Cellular immunity and immunostimulation in paracoccidioidomycosis.

We have evaluated clinical and laboratorial effects of immunostimulation scarification with antigen of Paracoccidioides brasiliensis in patients with paracoccidioidomycosis, who often show depressed immunity. We have studied 62 Brazilian patients with paracoccidioidomycosis, 46 with active disease and 16 cured, in a 10-year period between 1982 and 1992. Among the 46 patients with active disease: 10 had acute form, 12 chronic unifocal form and 24 the chronic multifocal form of the disease; 16 showed positive paracoccidioidin intradermal reaction and 30 negative reaction. Amongst 16 cured patients, 5 showed negative paracoccidioidin intradermal reaction and 11 positive reaction. We immunostimulated 20 patients by scarification with polysaccharide antigen of Paracoccidioides brasiliensis. All 20 immunostimulated patients had negative paracoccidioidin intradermal reaction, and 18 patients had active disease and 2 were cured. Out of 18 immunostimulated patients with active disease, 3 had active form, 10 chronic multifocal form and 5 chronic unifocal form of the disease. Before and after immunostimulation, each patients was inmunologically evaluated by in vivo and in vitro methods; in vivo methods consisted of intradermal reactions and DNCB sensitization tests; and in vitro methods consisted of total sub-set lymphocyte counting, leukocytes migration inhibition test, chemotaxix of total leukocytes and monuclear leukocyte phagocytosis. Remaining 42 patients served as a non-immunostimulated control group who has followed only clinically. We have observed significant clinical and immunological improvement in immunostimulated patients. We conclude that the immunostimulation by scarification with antigen of P. brasiliensis can be a helpful adjuvant therapy for paracoccidioidomycosis.

Direct immunofluorescence in lupus erythematosus (LE).

One hundred and twenty-six patients with LE were studied. They were distributed as follows: 84 with DLE, 13 with SALE and 29 with SLE. Biopsies from the skin lesions were performed and submitted to DIF. Positive results were equal to 69, 61.5 and 72.4 percent of the DLE, SALE and SLE cases, respectively. These data are in accordance with the literature. IgM was the most frequently found immunoglobulin, followed by the association IgM + C3.

Cellular immunity in paracoccidioidomycosis.

Paracoccidioidomycosis was studied in 62 patients from Brazil in the 10 year period between 1978 and 1988. In 46 patients included in a first group, the disease was active and in 16 patients included in a second group, the disease was cured. The study was conducted according to both the clinical form of the disease and the response to paracoccidioidin in both groups. In the first group, 10 patients presented the acute form, 12 presented the chronic unifocal form and 24 had the chronic multifocal form of the disease. As to the response to paracoccidioidin, in the first group 16 patients were negative and 30 were positive; in the second group, 11 were positive and 5 were negative. An immunological study was performed in all patients using in vivo methods such as skin tests and sensitization to DNCB and in vitro techniques such as total lymphocyte counts, T and B cell counts, leukocyte migration inhibition test, chemotaxis of total leukocytes and mononuclear leukocyte phagocytosis.

Cutaneous lupus erythematosus: direct immunofluorescence and epidermal basal membrane study.

Biopsy specimens of cutaneous discoid lesions of 71 patients with cutaneous lupus erythematosus (CLE) were studied. The material was examined by direct immunofluorescence (DIF) to establish positivity and morphologic patterns of immunoglobulins and complement deposits in the basement membrane zone (BMZ). A correlation between DIF results and thickening of the epidermis basement membrane (BM) stained by periodic acid-Schiff (PAS), obtained from 31 matched biopsy specimens, also is presented. Direct immunofluorescence had positive results in 66.20% of the 71 examinations and 70.97% of the matched examinations, whereas PAS showed BM thickening in 100% of the specimens. This observation stresses the importance of such histopathologic findings in the diagnosis of discoid lesions in CLE. There was no correlation between DIF patterns and PAS-stained BMZ thickening. These findings merit additional study. In conclusion, an accordance between PAS-stained BM thickening and immunoglobulin deposits has occurred in 70.97% of cases. This phenomenon does not depend on the presence of immunocomplexes, for it occurs even in cases in which immunocomplex deposits were not detected.

[Botryomycosis]. / Botriomicose.

Four cases of botryomycosis are presented. All patients had fistulous and ulcerated lesions of the lower limbs. Diagnosis was based on the clinical and laboratory findings (presence of grains on direct microscopy examination and positive bacterial cultures). All patients had osteomyelitis. Three were treated with antibiotics or sulfonamides (orientated by the antimicrobial susceptibility test) and were cured.

Tratamento de leishmaniose tegumentar americana na infancia. / Treatment of mucocutaneous leishmaniasis in childhood

Os autores estudaram 15 criancas portadoras de leishmaniose tegumentar americana em relacao a procedencia, aspectos clinicos e laboratoriais. Todos os casos foram tratados com antimoniato de N-metil glucamina, utilizando doses de 17-25,5mg de antimonio/quilo por dia (2 a 3ml/10kg por dia), via intramuscular durante 20 a 25 dias. Catorze casos curaram-se com uma serie e um curou-se com tres series

Tratamento da leishmaniose tegumentar americana pelo antimonio pentavalente.(Esquema rapido). / Treatment of American tegumentar leishmaniasis with pentavalent antimony. (Short schedule)

Os autores efetuaram tratamento em 21 doentes de leishmaniose tegumentar americana com esquema rapido utilizando N-metil-glucamina na dose total de 270 a 300 ml, diluidos em 250ml de soro fisiologico, administrados por via IV por 10 a 11 dias. Obtiveram cura clinica de todos os doentes seguidos. Verificaram efeitos colaterais em quatro casos, sem necessidade de interrupcao da terapeutica. Salientam que este tratamento permite menor tempo de hospitalizacao do doente,quando esta e necessaria por condicoes economico-sociais ou pela extensao ou gravidade da molestia. De outro lado aparentemente ocorre uma cicatrizacao mais rapida das lesoes