Aspergilloma formation in cavitary sarcoidosis.

Pulmonary cavitation is rather uncommon in patients with sarcoidosis, and aspergilloma is even more uncommon in such cases. Here, we present the case of a 63-year-old female patient with cavitary lung disease who had been under treatment for TB for 9 months. A diagnosis of pulmonary sarcoidosis was established based on the fiberoptic bronchoscopy finding of noncaseating granuloma. Treatment with corticosteroids led to a dramatic improvement in symptoms. While under treatment for sarcoidosis, the patient developed an aspergilloma. She presented immediate skin test reactivity to Aspergillus fumigatus, as well as positivity for A. fumigatus serum precipitins. This is the first reported case of aspergilloma formation in a patient with cavitary sarcoidosis in India.

Aspergilloma formation in cavitary sarcoidosis / Formação de uma aspergilloma em sarcoidose com cavitação

Pulmonary cavitation is rather uncommon in patients with sarcoidosis, and aspergilloma is even more uncommon in such cases. Here, we present the case of a 63-year-old female patient with cavitary lung disease who had been under treatment for TB for 9 months. A diagnosis of pulmonary sarcoidosis was established based on the fiberoptic bronchoscopy finding of noncaseating granuloma. Treatment with corticosteroids led to a dramatic improvement in symptoms. While under treatment for sarcoidosis, the patient developed an aspergilloma. She presented immediate skin test reactivity to Aspergillus fumigatus, as well as positivity for A. fumigatus serum precipitins. This is the first reported case of aspergilloma formation in a patient with cavitary sarcoidosis in India.

A cavitação pulmonar é rara em pacientes com sarcoidose, e o aspergiloma é ainda mais raro nestes casos. Apresentamos o caso de uma paciente de 63 anos com doença pulmonar cavitária em tratamento para a TB por 9 meses. Estabeleceu-se o diagnóstico de sarcoidose pulmonar com base nos achados de granuloma não-caseoso na fibrobroncoscopia. Houve grande melhora dos sintomas com o tratamento com corticosteroides. A paciente desenvolveu um aspergiloma durante o tratamento para a sarcoidose. Houve reação imediata ao teste cutâneo para Aspergillus fumigatus, assim como resultado positivo para precipitinas de A. fumigatus no soro. Este é o primeiro caso relatado de formação de aspergiloma em um paciente com sarcoidose com cavitação na Índia.

Imunidade humoral em pacientes com fibrose cística / Humoral immunity of patients with cystic fibrosis

Pacientes com FC frequentemente såo acometidos por infecçöes pulmonares, principalmente por P. aeruginosa tanto da variedade nåo mucóide como mucóide. Esta última, quando se instala, é acompanhada geralmente de deterioraçåo progressiva da funçåo pulmonar. Detectam-se nestes pacientes, anticorpos para o microorganismo e diversos produtos por ele produzidos. A imnunoeletroferese cruzada tem sido tradicionalmente utilizada para pesquisa de precipitinas para P. aeruginosa. Esta surgem pouco após o início do episódio infeccioso e guardam correlaçåo com a cronicidade do processo, quando se mostram mais numerosoas. Em pacientes infectados por P. auruginosa mucóide, o número de precipitinas costuma ser maior que nos infectados pela variedade nåo-mucóide. As precipitinas habitualmente nåo surgem nos pacientes apenas colonizados, servindo assim para distinguir casos de colonizaçåo dos de infecçåo, e indicando a oportunidade do emprego de antibioticoterapia nestes pacientes. O número de precipitinas se reduz após controle do processo infeccioso. Outras técnicas vêm sendo desenvolvidas com sucesso, para a pesquisa de anticorpos para P. aureginosa, visando a obtençåo de maior sensibilidade e especificidade, abrindo caminho para novas possibilidades de investigaçåo

The threat of reintroduction of natural transmission of Chagas' disease in Bambuí, Minas Gerais state, Brazil, due to Panstrongylus megistus

In the Epidemiological Surveillance Program in the county of Bambuí, Minas Gerais, between August 1986 and December 1988, 154 Panstrongylus megistus were captured by the local population in both peridomicile and intradomicile environments. Fifteen (9.8%) of the P. megistus harboured Trypanosoma cruzi. Preciptin tests showed that the most frequent triatomine blood meal sources were birds, but other sources were dogs, men and cats. The isoenzyme characterization of 13 T. cruzi strains showed that six belonged to zymodeme Z1, corresponding to the wild parasites, and seven belonged to zymodeme Z2, corresponding to parasites isolated from chronic chagasic patients (domestic cycle). As P. megistus were found to be naturally infected by parasites from both cycles, they are cleary able to transmit T. cruzi from the wild cycle to the domestic cycle. Furthermore the capacity of P. megistus in colonizing houses was observed in one residence, vacant for several years, in wich 153 triatomines were captured. The data show the possibility of P. megistus reintroducing transmission of Chaga's disease in the county if Epidemiological Surveillance is interrupted

The long-term evolution of immune deposits in passive Heymann nephritis.

1. To study the long term course of passive Heymann nephritis (PHN), 42 adult male Wistar rats were injected with rabbit anti-FX1A serum (PHN group) and 42 rats received normal rabbit serum (control group). Two animals from each group were sacrificed 2 weeks after the inoculation and 10 animals each from the control and PHN groups were sacrificed 4, 13, 25 and 53 weeks later. 2. The PHN group exhibited a significant elevation in 20-h proteinuria which lasted from the first week (control group, 9.19 +/- 0.87; PHN group, 25.3 +/- 2.66) to the 25th week (control group, 22.6 +/- 2.15; PHN group, 66.7 +/- 10.4) except for week 17. From week 29 to week 53 there was no statistical difference between the 2 groups. 3. Light microscopy showed no difference between the kidneys of PHN and control rats. Immunofluorescence microscopy in PHN rats showed granular deposition of autologous and heterologous IgG on the glomerular basement membrane (GBM), whose intensity and pattern did not change during 53 weeks of observation. 4. When examined by electron microscopy the glomeruli of PHN rats showed: a) electron-dense deposits which were initially subepithelial and homogeneous and later intramembranous, granular and often surrounded by an electron-transparent halo; b) focal thickening of the GBM at the sites of intramembranous deposits; c) effacement of podocytes located close to the deposits; d) "penetration" of the podocytes into the GBM associated with the deposits; e) presence of osmiophilic granules in the cytoplasm of the podocytes located inside the GBM similar to the granules of the deposits next to them. The association of the penetration of the podocytes into the GBM with the deposits and the presence of the osmiophilic granules inside the foot process have not been described previously in PHN.

Circulating immune complexes in sickle cell anaemia.

A polyethylene-glycol insoluble serum fraction was studied in patients with sickle cell anaemia during the steady state of the disease. The levels of C1q-precipitins were normal but increased amounts of proteins, IgM C3 and factor B were detected in this immune complex enriched serum fraction. These findings are a sign that circulating immune complexes can be detected even in the asymptomatic period of the disease.

Correlation between ANA determinations on tissue substrate, WiL-2 cell substrate, and precipitin antibody by double diffusion.

Four hundred fifty-five sera from patients with various connective tissue diseases were screened for the presence of fluorescent antinuclear antibodies (ANA) on two different substrates-mouse kidney sections and WiL-2 cell smears-and precipitin antibodies by using WiL-2 cell extracts as an antigenic source. The antigen for the precipitin was prepared as for extractable nuclear antigen tests. Of 258 sera from systemic lupus erythematosus cases, 73% were positive for ANA on mouse kidney sections, 98% on Wil-2 cell smears, and 47% by precipitin tests. However, 33 sera which were ANA negative on mouse kidney sections were positive on WiL-2 cell smears and also positive for precipitin antibodies. WiL-2 cells used as ANA substrates increased the frequency of ANA in connective tissue diseases, and there was a strong correlation between the WiL-2 cell ANA and the presence of precipitin antibodies. Twenty-four of these 33 sera had anti-SSA/Ro antibody. Some sera containing anti-SSB/La or anti-nRNP antibodies were ANA negative on mouse kidney sections, but all were positive on WiL-2 cells.

The detection and measurement of coproantibodies to Nippostrongylus brasiliensis in rats following a primary infection.

Investigations were initiated to study the possible detection and measurement of coproantibodies in animals infected with a gastrointestinal nematode parasite. Faecal extracts, extracts of small intestinal mucosa and sera of rats infected with intestinal nematode Nippostrongylus brasiliensis were examined for total IgA, IgM and IgG levels and haemagglutinating and precipitating antibodies specific to parasite antigens over a 30-day-period following infection. It was found that in both faecal and mucosal extracts immunoglobulin concentrations increased after a primary infection. In faecal extracts there was a seven-fold increase of IgA, a three to six-fold increase of IgG and about a fifty-fold increase of IgM. Haemagglutinins in faecal extracts detected by adult worm excretory-secretory (ES) products and adult worm and infective larvae somatic extracts were observed from 3 days after infection (DAI). Haemagglutinins detected by ES products reached their highest titres on 11-12 DAI while those reacting with adult worm somatic extracts showed the highest level between 15 and 19 DAI. A similar pattern of response was found in the antibody levels of the intestinal mucosa. Haemagglutinins detected in faeces during the first 12 DAI reacted with the same antigens as antibodies present in the sera at that time but coproantibodies from 18, 24 and 30 DAI were different from those circulating in sera at that stage of the infection. The results suggest that measurement of coproantibody levels may provide a convenient and useful index of local immune responses to gastrointestinal helminths.

[Production of coprecipitating antibody in rabbits immunized repeatedly with ovalbumin in different physical states]. / Producción de anticuerpo coprecipitante en conejos inmunizados a repetición con ovoalbumina en diferente estado físico.

A comparative study has been made of rabbit precipitating and coprecipitating anti-egg albumin antibody in rabbits repeatedly injected with soluble and particulate antigens. Four different antigens were used. a) Soluble egg albumin. b) Polymerized egg albumin. c) Egg albumin linked Brucella abortus 19 strain. d) Brucella abortus 19 strain. Rabbits were subcutaneously injected every 2 weeks during 29 weeks. Before each inoculation they were bled and the concentration of serum precipitating and coprecipitating antibodies was determined. In animals inoculated with the soluble antigen, coprecipitating antibodies were present during the whole course of the immune response and they constituted 10% of the total antibody population. In rabbits injected with particulate antigen (egg albumin linked Brucella abortus) coprecipitating antibodies were also present during the whole course of the immune response but their serum concentration was not the same in different periods of time. An increase in coprecipitating antibodies began at the 13th week reaching 50% of the total antibodies at the 28th week. Similar results had been obtained in rabbits injected with Brucella s. p. In animals inoculated with polymerized egg albumin, coprecipitating antibodies increased to high levels from the 1st to the 23rd week; during this period it constituted 50% of the total antibody population, after which, the animals became tolerogenic. On the basis of these results, the increase in coprecipitating antibodies in rabbit sera would be related to: 1) antigen physicochemical characteristics (soluble o particulate); 2) the number of epitopes in the particle, and 3) the size of the antigen particles.

Immunologic responses to therapy in allergic bronchopulmonary aspergillosis: serum IgE value as an indicator and predictor of disease activity.

Two patients, a child and an adult, with allergic bronchopulmonary aspergillosis were studied over an 18-month period. Initially elevated total serum IgE levels fell during prednisone therapy and rose prior to and during an exacerbation. Total serum IgG fell with therapy, whereas the values of IgA and IgM remained constant. Specific IgG and IgE values against Aspergillus fumigatus as measured by radioimmunoassay were elevated in both patients. Specific IgE values increased in each patient prior to exacerbation, whereas specific IgG values increased in only one patient at the time of exacerbation. Immunologic evaluation may provide an assessment of disease activity of prospective value.

Skin lesions, angioedema, eosinophilia, and hypocomplementemia.

A six-year-old girl with recurrent urticaria and angioedema, vasculitis, and probable renal disease exhibited marked blood eosinophilia, increased levels of serum IgE, circulating Clq precipitins, and hypocomplementemia with evidence of activation of complement by the classic pathway. Biopsies of skin and muscle revealed heavy infiltrations of the vessel walls with eosinophils. Immunofluorescence studies revealed deposition of IgM, IgE, and C3 in the vessel walls. Exacerbations of the disease were associated with an increase in the eosinophil count and a decrease in the serum levels of C4 and C3. Remission was achieved with corticosteroid therapy. This patient has many features in common with the syndrome of skin lesions, angioedema, and hypocomplementemia recently described in adults.