DISSEMINATED FUNGAL INFECTION WITH ADRENAL INVOLVEMENT: REPORT OF TWO HIV NEGATIVE BRAZILIAN PATIENTS / Infecções fúngicas disseminadas com acometimento das supra-renais: descrição de dois pacientes brasileiros HIV-negativos

Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.

A paracoccidioidomicose e a histoplasmose são infecções fúngicas sistêmicas endêmicas no Brasil. As formas clínicas disseminadas são incomuns em pacientes imunocompetentes. Nós descrevemos dois pacientes HIV-negativos com infecções fúngicas disseminadas, paracoccidioidomicose e histoplasmose, que foram diagnosticadas por biópsias de lesões de supra-renal. Ambos foram tratados por períodos prolongados com antifúngicos orais, evoluindo com boa resposta terapêutica.

Contagens leucocitárias e sintomas de infecções respiratórias após curto período de treinamento concorrente / Leukocyte counts and symptoms of upper respiratory tract infections after a short period of concurrent training

Introdução: Pessoas comumente iniciam a prática de exercícios por períodos não compatíveis com o nível de treinabilidade, podendo induzir diminuição da competência imunológica. Objetivos: Analisar as possíveis modulações nas contagens dos leucócitos circulantes e incidência de sintomas de infecções do trato respiratório superior, ao final de uma semana de treinamento concorrente. Métodos: Participaram dez voluntários do gênero masculino e sedentários, submetidos a uma semana de treino concorrente com cinco sessões em dias sequenciais, apresentando intensidades moderadas e duração de cem minutos. Resultados: Não foram observadas alterações nas contagens dos leucócitos. Quanto aos sintomas de infecções do trato respiratório superior, 10% dos voluntários apresentaram coriza, 20% congestão nasal e 40% dor de cabeça ao final da intervenção. Conclusões: A referida intervenção não apresenta potencial para modular negativamente as contagens dos leucócitos. Contudo, a incidência de sintomas de infecções do trato respiratório superior pode estar associada à diminuição da funcionalidade celular, possivelmente decorrente do volume delineado nas sessões.

Introduction: People often begin to practice exercises for periods not compatible with their level of trainability, and this could to induce a decrease in immune competence. Objective: To analyze the possible modulations in counts of circulating leukocytes and incidence of infections of the upper respiratory tract symptoms at the end of a week of concurrent training. Methods: A total of ten volunteers and sedentary male gender underwent a week of concurrent training sessions with five sequential days, with moderate intensity and duration of hundred minutes. Results: No changes were observed in leukocyte counts. As symptoms of upper respiratory tract infections, 10% of the volunteers had coryza, 20% nasal congestion, and 40% headache at the end of intervention. Conclusions: Such intervention has no potential to negatively modulate leukocyte counts. However, the incidence of symptoms of upper respiratory tract infections may be associated with decreased cellular functionality, possibly due to the volume outlined in the sessions.

DISSEMINATED FUNGAL INFECTION WITH ADRENAL INVOLVEMENT: REPORT OF TWO HIV NEGATIVE BRAZILIAN PATIENTS.

Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.

Immune neuroendocrine interactions during a fungal infection in immunocompetent or immunosuppressed hosts.

The yeast Candida albicans belongs to the microflora of healthy individuals, although it can infect a variety of tissues ensuing changes in the host's immune status. To evaluate the effect of neuroendocrine input on the early immune response during the fungal infection, we use a 3-day paradigm of chronic varied stress in Wistar rats infected with C. albicans. We find that stress mediators contribute to the spread of the fungus and downregulate critical functions of phagocytic cells at the infection site. Phenotypic and functional alterations of effector cells account for the decreased resistance to candidiasis and condition the development of the adaptive response. Stressed hosts exhibit a higher fungal burden in kidneys and livers associated with hyphal forms. The hepatic inflammatory reaction is compromised with severe steatosis, increment of functional enzymes, marked lipid peroxidation and hepatocyte apoptosis. Moreover, infection-related sickness symptoms are significantly increased by exposure to stress with anorexia, weight loss, lack of leptin and depletion of glycogen depots. Food deprivation exacerbates the liver injury. Stress mediators perturb the complex immune and metabolic program that operates early during fungal spread and promotes severe tissue damage.

Human glioblastoma cells display mesenchymal stem cell features and form intracranial tumors in immunocompetent rats.

Isolation of highly tumorigenic stem-like cells from human glioblastoma specimens and cell lines has been focusing on their neural stem cells properties or capacity to efflux fluorescent dyes. Here, we report that, under standard culture conditions, human glioblastoma cells of the U87MG cell line display a predominant mesenchymal phenotype and share some of the in vitro properties of mesenchymal stem cells. Moreover, these cells were capable of forming tumors in immunocompetent rats. Infiltrative intracranial tumors could be detected 15 to 30 days post-stereotaxic cell injection within the motor cortex. Tumors were comprised by pleomorphic and mitotically active cells and displayed necrotic and hemorrhagic foci, which are common features of human glioblastomas. This rather unexpected in vivo tumorigenesis in the absence of immune suppression more closely mimics the physiological milieu encountered by tumor cells and could be explored as a xenograft orthotopic model of human glioblastomas to address new therapeutic approaches, particularly those involving immune effector mechanisms.

Iron, copper and immunocompetence.

Microminerals including copper and iron are essential to immunity and health in human beings. The development of powerful tools in analytical cell biology and molecular genetics has facilitated efforts to identify specific cellular and molecular functions of trace elements in the maturation, activation and functions of host defence mechanisms. Selected recent reports about the role of copper and iron nutrition on immune functions are critically analysed here. Effects of trace element supplementation on infectious morbidity are also reviewed. While micromineral deficiencies, in general, may have widespread effects on nearly all components of immune response, these effects can be reversed by supplementation. However, the conflicting effects of iron deficiency and iron supplementation in vitro on the defensive systems reveals the urgent need for further additional information on the in vivo situation. In the elderly, vaccination against respiratory infections is likely to protect only 30-70% of the population. However, it may be possible to modulate immune function and ultimately reduce the severity of infections through micronutrient supplementation. Thus, microminerals contribute to the maintenance of the balance between immunity and health in humans.

Parkinsonism associated with basal ganglia cryptococcal abscesses in an immunocompetent patient.

Currently, infectious agents are a rare cause of parkinsonism. We report on an immunocompetent patient with persistent parkinsonism associated with cryptococcal abscesses of the basal ganglia.

Tubeculosis generalizada por Mycobacterium Bovis en un paciente inmunocompetente (presentación de un caso y revisión de la bibliografía) / Generalized tuberculosis by Mycobacterium bovis in a immunocompetent patient (case report and bibliographic review)

El Mycobacterium bovis es una variedad del complejo M. tuberculosis que afecta principalmente al ganado vacuno. Raramente puede producir tuberculosis pulmonar y extrapulmonar en el hombre. Presentamos el caso de una paciente de 72 años, con serología negativa para HIV y sin otras evidencias de inmunosupresión que se internó por tuberculosis pulmonar miliar, ósea y cutánea por M. bovis. El diagnóstico se confirmó por el examen directo y cultivo del esputo y la biopsia de piel. Al ingreso presentaba severa afectación de su estado general, pero luego de tres meses de tratamiento antituberculoso su evolución clínica y radiológica fue favorable. Analizamos la incidencia, las características del bacilo y las vías de contagio. Este es un caso poco frecuente de tuberculosis generalizada por M. bovis en un paciente inmunocompetente

Immunocompetence of macrophages in rats exposed to Candida albicans infection and stress.

The integration of innate and adaptive immune responses is required for efficient control of Candida albicans. The present work aimed to assess, at the local site of the infection, the immunocompetence of macrophages in rats infected intraperitoneally with C. albicans and exposed simultaneously to stress during 3 days (CaS group). We studied the 1) ability to remove and kill C. albicans, 2) tumor necrosis factor-alpha (TNF-alpha) release, 3) balance of the inducible enzymes NO synthase (iNOS) and arginase, and 4) expression of interleukin (IL)-1beta and IL-1 receptor antagonist (ra) mRNA. Compared with only infected animals (Ca group), the number of colony-forming units was significantly higher in CaS rats (P < 0.01), and the macrophage candidicidal activity was approximately 2.5-fold lower (P < 0.01). Release of TNF-alpha was diminished in both unstimulated and heat-killed C. albicans restimulated macrophages of the CaS group (Ca vs. CaS, P < 0.03 and P < 0.05, respectively). In Ca- and CaS-group rats, the rates for both the arginase activity and the NO synthesis were significantly enhanced. However, the stress exposure downregulated the activity of both enzymes (CaS vs. Ca, P < 0.05). After in vitro restimulation, the IL-1ra/IL-1beta ratio was significantly diminished in CaS-group rats (P < 0.05). Our results indicate that a correlation exists between early impairment of macrophage function and stress exposure.

Reduction of renal immune cell infiltration results in blood pressure control in genetically hypertensive rats.

Immunocompetent cells infiltrate the kidney in several models of experimental hypertension. We have previously shown that reduction of this infiltrate results in prevention of salt-sensitive hypertension induced by short-term angiotensin II infusion and nitric oxide inhibition (Quiroz Y, Pons H, Gordon KI, Rincón J, Chávez M, Parra G, Herrera-Acosta J, Gómez-Garre D, Largo R, Egido J, Johnson RJ, and Rodríguez-Iturbe B. Am J Physiol Renal Physiol 281: F38-F47, 2001; Rodríguez-Iturbe B, Pons H, Quiroz Y, Gordon K, Rincón J, Chávez M, Parra G, Herrera-Acosta J, Gómez-Garre D, Largo R, Egido J, and Johnson RJ. Kidney Int 59: 2222-2232, 2001). We therefore studied whether hypertension could be controlled in genetically hypertensive rats [spontaneously hypertensive rats (SHR)] by the administration of 20 mg x kg(-1) x day(-1) of the immunosuppressive drug mycophenolate mofetil (MMF group; n = 35). Other SHR received vehicle (n = 35), and Wistar-Kyoto rats (n = 20) were used as controls. MMF or vehicle was given in two separate 4-wk periods, separated by a 3-wk interval. Systemic hypertension was reduced to normal levels in both periods of MMF treatment in association with a reduction in lymphocyte, macrophage, and angiotensin II-positive cells infiltrating the kidney. Oxidative stress was also reduced by MMF, as indicated by a reduction in urinary malondialdehyde (MDA), renal MDA content, and superoxide-positive cells, and was highly correlated with blood pressure levels. We conclude that the renal immune infiltrate plays a major role in the hypertension in SHR.

Respuesta inmune disminuída por estrés académico intenso: cambios de la proliferación linfocitaria en estudiantes de medicina / Decreased immune response by acute academic stress: changes in lymphocyte proliferation in medical students

Blood samples were obtained from 42 medical students during a period of moderate academic stress, immediately before a final examination and after their summer vacations. T lymphocyte proliferation in response to 5, 10 and 20 mg/ml phytohemagglutinin was measured by the incorporation of 3H-thymidine, and plasma cortisol was measured by RIA. Results: T lymphocyte stimulation index in response to all phytohemagglutinin concentrations was significatively lower in the period before examination than in the other two periods.There were no differences in the index between the period of moderate stress and after summer vacations. Plasma cortisol levels were 15.6 ñ 4.3, 18.6 ñ 5.8 and 16.7 ñ 5.1 mg/dl during the periods of moderate stress, before the examination and after vacations, respectively (p < 0.05 for the difference between examination and the other two periods). Conclusions: There is a decrease in lymphocyte proliferation and an increase in cortisol levels during a period of acute academic stress in medical students, suggesting that, the exposure of healthy subjects to common stress ful stimuli, may affect their immunocompetance

Infección por bartonella henselae en pacientes inmunocompetentes: enfermedad por arañazo de gato / Infection by bartonella henselae in immunocompetent patients: cat scratch disease

Ten children (7 males), aged between 6 and 13 years old, with histologically or serologically confirmed cat scratch disease are reported. Lympadenopathy location was pre auricular in four cases, axillary in two, inguinal in 2 and epitrochlear in 2. Three children had fever over 39ºC and 2 had a Parinaud syndrome. Nine children had a history of cat scratch and one of a cat byte. Six had an arythrocyte sedimentation rate over 40. Lymph node ultrasound examination was a useful diagnostic tool. Two patients had splenic granulomas. Lymph node biopsies were obtained in 4 cases, showing a suppurative granulomatous lymphadenitis in all and positive Warthin-Starry stain in 2. Serology, done in patients without histological confirmation was positive with titles ranging from 1:64 to 1:8192. All patients had a satisfactory outcome with regression of lymphadenopathy. Infection by bartonella henselae occur in the Chilean population and must be considered in the differential diagnosis of regional lymph node enlargement

Nocardiosis diseminada en tres pacientes inmunocompetentes / Disseminated nocardiosis in 3 immunocompetent patients

Nocardia asteroide infections, an aerobic actinomycete, have several forms and lungs, skin and brain are the organs most frequently involved. When the infection suspected, special staining methods must be ordered to identify the agent. We report three immunocompetent patients with disseminated nocardiosis, 2 presenting with nodular lesions of skin and lungs and one presenting with pulmonary involvement and brain abscesses. The importance of clinical suspicion and early diagnosis of nocardiosis is emphasized

Absceso esplénico: presentación de un caso en un paciente inmunocompetente / Splenic absces: presentation of the a case in an immunocompetent patient

El absceso esplénico es una entidad poco común que se presenta en pacientes con factores predisponentes o con alguna condición de inmunosupresión. Durante las últimas décadas se han mejorado los procedimientos diagnósticos que han permitido una conducta terapéutica precoz a través de la esplenectomía o el drenaje percutáneo en combinación con la antibioticoterapia sistémica. Los autores presentan un caso de absceso esplénico único por enterococcus spp, en un paciente inmunocompetente, tratado mediante drenaje percutáneo dirigido por tomografía computarizada y seis semanas de antibioticoterapia

Determinacao dos valores de referencia para a regiao da atividade hemolitica do complemento serico pelo metodo cinetico / Determining reference values of the hemolytic activity of the serous complement through the kinetic method

Foi avaliada a capacidade litica do soro em 100 amostras provenientes de individuos de ambos os sexos e em bom estado nutricional para se verificar a atividade do sistema complemento. Os individuos foram agrupados dentro de uma ampla abrangencia de faixa etaria (15 a 90 anos), ressalvando-se criancas. Foi utilizado o metodo cinetico proposto por J.E. Barbosa; V.P.L. Ferriani e I.F. de Carvalho (1). Os resultados variaram de 1 a 5 minutos, todos dentro da normalidade. Segundo os autores e tempo de lise nao ultrapassa a 5 minutos. Os valores encontrados para o sexo feminino, mesmo dentro da normalidade, foram superiores ao do sexo masculino, nao sendo determinado neste trabalho sua causa.

Bases de inmunología

Aparato inmunocompetente; inmunidad natural, inmunidad adquirida; antígenos; anticuerpos; complemento; técnicas inmunológicas; carencia de respuesta inmunológica; daño hístico de origen inmunológico, reacciones de hipersensibilidad mediadas por anticuerpos; daño hístico de origen inmunológico, reacciones de hipersensibilidad mediadas por células; enfermedades mediadas por reacciones inmunológicas tipo I; enfermedades mediadas por reacciones de tipo II de la clasificiación de Gell y Coombs; enfermedades mediadas por reacciones del tipo III de la clasificación de Gell y Coombs; enfermedades mediadas por reacciones del tipo IV de la clasificación de Gell y Coombs; enfermedades autoinmunes; inmunidad tumoral; desórdenes de la respuesta inmunológica; glosario

Bases de inmunología

Aparato inmunocompetente; inmunidad natural, inmunidad adquirida; antígenos; anticuerpos; complemento; técnicas inmunológicas; carencia de respuesta inmunológica; daño hístico de origen inmunológico, reacciones de hipersensibilidad mediadas por anticuerpos; daño hístico de origen inmunológico, reacciones de hipersensibilidad mediadas por células; enfermedades mediadas por reacciones inmunológicas tipo I; enfermedades mediadas por reacciones de tipo II de la clasificiación de Gell y Coombs; enfermedades mediadas por reacciones del tipo III de la clasificación de Gell y Coombs; enfermedades mediadas por reacciones del tipo IV de la clasificación de Gell y Coombs; enfermedades autoinmunes; inmunidad tumoral; desórdenes de la respuesta inmunológica; glosario