to 12 days in chromomycosis lesions treated by cryosurgery with liquid nitrogen

A criocirurgia com nitrogênio líquido (C-N2L) é um método terapêutico que vem sendo usado com freqüência crescente no tratamento da cromomicose. Acreditava-se anteriormente que as temperaturas baixas poderiam destruir o agente infectante, mas foi demonstrado que as culturas fúngicas em temperaturas tão baixas como -196°C não causaria a morte do mesmo. Apesar da comprovada eficácia, ainda não se conhece o exato mecanismo de cura.Avaliar o período de persistência de fungos viáveis em lesões de cromomicose tratadas pela C-N2L.Cinco pacientes com cromomicose tiveram suas lesões tratadas pela C-N2L. Foram colhidos, em diferentes intervalos de tempo após a criocirurgia, fragmentos do tecido tratado. A coleta, realizada com punch de 4mm, foi feita em três períodos diferentes: de 0 a 48h, de cinco a sete dias e de 10 a 14 dias após a realização da criocirurgia. Os fragmentos obtidos foram inoculados em Agar Sabouraud para verificação de crescimento de colônias fúngicas. Cada paciente teve um total de três amostras colhidas, uma em cada um dos três períodos mencionados.O crescimento de colônias foi maior nas coletas mais precoces, enquanto nas amostras colhidas entre o pós-operatório imediato e o quinto dia de pós-operatório o índice de viabilidade foi de 7/8 (87,5 por cento), e naquelas colhidas a partir do sexto dia de pós-operatório foi de apenas 2/7 (28,5 por cento). O maior período de pós-operatório que demonstrou positividade foi de 12 dias.Os resultados confirmam os achados anteriores, os quais demonstraram que as baixas temperaturas alcançadas pela C-N2L não são responsáveis pela destruição dos fungos nas lesões de cromomicose. Os autores acreditam que fenômenos biológicos tardios, como necrose ou imunoestimulação sejam os verdadeiros responsáveis pela erradicação dos fungos nas lesões de cromomicose

Immunoprecipitation techniques and Elisa in the detection of anti-Fonsecaea pedrosoi antibodies in chromoblastomycosis.

Chromoblastomycosis (CBM) is a chronic subcutaneous infection caused by several dematiaceous fungi. The most commonly etiological agent found in Brazil is Fonsecaea pedrosoi, which appears as thick walled, brownish colored cells with transverse and longitudinal division in the lesions, called "muriform cells". This disease is found worldwide but countries like Madagascar and Brazil have highest incidence. Diagnosis is made by clinical, direct and histopathologic examination and culture of specimens. Serological tests have been used to identify specific antibodies against Fonsecaea pedrosoi antigens, as well as immunotechniques have been used for CBM serological identification and diagnosis. In the present study double immunodiffusion (DID), counterimmunoelectrophoresis (CIE) and immunoenzymatic test (ELISA) have been used to evaluate humoral immune response in patients with CBM caused by F. pedrosoi. Metabolic antigen was used for immunoprecipitation tests (DID and CIE) while somatic antigen for ELISA. Our results demonstrated 53% sensitivity and 96% specificity for DID, while CIE presented 68% sensitivity and 90.5% specificity. ELISA demonstrated 78% sensibility and 83% specificity. Serological tests can be a useful tool to study different aspects of CBM, such as helping differential diagnosis, when culture of the pathogenic agent is impossible.

Primary cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii serotype B, in an immunocompetent patient.

The authors report a male patient, a seller with no detected immunosuppression, with an extensive ulcerated skin lesion localized on the left forearm, caused by Cryptococcus neoformans var. gattii serotype B. Oral treatment with fluconazole was successful. A review of the literature showed the rarity of this localization in HIV-negative patients. In contrast, skin lesions frequently occurs in HIV-positive patients, with Cryptococcus neoformans var. neoformans serotype A predominating as the etiological agent. In this paper, the pathogenicity of C. neoformans to skin lesions in patients immunocompromised or not, is discussed, showing the efficacy of fluconazole for the treatment of these processes.

Primary cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii serotype B, in an immunocompetent patient

The authors report a male patient, a seller with no detected immunosuppression, with an extensive ulcerated skin lesion localized on the left forearm, caused by Cryptococcus neoformans var. gattii serotype B. Oral treatment with fluconazole was successful. A review of the literature showed the rarity of this localization in HIV-negative patients. In contrast, skin lesions frequently occurs in HIV-positive patients, with Cryptococcus neoformans var. neoformans serotype A predominating as the etiological agent. In this paper, the pathogenicity of C. neoformans to skin lesions in patients immunocompromised or not, is discussed, showing the efficacy of fluconazole for the treatment of these processes

História da Hematologia brasileira / The history of the Brazilian hematology

A partir de uma revisão histórica da medicina brasileira, enfoca a história da hematologia no mundo e no Brasil, dando destaque à hematologia no século XX e na atualidade. Apresenta, ainda, uma bibliografia hematológica brasileira

História da Hematologia brasileira / The history of the Brazilian hematology

A partir de uma revisäo histórica da medicina brasileira, enfoca a história da hematologia no mundo e no Brasil, dando destaque à hematologia no século XX e na atualidade. Apresenta, ainda, uma bibliografia hematológica brasileira. (MAM)

A Roda da Santa Casa de Misericórdia de Säo Paulo e o exposto 3381 / The Roda da Santa Casa de Misericórdia de Säo Paulo of São Paulo city, Brazil and exposed 3381

Retrata a vida plena de sucessos de um médico que nasceu na Roda da Santa Casa de Misericórdia de Säo Paulo, criado por um casal de Guaxupé e cujo sucesso profissional se baseou fundamentalmente no caráter, vocaçäo, talento, esforço e disciplina, somando ao grande amor que sempre dedicou a seus pacientes

Historia das vacinacoes: as grandes figuras de Edward Jenner (1749-1823) e Gustavo Ramon (1886-1963) / Vaccinations history: the great figures of Edward Jenner (1749-1823) and Gustavo Ramon (1886-1963)

Na historia das vacinacoes, protegendo ativamente a populacao contra diversas doencas infecciosas, duas grandes figuras aparecem, ao lado de Louis Pasteur, Albert Sabin, Wright, Calmette e tantos outros pesquisadores do passado e do presente. Refiro-me a Edward Jenner e a Gustavo Ramon. A primeira vacinacao praticada em seres humanos foi realizada pelo medico escoces Edward Jenner, utilizando material de pustulas do cow-pox, vaccinia ou variola do gado bovino. Dai o nome VACINA (do latim vacca) para designar todo imunogeno que, aplicado por via oral ou parenteral garante a...