RESUMO
Primary immunodeficiencies (PID) are genetic diseases that affect the immune system and for the last 20 years, the Latin American Society for Immunodeficiencies (LASID) has been promoting initiatives in awareness, research, diagnosis, and treatment for the affected patients in Latin America. These initiatives have resulted in the development of programmes such as the LASID Registry (with 4900 patients registered as of January 2014), fellowships in basic and clinical research, PID summer schools, biannual meetings, and scientific reports, amongst others. These achievements highlight the critical role that LASID plays as a scientific organisation in promoting science, research and education in this field in Latin America. However, challenges remain in some of these areas and the Society must envision additional strategies to tackle them for the benefit of the patients. In June 2013, a group of experts in the field met to discuss the contributions of LASID to the initiatives of PID in Latin America, and this article summarises the current state and future perspectives of this society and its role in the advance of PIDs in Latin America.
Assuntos
Síndromes de Imunodeficiência , Sociedades Médicas/organização & administração , Pesquisa Biomédica/organização & administração , Humanos , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/terapia , América Latina , Sistema de RegistrosRESUMO
Primary immunodeficiency diseases (PIDD) are associated with significant morbidity and mortality and result in a significant public health burden. This is in part due to the lack of appropriate diagnosis and treatment of these patients. It is critical that governments become aware of this problem and provide necessary resources to reduce this impact on health care systems. Leading physicians in their respective countries must be supported by their own governments in order to implement tools and provide education and thus improve the diagnosis and treatment of PIDD. The Latin American Society of Primary Immunodeficiencies (LASID) has initiated a large number of activities aimed at achieving these goals, including the establishment of a PIDD registry, development of educational programmes and guidelines, and the introduction of a PIDD fellowship programme. These initiatives are positively impacting the identification and appropriate treatment of patients with PIDD in Latin America. Nevertheless, much remains to be done to ensure that every person with PIDD receives proper therapy.
Assuntos
Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/terapia , Congressos como Assunto , Humanos , América Latina , Sociedades MédicasRESUMO
Experts from six Latin American countries met to discuss critical issues and needs in the diagnosis and management of primary immunodeficiency diseases (PIDD). The diagnosis of PIDD is generally made following referral to an immunology centre located in a major city, but many paediatricians and general practitioners are not sufficiently trained to suspect PIDD in the first place. Access to laboratory testing is generally limited, and only some screening tests are typically covered by government health programmes. Specialised diagnostic tests are generally not reimbursed. Access to treatment varies by country reflecting differences in healthcare systems and reimbursement policies. An online PIDD Registry Programme for Latin America has been available since 2009, which will provide information about PIDD epidemiology in the region. Additional collaboration across countries appears feasible in at least two areas: a laboratory network to facilitate the diagnosis of PIDD, and educational programmes to improve PIDD awareness. In total, these collaborations should make it possible to advance the diagnosis and management of PIDD in Latin America.
Assuntos
Gerenciamento Clínico , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/terapia , Alergia e Imunologia/educação , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Imunoglobulinas Intravenosas/economia , Imunoglobulinas Intravenosas/uso terapêutico , Síndromes de Imunodeficiência/economia , Cobertura do Seguro , Reembolso de Seguro de Saúde , América Latina , Sistema de RegistrosRESUMO
The digenean trematode Schistosoma mansoni is responsible for chronic schistosomiasis worldwide, and in Brazil alone an estimated 35 million people are at risk. To evaluate epidemiological patterns among human definitive hosts, we assessed genetic diversity and population subdivision of S. mansoni infrapopulations in human hosts from the highly endemic village of Virgem das Graças in the state of Minas Gerais, Brazil. We believe this is the largest such survey to date. Genetic diversity of parasites, measured over eight polymorphic microsatellite loci, was relatively high and standard measures of inbreeding indicated that the population was panmictic. Furthermore, there was no significant isolation-by-distance of parasite infrapopulations, and measures of population subdivision indicated significant but low to moderate levels of population differentiation. We conclude that patients within this village sample from a broad range of schistosome genetic diversity and effectively act as "genetic mixing bowls" for the parasites. These results contrast with those previously observed in the Brazilian village of Melqui ades and thus provide the opportunity for comparisons of environmental and epidemiological differences that are likely to influence host-parasite coevolution and parasite transmission.
Assuntos
DNA de Helmintos/análise , Variação Genética , Interações Hospedeiro-Parasita , Polimorfismo Genético , Schistosoma mansoni/genética , Animais , Biomphalaria/parasitologia , Brasil , Humanos , Estágios do Ciclo de Vida , Camundongos , Camundongos Endogâmicos BALB C , Contagem de Ovos de Parasitas , Técnica de Amplificação ao Acaso de DNA Polimórfico , Esquistossomose mansoni/parasitologia , Esquistossomose mansoni/transmissãoRESUMO
The majority of children with Down syndrome (DS) tend to have frequent bacterial infections including recurrent respiratory infections. Our objective was to evaluate the production of antibodies to pneumococcal polysaccharide antigens after active immunization in DS subjects. IgG antibodies to pneumococcal serotypes (1, 3, 6B, 9V, and 14) were measured before and 6 weeks after immunization with a 23-valent pneumococcal vaccine (Pneumo23, Pasteur-Merrieux) in 6- to 13-year-old DS children (N = 17) and in aged-matched normal controls (N = 30). An adequate response was defined as a 4-fold increase over baseline or a post-immunization level of specific pneumococcal serotype antibody > or = 1.3 microg/mL. After immunization, all DS children had an increase in post-immunization levels against all serotypes analyzed. A 4-fold or more increase was observed in all DS children concerning serotypes 1 and 14, in 90% of subjects for serotypes 3 and 9V, and in 65% for serotype 6B. Regarding this increase, 8 of the 17 DS children had an adequate response to all serotypes analyzed, 8/17 patients to 4 serotypes and 1/17 to 3 serotypes. However, when we compared post-immunization levels between DS children and controls, we observed lower levels in the former group (P < 0.05) for all serotypes except serotype 3. We conclude that pneumococcal polysaccharide immunization could be beneficial for these DS children.
Assuntos
Anticorpos Antibacterianos/imunologia , Síndrome de Down/imunologia , Imunoglobulina G/imunologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Adolescente , Anticorpos Antibacterianos/sangue , Estudos de Casos e Controles , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , MasculinoRESUMO
The majority of children with Down syndrome (DS) tend to have frequent bacterial infections including recurrent respiratory infections. Our objective was to evaluate the production of antibodies to pneumococcal polysaccharide antigens after active immunization in DS subjects. IgG antibodies to pneumococcal serotypes (1, 3, 6B, 9V, and 14) were measured before and 6 weeks after immunization with a 23-valent pneumococcal vaccine (Pneumo23®, Pasteur-Merrieux) in 6- to 13-year-old DS children (N = 17) and in aged-matched normal controls (N = 30). An adequate response was defined as a 4-fold increase over baseline or a post-immunization level of specific pneumococcal serotype antibody > or = 1.3 æg/mL. After immunization, all DS children had an increase in post-immunization levels against all serotypes analyzed. A 4-fold or more increase was observed in all DS children concerning serotypes 1 and 14, in 90 percent of subjects for serotypes 3 and 9V, and in 65 percent for serotype 6B. Regarding this increase, 8 of the 17 DS children had an adequate response to all serotypes analyzed, 8/17 patients to 4 serotypes and 1/17 to 3 serotypes. However, when we compared post-immunization levels between DS children and controls, we observed lower levels in the former group (P < 0.05) for all serotypes except serotype 3. We conclude that pneumococcal polysaccharide immunization could be beneficial for these DS children.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Anticorpos Antibacterianos/imunologia , Síndrome de Down/imunologia , Imunoglobulina G/imunologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Anticorpos Antibacterianos/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Imunoglobulina G/sangueRESUMO
All clinical S. pneumoniae specimens isolated from patients with invasive or sterile-site infections admitted to one regional general hospital in southern Chile were collected during a 5-year period (February 1994 to September 1999). A total of 247 strains belonging to 50 serotypes were isolated in this survey: 69 in patients under 5 years of age, 129 in patients 5 to 64 years old, and 49 from patients 65 years and older. Eight serotypes were identified in all age groups, while all other serotypes were found exclusively in one age group or in patients over 4 years of age. Serotype 3 was never found in patients under 5 years old, and serotype 14 was not found in patients >64 years of age. There was no difference in the serotypes causing infection in each one of the 5 years of the survey. Our results suggest that both bacterial virulence factors and host factors play an important role in the selection of S. pneumoniae serotypes causing invasive infection. Possible host factors include age-related differences in the immune response. Comparative studies with other areas of the world may help to further understanding of our observations in southern Chile.
Assuntos
Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/patogenicidade , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/fisiopatologia , Streptococcus pneumoniae/genética , VirulênciaRESUMO
The Proton Irradiation Facility (PIF) has been designed and constructed, in cooperation between Paul Scherrer Institute (PSI) and European Space Agency (ESA), for terrestrial proton testing of components and materials for spacecraft. Emphasis has been given to generating realistic proton spectra encountered by space-flights at any potential orbit. The facility, designed in a user-friendly manner, can be readily adapted to the individual requirements of experimenters. It is available for general use serving also in testing of radiation monitors and for proton experiments in different scientific disciplines. The Radiation Environment Monitor REM has been developed for measurements of the spacecraft radiation conditions. Two instruments were launched into space, one into a Geo-stationary Transfer Orbit on board of the STRV-1b satellite and one into a Low Earth Orbit on the Russian MIR station. The next generation of monitors (SREMs--Standard REMs) is currently under development in partnership of ESA, PSI and Contraves-Space. They will operate both as minimum intrusive monitors, which provide radiation housekeeping data and alert the spacecraft when the radiation level crosses allowed limits and as small scientific devices measuring particle spectra and fluxes. Future missions as e.g. INTEGRAL, STRV-1c and PROBA will be equipped with new SREMs.
Assuntos
Arquitetura de Instituições de Saúde , Teste de Materiais , Prótons , Monitoramento de Radiação/instrumentação , Proteção Radiológica , Voo Espacial/instrumentação , Oceano Atlântico , Calibragem , Radiação Cósmica , Desenho de Equipamento , Aceleradores de Partículas , Atividade Solar , América do Sul , Astronave/instrumentação , SuíçaRESUMO
BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier induces bone for reconstruction of skeletal defects. The rhBMP-2/ACS implant is prepared by administering a rhBMP-2 solution to dry ACS. Once prepared, rhBMP-2/ACS forms a moldable, cohesive, and adhesive implant. However, rhBMP-2/ACS does not have sufficient structural strength to withstand soft tissue compression at specific anatomic sites. To more fully understand the mechanisms that affect bone induction by rhBMP-2/ACS in the presence of soft tissue compression, it would be useful to have a preclinical model that appropriately simulates such circumstances in patients. This pilot study evaluated one such potential model. METHODS: Bilateral, Class III alveolar defects were surgically produced in 4 adult mongrel dogs following extraction of the mandibular fourth premolars and reduction of the alveolar ridge. After an 8-week healing interval, mucoperiosteal flaps were elevated and rhBMP-2/ACS or rhBMP-2/ACS combined with hydroxyapatite (HA) was implanted into contralateral defects. The animals were euthanized at 12 weeks post-augmentation and block biopsies processed for histologic evaluation. RESULTS: Limited augmentation followed implantation of rhBMP-2/ACS (0.7 +/- 0.6 mm). In contrast, sites receiving rhBMP-2/ACS/HA exhibited clinically relevant ridge augmentation (5.5 +/- 1.6 mm). Defects implanted with rhBMP-2/ACS exhibited dense trabeculation within the corpus of the reduced alveolar process. The cortices appeared intact without evidence of expansion into the defect area. Three defects receiving rhBMP-2/ACS/HA exhibited sparse bone trabeculae amidst HA particles, fibrovascular tissue, and marrow. Commonly, the HA particles were encapsulated by fibrous tissue. Some particles were observed in contact with bone. CONCLUSIONS: The results suggests that rhBMP-2/ACS has limited effect alone in this augmentation model of Class III alveolar ridge defects. Inclusion of HA into the rhBMP-2 construct results in clinically relevant augmentation, however, the quality of bone is compromised.
Assuntos
Implantes Absorvíveis , Aumento do Rebordo Alveolar/métodos , Proteínas Morfogenéticas Ósseas/uso terapêutico , Colágeno , Mandíbula/cirurgia , Fator de Crescimento Transformador beta/uso terapêutico , Processo Alveolar/patologia , Alveolectomia , Animais , Dente Pré-Molar/cirurgia , Materiais Biocompatíveis/uso terapêutico , Biópsia , Proteína Morfogenética Óssea 2 , Proteínas Morfogenéticas Ósseas/administração & dosagem , Regeneração Óssea/efeitos dos fármacos , Substitutos Ósseos/uso terapêutico , Modelos Animais de Doenças , Cães , Portadores de Fármacos , Durapatita/uso terapêutico , Humanos , Mucosa Bucal/patologia , Projetos Piloto , Pressão , Proteínas Recombinantes , Retalhos Cirúrgicos , Extração Dentária , Fator de Crescimento Transformador beta/administração & dosagem , CicatrizaçãoRESUMO
BACKGROUND: The hyper-IgE syndrome is a primary immunodeficiency characterized by severe recurrent abscesses, pneumonia with pneumatocele formation, and elevated serum IgE. Eosinophilia, neutrophil chemotactic defects, and marked tissue damage are frequently present in this syndrome. OBJECTIVE: To study whether functional changes in cytokines, adhesion molecules, and neutrophils might help explain these clinical observations. METHODS: The following functions were analyzed in patients with the hyper-IgE syndrome and in controls: (1) production of granulocyte-macrophage-colony-stimulating factor by peripheral blood mononuclear cells by ELISA; (2) respiratory burst and reactive oxygen intermediates production by peripheral neutrophils using the luminol-enhanced chemiluminescense technique; and (3) expression of L-selectin on granulocytes and lymphocytes by flow cytometry. RESULTS: Patients with hyper-IgE syndrome had significantly increased production of granulocyte-macrophage-colony-stimulating factor by resting or stimulated mononuclear cells, increased generation of reactive oxygen intermediates by neutrophils treated with opsonized zymosan, and reduced L-selectin expression on quiescent and activated granulocytes and lymphocytes. CONCLUSIONS: Our results suggest that an important feature of the hyper-IgE syndrome is the increased production of granulocyte-macrophage-colony-stimulating factor, which may explain the reduced L-selectin expression, decreased chemotaxis, and increased oxygen radical production and tissue damage in this disease.
Assuntos
Fator Estimulador de Colônias de Granulócitos e Macrófagos/metabolismo , Síndrome de Job/metabolismo , Selectina L/biossíntese , Explosão Respiratória/efeitos dos fármacos , Adolescente , Células Cultivadas , Criança , Pré-Escolar , Feminino , Granulócitos/metabolismo , Humanos , Medições Luminescentes , Luminol/farmacologia , Ativação Linfocitária/efeitos dos fármacos , Linfócitos/imunologia , Linfócitos/metabolismo , Masculino , Espécies Reativas de Oxigênio/metabolismo , Acetato de Tetradecanoilforbol/farmacologiaRESUMO
The highest incidence of severe pneumococcal infections in children occurs in the first 6 months of life; however, immunization of infants with the existing polysaccharide vaccines is ineffective. We wished to determine the prevalence of immunoglobulin G (IgG) pneumococcal antibodies in unimmunized Brazilian mothers and their transplacental transmission to term and preterm infants. Total IgG, IgG1 and -2 subclass levels, and IgG antibodies against Streptococcus pneumoniae serotypes 1, 3, 6B, 9V, and 14 were determined in 15 pairs of mothers and term newborns (gestational age, >/=37 weeks) and in 18 pairs of mothers and preterm newborns (gestational age, 32 to 36 weeks). Serotype-specific anti-pneumococcal antibodies were detected by a recently standardized enzyme-linked immunosorbent assay calibrated with the 89-SF reference serum. Varying percentages of the mothers had antibody concentrations below arbitrarily defined protective levels: 33% for serotype 1, 67% for serotype 3, 30% for serotype 6B, 52% for serotype 9V, and 22% for serotype 14. In term newborns, IgG1 concentrations were slightly higher than maternal concentrations; in preterm newborns, the concentrations were much lower. Concentrations of IgG2 in term and preterm infants were significantly lower than in the mothers. Transplacental transmission of antibodies to serotypes 3 and 14 was clearly different from that of antibodies to serotypes 1, 6B, and 9V. Concentrations of IgG antibodies against serotypes 3 and 14 were similar to or higher than those of the mothers; against serotypes 1, 6B, and 9V they ranged from 77 to 83% of maternal concentrations in term newborns and also in preterm infants, although transplacental transmission of antibodies was proportionally lower for each specific serotype in preterm than in term infants. These data are relevant for developing strategies to protect infants against pneumococcal infections in the first months of life. Our findings and a review of existing information stress the importance of understanding the relationships among pneumococcal immunization, IgG subclass antibodies to individual serotypes, transplacental transport, half-life, and antibody function and their protective values against infection.
Assuntos
Anticorpos Antibacterianos/sangue , Imunidade Materno-Adquirida , Streptococcus pneumoniae/imunologia , Adolescente , Adulto , Brasil , Feminino , Sangue Fetal/imunologia , Humanos , Imunoglobulina G/sangue , Recém-Nascido , Recém-Nascido Prematuro , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/prevenção & controle , Gravidez , Sorotipagem , Streptococcus pneumoniae/classificaçãoRESUMO
The Latin American Group for Primary Immunodeficiencies, formed in 1993, presently includes 12 countries. One goal was to study the frequency of primary immunodeficiencies in various regions of the American continent and to enhance knowledge about these diseases among primary-care physicians, as well as allergist-immunologists. Important for this purpose was the development of a registry of primary immunodeficiencies using a uniform questionnaire and computerized database. To date, eight countries have collected information on a total of 1428 patients. Predominantly antibody deficiencies were reported in 58% of patients, followed by cellular and antibody immunodeficiencies associated with other abnormalities in 18%, immunodeficiency syndromes associated with granulocyte dysfunction in 8%, phagocytic disorders in 9%, combined cellular and antibody immunodeficiencies in 5%, and complement deficiencies in 2% of patients. The information gathered from this initial analysis of data will serve to expand the patient database to more areas within participating countries and to new countries and to increase collaboration toward better diagnosis and treatment of these diseases.
Assuntos
Síndromes de Imunodeficiência/epidemiologia , Humanos , Síndromes de Imunodeficiência/classificação , Síndromes de Imunodeficiência/imunologia , América Latina/epidemiologia , Fenótipo , Sistema de RegistrosRESUMO
We compared the incidence of nasopharyngeal colonization by Streptococcus pneumoniae, the serotypes causing mucosal and invasive diseases, and the antibiotic resistance of these strains in patients admitted to three large hospitals and children attending day care centers in two Chilean cities (Santiago and Temuco). The populations in both cities were similar in ethnic background, socioeconomic status, family size, and access to medical care. Significant differences in nasopharyngeal colonization rates, in serotypes causing infections, and in antibiotic resistance were found between the two cities. In children 0 to 2 years of age, 42% were colonized with S. pneumoniae in Santiago compared to 14% in Temuco. A total of 41 serotypes were identified in both Chilean cities studied. Six serotypes were found only in Santiago; 14 serotypes were found only in Temuco. Antibiotic-resistant serotypes 6A, 6B, 14, 19F, and 23F were detected only in Santiago. We show that important differences in the incidence of nasopharyngeal carriage, infection, and S. pneumoniae serotypes can exist in similar populations in different areas of the same country. Our findings are relevant for prevention strategies, antibiotic usage, and vaccine design.
Assuntos
Resistência Microbiana a Medicamentos/genética , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Criança , Pré-Escolar , Chile/epidemiologia , Humanos , Lactente , Infecções Pneumocócicas/epidemiologia , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genéticaRESUMO
OBJECTIVE: We wished to investigate whether increased IgG infusion rates are associated with metabolic and hematologic changes in pediatric patients with antibody deficiency syndromes. METHODS: We studied 7 patients (2-16 years old) with primary antibody deficiencies who had been on regular IgG replacement treatment, 350-600 mg/kg/dose every 3 weeks with a 3% IVIG preparation, for periods ranging from 6 months to 4 years. Initially, the IgG concentration of IVIG preparations was increased to 6, 9 and 12% in consecutive infusions at a constant IgG infusion rate of 4 mg/kg/min. Subsequently, the infusion rates were increased to 8, 12, and 16 mg/kg/min using the IVIG 12% preparation. RESULTS: Clinically, all patients tolerated increases in IVIG concentrations while the infusion rate was 4 mg/kg/min. However, 3 patients presented side effects when the infusion rate was increased to 8 and 16 mg/kg/min. CONCLUSION: We conclude that metabolic and hematologic sides effects occur with rapid infusion of IVIG even in patients who tolerate the increased infusion rate clinically. The advantages of using high infusion rates have to be re-evaluated.
Assuntos
Imunoglobulina G/administração & dosagem , Síndromes de Imunodeficiência/tratamento farmacológico , Síndromes de Imunodeficiência/metabolismo , Adolescente , Análise de Variância , Gasometria , Criança , Pré-Escolar , Humanos , Imunoglobulina G/uso terapêutico , Infusões Intravenosas , Concentração Osmolar , Fatores de TempoRESUMO
Pregnancy can be considered a successful transplantation of allogeneic paternal tissue to the mother. Soluble HLA class I serum levels have been found to increase during solid organ rejection episodes and during graft-versus-host disease after bone marrow transplantation. We wished to determine whether significant changes in sHLA class I and beta 2-microglobulin light chain levels occurred during pregnancy, because these may reflect adaptive changes permitting the acceptance of the fetal graft. Serum samples were obtained from women at different stages of pregnancy and in the postpartum period. Cord blood samples and serum samples from nonpregnant female and male controls living in the same geographic area in Southern Chile were also studied. The levels of sHLA class I heterodimers were determined by an ELISA sandwich technique; beta 2-microglobulin levels were measured by MEIA IMX-Abbott. There was a significant elevation of sHLA class I levels in the first 2 trimesters of pregnancy, followed by a significant drop below normal levels at the end of pregnancy, with normalization in the post-partum period. beta 2-microglobulin levels did not change significantly during pregnancy and did not correlate with sHLA class I levels. In cord blood samples, sHLA class I levels were lower and beta 2-microglobulin levels higher than those of adult controls and of mothers at the time of delivery. The variations in sHLA class I levels during pregnancy may reflect or contribute to immunoregulatory events related to the acceptance of the fetal graft.
Assuntos
Sangue Fetal/química , Antígenos HLA/sangue , Antígenos de Histocompatibilidade Classe I/sangue , Microglobulina beta-2/metabolismo , Adulto , Feminino , Humanos , Recém-Nascido , Trabalho de Parto/imunologia , Masculino , Gravidez , Primeiro Trimestre da Gravidez/imunologia , Segundo Trimestre da Gravidez/imunologia , Terceiro Trimestre da Gravidez/imunologia , SolubilidadeRESUMO
SETTING: Immune response induced by BCG vaccination seems to reflect the development of T-cell immunity and monocyte activation. Participants were recruited from a large prospective study in infants from a suburb in Santiago, Chile. OBJECTIVE: To determine whether newborn BCG immunization changes the innate ability of cultured monocyte-macrophages to ingest and kill virulent mycobacteria in the absence of lymphocytes. DESIGN: The study population consisted of 15 three-month-old, tuberculin-positive infants immunized with BCG (Japanese) at birth, 13 randomly-selected, age-matched tuberculin-nonreactive infants in whom BCG immunization was postponed until one year of age, and five BCG-immunized, tuberculin-reactive adults. Adherent cells were cultured for 48 h. Monocyte-macrophage viability and number and viability of intracellular Mycobacterium tuberculosis bacilli were assessed after an additional 2 h and 4 and 7 days of incubation. RESULTS: There was no difference in the mean number of adherent cells present after 48 h among the three study groups. Adherent cells from BCG-immunized infants and adults had a significantly higher viability after 7 days in culture than adherent cells from non-immunized infants. The percentage of cells ingesting M. tuberculosis and the number of bacilli per cell after 2 h and 4 days was significantly higher in immunized infants and adults than in non-immunized infants. However, there was no evidence for increased killing of mycobacteria by cells from immunized infants and adults. CONCLUSION: These results suggest that BCG vaccination increases monocyte viability and the uptake of M. tuberculosis without enhancing the ability to kill ingested M. tuberculosis in the absence of lymphocytes.
Assuntos
Vacina BCG/administração & dosagem , Monócitos/imunologia , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Tuberculose/prevenção & controle , Vacinação , Adulto , Fatores Etários , Análise de Variância , Células Cultivadas , Chile , Contagem de Colônia Microbiana , Humanos , Imunidade Celular/fisiologia , Lactente , Recém-Nascido , Mycobacterium tuberculosis/crescimento & desenvolvimento , Estudos Prospectivos , Valores de Referência , Linfócitos T/imunologia , Tuberculose/sangueRESUMO
The aim of this work was to define antibody levels against four neumococcal serotypes, before and after neumococcal vaccination in patients with respiratory infections. Fifty one patients were studied, 19 children from 1 to 5 years old; children from 6 to 18 years old and 22 adults from 27 to 65 years old. IgG anti-neumococcal, antibodies, against weeks after vaccination. There was a significant increase in antibody titers against all serotypes in subjects older 7 years. In children of less than 6 years, the response to serotype 14 was non significant. The intensity of response differed according to the studied serotype and the percentage of patients that responded to each serotype increased with age. Five patients older than 18 years were identified as non responders to all four serotypes. It is concluded that neumococcal vaccine increases anti-neumococcal antibodies in patients with recurrent infections and allows the identification of patients with specific antibody deficiency syndromes and normal total immunoglobulin levels.
Assuntos
Anticorpos Antibacterianos/sangue , Autoimunidade/imunologia , Vacinas Bacterianas/imunologia , Streptococcus pneumoniae/imunologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Pessoa de Meia-Idade , Infecções Respiratórias/imunologiaRESUMO
SETTING: Tuberculin testing is an accepted method for screening pregnant women for tuberculosis. The interpretation of tuberculin reactivity in bacillus Calmette-Guerin (BCG)-immunized pregnant women is still in debate. OBJECTIVE: Four related issues were addressed: (1) The effect of pregnancy on tuberculin reactivity; (2) the effect of age differential on tuberculin reactivity; (3) the effect of repeated immunization with BCG; and (4) the risk of developing tuberculosis during pregnancy or a 3-year post-partum period. DESIGN: We performed tuberculin testing in 840 healthy Chilean women in the 32nd to 34th week of pregnancy; 807 had been immunized with 1 or more doses of BCG. There were 3 age groups: 177 were < or = 19 years old, 534 were 20-29 years old, and 129 were > or = 30 years old. All women in the study were followed at least 3 years post-partum. RESULTS: Women < or = 19 years old and non-pregnant women of similar age studied in the same geographical area had a similar distribution of the size of tuberculin reactions. Over 50% of all BCG-immunized women in each group had tuberculin reactions > or = 10 mm. A differential effect of different doses of BCG was significant only in 20- to 29-year-old women. None of the women in this study developed tuberculosis during pregnancy or a 3-year post-partum observation period. CONCLUSIONS: Healthy, BCG-immunized pregnant women may have positive tuberculin reactions without having an increased risk for tuberculosis. The incidence of tuberculosis and the BCG immunization status need to be considered in the development of policy recommendations for diagnosis and treatment of Mycobacterium tuberculosis infection in pregnant women.
Assuntos
Vacina BCG/imunologia , Complicações Infecciosas na Gravidez/imunologia , Teste Tuberculínico , Tuberculose/imunologia , Adulto , Fatores Etários , Vacina BCG/administração & dosagem , Chile , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Terceiro Trimestre da Gravidez , Fatores de Risco , Tuberculose/prevenção & controleRESUMO
Beta 2m serum levels have been shown to be increased in patients with tuberculosis and HIV infection. We determined the stability of beta 2m and of sHLA-I dimers in serum, and then determined the levels of both molecules in 60 non-HIV-infected patients with active pulmonary tuberculosis and in 55 adult controls. The levels of sHLA-I in samples kept at room temperature declined by 8% at 30 minutes, 16% at 60 minutes, and 36% at 120 minutes. Beta 2m levels remained stable at all times tested. Mean sHLA-I levels were 0.99 +/- 0.16 micrograms/ml in controls and 1.34 +/- 0.11 micrograms/ml in patients with tuberculosis (P < 0.0001). Beta 2m levels were 1.23 +/- 0.26 micrograms/ml in controls and 2.26 +/- 0.64 micrograms/ml in patients with tuberculosis (P < 0.0001). All patients with tuberculosis had elevation of sHLA-I and/or beta 2m above 1 standard deviation of normal values. However, there was no correlation between sHLA-I and beta 2m levels in individual samples. Evaluation of sHLA-I holds the promise of further understanding of the biology and genetic regulation of the immune response to mycobacterial infection.
Assuntos
Antígenos de Histocompatibilidade Classe I/sangue , Tuberculose Pulmonar/sangue , Microglobulina beta-2/análise , Adolescente , Adulto , Idoso , Ensaio de Imunoadsorção Enzimática , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , SolubilidadeRESUMO
SETTING: Studies showing significantly higher concordance of tuberculosis among monozygotic twins than dizygotic twins have provided support for genetically determined susceptibility to tuberculosis. OBJECTIVE: We wished to explore whether the development of delayed type hypersensitivity to tuberculin after newborn BCG immunization of twins suggested genetic regulation of the response to BCG in humans. DESIGN: Our study population consisted of 17 monozygotic twin pairs, 18 dizygotic twin pairs, and 64 single infants 3-34 months of age from Santiago, Chile. All had a BCG scar and were tuberculin tested by one trained nurse. RESULTS: The mean birth weight of both groups of twins was significantly lower than that of singletons and the percentage of individuals who failed to respond to tuberculin was approximately twice as high in twins as in singletons. After adjustment for birth weight and age by regression analysis, it was found that the distribution of tuberculin reactivity in both monozygotic and dizygotic twins was not significantly different from that of singletons. Both twin pair correlations is adjusted tuberculin reactivity were significantly greater than zero (P < 0.01) and led to a heritability estimate of 0.28. However, the monozygotic twin correlation was not significantly larger than the dizygotic twin correlation so that heritability is poorly estimated. CONCLUSION: These results are consistent with a genetic regulation of the response to newborn BCG immunization in humans by a mechanism capable of producing similar responses in identical and nonidentical twins alike.