RESUMO
ABSTRACT Aim: To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL). Methods: Case series with 10 patients with overactive bladder refractory to conservative treatment with anticholinergic or physical therapy. They received 200Ui of onabotulinumtoxin type A intravesically and were evaluated by overactive bladder symptoms score (OABSS) and King's Health Questionnaire. Results: The mean (SD) of the age was 52 + 14.5 years and 60% were female. All of them had confirmed detrusor overactivity on urodynamic study. Seven patients had HAM/TSP. The median and range of the OABSS was 13 (12-15) before therapy and decreased to 1.0 (0-12) on day 30 and to 03 (0-14) on day 90 (p < 0.0001). There was a significant improvement in 8 of the 9 domains of the King's Health Questionnaire after the intervention. Hematuria, urinary retention and urinary infection were the complications observed in 3 out of 10 patients. The mean time to request retreatment was 465 days. Conclusion: Onabotulinum toxin type A intravesically reduced the OABSS with last long effect and improved the quality of life of HTLV-1 infected patients with severe overactive bladder.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Qualidade de Vida , Infecções por HTLV-I/complicações , Toxinas Botulínicas Tipo A/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Inibidores da Liberação da Acetilcolina/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Urodinâmica , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/virologia , Avaliação de SintomasRESUMO
AIM: To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL). METHODS: Case series with 10 patients with overactive bladder refractory to conservative treatment with anticholinergic or physical therapy. They received 200Ui of onabotulinumtoxin type A intravesically and were evaluated by overactive bladder symptoms score (OABSS) and King's Health Questionnaire. RESULTS: The mean (SD) of the age was 52+14.5 years and 60% were female. All of them had confirmed detrusor overactivity on urodynamic study. Seven patients had HAM/TSP. The median and range of the OABSS was 13 (12-15) before therapy and decreased to 1.0 (0-12) on day 30 and to 03 (0-14) on day 90 (p<0.0001). There was a significant improvement in 8 of the 9 domains of the King's Health Questionnaire after the intervention. Hematuria, urinary retention and urinary infection were the complications observed in 3 out of 10 patients. The mean time to request retreatment was 465 days. CONCLUSION: Onabotulinum toxin type A intravesically reduced the OABSS with last long effect and improved the quality of life of HTLV-1 infected patients with severe overactive bladder.
Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Infecções por HTLV-I/complicações , Fármacos Neuromusculares/uso terapêutico , Qualidade de Vida , Bexiga Urinária Hiperativa/tratamento farmacológico , Adulto , Idoso , Feminino , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Masculino , Avaliação de Sintomas , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/virologia , UrodinâmicaRESUMO
BACKGROUND: Previous studies have reported high rates of depression and anxiety in HTLV-1 infected individuals with the neurological disease and in the asymptomatic phase. No study has investigated the rates in individuals that already show bladder symptoms without severe neurological changes; that is, during the oligosymptomatic phase. The present study investigated patients in this intermediate form on the spectrum of the infection. METHODOLOGY/PRINCIPAL FINDINGS: Participants answered a sociodemographic questionnaire, the Mini International Neuropsychiatric Interview Brazilian Version 5.0.0 (MINI PLUS) and the Hospital Anxiety and Depression Scale (HADS). Data analysis was performed in STATA statistical software (version 12.0). Depressive disorder was the most frequent comorbidity. Current depressive disorder was higher in the group of overactive bladder subjects (11.9%), and lifelong depression was more frequent in the HAM/TSP group (35%). The three groups had similar frequencies of anxiety disorders. Increased frequency and severity of anxiety and depression symptoms were observed in the overactive bladder group. CONCLUSION/SIGNIFICANCE: The results suggest that individuals with overactive bladders need a more thorough assessment from the mental health perspective. These patients remain an understudied group regarding psychiatric comorbidities.
Assuntos
Transtornos de Ansiedade/etiologia , Transtorno Depressivo/etiologia , Infecções por HTLV-I/complicações , Infecções por HTLV-I/psicologia , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/psicologia , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/virologia , Brasil , Estudos de Coortes , Estudos Transversais , Transtorno Depressivo/psicologia , Transtorno Depressivo/virologia , Feminino , Vírus Linfotrópico T Tipo 1 Humano , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Bexiga Urinária/patologia , Bexiga Urinária/virologia , Bexiga Urinária Hiperativa/virologiaRESUMO
BACKGROUND: Human T cell lymphotropic virus type 1 (HTLV-1) infection has been associated with recurrent and disseminated strongyloidiasis and adult T cell leukemia/lymphoma (ATLL). METHODS: We compared immunological aspects and markers for ATLL in HTLV-1 patients with or without strongyloidiasis, and evaluated the influence of Strongyloides stercoralis treatment on the immune response and clinical outcomes of HTLV-1 infection. RESULTS: Levels of TNFα and IFNγ were lower in patients coinfected with HTLV-1 and S. stercoralis than in patients with HTLV-1 only (p < 0.05), and there was an increase in TNFα levels after anthelmintic treatment. Levels of sIL-2R were higher in patients with HTLV-1 coinfected with S. stercoralis and anthelmintic treatment decreased sIL-2R levels (p < 0.05). The one patient who developed ATLL was coinfected with S. stercoralis. CONCLUSION: These data show that helminthic infection has a modulatory role in HTLV-1 infection and that S. stercoralis may be a cofactor in the development of ATLL.
Assuntos
Anti-Helmínticos/uso terapêutico , Infecções por HTLV-I/tratamento farmacológico , Receptores de Interleucina-2/sangue , Estrongiloidíase/tratamento farmacológico , Fator de Necrose Tumoral alfa/sangue , Adulto , Animais , Coinfecção , Progressão da Doença , Feminino , Infecções por HTLV-I/sangue , Infecções por HTLV-I/complicações , Infecções por HTLV-I/imunologia , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Humanos , Leucemia-Linfoma de Células T do Adulto/imunologia , Masculino , Pessoa de Meia-Idade , Receptores de Interleucina-2/imunologia , Strongyloides stercoralis/imunologia , Estrongiloidíase/sangue , Estrongiloidíase/complicações , Estrongiloidíase/imunologia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/imunologiaRESUMO
Leishmaniases have a high prevalence in tropical countries. In order to improve existing diagnostic systems based on total Leishmania proteins, and to identify antigen candidates for vaccine development, an intensive search for the identification of antigens was performed using molecular biology techniques. In this study, the immune response to three L. infantum recombinant antigens was evaluated. Upon stimulation with KMP11, mononuclear cells from leishmaniasis patients produced high levels of IL-10, while a predominant IFN-gamma production could be observed in cultures stimulated with H2A and soluble Leishmania antigen. All the recombinant antigens induced very little IL-5. KMP11 decreased IFN-gamma production by 48% in cultures of peripheral blood mononuclear cells from cutaneous leishmaniasis patients who had been stimulated with soluble Leishmania antigen. Furthermore, antibodies to KMP11 were detected in the sera from all patients with visceral leishmaniasis and in the majority of the sera from patients with cutaneous leishmaniasis or individuals with asymptomatic L. chagasi infection. Thus, KMP11 is recognized by cells and sera of patients with different clinical forms of leishmaniasis, and KMP11, through IL-10 production, proved to be a potent antigen in modulating type 1 immune response.
Assuntos
Antígenos de Protozoários/imunologia , Leishmania infantum/imunologia , Leishmaniose Cutânea/imunologia , Leishmaniose Visceral/imunologia , Animais , Antígenos de Protozoários/genética , Células Cultivadas , Humanos , Imunoglobulina G/análise , Interferon gama/análise , Interferon gama/antagonistas & inibidores , Interleucina-10/agonistas , Interleucina-10/análise , Interleucina-5/análise , Glicoproteínas de Membrana/imunologia , Glicoproteínas de Membrana/farmacologia , Proteínas de Protozoários/imunologia , Proteínas de Protozoários/farmacologia , Proteínas Recombinantes/imunologiaRESUMO
The immunological response in healthy subjects to a crude leishmania antigen vaccine (Leishvacin) plus rhGM-CSF without prior Montenegro (DTH) skin testing was evaluated. Fifty-six healthy volunteers received vaccine plus either placebo or rhGM-CSF at day 0, followed by either a vaccine booster or placebo at day 21. IFN-gamma and IL-5 levels were significantly enhanced by day 21. The adjuvant group had a higher percentage of individuals with a significant response to vaccination than the corresponding placebo group. Eighty-six percent of all volunteers were DTH-positive by day 42. Leishvacin is capable of sensitizing lymphocytes from individuals not previously exposed to leishmania antigen. Use of rhGM-CSF enhanced the immune response, indicating that it may improve immunological response to the vaccine.