RESUMO
Thirty cystic echinococcosis (CE) patients in Uruguay with severe bone or secondary disseminated echinococcosis were immunologically assessed using cellular (lymphocyte transformation assay, LTA) and humoral (specific antibody and subclass responses, circulating antigen and circulating immune-complexes) immunological assays during the course of chemotherapy (albendazole and/or praziquantel). CE patients were divided into 4 groups, according to clinical treatment and outcome: (I) surgery and chemotherapy, (II) chemotherapy with outcome unchanged, (III) chemotherapy with outcome improved, and (IV) chemotherapy considered cured. Increased circulating antigen was of prognostic value in some severe CE cases where levels remained high and/or increased. The lymphoproliferative response in vitro to Echinococcus granulosus antigen was statistically greater in all patient groups compared to normal individuals but at lower levels in improved or cured CE patients. Levels of non-specific LTA response were significantly lower than controls for all groups during albendazole treatment (P < 0.001) but returned to normal levels in cured patients, a result consistent with parasite-induced suppression of cellular responses. This study suggests that, at least in severe osseous and secondary CE, immunosurveillance by specific antibodies, especially total specific immunoglobulin, was overall of more practical use than antigen-specific in-vitro lymphocyte transformation assays.
Assuntos
Anticorpos Anti-Helmínticos/sangue , Equinococose/imunologia , Imunoglobulina G/análise , Adulto , Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Complexo Antígeno-Anticorpo/sangue , Antígenos de Helmintos/sangue , Biomarcadores/sangue , Doenças Ósseas/imunologia , Doenças Ósseas/parasitologia , Doenças Ósseas/terapia , Estudos de Casos e Controles , Terapia Combinada , Quimioterapia Combinada , Equinococose/tratamento farmacológico , Equinococose/cirurgia , Feminino , Humanos , Ativação Linfocitária , Masculino , Praziquantel/uso terapêutico , Resultado do Tratamento , UruguaiRESUMO
Eighteen adult white male patients with cutaneous sporotrichosis were treated with itraconazole following different daily dose schemes. Cure was obtained in all cases after periods of 15-75 days (median 44 days) with total doses between 3.1 and 14.8 g (median 8.4 g). No serious side effects were observed and no relapses occurred in the follow-up period of between 1 and 26 months (median 14.7). These results show that itraconazole represents a safe and effective drug for the treatment of sporotrichosis. Comparison with other studies leads us to consider a daily dose of 200 mg as the most appropriate. A concomitant warming of the affected limbs should be recommended.