RESUMEN

METHODS: We analyzed the potential influence that associated risk factors (ARF), such as smoking, alcoholism, overweight, and hypertension, could have on the establishment of chronic chagasic cardiomyopathy (CC). The sample was comprised of 124 individuals, 69 males and 55 females (mean age +/- SD, 41 +/- 9.5 years), who were born in en demic areas of Northern Argentina and migrated further to Rosario City, an area where autochthonous cases of Chagas' disease have never been registered. Assessments included the following: clinical examination to discard previous cardiomyopathies; search for the presence of ARF according to standard criteria; specific serology; frontal chest X-ray, and 12-lead resting electrocardiogram (ECG). Subjects were classified on the basis of their serological status and presence of ARF into four groups: Tc+ARF+ T. cruzi-infected persons with ARF (n = 41); Tc-ARF+ seronegativity in presence of ARF (n = 27); Tc+ARF- individuals showing positive serology that lacked ARF (n = 27), and Tc-ARF- seronegative individuals having no ARF (n = 29). RESULTS: Except for a higher female/male ratio in groups presenting no ARF (p < 0.02), no statistical differences as to age, length of residence in endemicity areas (LR), and ARF distribution were recorded among groups. Forty-one persons presented abnormal ECG tracings, distributed thus: Tc+ARF+, 18/41; Tc-ARF+, 14/27, Tc+ARF-, 14/27, and Tc-ARF, 4/29 (p < 0.01, in relation to the latter group). Subjects from the Tc+ARF+, Tc-ARF+, and Tc+ARF- groups had 4.89-, 6.7-, and 6.7-fold increases, respectively, if having an abnormal ECG when compared with Tc-ARF- individuals. Comparisons on the frequency of abnormal ECG between seropositives carrying ARF or not yielded a non-significant odds ratio, be it estimated as crude, or after adjusting for sex, age, and LR in multivariate analysis. CONCLUSIONS: Presence of ARF was not associated with an increasing risk of cardiac affectation in chronically T. cruzi-infected persons, but resulted in chagasic-compatible ECG abnormalities in those seronegative individuals.

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To evaluate the status of the cellular immune response of patients with community acquired pneumonia (CAP), 8 CAP cases were studied for their in vitro T-cell responses to concanavalin A (Con A), tuberculin, and candidin, as well as levels of major T-cell populations in peripheral blood. Assessment on admission revealed that CAP patients had significantly decreased responses to both antigen and mitogen driven lymphocyte proliferation when compared to age and sex matched controls. Studies performed upon 1 week of antibiotic treatment made evident, in turn, that clinical improvement was accompanied by a reestablishment of the in vitro responses to tuberculin and candidin, whereas the lymphoproliferation induced by Con A remained decreased as in its first evaluation. Data from admission and day 7 of treatment showed no significant differences as to the levels of peripheral T-cell subsets when compared to those of healthy controls. Our results indicate that CAP coincides with reduced in vitro T-cell responses to antigen and mitogen stimulation.

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To analyze whether electrocardiographic alterations (ECGA) in patients with antibodies to Trypanosoma cruzi showed a pattern of familial aggregation, a sample of 379 young adults (166 men and 213 women) distributed in sibships, were assessed for the presence of anti-T. cruzi antibodies, and subjected to a complete clinical examination and a standard resting electrocardiogram (ECG). Positive T. cruzi serology was detected in 165 individuals, 48 of them showing an abnormal ECG (overall prevalence 29%). One hundred and eleven seropositive individuals were distributed in 45 sibships, each of them constituted by more than one seropositive sib, with ECGA being present in 34 out of these patients. Seropositive subjects with ECGA were detected in 27 sibships. Since the index case within each sibship is counted exactly once, affected individuals selected at random as propositi were extracted to calculate the prevalence of ECGA among first degree relatives of probands. Abnormal ECGs were recorded in 7 out of 45 sibs yielding a prevalence that did not differ from estimations registered in the general population or seropositive sibs. Data from the present sample show no familial aggregation for the occurrence of ECGA in patients with T. cruzi. infection.

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To ascertain whether maternal infection with Trypanosoma cruzi may influence the course of the parasitic infection in offspring, two groups of female 1 rats were mated with syngeneic sires. One group of females was infected with 10(6) trypomastigotes of T. cruzi three times at weekly intervals. All offspring were nursed by their mothers until weaning and then separated into two groups of young, one to be infected with the same dose of T. cruzi, and the other to remain uninfected. Infection of pregnant rats caused no aggravated disease but resulted in a self-controlled infection that did not cause any deaths or affect their reproductive capacity. The number of young delivered, litter size, fertility coefficient, and offspring weights at weaning were also unaffected by maternal infection; however, the survival coefficient decreased in comparison with values recorded in the offspring of uninfected mothers. The latter finding is likely due to neonatal transmission, since bloodstream forms of T. cruzi were observed in a few offspring of infected mothers. While infected offspring whose mothers had been inoculated with T. cruzi during pregnancy were not protected from acute infection, the occurrence of chronic focal myocarditis was less prevalent when compared with that recorded in chronically infected offspring born to uninfected mothers.

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Concomitant immunity (IC) is usually defined as the capacity of any animal bearing a progressor tumor to inhibit a second challenge with the same tumor. In order to establish the contribution of the host to the origin of this phenomenon, IC was induced in two lines of rats with a different behavior when challenged with Sarcoma E 100 (SE 100), i.e., line IIMc: 90% take and 100% regression; line "m": 100% take and death. The rats received a second challenge on day 3 (Group II), 7 (III), and 14 (IV), as well as the control groups: II', III' and IV', respectively. The animals reinoculated on day 7 showed a decrease, both in percentage of takes (Fig. 1, III vs III') and tumor surface (Table 1, 2). Likewise, in rats IIMc, a lesser development of the first inoculum (Table 1, Ia vs I') was observed. The Winn assay (Table 3) confirmed the presence of immunocompetent spleen cells (CE) against SE 100 in IIMc rat spleens: namely, 1) immune rats (II), 2) unique tumor bearing rats (IV), 3) first progressor and second negative inoculum (V). In line "m" the percentage of takes was only smaller in the group inoculated conjointly with CE from immune rats (Table 3, VI vs VII). A mere 10% (3/30) of "m" rats were immunized against SE 100. Consequently, these results could attribute the IC, in IIMc rats, to immunological mechanisms, while in "m" it could be due to factor(s) released and/or induced by the first tumor, as proposed by Gorelik.

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Concomitant immunity (IC) is usually defined as the capacity of any animal bearing a progressor tumor to inhibit a second challenge with the same tumor. In order to establish the contribution of the host to the origin of this phenomenon, IC was induced in two lines of rats with a different behavior when challenged with Sarcoma E 100 (SE 100), i.e., line IIMc: 90

take and 100

regression; line [quot ]m[quot ]: 100

take and death. The rats received a second challenge on day 3 (Group II), 7 (III), and 14 (IV), as well as the control groups: II, III and IV, respectively. The animals reinoculated on day 7 showed a decrease, both in percentage of takes (Fig. 1, III vs III) and tumor surface (Table 1, 2). Likewise, in rats IIMc, a lesser development of the first inoculum (Table 1, Ia vs I) was observed. The Winn assay (Table 3) confirmed the presence of immunocompetent spleen cells (CE) against SE 100 in IIMc rat spleens: namely, 1) immune rats (II), 2) unique tumor bearing rats (IV), 3) first progressor and second negative inoculum (V). In line [quot ]m[quot ] the percentage of takes was only smaller in the group inoculated conjointly with CE from immune rats (Table 3, VI vs VII). A mere 10

(3/30) of [quot ]m[quot ] rats were immunized against SE 100. Consequently, these results could attribute the IC, in IIMc rats, to immunological mechanisms, while in [quot ]m[quot ] it could be due to factor(s) released and/or induced by the first tumor, as proposed by Gorelik.

RESUMEN

El fenómeno de inmunidad concomitante (IC) se define clásicamente como la capacidad que tiene un animal portador de un tumor progresor de inhibir el crecimiento de un segundo inóculo del mismo tumor. En dos líneas de ratas, que tienen distinto comportamiento al desafiarse con Sarcoma E 100 (SE 100), lnea IIMc: 90 por ciento de toma y 100 por ciento de regresión; línea "m": 100 por ciento de toma y muerte), se indujo IC a fin de establecer la participación del huésped en la generación de este fenómeno frente al mismo tumor. Las ratas recibieron el segundo desafío los días 3 ó 14, al igual que los respectivos grupos testigos. Los animales reinoculados el día 7 presentarón menor porcentagen de toma y menores superficies tumorales; además en las ratas IIMc se observó menor desarrollo del primer inóculo. El ensayo de Winn en ratas IIMc confirmó la presencia de células esplénicas (CE) comprometidas contra el SE 100 en los bazos de: ratas inmunes: portadoras de un solo tumor; de primer inóculo en crecimiento y segundo negativo en IC. En línea "m" el porcentagen de toma sólo fue menor en el grupo inoculado conjuntamente con el CE de ratas inmunes. Sólo un 10 por ciento (3/30) de ratas "m" pudieron inmunizarse contra el SE 100. Estos resultados perimitirían atribuir el fenômeno de IC, en ratas IIMc, a mecanismos inmunitários y en ratas "m", de acuerdo a lo postulado por Gorelik, a un factor o factores liberados y/o inducidos por el primer tumor. Se sugiere que prevalecería uno u otro mecanismo según las características biológicas del huésped

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El fenómeno de inmunidad concomitante (IC) se define clásicamente como la capacidad que tiene un animal portador de un tumor progresor de inhibir el crecimiento de un segundo inóculo del mismo tumor. En dos líneas de ratas, que tienen distinto comportamiento al desafiarse con Sarcoma E 100 (SE 100), lnea IIMc: 90 por ciento de toma y 100 por ciento de regresión; línea "m": 100 por ciento de toma y muerte), se indujo IC a fin de establecer la participación del huésped en la generación de este fenómeno frente al mismo tumor. Las ratas recibieron el segundo desafío los días 3 ó 14, al igual que los respectivos grupos testigos. Los animales reinoculados el día 7 presentarón menor porcentagen de toma y menores superficies tumorales; además en las ratas IIMc se observó menor desarrollo del primer inóculo. El ensayo de Winn en ratas IIMc confirmó la presencia de células esplénicas (CE) comprometidas contra el SE 100 en los bazos de: ratas inmunes: portadoras de un solo tumor; de primer inóculo en crecimiento y segundo negativo en IC. En línea "m" el porcentagen de toma sólo fue menor en el grupo inoculado conjuntamente con el CE de ratas inmunes. Sólo un 10 por ciento (3/30) de ratas "m" pudieron inmunizarse contra el SE 100. Estos resultados perimitirían atribuir el fen¶meno de IC, en ratas IIMc, a mecanismos inmunitários y en ratas "m", de acuerdo a lo postulado por Gorelik, a un factor o factores liberados y/o inducidos por el primer tumor. Se sugiere que prevalecería uno u otro mecanismo según las características biológicas del huésped (AU)

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Control animals and rats infected 90 days earlier, by inoculation of 1 x 10(6) trypomastigotes of Trypanosoma cruzi at weaning, were subjected to adult thymectomy (ATx) or sham operation (S-ATx) and assessed 3 months later for the presence of myocardial lesions and levels of lymph node and spleen T-cell populations. Chronic focal myocarditis (CFM) developed in 78% and 84% of S-ATx or ATx infected rats, respectively. While the two groups of infected rats did not differ as to the occurrence of myocardial lesions, large foci of CFM were more prevalent in ATx infected rats. Chronic T. cruzi (Tc) infection resulted in decreased CD4+ and increased CD8+ lymph node and spleen cell, with CD8+ lymphocytes being lowered to normal values in the spleen of the ATx infected group. It is suggested that ATx might act by interfering with a down-regulating immunoregulatory mechanism, leading to an exacerbation of autoimmune reactions believed to be involved in the generation of myocardial damage.

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A high mortality rate for lung cancer (62.7 per 100,000) is found in Rosario, Argentina. To investigate the reasons for this high rate, a case-control study was carried out among 215 male cases with histologically confirmed lung cancer and 433 hospitalized controls for conditions unrelated to tobacco consumption. Odds ratios (OR) of squamous cell (SQ), adenocarcinoma (AD), and small cell (SM) carcinoma of the lung associated with different characteristics of the smoking habit were quantified. Ninety-eight percent of the cases had smoked regularly. Smokers were significantly younger at diagnosis than ex-smokers (P < 0.0001), a pattern consistent for all cell types. The ORs for the heaviest cf the lowest consumption categories were 15.3 for SQ, 11.6 for AD, and 11.6 for all lung cancer (P < 0.0001). Risks associated with the use of unfiltered cigarettes were three to five times higher than those for filtered cigarettes, depending on cell types. For ex-smokers, risks after 10 years of nonsmoking were about 12 times lower than those of current smokers (P < 0.001). To halt further increases in lung cancer, preventive measures in Argentina should be directed primarily towards smoking control.

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El objetivo de este trabajo fue detectar infección y daño tisular en una línea endocriada de ratas, inducidos por formas vivas de una cepa de T. cruzi cultivada in vitro (TCC). Se inocularon: a) ratas cultivadas in vitro (TCC). Se inocularon: a) ratas lactantes (S), de 3-5 días de edad por vía i.p. con 10**6 TCC (S1), 10**7 TCC (S2) y 10**8 TCC (S3); b) ratas al destete, de 21-25 días de edad por vía s.c. con 10**6 TCC (W1), 10**7 TCC (W2) y 10**8 TCC (W3). Los cultivos tenían como máximo un 2// de trypomastigotes; c) testigos por vía i.p. o s.c. con 10**6 trypomastigotes sanguiíneos de la cepa Tulahuén (SC y WC); se incluyeron testigos normales. La sobrevida fue del 100// en S1, S2 y S3 y 0// en SC en el día 13 post-infección (p.i.). Estos animales murieron con signos de enfermedad de Chagas aguda. La sobrevida fue del 100// en el grupo W. En los primeros 30 días p.i. los parásitos fueron detectados en los grupos S1, S2, S3 y W1, W2 y W3 por búsqueda exhaustiva. Los parásitos se encontraron rápidamente en los testigos SC y WC hasta el día 13. Los xenodiagnósticos fueron positivos (5/5) a los 2 meses p.i. y negativos a los 6 meses p.i. (W1, W2, W3, 0/23; WC, 0/5) Tabla 1). Se observó un leve aumento de la frecuencia de miocarditis crónica focal en algunos animales infectados, independientemente a la dosis (S1, S2, S3, 26//; W1, W2, W3, 46//) que no fue significativo en comparación con la de los testigos y no alcanza el porcentaje de lesión obtenida habitualmente en WC (61,3//). La menor virulencia y patogenicidad observadas en las ratas, especie no estudiada hasta ahora, sugieren que la cepa TCC tiene una importante atenuación después de largo tiempo de cultivo in vitro

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RESUMEN

El objetivo de este trabajo fue detectar infección y daño tisular en una línea endocriada de ratas, inducidos por formas vivas de una cepa de T. cruzi cultivada in vitro (TCC). Se inocularon: a) ratas cultivadas in vitro (TCC). Se inocularon: a) ratas lactantes (S), de 3-5 días de edad por vía i.p. con 10**6 TCC (S1), 10**7 TCC (S2) y 10**8 TCC (S3); b) ratas al destete, de 21-25 días de edad por vía s.c. con 10**6 TCC (W1), 10**7 TCC (W2) y 10**8 TCC (W3). Los cultivos tenían como máximo un 2// de trypomastigotes; c) testigos por vía i.p. o s.c. con 10**6 trypomastigotes sanguiíneos de la cepa Tulahuén (SC y WC); se incluyeron testigos normales. La sobrevida fue del 100// en S1, S2 y S3 y 0// en SC en el día 13 post-infección (p.i.). Estos animales murieron con signos de enfermedad de Chagas aguda. La sobrevida fue del 100// en el grupo W. En los primeros 30 días p.i. los parásitos fueron detectados en los grupos S1, S2, S3 y W1, W2 y W3 por búsqueda exhaustiva. Los parásitos se encontraron rápidamente en los testigos SC y WC hasta el día 13. Los xenodiagnósticos fueron positivos (5/5) a los 2 meses p.i. y negativos a los 6 meses p.i. (W1, W2, W3, 0/23; WC, 0/5) Tabla 1). Se observó un leve aumento de la frecuencia de miocarditis crónica focal en algunos animales infectados, independientemente a la dosis (S1, S2, S3, 26//; W1, W2, W3, 46//) que no fue significativo en comparación con la de los testigos y no alcanza el porcentaje de lesión obtenida habitualmente en WC (61,3//). La menor virulencia y patogenicidad observadas en las ratas, especie no estudiada hasta ahora, sugieren que la cepa TCC tiene una importante atenuación después de largo tiempo de cultivo in vitro (AU)

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Infection and tissue damage induced by parasites of an attenuated Trypanosoma cruzi culture strain (TCC) were studied in "I" line of inbred rats. Suckling rats (S), 3-5 day old were inoculated i.p. with 10(6) TCC (S1), 10(7) TCC (S2) and 10(8) TCC (S3). Weaned rats (W), 21-25 day old were inoculated s.c. with 10(6) TCC (W1), 10(7) TCC (W2) and 10(8) TCC (W3). The cultures yielded up to 2% of trypomastigotes. Controls inoculated either i.p. or s.c. with 10(6) blood form trypomastigotes (SC and WC) as well as normal controls (NC) were included. Survival was 100% in S1, S2 and S3, and 0% in SC on day 13 post-infection (p.i.). The latter animals died with acute Chagas disease signs. Survival was 100% in the W groups. In the first 30 days p.i. parasites were detected in S1, S2 and S3 and W1, W2, W3 groups after exhaustive examination. Parasites were easily found in WC and SC until day 13. Xeno-diagnoses were positive (5/5) at 2 months p.i. and negative at 6 months p.i. (W1, W2, W3, 0/23; WC, 0/5). Only cardiac lesions were slightly increased. The frequency of focal chronic myocarditis seemed to be increased in a dose-independent manner (S1, S2, S3, 26%; W1, W2, W3, 46%) but was not significant in comparison with NC, and even was lower than usually found in WC (61.3%). The reduced virulence and pathogenicity suggest that the TCC strain suffered a remarkable attenuation after long term in vitro culture.

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Infection and tissue damage induced by parasites of an attenuated Trypanosoma cruzi culture strain (TCC) were studied in [quot ]I[quot ] line of inbred rats. Suckling rats (S), 3-5 day old were inoculated i.p. with 10(6) TCC (S1), 10(7) TCC (S2) and 10(8) TCC (S3). Weaned rats (W), 21-25 day old were inoculated s.c. with 10(6) TCC (W1), 10(7) TCC (W2) and 10(8) TCC (W3). The cultures yielded up to 2

of trypomastigotes. Controls inoculated either i.p. or s.c. with 10(6) blood form trypomastigotes (SC and WC) as well as normal controls (NC) were included. Survival was 100

in S1, S2 and S3, and 0

in SC on day 13 post-infection (p.i.). The latter animals died with acute Chagas disease signs. Survival was 100

in the W groups. In the first 30 days p.i. parasites were detected in S1, S2 and S3 and W1, W2, W3 groups after exhaustive examination. Parasites were easily found in WC and SC until day 13. Xeno-diagnoses were positive (5/5) at 2 months p.i. and negative at 6 months p.i. (W1, W2, W3, 0/23; WC, 0/5). Only cardiac lesions were slightly increased. The frequency of focal chronic myocarditis seemed to be increased in a dose-independent manner (S1, S2, S3, 26

; W1, W2, W3, 46

) but was not significant in comparison with NC, and even was lower than usually found in WC (61.3

). The reduced virulence and pathogenicity suggest that the TCC strain suffered a remarkable attenuation after long term in vitro culture.

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We report on the histologic changes occurring in single cutaneous lesions, from six active lepromatous patients, 1 week following the administration of three daily intradermal injections, 35 micrograms each, of recombinant interferon gamma (rIFN-gamma). Except for a strong induration at the injection site, rIFN-gamma produced no adverse systemic reactions and was able to promote a remarkable influx of T-lymphocytes, mononuclear phagocytes with large nuclei, nonvacuolated cytoplasm, and reduced lysozyme reactivity. Furthermore, despite no clear-cut reduction of mycobacterial dermal burden, bacilli showed a clear increase in the granular appearance. Present findings provide a basis for further elucidation of rIFN-gamma as an additional tool for leprosy treatment.

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Within the wide range of immunological abnormalities occurring in lepromatous leprosy (LL), antiphospholipid antibodies unrelated to treponemal infection, the so-called biological false positive test for syphilis (BFP), have long been recognized. Considering that BFP may also be encountered in different clinical situations, the fact that whether BFP in LL occurs solely or is associated with other concomitant infections or serological abnormalities was investigated. For this purpose, two groups of LL patients with similar clinical features and no evidence of treponemal infection were studied, one group with BFP (n = 21) and the other without BFP (n = 13). At the time of study, patients underwent the following tests: hepatitis B surface antigen (HBsAg), anti-Trypanosoma cruzi specific antibodies, infectious mononucleosis-associated heterophil antibodies, rheumatoid factors, antinuclear antibodies, anti-dsDNA antibodies and gamma-globulin serum levels. Except for HBsAg, which was more frequently detected in patients with BFP (p < 0.02), the other variables showed no significant differences between groups. This finding suggests the possibility that simultaneous infection with hepatitis B virus could contribute, to some extent as an additional factor, to the generation of an altered humoral immune response. The possible physiopathologic significance of anti-phospholipid antibodies, in the light of current knowledge, is also discussed.

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The possible relationship between circulating immune complexes (CIC) and peripheral T lymphocyte populations was studied in thirteen active multibacillary leprosy (10 lepromatous--LL--and 3 borderline lepromatous--BL--) and 19 matched controls. Theophylline-resistant T cells (The-R, a lymphocyte subpopulation displaying helper activity on B cells) and total T cells were assessed by means of the E rosette technique, with and without previous theophylline incubation, 1h 37 degrees C, respectively. CIC were quantified by 125I-C1q binding test. Although leprosy patients showed a statistical non significant light depression in total T cells the remarkable variability in circulating levels of The-R T cells enabled us to separate them into two well delineated groups (in relation to this variable p less than 0.001) with no difference in age, sex and bacteriologic state: a) leprosy patients with The-R T cells proportionally conserved (6LL and 2BL); b) leprosy patients with The-R T cells proportionally depressed (4LL and 1BL). Patients belonging to the latter group showed the highest statistically significant levels of CIC. Even though we do not discard an unknown factor being responsible for our findings, we believe that this inverse relationship between elevated CIC and depressed The-R circulating T cells might be representing a lower helper activity on antibody synthesis intending to reduce its excessive production.

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The age-standardized mortality rates by sex for cancer of all sites and some specific sites were calculated in the 22 areas of Rosario (Argentina). The rates by area were correlated with education, occupation, housing quality and population density, applying Kendall's tau. Cervical cancer rates showed the strongest correlations, which were positive with illiteracy, unqualified occupations and poor housing. These variables presented positive correlations with stomach cancer also, which were more significant in males than in females. Colon and breast cancer rates had positive correlations with the highest levels of education, occupational status, housing conditions and population density.

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