RESUMO
This report describes clinical and immunologic features of five illustrative cases of paracoccidioidomycosis in previously healthy children. All had disseminated disease and two of them died despite treatment. The major clinical presentation in four patients was fever and diffuse superficial and intraabdominal adenopathy, with or without hepatosplenomegaly. Other sites were also affected: three patients had multiple osteoarticular lesions, occasionally with intense tissue destruction; two had cutaneous eruptions; two had pericardial effusions; and two had pulmonary involvement, once considered an organ spared in the young. We detected variable lymphocyte responses to mitogens and to Candida albicans antigen and non-responsiveness to Paracoccidioides brasiliensis cell wall antigen. High concentrations of serum immunoglobulins and anti-P. brasiliensis antibodies were present. These immune alterations tended to resolve with treatment, suggesting a reversible nature of the immune defect. We conclude that this mycosis has a high morbidity and mortality in children, which is probably related to an antigen-specific immunodeficiency. Further studies are needed to increase knowledge of this mycosis in children.
Assuntos
Paracoccidioidomicose/imunologia , Paracoccidioidomicose/fisiopatologia , Doença Aguda , Candida albicans/imunologia , Criança , Evolução Fatal , Feminino , Humanos , Imunidade Celular , Hospedeiro Imunocomprometido , Ativação Linfocitária , Masculino , Paracoccidioides/imunologia , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/terapiaRESUMO
This study reports Mycobacterium bovis (BCG strain) dissemination in four primary immunodeficient (PID) patients. Their diagnoses were: chemotaxis defect, cellular immunodeficiency, combined immunodeficiency and chronic granulomatous disease (CGD). Patients were vaccinated with BCG (Moreau strain) between 17 days and 4 months of age. Identification of the BCG strain was performed in many sites, such as bone marrow, ganglionic mass, cerebrospinal fluid and in the site of vaccination. The first therapeutic schedule included rifampicin, isoniazid and ethambutol; no uniform treatment could be used for these patients. Therapy was adjusted as required on the basis of BCG sensitivity results. This study shows that PID patients are susceptible to BCG dissemination and demonstrates the importance of an early diagnosis for their prognosis.
Assuntos
Vacinas Bacterianas/efeitos adversos , Síndromes de Imunodeficiência/microbiologia , Mycobacterium bovis/isolamento & purificação , Mycobacterium bovis/patogenicidade , Vacinas Bacterianas/imunologia , Brasil , Humanos , Síndromes de Imunodeficiência/tratamento farmacológico , LactenteRESUMO
Two cases of Aspergillosis in immunocompromised children are reported. Both were caused by Aspergillus flavus. Early diagnosis and treatment led to the remission of the process. One patient had acute myeloid leukemia; the fungus was isolated from the blood. The other patient with bone marrow aplasia, presented an invasive aspergillosis of the paranasal sinuses with dissemination of fungal infection; the diagnosis was obtained by histology and culture of biopsied tissue from a palatal ulceration.