RESUMEN
This study compared clinical manifestations, blood biochemistry and cerebrospinal fluid (CSF) results of HIV-positive and HIV-negative patients with cryptococcal meningitis. We collected 57 cases of cryptococcal meningitis from cytological specimens submitted to the Department of Tropical Pathology, Faculty of Tropical Medicine. Pertinent clinical data were analyzed retrospectively in 47 cases for clinical manifestations, laboratory features and outcomes of 38 HIV-positive and 9 HIV-negative patients. Headache was the most common symptom seen in all cases, of which 70.2% occurred with fever. CSF examination of both groups revealed elevated opening pressure. Increased CSF protein and depressed CSF glucose levels were seen in HIV-negative cases, which differed from HIV-positive cases, where a slight change was noted. CSF pleocytosis in HIV-positive patients was variable. Forty-eight percent of HIV-positive patients had CSF leukocyte counts below 20 cells/ mm3. None was found in the HIV-negative patients. Specific treatments with amphotericin B and fluconazole were given. Five fatal cases of cryptococcal meningitis were noted, all of which were HIV-positive. There were statistically significant differences in blood neutrophils, blood eosinophils, CSF leukocyte counts, CSF neutrophils, CSF lymphocytes, CSF glucose, and CSF total protein, in HIV-positive and HIV-negative patients (p = 0.050, p = 0.022, p = 0.002, p = 0.016, p = 0.047, p = 0.031, p = 0.009, respectively).
Asunto(s)
Seronegatividad para VIH , Seropositividad para VIH , Meningitis Criptocócica/epidemiología , Adolescente , Adulto , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Meningitis Criptocócica/sangre , Meningitis Criptocócica/líquido cefalorraquídeo , Meningitis Criptocócica/tratamiento farmacológico , Persona de Mediana Edad , Estudios Retrospectivos , Estadísticas no Paramétricas , Tailandia/epidemiologíaRESUMEN
Nitrate levels in CSF and sera from 16 coma and 19 noncoma falciparum malaria patients were determined using nitric oxide colorometric assay. The medians (range lower, upper limits) of nitrate in sera of comatose and noncomatose patients were 0.28 (0.11, 1.24) and 0.23 (0.05, 0.87) microM, respectively. The medians of nitrate level in CSF of coma and noncoma cases were 0.09 (0.01, 0.28) and 0.15 (0, 1.18) microM, respectively. There was no difference of nitrate level in sera and CSF from comatose or noncomatose patients compared to that in normal sera and CSF. The amount of nitrate in sera and CSF of both groups was not significantly correlated with coma depth, parasitemia, parasite clearance time and time to recovery. Contrast to our in vitro study using immunoperoxidase staining, we found inducible nitric oside synthase production by brain endothelial cells during 4-24 hours of coculturing with late stage of P. falciparum infected red blood cells. These results suggests that malaria severity can not be differentiated by nitrate level in body fluid.
Asunto(s)
Malaria Falciparum/sangre , Malaria Falciparum/líquido cefalorraquídeo , Óxido Nítrico/sangre , Óxido Nítrico/líquido cefalorraquídeo , Adolescente , Adulto , Animales , Células Cultivadas , Coma/sangre , Coma/líquido cefalorraquídeo , Endotelio Vascular/metabolismo , Eritrocitos/parasitología , Femenino , Humanos , Técnicas In Vitro , Malaria Falciparum/enzimología , Malaria Falciparum/fisiopatología , Masculino , Persona de Mediana Edad , Óxido Nítrico/biosíntesis , Óxido Nítrico Sintasa/biosíntesis , Óxido Nítrico Sintasa/sangre , Plasmodium falciparum/fisiología , TailandiaRESUMEN
AIMS: Nitric oxide (NO) has been hypothesized to play a major role in the pathogenesis of cerebral malaria caused by P. falciparum infection. NO may act as a local neuroactive mediator contributing to the coma of cerebral malaria (CM). We hypothesized that increased expression of inducible nitric oxide synthase (iNOS) may cause increased release of NO, and examined the expression and distribution of iNOS in the brain during CM. MATERIAL AND RESULTS: Brain tissues from fatal cases of cerebral malaria in Thai adults were examined using immunohistochemical staining to detect iNOS. The distribution and strength of staining was compared between 14 patients with CM, three of whom were recovering from coma, and controls. iNOS expression was found in endothelial cells, neurones, astrocytes and microglial cells in CM cases. There was also strong staining in macrophages surrounding ring haemorrhages. iNOS staining was decreased in recovering malaria cases compared to acute CM, and was low in controls. Quantification showed a significant association between the intensity and number of iNOS positive vessels with the severity of malaria related histopathological changes, although the total number of cells staining was not increased compared to recovering CM cases. CONCLUSIONS: This study indicates that an acute induction of iNOS expression occurs in the brain during CM. This occurs in a number of different cells types, and is increased in the acute phase of CM compared to cases recovering from coma. As NO may activate a number of secondary neuropathological mechanisms in the brain, including modulators of synaptic function, induction of iNOS expression in cerebral malaria may contribute to coma, seizures and death.
Asunto(s)
Encéfalo/patología , Malaria Cerebral/patología , Óxido Nítrico Sintasa/biosíntesis , Adolescente , Adulto , Encéfalo/enzimología , Encéfalo/parasitología , Niño , Resultado Fatal , Femenino , Humanos , Inmunohistoquímica , Malaria Cerebral/enzimología , Malaria Cerebral/parasitología , Masculino , Persona de Mediana Edad , Óxido Nítrico Sintasa de Tipo IIRESUMEN
Two types of antimalaria antibodies in the serum of 54 villagers living in a malaria endemic area of Thailand were determined by indirect immunofluorescence assay in order to define the status of malaria immunity within the group. Antibodies to parasite-derived antigens in the membrane of ring stage-infected erythrocytes were very high (> or = 1:1,250) in 44%, moderate to low (< or = 1:250) in 37% of the sera, and the rest did not have the antibody. However, all the sera had antibodies to antigens of the intraerythrocytic mature parasites, showing a very high level in 65% and moderate to low levels in 37% of the sera. Sera with high antibody titers to either type of antigen significantly inhibited cytoadherence of P. falciparum-infected erythrocytes. All the sera variably inhibited rosette formation of the parasites but showed no association with the antibody titers. These results suggest that the antibodies to cytoadherence and rosette formation can be elicited and sustained in the malaria experienced host while living in the endemic area. This may be a natural preventive mechanism against the severity of P. falciparum infection in the infected host. How long the antiparasite adherence activity will last remains to be investigated.
Asunto(s)
Eritrocitos/parasitología , Malaria Falciparum/sangre , Plasmodium falciparum/inmunología , Adolescente , Adulto , Animales , Anticuerpos Antiprotozoarios/sangre , Adhesión Celular , Enfermedades Endémicas , Eritrocitos/citología , Eritrocitos/inmunología , Humanos , Incidencia , Malaria Falciparum/epidemiología , Malaria Falciparum/parasitología , Persona de Mediana Edad , Parasitemia/sangre , Parasitemia/epidemiología , Población Rural , Tailandia/epidemiología , Células Tumorales CultivadasRESUMEN
Cytoadherence of Plasmodium falciparum-infected erythrocytes to the brain microvascular endothelial cells is believed to be an important cause of circulatory blockage in cerebral malaria. Cytokines released during acute infection may activate brain endothelial cells leading to increased binding of infected erythrocytes in the brain and reduced cerebral blood flow. This effect may be direct and more potent with the tissue-localized cytokines in the brain. In order to establish this relationship, brain tissues of cerebral and noncerebral malaria were compared. The most prominent histopathologic changes in the brain included edema, neuronal degeneration, ring hemorrhage, and percentage of parasitized erythrocytes sequestration were observed in cerebral malaria. Immunohistochemical staining of the brain sections demonstrated that tissue-localized TNF-alpha, IFN-gamma, IL-I1B, and IL-10 were associated with the histopathology. However, IL-4 was the only cytokine presented at moderate level in the brain tissue of noncerebral malaria which histopathology was the least. No tissue-localized cytokine was observed in the brain of P. vivax infection or of the car accident control cases.
Asunto(s)
Citocinas/metabolismo , Malaria Cerebral/inmunología , Malaria Cerebral/patología , Malaria Falciparum/inmunología , Malaria Falciparum/patología , Adolescente , Adulto , Anciano , Anticuerpos Monoclonales , Estudios de Casos y Controles , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Due to improvements in socio-economic and sanitation conditions, Thailand has undergone a change from hyperendemicity to intermediate endemicity for hepatitis A virus infection, leaving a large part of the adult population without immunity. At the same time, the country is still highly endemic for hepatitis B and especially in the northeast, hepatitis C virus infection both of which when acquired during infancy or early childhood exhibit a strong tendency to turn towards chronic liver disease, although in particular with hepatitis B virus the asymptomatic carrier state is also rather common. As no cross-immunity exists between any of these viruses, double or triple infections do occur, a situation where previously acquired immunity to HAV becomes crucial as double infections have been shown to take a more severe or even fatal course. In the present study, we investigated 820 HBV- and/or HCV-related chronic liver disease (CLD) patients and 195 blood donors, both groups divided by 10-year age intervals, for the prevalence of anti-HAV. The results showed the same age dependence of immunity for all groups tested as can be expected for an area of intermediate endemicity, in that approximately 50% of those between 21 and 30 years of age had acquired anti-HAV. These findings indicate the immune response to HAV infection not to be altered by chronic infection with either HBV or HCV. Hence, vaccination against HAV should be considered, particularly in anti-HAV-negative patients with CLD.
Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Portador Sano , Susceptibilidad a Enfermedades/etiología , Hepatitis A/etiología , Hepatitis B Crónica/complicaciones , Hepatitis C Crónica/complicaciones , Cirrosis Hepática/complicaciones , Adulto , Distribución por Edad , Anciano , Portador Sano/epidemiología , Estudios de Casos y Controles , Enfermedad Crónica , Susceptibilidad a Enfermedades/sangre , Susceptibilidad a Enfermedades/epidemiología , Susceptibilidad a Enfermedades/inmunología , Enfermedades Endémicas/estadística & datos numéricos , Femenino , Hepatitis A/sangre , Hepatitis A/epidemiología , Hepatitis A/inmunología , Hepatitis A/transmisión , Anticuerpos de Hepatitis A , Anticuerpos Antihepatitis/sangre , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Estudios Seroepidemiológicos , Factores Socioeconómicos , Tailandia/epidemiologíaRESUMEN
A retrospective study of stool samples of HIV-infected patients from January 1994 to December 1995 submitted to the Department of Tropical Pathology was analyzed. There were twenty-two cases, all of which presented with chronic diarrhea. Result showed that 50% were infected with protozoa. These include Microsporidium (27.27%), Cryptosporidium (9.09%), Isospora belli (4.54%) and Giardia intestinalis cysts (9.09%). Other infections were Candida sp, Strongyloides stercoralis larva and Opisthorchis viverrini ova. The data stress the importance of opportunistic protozoa in the HIV-infected patients. Awareness of their existence of the diseases is important areas with increasing number of HIV-infected patients for early detection and proper treatment.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/parasitología , Heces/parasitología , Infecciones por VIH/parasitología , Infecciones por Protozoos/etiología , Infecciones por VIH/complicaciones , Humanos , Infecciones por Protozoos/parasitología , Estudios Retrospectivos , TailandiaRESUMEN
A 33 year-old Thai woman was diagnosed with scrub typhus infection according to clinical symptoms, eschar lesions compatible with the disease, and specific antibody to Rickettsia tsutsugamushi detected by indirect immunoperoxidase. Percutaneous transhepatic needle biopsies were taken before and 7 days after treatment with tetracycline to study the pathology of the liver. The liver tissue was evaluated by light microscopy, using H & E and Pinkerton's stains, and by transmission electron microscopy (TEM). Before treatment it showed reactive hepatitis. Rickettsia organisms within the hepatocytes and sinusoids detected by Pinkerton's stain appeared as tiny bright-red organisms. By TEM, the rod-shaped double-membrane Rickettsiae appeared intact in the cytoplasm of Kupffer's cells and hepatocytes. After tetracycline treatment, moderate levels of acidophilic and ballooning liver cells were observed. The degree of cytoplasmic organelle damage varied, including fatty metamorphosis, depletion of glycogen granules, loss of the mitochondrial cristae, dilatation of endoplasmic reticulum and cytoplasmic vacuolation. Rickettsia organisms cannot be visualized by Pinkerton's stain but were detected by TEM, in markedly vacuolated hepatocytes, in congested sinusoids and in Kupffer's cells. Intranuclear Rickettsia were discovered in the endothelial nucleus, showing various degrees of injury. Some were mildly degenerated, while others exhibited clumping of nucleoprotein at the cytoplasm periphery and large vacuolation centrally. Many indented organisms were found, and binary fission during Rickettsiae multiplication was always affected. Electron-microscopic examination of hepatic injury associated with scrub typhus is rare. This is the first ultrastructural localization of Rickettsiae in the infected human liver.
Asunto(s)
Hígado/microbiología , Hígado/ultraestructura , Tifus por Ácaros/patología , Adulto , Femenino , HumanosRESUMEN
A significant number of acute non A to E hepatitis cases are reported in Thailand every year, and the etiologies of these cases are unknown. Members of the herpesviridae family have been reported to cause either a self limited or fatal hepatitis in a small proportion of patients in other parts of the world. To determine whether herpesviruses may play a role in acute non A to E hepatitis, sera from 32 acute hepatitis patients without markers for acute hepatitis A to E virus infection were examined for IgM to herpesvirus type 2 (HSV-2), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) using commercially available assays. IgM to HSV-2 was detected in four sera, IgM to CMV was detected in one serum, and IgM to EBV was detected in one serum. All of the acute non A to E hepatitis patients recovered and none had underlying conditions associated with impaired immunity. These results suggest that herpesviruses should be considered in the differential diagnosis for Thai patients with hepatitis.
Asunto(s)
Infecciones por Citomegalovirus/virología , Hepatitis Viral Humana/virología , Herpes Genital/virología , Infecciones por Herpesviridae/virología , Enfermedad Aguda , Adolescente , Adulto , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/inmunología , Femenino , Hepatitis Viral Humana/diagnóstico , Hepatitis Viral Humana/inmunología , Herpes Genital/diagnóstico , Herpes Genital/inmunología , Infecciones por Herpesviridae/diagnóstico , Infecciones por Herpesviridae/inmunología , Herpesvirus Humano 2/inmunología , Herpesvirus Humano 4/inmunología , Humanos , Masculino , Persona de Mediana Edad , Pruebas Serológicas , TailandiaRESUMEN
To better characterize the etiology of acute non-A, B, C hepatitis, 24 sera from 50 acute hepatitis without acute markers for hepatitis A, B, and C were examined for acute markers for the hepatitis E virus (HEV), cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2), and Epstein-Barr virus. Immunoglobulin M (IgM) specific for HEV, HSV-2, and CMV was detected using ELISA and total Ig specific to EBV was determined by standard indirect immunofluorescence. IgM to CMV was not observed in sera from any of the patients; whereas, IgM to HEV was detected in sera from 2 patients and IgM to HSV-2 was detected in 5 of 24 acute hepatitis patients. In addition, high titer of antibody was found in 2 of the patients. This results indicate that HSV-2 and HEV circulate in Thailand and are responsible for a small proportion of non-A, B, C hepatitis in Thailand.
Asunto(s)
Hepatitis E/etiología , Anticuerpos Antihepatitis/inmunología , Hepatitis E/inmunología , Humanos , TailandiaRESUMEN
To confirm an earlier report that laboratory rats are susceptible to infection with the hepatitis E virus (HEV), we inoculated 27 Wistar rats intravenously with a suspension of a human stool known to contain infectious HEV. Stool, sera, and various tissues were collected from three rats each on days 0 (preinoculation) and 4, 7, 11, 14, 18, 21, 25, 28, and 35 postinoculation. Stool and sera specimens were examined by reverse transcription-polymerase chain reaction for the presence of HEV genomic sequences. Tissues were examined by light microscopy for detection of histopathological changes and by direct immunofluorescence for detection of HEV antigens. We detected HEV RNA in stools on day 7 in all three animals and in serum intermittently between days 4 and 35. We found HEV antigens in liver, peripheral blood mononuclear cells, spleen, mesenteric lymph nodes, and small intestine. We detected histopathology attributable to the inoculum in liver, spleen, and lymph nodes. The results confirm that HEV can replicate in laboratory rats and suggest new tissue sites for HEV replication.