RESUMO
A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muñiz Hospital. At diagnosis, the patient presented cough with mucopurulent expectoration, dyspnea, fever, bilateral pulmonary infiltrates on the chest X-ray, negative bacilloscopy for acid fast bacteria and a CD4(+) T lymphocytes count of 52 cells/µL. The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage, while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates, pathognomonic of the pulmonary pneumocystosis. It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy. Other complementary stains (a rapid modification of Grocott, Kinyoun and Giemsa) were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy. Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients, such as those with AIDS.
Assuntos
Coinfecção/diagnóstico , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Animais , Argentina , Líquido da Lavagem Broncoalveolar/microbiologia , Líquido da Lavagem Broncoalveolar/parasitologia , Técnicas de Laboratório Clínico , Coinfecção/patologia , Humanos , Masculino , Microscopia , Pneumonia por Pneumocystis/patologia , Estrongiloidíase/patologiaRESUMO
The microscopic observation and isolation of Cryptococcus neoformans from the gastric contents of an AIDS patient, obtained by aspiration with a nasogastric catheter and parasitologically studied, is communicated. Because of the limited number of round yeasts visualized by wet mount of the sample concentrate, India ink was added: the typical capsules of C. neoformans were then observed. Dark brown colonies of C. neoformans were isolated from the clinical sample cultured on sunflower-seed-extract agar, incubated at 37 degrees C for 7 days. Bloodcultures for fungi were negative; it was impossible to obtain CSF due to the patient's refusal, then the capsular polysaccharide antigen of C. neoformans in blood was determined and proved positive to the 1:100 dilution. The patient, who had supposedly been suffering from Cryptosporidium sp. diarrhea, after the finding of C. neoformans in the gastric sample and the positive result of the antigenemia for this fungus, was treated with oral fluconazol, (800 mg/day), because he did not accept intravenous treatment. This communication emphasizes the finding of C. neoformans in a clinical sample where its presence is infrequent and its usefulness for the diagnosis of cryptococcosis is significant.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Conteúdo Gastrointestinal/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Líquidos Corporais/microbiologia , Candida albicans/isolamento & purificação , Candidíase/complicações , Criptococose/sangue , Criptococose/complicações , Criptococose/tratamento farmacológico , Criptosporidiose/diagnóstico , Deglutição , Diagnóstico Diferencial , Diarreia/etiologia , Fluconazol/uso terapêutico , Fungemia/sangue , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/complicações , Infecções Respiratórias/microbiologia , Coloração e RotulagemRESUMO
Since Pneumocystis jiroveci cannot be grown in vitro, laboratory diagnosis of pulmonary pneumocystosis (PCP) has been based mainly upon microscopy. The usefulness of 3 diagnostic methods of PCP was compared in 111 bronchoalveolar fluids belonging to an equal number of AIDS patients assisted in different wards of the Muñiz Hospital. Wet mount preparations, a rapid modification of Grocott technique and the direct immunofluorescence (DIF) with monoclonal antibodies were compared for the diagnosis of PCP on smears of clinical samples. Similar results (15 positive and 90 negative) were obtained with these three techniques in 105 (93.6%) of the studied samples; in 3 (2.7%) cases the DIF was positive while the other techniques were negative, and in other 3 (2.7%), the Grocott stain was negative when the other two techniques were positive. In the investigated samples, due to the abundance of P. jiroveci, the searching of "honeycombs" structures in wet mount preparations is perfectly adaptable as screening test. The Grocott stain showed to be useful for the diagnosis of other mycoses, and the DIF, due to its high cost, can be employed when the other techniques are negative.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Anticorpos Antifúngicos/imunologia , Anticorpos Monoclonais/imunologia , Líquido da Lavagem Broncoalveolar/microbiologia , Técnica Direta de Fluorescência para Anticorpo , Humanos , Pneumocystis carinii/imunologia , Valor Preditivo dos Testes , Coloração e RotulagemRESUMO
Since Pneumocystis jiroveci cannot be grown in vitro, laboratory diagnosis of pulmonary pneumocystosis (PCP) has been based mainly upon microscopy. The usefulness of 3 diagnostic methods of PCP was compared in 111 bronchoalveolar fluids belonging to an equal number of AIDS patients assisted in different wards of the Muñiz Hospital. Wet mount preparations, a rapid modification of Grocott technique and the direct immunofluorescence (DIF) with monoclonal antibodies were compared for the diagnosis of PCP on smears of clinical samples. Similar results (15 positive and 90 negative) were obtained with these three techniques in 105 (93.6
) of the studied samples; in 3 (2.7
) cases the DIF was positive while the other techniques were negative, and in other 3 (2.7
), the Grocott stain was negative when the other two techniques were positive. In the investigated samples, due to the abundance of P. jiroveci, the searching of [quot ]honeycombs[quot ] structures in wet mount preparations is perfectly adaptable as screening test. The Grocott stain showed to be useful for the diagnosis of other mycoses, and the DIF, due to its high cost, can be employed when the other techniques are negative.
RESUMO
Se evaluaron retrospectivamente aspectos epidemiológicos, clínicos y micológicos de 15 pacientes con histoplasmosis asociada al SIDA internados en la Sala 11 del Hospital Muñiz, durante un período de 5 años. La mayor parte de los pacientes habitaban al momento de la internación o habían nacido dentro del área endémica de la histoplasmosis, en localidades del Gran Buenos Aires o en la ciudad de Buenos Aires. Fiebre, disminución del peso corporal, tos con expectoración y lesiones mucocutáneas fueron los hallazgos clínicos más frecuentes, seguidos por adenomegalias, sudoración, diarrea, dolor abdominal, cefalea y disnea. La radiografía de tórax reveló infiltrados pulmonares, en su mayoría con distribución bilateral y la ecografía abdominal evidenció la presencia de hepato y esplenomegalia. La microscopía del material obtenido por escarificación de las lesiones cutáneomucosas y los hemocultivos por el método de lisis-centrifugación permitieron el diagnóstico micológico de la casi totalidad de los casos
Assuntos
Humanos , Masculino , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , HIV , Contagem de Linfócito CD4RESUMO
Se evaluaron retrospectivamente aspectos epidemiológicos, clínicos y micológicos de 15 pacientes con histoplasmosis asociada al SIDA internados en la Sala 11 del Hospital Muñiz, durante un período de 5 años. La mayor parte de los pacientes habitaban al momento de la internación o habían nacido dentro del área endémica de la histoplasmosis, en localidades del Gran Buenos Aires o en la ciudad de Buenos Aires. Fiebre, disminución del peso corporal, tos con expectoración y lesiones mucocutáneas fueron los hallazgos clínicos más frecuentes, seguidos por adenomegalias, sudoración, diarrea, dolor abdominal, cefalea y disnea. La radiografía de tórax reveló infiltrados pulmonares, en su mayoría con distribución bilateral y la ecografía abdominal evidenció la presencia de hepato y esplenomegalia. La microscopía del material obtenido por escarificación de las lesiones cutáneomucosas y los hemocultivos por el método de lisis-centrifugación permitieron el diagnóstico micológico de la casi totalidad de los casos
Assuntos
Humanos , Masculino , Histoplasmose , HIV , Contagem de Linfócito CD4RESUMO
Since Pneumocystis jiroveci cannot be grown in vitro, laboratory diagnosis of pulmonary pneumocystosis (PCP) has been based mainly upon microscopy. The usefulness of 3 diagnostic methods of PCP was compared in 111 bronchoalveolar fluids belonging to an equal number of AIDS patients assisted in different wards of the Muñiz Hospital. Wet mount preparations, a rapid modification of Grocott technique and the direct immunofluorescence (DIF) with monoclonal antibodies were compared for the diagnosis of PCP on smears of clinical samples. Similar results (15 positive and 90 negative) were obtained with these three techniques in 105 (93.6
) of the studied samples; in 3 (2.7
) cases the DIF was positive while the other techniques were negative, and in other 3 (2.7
), the Grocott stain was negative when the other two techniques were positive. In the investigated samples, due to the abundance of P. jiroveci, the searching of [quot ]honeycombs[quot ] structures in wet mount preparations is perfectly adaptable as screening test. The Grocott stain showed to be useful for the diagnosis of other mycoses, and the DIF, due to its high cost, can be employed when the other techniques are negative.
RESUMO
To determine the ability of monocyte phagosomal acidification in chronic paracoccidioidomycosis, 13 patients were recruited at different times during follow-up and compared with 18 normal controls. Eight patients were studied at diagnosis, six of them also during treatment and five additional patients after ending treatment. Phagosomal acidification of monocytes, triggered by challenge with opsonized zymosan, was evaluated with acridine orange and expressed as percentage of orange-stained intracellular particles, as mean +/- SE. In comparison with controls, acidification was severely impaired before treatment (33 +/- 11% vs. 67 +/- 6%) and reached values similar to controls during treatment (73 +/- 6%, n = 6). In addition, phagosomal acidification of the patients studied after treatment (63 +/- 4%) had no difference when compared with controls. This study demonstrates that phagosomal acidification is perturbed among chronic paracoccidioidomycosis patients and reverses with antifungal treatment.
Assuntos
Monócitos/metabolismo , Paracoccidioidomicose/imunologia , Fagossomos/metabolismo , Laranja de Acridina/metabolismo , Adulto , Antifúngicos/uso terapêutico , Células Cultivadas , Humanos , Concentração de Íons de Hidrogênio , Masculino , Microscopia de Fluorescência/métodos , Pessoa de Meia-Idade , Monócitos/citologia , Paracoccidioidomicose/tratamento farmacológico , Zimosan/imunologia , Zimosan/metabolismoRESUMO
To determine the distribution of etiologic agents of fungemia in San Martin Hospital, La Plata, we retrospectively studied 81 consecutive episodes of fungemia, diagnosed in 46 adults and 35 preterm newborn (PNB) hospitalized from November 1998 to August 2001. The diagnosis was achieved by blood culture obtained by venipuncture and by catheter aspiration and was processed using BactAlert and lysis-centrifugation technique. Isolated yeasts were identified employing API 32C system and additional tests. Candida parapsilosis (28.4%), C. albicans (25.9%) and C. tropicalis (25.9%) were predominant as etiological agents (80%). Other species of Candida (C. pelliculosa, C. kefyr and C. guillermondii), Malassezia pachydermatis, Cryptococcus neoformans and Histoplasma capsulatum were recovered in low percentage (each one < or = 7%). C. parapsilosis was predominant as causative agent among PNB male (47.4%), C. albicans among adult women (41.7%) and C. tropicalis among adult men (32.3%). The species of Candida (C. parapsilosis, C. tropicalis and C. albicans) were predominant as etiologic agents of fungemia, with a different distribution in the episodes which occurred in adults and PNB patients, and also according to gender in both groups.
Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Hospitais Gerais/estatística & dados numéricos , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Candida/classificação , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Criptococose/epidemiologia , Criptococose/microbiologia , Feminino , Fungemia/microbiologia , Histoplasma/isolamento & purificação , Histoplasmose/epidemiologia , Departamentos Hospitalares/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Malassezia/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We communicate 5 episodes of fungemia produced by Hansenula anomala (Candida pelliculosa) in 4 adult patients and 1 preterm newborn admitted in different wards of the HIGA San Martín of La Plata City during a 13 month period. The isolates were achieved by culture of blood obtained by venipuncture (5/5) and from catheter (2/5) and were processed with BacTAlert system and lysis-centrifugation method. API 32 C system achieved the identification of the isolated yeasts. Among the patients, treatments with antibiotics (5/5) and corticoids (2/5), catheters (3/5), previous surgical procedures and surgical wounds (2/5), prematurely (1/5) and neutropenia (1/5) were present as predisposing factors of fungemia. Three out of the 5 episodes evolved favorably and the remaining 2 patients died in spite of the antifungal treatment. The diagnosis of 4 out of 5 cases in a brief lapse (3 months), and 2 simultaneously in 2 different wards, as well as the lack of other isolates of H. anomala in our Hospital, before and after of the studied period, suggests the possibility of an outbreak. We claim that H. anomala is an emergent fungal pathogen that must be taken into account as etiological agent of fungemia, fundamentally in patients with different predisposing factors.
Assuntos
Infecção Hospitalar/microbiologia , Fungemia/microbiologia , Pichia/isolamento & purificação , Corticosteroides/efeitos adversos , Adulto , Cateterismo/efeitos adversos , Infecção Hospitalar/epidemiologia , Suscetibilidade a Doenças , Feminino , Fungemia/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Pessoa de Meia-Idade , Técnicas de Tipagem Micológica , Neutropenia/complicações , Complicações Pós-Operatórias/microbiologia , Fatores de Risco , SuperinfecçãoRESUMO
Para determinar la distribución de los agentes causales de fungemia en el Hospital Interzonal General de Agudos San Martín, de La Plata, Argentina, se estudió retrospectivamente la etiología de 81 episodios consecutivos ocurridos en 46 adultos y 35 recién naciddos pre-término (RNPT) internados entre noviembre de 1998 y agosto de 2001. El diagnóstico se hizo a partir de cultivos de sangre obtenida por punción venosa y/o a través de catéter, procesados con el equipo BactAlert y la técnica de lisis-centrifugación. La identificación de los aislamientos fue realizada con el equipo API 32C para levaduras y pruebas adicionales. Candida parapsilosis (28,4 por ciento), C.albicans (25,9 por ciento) y C.tropoicalis (25,9 por ciento) predominaron como agentes causales (en conjunto 80 por ciento). Otras especies de Candida (C.pelliculosa, C.kefyr y C.guillermondii), Malassezia pachydermatis, Cryptococcus neoformans e Histoplasma capsulatum se recuperaron en menor porcentaje (individualmente <_7 por ciento). C.parapsilosis predominó como agente causal de fungemia en RNPT varones (47,4 por ciento), C albicans en mujeres adultas (41,7 por ciento) y C.tropicalis en varones adultos (32,3 por ciento). Las especies de Candida (C.parapsilosis, C.tropicalis y C.albicans) predominaron como agentes causales de fungemia en nuestro hospital, con una distribución diferente en los episodios ocurridos en los pacientes adultos y RNPT y entre los varones y mujeres de ambos grupos. (AU)
Assuntos
Fungemia/etiologia , Candida/isolamento & purificação , Candidíase/epidemiologia , Candidíase/imunologia , ArgentinaRESUMO
Para determinar la distribución de los agentes causales de fungemia en el Hospital Interzonal General de Agudos San Martín, de La Plata, Argentina, se estudió retrospectivamente la etiología de 81 episodios consecutivos ocurridos en 46 adultos y 35 recién naciddos pre-término (RNPT) internados entre noviembre de 1998 y agosto de 2001. El diagnóstico se hizo a partir de cultivos de sangre obtenida por punción venosa y/o a través de catéter, procesados con el equipo BactAlert y la técnica de lisis-centrifugación. La identificación de los aislamientos fue realizada con el equipo API 32C para levaduras y pruebas adicionales. Candida parapsilosis (28,4 por ciento), C.albicans (25,9 por ciento) y C.tropoicalis (25,9 por ciento) predominaron como agentes causales (en conjunto 80 por ciento). Otras especies de Candida (C.pelliculosa, C.kefyr y C.guillermondii), Malassezia pachydermatis, Cryptococcus neoformans e Histoplasma capsulatum se recuperaron en menor porcentaje (individualmente <_7 por ciento). C.parapsilosis predominó como agente causal de fungemia en RNPT varones (47,4 por ciento), C albicans en mujeres adultas (41,7 por ciento) y C.tropicalis en varones adultos (32,3 por ciento). Las especies de Candida (C.parapsilosis, C.tropicalis y C.albicans) predominaron como agentes causales de fungemia en nuestro hospital, con una distribución diferente en los episodios ocurridos en los pacientes adultos y RNPT y entre los varones y mujeres de ambos grupos.
Assuntos
Argentina , Candida , Candidíase , FungemiaRESUMO
Se comunican 5 episodios de fungemia producidos por Hansenula anomala (Candida pelliculosa) en 4 adultos y 1 recién nacido pre-término internados en diferentes salas del HIGA San Martín (La Plata), en un lapso de 13 meses. Los aislamientos fueron hechos a partir de cultivos de sangre obtenida por punción venosa (5/5) y de catéter (2/5) y procesados con el equipo BactAlert y el método de lisis-centrifugación. La identificación de los aislamientos fue realizada con el equipo API 32C. Como causas favorecedoras de fungemia los pacientes presentaron tratamientos con antibióticos (5/5) y corticoides (2/5), neutropenia (1/5), prematurez (1/5), presencia de catéteres centrales (2/5), procedimientos quirúrgicos previos y heridas quirúrgicas (2/5). Tres de los cinco pacientes evolucionaron favorablemente y sobrevivieron, mientras que los dos restantes fallecieron, a pesar del tratamiento antifúngico instituido. El diagnóstico de 4 de los 5 casos en un lapso breve (3 meses) y de 2 simultáneamente en 2 salas diferentes, sumado a la ausencia en nuestro Hospital de aislamientos del hongo, previos y posteriores al período estudiado, sugieren un posible brote epidémico. Destacamos a H.anomala como patógeno fúngico emergente a tener en cuenta como agente productor de fungemia, principalmente en pacientes portadores de determinados factores de riesgo. (AU)
Assuntos
Fungemia/etiologia , Fungemia/microbiologia , ArgentinaRESUMO
Se comunican 5 episodios de fungemia producidos por Hansenula anomala (Candida pelliculosa) en 4 adultos y 1 recién nacido pre-término internados en diferentes salas del HIGA San Martín (La Plata), en un lapso de 13 meses. Los aislamientos fueron hechos a partir de cultivos de sangre obtenida por punción venosa (5/5) y de catéter (2/5) y procesados con el equipo BactAlert y el método de lisis-centrifugación. La identificación de los aislamientos fue realizada con el equipo API 32C. Como causas favorecedoras de fungemia los pacientes presentaron tratamientos con antibióticos (5/5) y corticoides (2/5), neutropenia (1/5), prematurez (1/5), presencia de catéteres centrales (2/5), procedimientos quirúrgicos previos y heridas quirúrgicas (2/5). Tres de los cinco pacientes evolucionaron favorablemente y sobrevivieron, mientras que los dos restantes fallecieron, a pesar del tratamiento antifúngico instituido. El diagnóstico de 4 de los 5 casos en un lapso breve (3 meses) y de 2 simultáneamente en 2 salas diferentes, sumado a la ausencia en nuestro Hospital de aislamientos del hongo, previos y posteriores al período estudiado, sugieren un posible brote epidémico. Destacamos a H.anomala como patógeno fúngico emergente a tener en cuenta como agente productor de fungemia, principalmente en pacientes portadores de determinados factores de riesgo.
Assuntos
Argentina , FungemiaRESUMO
An episode of fungal peritonitis was produced by Bipolaris spicifera in a 3-year-old girl with chronic renal failure secondary to uremic-hemolytic syndrome and who was under treatment with continuous ambulatory peritoneal dialysis (CAPD). Previously, an episode of purulent peritonitis caused by Pseudomonas spp. had been treated successfully with combined antibacterial therapy for 10 days. Microscopic and macroscopic examinations of the freshly collected purulent dialysate were negative for fungal structures and bacteria. The fungus grew from the dialysate plated on Sabouraud dextrose agar and was also macroscopically recognized as a colony attached to the inner wall of the Tenckhoff catheter. Specific cultures of dialysate for common bacteria and mycobacteria were negative. The patient was successfully treated with early catheter removal and empirical administration of 200 mg/day oral fluconazole for 2 weeks. Subsequently, a new catheter was placed and the patient continued well on CAPD. Post-treatment control cultures of dialysate for fungi, bacteria and mycobacteria were negative and the cell count returned to normal.
Assuntos
Ascomicetos/isolamento & purificação , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/microbiologia , Antifúngicos/uso terapêutico , Cateterismo , Pré-Escolar , Feminino , Fluconazol/uso terapêutico , Humanos , Micoses/tratamento farmacológico , Peritonite/tratamento farmacológicoRESUMO
We communicate 5 episodes of fungemia produced by Hansenula anomala (Candida pelliculosa) in 4 adult patients and 1 preterm newborn admitted in different wards of the HIGA San Martín of La Plata City during a 13 month period. The isolates were achieved by culture of blood obtained by venipuncture (5/5) and from catheter (2/5) and were processed with BacTAlert system and lysis-centrifugation method. API 32 C system achieved the identification of the isolated yeasts. Among the patients, treatments with antibiotics (5/5) and corticoids (2/5), catheters (3/5), previous surgical procedures and surgical wounds (2/5), prematurely (1/5) and neutropenia (1/5) were present as predisposing factors of fungemia. Three out of the 5 episodes evolved favorably and the remaining 2 patients died in spite of the antifungal treatment. The diagnosis of 4 out of 5 cases in a brief lapse (3 months), and 2 simultaneously in 2 different wards, as well as the lack of other isolates of H. anomala in our Hospital, before and after of the studied period, suggests the possibility of an outbreak. We claim that H. anomala is an emergent fungal pathogen that must be taken into account as etiological agent of fungemia, fundamentally in patients with different predisposing factors.
RESUMO
To determine the distribution of etiologic agents of fungemia in San Martin Hospital, La Plata, we retrospectively studied 81 consecutive episodes of fungemia, diagnosed in 46 adults and 35 preterm newborn (PNB) hospitalized from November 1998 to August 2001. The diagnosis was achieved by blood culture obtained by venipuncture and by catheter aspiration and was processed using BactAlert and lysis-centrifugation technique. Isolated yeasts were identified employing API 32C system and additional tests. Candida parapsilosis (28.4
), C. albicans (25.9
) and C. tropicalis (25.9
) were predominant as etiological agents (80
). Other species of Candida (C. pelliculosa, C. kefyr and C. guillermondii), Malassezia pachydermatis, Cryptococcus neoformans and Histoplasma capsulatum were recovered in low percentage (each one < or = 7
). C. parapsilosis was predominant as causative agent among PNB male (47.4
), C. albicans among adult women (41.7
) and C. tropicalis among adult men (32.3
). The species of Candida (C. parapsilosis, C. tropicalis and C. albicans) were predominant as etiologic agents of fungemia, with a different distribution in the episodes which occurred in adults and PNB patients, and also according to gender in both groups.
RESUMO
In patients with chronic paracoccidioidomycosis (n = 10), levels of tumor necrosis factor alpha, interleukin-10, and interleukin-2 in serum, measured by enzyme-linked immunosorbent assay (in picograms per milliliter, as mean +/- standard error of the mean), were higher than in normal controls (n = 8): 186 +/- 40 versus 40 +/- 7 (P < 0.05), 203 +/- 95 versus 20 +/- 8 (P = 0.001), and 96.3 +/- 78.57 versus 1.19 +/- 1.19 (P = 0.045), respectively. Gamma interferon and interleukin-4 levels were similar in patients and controls.