Longitudinal study of the indirect immunofluorescence and complement fixation tests for diagnosis of Chagas' disease in immunosuppressed patients submitted to renal transplantation.

Clinical and serological follow-up of 7 patients submitted to renal transplantation and presenting positive serological reactions to Chagas' disease before immunosuppression did not show significant changes in indirect immunofluorescence and complement fixation titres for Chagas' disease, or signs and symptoms indicating exacerbation of the disease during follow-up. In addition, 18 of 66 recipients of renal transplants considered to be non-chagasic before immunosuppression showed at least one positive result to the indirect immunofluorescence test for Chagas' disease during the study period. The results suggest that the immunosuppression state induced in chagasic patients submitted to renal transplant did not promoted exacerbation of the chronic infection in these patients and not interfere with the serological response of chronic chagasics, thus permitting the use of these serologic reactions for diagnostic purposes in these cases. However, the positive results of the indirect immunofluorescence test in non-chagasic patients indicate the need for judicious interpretation of the indirect immunofluorescence test for the diagnosis of Chagas' disease in renal transplanted patients.

[Cryptococcus meningitis: clinical course, development and histopathologic aspects depending on the predisposing factors]. / Meningite criptocócica: aspectos clínicos, evolutivos e histopatológicos segundo a condição predisponente.

Seventeen consecutive cases of cryptococcal meningitis diagnosed at Hospital das Clínicas of Ribeirão Preto Medical School (São Paulo State Brazil) between 1969 and 1985 were reviewed. For analysis the patients were separated in 3 groups: I. three patients without immunodeficiency; II. six patients with associated disease: cancer (3), diabetes (2) and alcoholism (1); III. Eight renal transplant recipients that developed cryptococcosis after 18 to 67 months of immunosupression with steroids and azathioprine. The median interval between onset of symptoms and diagnosis of infection was greater in Group II (53 days) than in Groups I (25 days) or III (28 days). Neck stiffness, cranial nerve involvement and papilledema were more frequent in Group I than in Group II or III, but fever and focal neurological signs were observed only in patients of two last groups. Cerebrospinal fluid examination showed a mild lymphocytic pleocytosis in most patients, but transplant cases had polymorphonuclear cells more frequently. Late mortality was higher in patients with underlying disease and the prognosis was better for transplant patients that received effective antifungal therapy. Besides cryptococci, autopsy findings in 8 cases revealed granuloma formation in tissues, except in patients of Group II (2 cases). The differences between the groups suggest that clinical characteristics, evolution and postmortem findings of the cryptococcal meningitis are changed according to type of immunodeficiency presented by the patient.

[Endoscopic evaluation of the involvement of the esophagus, stomach and duodenum in human paracoccidioidomycosis]. / Avaliação endoscópica do comprometimento de esôfago, estômago e duodeno na paracoccidioidomicose humana.

The upper gastrointestinal tract was investigated endoscopically in 30 patients with paracoccidioidomycosis. Esophagus, stomach and duodenum showed, respectivelly, 40%, 53% and 43% of endoscopic alterations. The histopathological examination of biopsy tissue revealed no specific lesions in esophagus and stomach, but P. brasiliensis was observed in three cases of duodenal lesions: two cases with mucosal diffuse erosions and one case of duodenal polyp. It is concluded that duodenal paracoccidioidomycosis is not rare and could be revealed by endoscopic examination in patients with disseminated disease.

Natureza de anticorpos precipitantes especificos da paracoccidioidomicose (blastomicose sul-americana), revelados por contra-imunoeletroforese. / Nature of precipitating specific antibodies of paracoccidioidomycosis (South American blastomycosis) detected by counterimmunoelectrophoresis

Os Autores estudaram soros de 20 pacientes, portadores de paracoccidioidomicose (blastomicose Sul - Americana), utilizando coluna de Sephadex G-200 para a separacao das imunoglobulinas e o metodo de contraimunoeletroforese em agarose para a verificacao de anticorpos especificos aos fungos. Como antigeno usaram culturas de Paracoccidioides em fase de levedura, tratadas por ultra-som. Os soros dos pacientes que apresentam 1, 2, 3 ou 4 linhas de precipitacao foram separados em coluna e as fracoes obtidas foram examinadas e concentradas em contra - imunoeletroforese, com o antigeno citado. Verificaram, assim, que apenas as fracoes com teor conveniente de imunoglobulinas IgG reproduziram os achados obtidos com os soros correspondentes; as fracoes com teor normal de IgA e IgM com quantidade pequena ou nula de IgC nao produziram linha de precipitacao. Concluem que os anticorpos precipitantes em gel especificos do Paracoccidioides sao do tipo IgG

Lymphocyte transformation test in patients with paracoccidioidomycosis.

The lymphocyte transformation test (LTT) by phytohemagglutinin was carried out on lymphocyte cultures from patients with paracoccidioidomycosis, in medium with autologous plasma (from the patient) or homologous plasma (from an unaffected individual), and lymphocyte cultures from unaffected and apparently normal individuals, in medium with autologous plasma (from the individual) or homologous plasma (from a patient with paracoccidioidomycosis). Blastogenesis was evaluated morphologically by 'blast' percentage, and the results analyzed according to clinical form of the disease and general condition of the patient. In the medium containing autologous plasma, percentages below the lower limit of the confidence interval for the distribution of the values for apparently normal individuals were encountered more frequently among patients with diffuse extrapulmonary paracoccidioidomycosis and in poor general condition. When the lymphocytes from patients with the disease were cultured in medium containing homologous plasma, blastogenesis increased in most cases. The lymphocytes of unaffected individuals exhibited a lower response more frequently when cultured in medium containing plasma from patients with the disease than when cultured in medium containing their own plasma. These results suggest that existence of factor(s) inhibiting blastogenesis in the plasma of these patients. In addition to such factor(s), an intrinsic lymphocyte defect may also occur in some patients, which might prevent a greater response to phytohemagglutinin even in homologous plasma. Smears of lymphocytes cultured in autologous plasma and obtained from patients, especially those with diffuse extrapulmonary disease and in regular or poor general condition, and smears from most of the controls whose lymphocytes were cultured in the plasma of these patients revealed deeply stained cells with altered morphology and considerably reduced in number.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibody titers to Toxoplasma gondii in renal transplant patients.

Of 70 renal transplant patients submitted to the indirect immunofluorescence reaction test for toxoplasmosis, 16 (23%) had titers higher than 1/4,000, as compared to 0/41 for chronic hemodialysis patients and 0/50 for blood donors. The indirect immunofluorescence reaction titers in the renal transplant patients correlated with time since initiation of immunosuppressive therapy. Six percent (2/33) of the patients had been on immunosuppressors for less than one year, 30.7% (4/13) for 1 to 2 years, and 41.6% (10/24) for 2 or more years. The frequency of negative titers among the immunosuppressed patients was similar to that observed for blood donors and chronic hemodialysis patients. Fifty percent (8/16) of the patients with higher immunofluorescence reaction titers also had significantly high (greater than or equal to 320) positive titers in the complement fixation test. The results indicate that: 1) the immunosuppressive scheme used for the transplant patients may favor the reactivation of infection from latent Toxoplasma gondii foci, and 2) even though the patients were immunosuppressed, their antitoxoplasma antibody levels were high enough to be detected by the serologic test.

Doenca de Chagas aguda pos-transfusional. Relato de um caso com evolucao clinico-terapeutica atipica. / Acute post-transfusional Chagas' disease. Report of a case with atypical clinico-therapeutic course

Os Autores apresentam um caso de doenca de Chagas aguda pos-transfusional, chamando a atencao para as particularidades dos achados clinicos e laboratoriais. Analisam tambem a resposta clinica e parasitologica ao tratamento especifico

Contraimunoeletroforese e hemaglutinacao passiva como metodos complementares para o estudo da infeccao meningococica. / Counterinmmunoelectrophoresis and passive hemagglutination as complementary methods in the study of meningococcal infection

Analisamos 108 casos de meningite bacteriana, atendidos no Hospital das Clinicas da FMRP-USP, atraves de bacterioscopia do sedimento do liquido cefalorraquiano (LCR) corado pelo Gram, cultura do LCR em agar-chocolate, contraimunoeletroforese (CIE) do LCR para pesquisa de polissacarides meningococicos A e C, de hemofilos tipo b e de pneumococo com soro polivalente, hemocultura e hemaglutinacao passiva (HP) para avaliar titulos de anticorpos antimeningococicos A e C no soro. Embora nem todos os testes tenham sido aplicados simultaneamente, foram diagnosticados 71 casos de meningites meningococicas (41 tipo A, 11 C, 2A e C e 18 nao tipadas), 9 por hemofilos tipo b, 6 por pneumococos, 2 por E. aerogenes, 1 por Streptococcus sp e 19 permaneceram sem diagnostico etiologico. Isoladamente, a HP revelou maior indice de positividade, enquanto que os metodos tradicionais (bacterioscopia e cultura do LCR) e a CIE forneceram resultados satisfatorios. A associacao de pelo menos dois desses metodos aumentou significantemente a porcentagem de identificacao dos casos de meningite meningococica

[Immune response to heart in rabbits: study of cellular and humoral immunity (author's transl)]. / Aspectos da resposta imune anti-coração em coelhos. Estudo da imunidade sérica e celular

Four groups of rabbits injected with cardiac tissue and complete Freund's adjuvant or aluminum hydroxide gel adjuvant and two groups only injected with aluminum hydroxide gel adjuvant or complete Freud's adjuvant were studied. The humoral and cellular immunity in immunized animals was studied using heart soluble and insoluble extracts. The tests results from hemagglutination, immunoelectrophoresis and immunofluorescence have presented cross-reactions among sera and hearts of the several species. Similar cross-reactions were not revealed by immunodiffusion. The immunoelectrophoresis and hemagglutination reactions were related to heart soluble extract and the immunofluorescence reactions were related to insoluble extract located in sarcolemal, subsarcolemal and intermyofibrilar sites. By hemagglutination, it was verified the presence of antibodies to heart and skeletal muscle in the antisera. Is was not possible to negative completely the reactivity of these antibodies to heart by absorptions with skeletal muscle. Inhibition tests to leucocytes migration revealed that leucocytes from immunized animals present migration inhibition when faced to antigens sedimented at.....56.500 g.