RESUMO
The co-occurrence of COVID-19 with endemic diseases is a public health concern that may affect patient prognosis and outcomes. The objective of this study was to describe the clinical characteristics of patients with dengue virus (DENV) and SARS-CoV-2 co-infections and compare their outcomes against those of COVID-19 patients without dengue. A cross-sectional study was conducted in patients with SARS-CoV-2 infection who attended a single center in Cali, Colombia, from March 2020 to March 2021. All patients who were tested by both real-time polymerase chain reaction for SARS-CoV-2 and IgM/NS1 for DENV were included. Dengue was diagnosed as having either an IgM- or an NS1- positive test. A total of 90 patients were included (72 with COVID-19 only and 18 with co-infection). Patients with co-infection had more dyspnea (61.1% versus 22.2%; P = 0.003) as well as higher oxygen desaturation (53.3% versus 13.4%; P = 0.002) and neutrophil-to-lymphocyte ratio (5.59 versus 3.84; P = 0.038) than patients with COVID-19 alone. The proportion of patients classified with moderate to severe COVID-19 was higher in the co-infection group (88.3% versus 47.8%; P = 0.002). Also, co-infection was associated with an increased need for mechanical ventilation (P = 0.06), intensive care unit (ICU) initial management (P = 0.02), and ICU admission during hospitalization (P = 0.04) compared with COVID-19 only. The ICU mortality rate was 66.6% in patients with co-infection versus 29.4% in patients infected with only SARS-CoV-2 (P < 0.05). The possibility of DENV and SARS-CoV2 co-infection occurred in the convergence of both epidemic waves. Co-infection was associated with worse clinical outcomes and higher mortality in ICU-admitted patients than in patients with the COVID-19 only.
Assuntos
COVID-19 , Coinfecção , Vírus da Dengue , Dengue , Humanos , SARS-CoV-2 , COVID-19/epidemiologia , Vírus da Dengue/genética , Coinfecção/epidemiologia , Colômbia/epidemiologia , Estudos Transversais , RNA Viral , Dengue/complicações , Dengue/epidemiologia , Imunoglobulina MRESUMO
Tuberculosis (TB) is one of the most important public health issues in developing countries. The World Health Organization estimates that approximately 20%-40% of the world's population is infected. Pulmonary forms account for the majority of cases; however, it can manifest as extrapulmonary disease in 8.4%-13.7% of cases. Of these extrapulmonary forms of TB, only 1%-2% may have skin manifestations. Cutaneous tuberculosis (CTB) is relatively uncommon and is not a well-defined disease, which complicates diagnosis. We present two patients with Pott's disease that manifested as CTB, one with tuberculous gumma and the other with scrofuloderma. Both patients with non-HIV immunosuppression. The diagnosis of CTB was made by detecting Mycobacterium tuberculosis in skin samples by real-time polymerase chain reaction (Xpert MTB/RIF test) and Ziehl-Neelsen staining. The histologic findings described in these two forms of TB may vary or be absent in immunosuppressed patients, making diagnosis difficult.
Assuntos
Mycobacterium tuberculosis , Tuberculose Cutânea , Tuberculose Pulmonar , Tuberculose da Coluna Vertebral , Humanos , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/patologia , Rifampina , Tuberculose Pulmonar/microbiologia , Sensibilidade e Especificidade , Mycobacterium tuberculosis/genética , Terapia de ImunossupressãoRESUMO
BACKGROUND: Dengue fever and coronavirus disease 2019 have now begun to overlap within tropical and subtropical regions. This is due to the high prevalence of dengue fever in these regions and the current severe acute respiratory syndrome coronavirus 2 pandemic situation. The similarity of symptoms between the two diseases can confuse diagnoses, but coinfection can also occur. CASE PRESENTATION: We present two cases of patients with dengue and severe acute respiratory syndrome coronavirus 2 coinfection. The first case is that of a 24-year-old Hispanic woman with acute fever, odynophagia, and diarrhea, without respiratory symptoms and with positive molecular tests for both dengue and severe acute respiratory syndrome coronavirus 2. The second case is that of a 59-year-old Hispanic male patient with fever and respiratory symptoms of 2 weeks duration, negative molecular tests, and positive serological tests for both viruses. The clinical and epidemiological characteristics of both viral infections can help elucidate diagnoses and prognoses. CONCLUSIONS: Severe dengue infection is common in young adults, while coronavirus disease 2019 is generally asymptomatic. In older people, the severity of dengue fever will depend on their comorbidities or the infectious serotype, but coronavirus disease 2019 is consistently more severe in this group. The accurate diagnosis of both infections can better guide clinical management, as well as public health actions in transmission control, now especially important during the coronavirus disease 2019 pandemic.
Assuntos
COVID-19 , Coinfecção , Dengue , Dengue Grave , Adulto , Idoso , Coinfecção/diagnóstico , Dengue/complicações , Dengue/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Adulto JovemRESUMO
Brucellosis is the most common zoonosis, particularly in developing countries. The true incidence of human brucellosis is unknown. The WHO points out that 500,000 cases of brucellosis are reported each year from around the world. In Colombia, there is currently no regular surveillance of the event in humans and its prevalence is low due a low clinical suspicion. We report a case of a 66-year-old man, an urban merchant, who had received a liver transplant 11 years ago. The patient presented to the emergency department for two months of fatigue, severe myalgia, paresis of the extremities, loss of muscle strength, and progressive deterioration of functional class. In the emergency room, he became disoriented and was transferred to the intensive-care unit. He had a white blood cell count of 18990/uL and creatine phosphokinase 10302 U/L. Routine blood cultures were positive for Brucella melitensis. The patient reported consumption of unpasteurized bovine milk. He was treated with doxycycline and ciprofloxacin. Despite antibiotic management, after one month of hospitalization and in the context of septic shock with multiorgan failure, the patient died. Brucellosis is an unsuspected and underdiagnosed disease. It can occur in people with or without risk factors. Although the mortality is low, immunocompromised patients can develop fatal infections. A presumptive diagnosis can be established through the correlation of patient history and classic laboratory findings, which include transaminitis, anemia, and leukopenia with relative lymphocytosis; however, other findings can help us to guide the diagnosis, such as rhabdomyolysis, which appears as a complication in different infections; however, it had not been described before in brucellosis. A partnership between clinical suspicion laboratory diagnostic tests and improved disease surveillance systems is necessary to fight the disease.
RESUMO
Malaria is a febrile and potentially fatal infection. It is typically transmitted to humans through the bite of Anopheles mosquitoes and less frequently can be contracted through blood transfusions, sharing contaminated needles and syringes, mother-to-child transmission, or after solid organ transplantation. Posttransplant malaria has rarely been reported in the literature, even in endemic areas. We report the cases of three solid organ recipients in which Plasmodium vivax infection was documented during postsurgical evaluation 30 days after transplant surgery. The diagnosis of donor-derived malaria was confirmed in all patients by demonstrating Plasmodium in a peripheral blood smear and by polymerase chain reaction (PCR). All recipients had symptoms. The liver transplant recipient had myalgia, arthralgia, and thrombocytopenia; the kidney transplant recipient developed acute renal failure; and the heart transplant recipient had fever, cephalalgia, and tonic-clonic seizures. Pre-transplant screening of donors and recipients from endemic regions may not be sufficient to safely rule out persistent malaria. In Colombia, according to legislation, no mandatory testing is required for the diagnosis of malaria in organ donors in nonendemic areas. Therefore, donor screening by questionnaire is the only tool for preventing transplant-borne malaria. The migratory trend from Venezuela to Colombia has increased the number of imported cases of malaria, and the infection may be present in endemic and nonendemic regions. Although donor evaluation is not standardized in current guidelines, we suggest that donors be tested for malaria with a peripheral blood smear, detection of specific IgG antibodies against Plasmodium, and techniques such as PCR, if possible.
Assuntos
Malária , Transplante de Órgãos , Animais , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas , Transplante de Órgãos/efeitos adversos , Doadores de Tecidos , TransplantadosRESUMO
Primary immunodeficiencies (PID) are traditionally considered childhood diseases; however, adults account for 35% of all patients with PID. Antibody deficiencies, especially Common Variable Immunodeficiency (CVID), which have their peak incidence in adulthood, require a high suspicion index. Even though the estimated frequency of CVID is not high (1:25,000), high rates of under diagnosis and under reporting are very likely. The delay in diagnosis increases the morbidity and mortality; therefore, adult physicians should be able to suspect, identify and initiate management of individuals with PID. Here we report the case of a 37 year-old man presenting to the emergency room with dyspnea, fever and cough; he developed respiratory failure requiring mechanical ventilation. He complained of recurring pneumonia associated with widespread bronchiectasis since he was 18 years old. Serum immunoglobulins quantification showed severe hypogammaglobulinemia (total IgG <140 mg/dL; total IgA, 2.9 mg/dL; and total IgM <5 mg/dL). Treatment with Human Intravenous Immunoglobulin (IVIG) 10% was started, and with antibiotic treatment for severe pneumonia (during 14 days) was also prescribed. His clinical evolution has been favorable after one year follow-up. Common Variable Immunodeficiency (CVID) diagnosis was made.
Las inmunodeficiencias primarias (IDP) son patologías que tradicionalmente se consideran de la niñez sin embargo los adultos representan el 35% del total de pacientes con IDP. Las deficiencias de anticuerpos, en especial la Inmunodeficiencia Común Variable (IDCV) tienen su pico de incidencia en la edad adulta, requiere un alto índice de sospecha y si bien su frecuencia estimada no es alta (1:25,000), es muy posible que el subregistro y subdiagnóstico si lo sean. El retraso en el diagnóstico aumenta la morbi-mortalidad razón por la cual los médicos de adultos deben estar en capacidad de sospechar, identificar e iniciar el manejo de las personas con IPD. Presentamos el caso de un hombre de 37 años de edad atendido en la sala de urgencias con disnea, fiebre y tos, desarrolla falla respiratoria requiriendo ventilación mecánica. Refería neumonías a repetición desde los 18 años de edad asociadas con bronquiectasias generalizadas. La cuantificación de inmunoglobulinas séricas evidenció hipogammaglobulinemia severa (IgG total <140 mg/dL, IgA total 2.9 mg/dL, IgM total <5 mg/dL), se inició inmunoglobulina humana endovenosa (IGIV) al 10%, y recibió tratamiento antibiótico por 14 días para neumonía severa, su evolución clínica ha sido favorable hasta ahora (un año de seguimiento), se estableció el diagnostico de Inmunodeficiencia Común Variable (IDCV).
Assuntos
Agamaglobulinemia/etiologia , Bronquiectasia/diagnóstico , Imunodeficiência de Variável Comum/diagnóstico , Imunoglobulinas Intravenosas/administração & dosagem , Adulto , Agamaglobulinemia/diagnóstico , Bronquiectasia/tratamento farmacológico , Imunodeficiência de Variável Comum/tratamento farmacológico , Tosse/etiologia , Dispneia/etiologia , Febre/etiologia , Seguimentos , Humanos , Masculino , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , RecidivaRESUMO
Primary immunodeficiencies (PID) are traditionally considered childhood diseases; however, adults account for 35% of all patients with PID. Antibody deficiencies, especially Common Variable Immunodeficiency (CVID), which have their peak incidence in adulthood, require a high suspicion index. Even though the estimated frequency of CVID is not high (1:25,000), high rates of under diagnosis and under reporting are very likely. The delay in diagnosis increases the morbidity and mortality; therefore, adult physicians should be able to suspect, identify and initiate management of individuals with PID. Here we report the case of a 37 year-old man presenting to the emergency room with dyspnea, fever and cough; he developed respiratory failure requiring mechanical ventilation. He complained of recurring pneumonia associated with widespread bronchiectasis since he was 18 years old. Serum immunoglobulins quantification showed severe hypogammaglobulinemia (total IgG <140 mg/dL; total IgA, 2.9 mg/dL; and total IgM <5 mg/dL). Treatment with Human Intravenous Immunoglobulin (IVIG) 10% was started, and with antibiotic treatment for severe pneumonia (during 14 days) was also prescribed. His clinical evolution has been favorable after one year follow-up. Common Variable Immunodeficiency (CVID) diagnosis was made.
Las inmunodeficiencias primarias (IDP) son patologías que tradicionalmente se consideran de la niñez sin embargo los adultos representan el 35% del total de pacientes con IDP. Las deficiencias de anticuerpos, en especial la Inmunodeficiencia Común Variable (IDCV) tienen su pico de incidencia en la edad adulta, requiere un alto índice de sospecha y si bien su frecuencia estimada no es alta (1:25,000), es muy posible que el subregistro y subdiagnóstico si lo sean. El retraso en el diagnóstico aumenta la morbi-mortalidad razón por la cual los médicos de adultos deben estar en capacidad de sospechar, identificar e iniciar el manejo de las personas con IPD. Presentamos el caso de un hombre de 37 años de edad atendido en la sala de urgencias con disnea, fiebre y tos, desarrolla falla respiratoria requiriendo ventilación mecánica. Refería neumonías a repetición desde los 18 años de edad asociadas con bronquiectasias generalizadas. La cuantificación de inmunoglobulinas séricas evidenció hipogammaglobulinemia severa (IgG total <140 mg/dL, IgA total 2.9 mg/dL, IgM total <5 mg/dL), se inició inmunoglobulina humana endovenosa (IGIV) al 10%, y recibió tratamiento antibiótico por 14 dias para neumonía severa, su evolución clínica ha sido favorable hasta ahora (un año de seguimiento), se estableció el diagnostico de Inmunodeficiencia Común Variable (IDCV).
Assuntos
Adulto , Humanos , Masculino , Agamaglobulinemia/etiologia , Bronquiectasia/diagnóstico , Imunodeficiência de Variável Comum/diagnóstico , Imunoglobulinas Intravenosas/administração & dosagem , Agamaglobulinemia/diagnóstico , Bronquiectasia/tratamento farmacológico , Imunodeficiência de Variável Comum/tratamento farmacológico , Tosse/etiologia , Dispneia/etiologia , Seguimentos , Febre/etiologia , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , RecidivaRESUMO
La colecistectomía laparoscópica es uno de los procedimientos quirúrgicos practicados más frecuentemente por el cirujano general y en un importante número de casos se efectúa en pacientes mayores con gran inflamación vesicular, lo que pone a prueba los conocimientos y habilidades del cirujano. Es perfectamente posible reconocer, antes del acto quirúrgico, en cuáles pacientes este resultará difícil en mayor o menor grado, para así diseñar estrategias de manejo intraoperatorio que nos permitan resolver favorablemente estos casos. En este artículo, el cual se presenta acompañado de videos de casos clínicos publicados en la página electrónica de la Asociación Colombiana de Cirugía (http://www.ascolcirugia.org), se pretende mostrar cuáles son las opciones de manejo en aquellos pacientes cuyas colecistectomías son muy difíciles por el grado de inflamación o por las enfermedades subyacentes y que constituyen alternativas de manejo viables para la colecistectomía laparoscópica clásica o para evitar la conversión a cirugía abierta; aunque también, se llama fuertemente la atención sobre la necesidad de una conversión temprana y oportuna antes de tener complicaciones o alteraciones iatrogénicas de la vía biliar u otro órgano vecino.
Laparoscopic cholecystectomy is one of the most commonly performed procedures by the general surgeon and an important number of cases occur in elderly patients with major inflammation of the gallbladder, a condition that challenges the knowledge and ability of the surgeon. It is perfectible possible to recognize, prior to surgery, which patients will present major or minor difficulties so as to design intraoperative strategies in order to favorably resolve such situations. This article is complemented wit uploaded YouTube videos in the web page of the Asociación Colombiana de Cirugía, http://www.ascolcirugia.org. It intends to show the different management options in those patients with very difficult cholecystectomies because of the degree of inflammation or the underlying pathology that constitute viable alternatives to the classic laparoscopic cholecystectomy or to avoid conversion open surgery; however, it also strongly calls attention to the need of early and timely conversion so as to avoid complications or iatrogenic lesion of the bile duct or neighbor organs.
Assuntos
Vesícula Biliar , Colecistite , Colecistectomia Laparoscópica , Conversão para Cirurgia AbertaRESUMO
Rotavirus (RV) predominantly replicates in intestinal epithelial cells (IEC), and "danger signals" released by these cells may modulate viral immunity. We have recently shown that human model IEC (Caco-2 cells) infected with rhesus-RV release a non-inflammatory group of immunomodulators that includes heat shock proteins (HSPs) and TGF-ß1. Here we show that both proteins are released in part in association with membrane vesicles (MV) obtained from filtrated Caco-2 supernatants concentrated by ultracentrifugation. These MV express markers of exosomes (CD63 and others), but not of the endoplasmic reticulum (ER) or nuclei. Larger quantities of proteins associated with MV were released by RV-infected cells than by non-infected cells. VP6 co-immunoprecipitated with CD63 present in these MV, and VP6 co-localized with CD63 in RV-infected cells, suggesting that this viral protein is associated with the MV, and that this association occurs intracellularly. CD63 present in MV preparations from stool samples from 36 children with gastroenteritis due or not due to RV were analyzed. VP6 co-immunoprecipitated with CD63 in 3/8 stool samples from RV-infected children, suggesting that these MV are released by RV-infected cells in vivo. Moreover, fractions that contained MV from RV-infected cells induced death and inhibited proliferation of CD4(+) T cells to a greater extent than fractions from non-infected cells. These effects were in part due to TGF-ß, because they were reversed by treatment of the T cells with the TGF-ß-receptor inhibitor ALK5i. MV from RV-infected and non-infected cells were heterogeneous, with morphologies and typical flotation densities described for exosomes (between 1.10 and 1.18 g/mL), and denser vesicles (>1.24 g/mL). Both types of MV from RV-infected cells were more efficient at inhibiting T-cell function than were those from non-infected cells. We propose that RV infection of IEC releases MV that modulate viral immunity.
Assuntos
Linfócitos T CD4-Positivos/imunologia , Exossomos/metabolismo , Proteínas de Choque Térmico/metabolismo , Mucosa Intestinal/virologia , Infecções por Rotavirus/imunologia , Fator de Crescimento Transformador beta1/metabolismo , Antígenos CD/metabolismo , Antígenos Virais/metabolismo , Western Blotting , Células CACO-2 , Proteínas do Capsídeo/metabolismo , Pré-Escolar , Epitopos/imunologia , Epitopos/ultraestrutura , Exossomos/imunologia , Feminino , Gastroenterite/imunologia , Gastroenterite/metabolismo , Gastroenterite/virologia , Proteínas de Choque Térmico/imunologia , Humanos , Imunidade Celular , Lactente , Masculino , Microscopia Eletrônica de Transmissão , Microscopia de Fluorescência , Glicoproteínas da Membrana de Plaquetas/metabolismo , Tetraspanina 30 , Fator de Crescimento Transformador beta1/imunologiaRESUMO
OBJECTIVE: To identify HLA-DRB1 alleles contributing to susceptibility to multiple sclerosis (MS) in a Colombian population and to estimate the common effect size of HLA class II on MS susceptibility in Latin American populations through a meta-analysis. METHODS: A total of 65 Colombian patients with MS and 184 matched controls were included. HLA-DRB1 typing was done using the sequence-specific oligonucleotide probe method. A bivariate and a multivariate logistic regression analyses were done. Case-control studies performed in Latin America were searched up to January 2009 through a systematic review of the literature. Effect summary odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by means of the random effect model. RESULTS: A total of 464 cases and 2581 controls from 7 studies and the results of the present study in Colombians were analyzed. HLA-DRB1*15 (OR: 2.3; 95% CI: 1.68-3.07; p<0.001) and HLA-DQB1*06 (OR: 2.2; 95% CI: 1.54-3.07; p<0.001) groups as well as DRB1*1501 (OR: 2.6; 95% CI: 1.67-4.02; p<0.001), DRB1*1503 (OR: 2.2; 95% CI: 1.39-3.62; p=0.001) and DQB1*0602 (OR: 2.5; 95% CI: 1.66-3.71; p<0.001) alleles were found to be risk factors for MS. The myelin basic protein immunodominant sequence (221)VHFFKNIVT(229) was predicted to strongly and simultaneously bind to HLA-DRB1*1501 and *1503. CONCLUSION: The current study highlights the effect size of HLA class II in MS in Latin America and confirms similar allelic risk factors across diverse populations. Receptor-ligand interactions in the HLA-antigenic peptide complex could have potential predictive and therapeutical implications.
Assuntos
Antígenos HLA-DQ/genética , Antígenos HLA-DR/genética , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/genética , Esclerose Múltipla/imunologia , Autoantígenos/metabolismo , Estudos de Casos e Controles , Colômbia , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Antígenos HLA-DQ/metabolismo , Antígenos HLA-DR/metabolismo , Cadeias HLA-DRB1 , Teste de Histocompatibilidade , Humanos , Masculino , Proteína Básica da Mielina/metabolismo , Fragmentos de Peptídeos/metabolismo , Polimorfismo Genético , Ligação Proteica , Fatores de RiscoRESUMO
We quantified circulating total, rotavirus (RV) and Tetanus toxin (TT) memory B cells (mBc) in healthy adults using a limiting dilution assay (LDA) and a flow cytometry assay (FCA) that permit evaluation of both CD27+ and CD27- mBc. RV mBc were enriched in the CD27-, IgG+ and in the CD27+, IgM+ subsets. The numbers of RV mBc were higher by FCA than by LDA and results of the two assays did not correlate. TT IgGmBc and RV IgA mBc determined by FCA and by LDA correlated with TT plasma IgG and RV plasma IgA, respectively. The mean ratio of specific mBc/mug/ml of the corresponding plasma immunoglobulin was lower for TT IgG than for RV IgA mBc. Our studies contribute to understand the relationship between circulating mBc and serological memory, and enhance our capacity to develop better correlates of protection against RV disease.
Assuntos
Linfócitos B/imunologia , Memória Imunológica , Subpopulações de Linfócitos/imunologia , Rotavirus/imunologia , Adulto , Anticorpos Antivirais/biossíntese , Linfócitos B/química , Citometria de Fluxo , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/biossíntese , Imunoglobulina G/sangue , Imunoglobulina M/biossíntese , Imunoglobulina M/sangue , Antitoxina Tetânica/sangue , Toxina Tetânica/imunologia , Membro 7 da Superfamília de Receptores de Fatores de Necrose Tumoral/análiseRESUMO
In a double blind trial, 319 fully immunized children received two doses of either placebo or 10(6.7) focus-forming units of the attenuated RIX4414 human rotavirus (RV) vaccine ("all-in-one" formulation). Plasma RV-specific IgA (RV IgA), stool RV IgA, and circulating total and RV memory B cells (CD19+ IgD+/- CD27+) with an intestinal homing phenotype (alpha4beta7+ CCR9+/-) were measured, after the first and second doses, as potential correlates of protection. After the first and/or second dose, 54% of vaccinees and 13% of placebo recipients had plasma RV IgA. Before vaccination, most (95%) of the children (of both study groups) were breast-fed and had stool RV IgA (68.64%). Coproconversion (4-fold increase) after the first and/or second dose was observed in 32.7% of vaccinees and 17.4% of placebo recipients. No significant difference was seen when comparing the frequencies of any subset of memory B cells between vaccinees and placebo recipients. Statistically significant weak correlations were found between plasma RV IgA titers and coproconversion, and several subsets of memory B cells. The vaccine provided 74.8% protection (95% confidence interval, 30.93-92.62) against any RV gastroenteritis and 100% protection (95% confidence interval, 14.53-100) against severe RV gastroenteritis. When vaccinees and placebo recipients were considered together, a correlation was found between protection from disease and plasma RV IgA measured after dose 2 and RV memory (IgD- CD27+ alpha4beta7+ CCR9+) circulating B cells measured after dose 1. However, the correlation coefficients for both tests were low (<0.2), suggesting that other factors are important in explaining protection from disease.
Assuntos
Subpopulações de Linfócitos B/imunologia , Imunoglobulina A/imunologia , Infecções por Rotavirus/imunologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Rotavirus/imunologia , Vacinas Atenuadas/imunologia , Subpopulações de Linfócitos B/metabolismo , Colômbia , Método Duplo-Cego , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina A/metabolismo , Memória Imunológica , Lactente , Masculino , Vacinas Atenuadas/uso terapêuticoRESUMO
Using an intracellular cytokine assay, we recently showed that the frequencies of rotavirus (RV)-specific CD4(+) and CD8(+) T cells secreting INFgamma, circulating in RV infected and healthy adults, are very low compared to the frequencies of circulating cytomegalovirus (CMV) reactive T cells in comparable individuals. In children with acute RV infection, these T cells were barely or not detectable. In the present study, an ELISPOT assay enabled detection of circulating RV-specific INFgamma-secreting cells in children with RV diarrhea but not in children with non-RV diarrhea without evidence of a previous RV infection. Using microbead-enriched CD4(+) and CD8(+) T cell subsets, IFNgamma-secreting RV-specific CD8(+) but not CD4(+) T cells were detected in recently infected children. Using the same approach, both CD4(+) and CD8(+) RV-specific T cells were detected in healthy adults. Furthermore, stimulation of purified subsets of PBMC that express lymphocyte homing receptors demonstrated that RV-specific INFgamma-secreting CD4(+) T cells from adult volunteers preferentially express the intestinal homing receptor alpha4beta7, but not the peripheral lymph node homing receptor L-selectin. In contrast, CMV-specific INFgamma-secreting CD4(+) T cells preferentially express L-selectin but not alpha4beta7. These results suggest that the expression of homing receptors on virus-specific T cells depends on the organ where these cells were originally stimulated and that their capacity to secrete INFgamma is independent of the expression of these homing receptors.
Assuntos
Linfócitos T CD4-Positivos/imunologia , Rotavirus/imunologia , Adulto , Linfócitos T CD8-Positivos/imunologia , Criança , Pré-Escolar , Diarreia/imunologia , Ensaio de Imunoadsorção Enzimática/métodos , Humanos , Lactente , Interferon gama/biossíntese , Interleucina-4/biossíntese , Ativação Linfocitária , Pessoa de Meia-Idade , Receptores de Retorno de Linfócitos/metabolismo , Infecções por Rotavirus/imunologiaRESUMO
Human rotavirus-specific CD4(+) and CD8(+) T-cell responses in peripheral blood lymphocytes were studied using a flow cytometric assay that detects the intracellular accumulation of cytokines after short-term in vitro antigen stimulation. The frequencies of virus-specific T cells that secrete gamma interferon and interleukin-13 (IL-13) were determined in adults and children during the acute or convalescent phase of rotavirus-induced diarrhea, in asymptomatically infected adults and laboratory workers who worked with human stool samples containing rotavirus, and in healthy adults. Significantly higher frequencies of rotavirus-specific interferon gamma-secreting CD8(+) and CD4(+) T cells, but not IL-13-secreting T cells, were detected in symptomatically infected adults and exposed laboratory workers than in healthy adults and children with acute rotavirus diarrhea. The levels of rotavirus-specific T cells returned to levels found in healthy adults by 32 days after the onset of rotavirus diarrhea in most adult subjects. Children with rotavirus diarrhea had undetectable or very low levels of CD4(+) and CD8(+) T cells that secrete gamma interferon. Adult cytomegalovirus-seropositive individuals had frequencies of cytomegalovirus-specific T cells that secrete gamma interferon that were approximately 20 times the level of rotavirus-specific T cells. This result suggests that rotavirus is a relatively poor inducer of circulating memory T cells that secrete gamma interferon. The frequencies of gamma interferon-secreting CD4(+) and CD8(+) T cells and the frequencies of IL-13-secreting CD4(+) T cells responding to the T-cell superantigen staphylococcal enterotoxin B (SEB) were lower in children than in adults. In both adults and children, the frequencies of CD4(+) cells secreting gamma interferon in response to SEB were higher than the frequencies of cells secreting IL-13.
Assuntos
Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Interferon gama/análise , Interleucina-13/análise , Infecções por Rotavirus/imunologia , Rotavirus/imunologia , Doença Aguda , Adulto , Criança , Pré-Escolar , Convalescença , Citomegalovirus/imunologia , Diarreia/sangue , Diarreia/imunologia , Enterotoxinas , Citometria de Fluxo , Humanos , Lactente , Contagem de Linfócitos , Pessoa de Meia-Idade , Infecções por Rotavirus/sangue , Especificidade da Espécie , Fatores de TempoRESUMO
Se revisaron las historias clinicas de 153 pacientes operados en 1983 poe enfermedad vesicular; 61% eran mayores de 40 anos y las mujeres predominaron sobre los hombres en proporcion de 5:1. El sintoma y signo mas frecuente fue el dolor en el cuadrante superior derecho del abdomen. Hubo leucocitosis en 35% de los pacientes e ictericia en 15%. La colecistografia oral, solo, solo se practico a 50% de los enfermos y ecografia a 26.8%. Tenian colecistitis aguda, en sus difernetes formas de presentacion 45% de los pacienteas. A 3% se les extirpo la vesicula siendo normal. La colecistitis acalculosa aparecio en 9.2%. Los germenes mas comunmente aislados fueron Eschericha coli y Klebsiella pneumoniae. Tan solo se dejo un drenaje subhepatico en 5% de los casos. Hubo complicaciones post-operatorios en 13% y las mas frecuentes fueron: infeccion de la herida y litiasis desapercibida en el coledoco. La mortalidad fue 1.3%
Assuntos
Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Colecistite/terapia , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/terapia , Colecistite/complicações , Colecistite/mortalidade , Colômbia , Doenças da Vesícula Biliar/sangueRESUMO
Se revisan las historias clinicas de 47 pacientes con absceso intraabdominal intervenidos quirurgicamente en el Hospital Universitario del Valle, entre julio 1 y diciembre 31 de 1984. Casi 66% de los pacientes estaban en el grupo entre 15 y 44 anos de edad. Presentaron leucocitosis 70% de los pacientes e ictericia 15%. Las radiografias simples de abdomen fueron importantes para hacer el diagnostico en 36% de los casos y se encontraron alteraciones en la radiografia de torax en 7%. La ecografia y la gammagrafia se hizo en muy pocos pacientes y a ninguno se le practico TAC
Assuntos
Humanos , Abdome , Abscesso , Abscesso , Abscesso/diagnóstico , Abscesso/terapiaRESUMO
Se analizaron las historias clinicas de 524 persoas que ingresaron al Hospital Universitario del Valle entre enero 1 y diciembre 31 de 1983. Fueron hombres 55% de los pacientes; la mayor proporcion de casos con apendicitis aguda se presento en el grupo entre 10 y 19 anos. La enfermedad es rara en los extremos de la vida. El analisis permitio estudiar las distintas variables segun la fase inflamatoria de la enfermedad. Los sintomas y signos que se presentaron en la casi totalidad de los pacientes fueron dolor abdominal, nauseas, vomito, anorexia y signo de Blumberg positivo. Alrededor de 70% de los enfermos tenian el leucograma alterado. La cifra de laparotomias innecesarias fue de 4.4% en 5 pacientes en quienes el cirujano juzgo que el apendice estaba sano; la patologia informo apendicitis aguda. El apendice se extirpo a los 524 pacientes del estudio. Se utilizaron antibioticos pre y post-operatorios en todos los pacientes con perforacion apendicular; la combinacion mas utilizada fue gentamicina y cloranfenicol. Solo se utilizaron drenajes de la cavidad peritoneal en 5% de los casos. A la casi totalidad de los pacienes con apendicitis aguda complicada se les dejaron descubiertos el tejido celular subcutaneo y la piel para prevenir la infeccion severa de la herida. El germen mas comunmente aislado fue Escherichia coli. En el Hospital no se hacen cultivos sistematicos para bacterias anaerobicas. Las complicaciones mas frecuentes fueron septicas. El porcentaje global de mortalidad fue 1.5%
Assuntos
Humanos , Apendicite/diagnóstico , Apendicite/terapia , Apendicite/prevenção & controle , ColômbiaRESUMO
Se analizan las historias clinicas de 240 pacientes que ingresaron al Hospital Universitario del Valle con sepsis intraabdominal durante el segundo semestre de 1984. Buena proporcion de pacientes, 48.3%, pertenecia al grupo entre 15 y 44 anos. Hubo leucocitosis en 66.7% de los casos e ictericia en 7.5%. Los estudios radiologicos simples, de abdomen y torax, se hicieron en menos de 20% de los pacientes. Aunque el ultrasonido se efectuo en 8% de los enfermos en estos pocos casos fue de gran ayuda para el diagnostico. La tomografia axial computadorizada no se realizo a ningun paciente. Las principales causas de la sepsis intraabdominal fueron: 1) apendicitis aguda perforada; 2) perforacion de viscera hueca; 3) trauma abdominal; 4) enfermedades de vesicula y vias biliares; y 5) enfermedades ginecoobstetricas. Todos los pacientes fueron atendidos con cirugia; 51% recibieron una asociacion de gentamicina y cloramfenicol y el resto distintas combinaciones para cubrir germenes aerobios y anaerobios. El germen mas comun fue la Escherichia coli. La mortalidad global fue 10.8% y el promedio de estancia hospitalaria fue 13.3 dias