RESUMO
OBJECTIVES: To characterize the seroepidemiological features of Pneumocystis jirovecii infection in healthy Chilean children using overlapping fragments (A, B, C) of the P. jirovecii major surface glycoprotein (Msg). METHODS: Serum antibodies to MsgA, MsgB, and MsgC were measured every 2 months by enzyme-linked immunosorbent assay (ELISA) in 45 Chilean infants from about age 2 months to 2 years. RESULTS: Peak antibody levels (usually reached at age 6 months) and the force (or rate) of infection were somewhat greater for MsgC than for MsgA. Significant seasonal variation in antibody levels was only found with MsgA. Respiratory infections occurred in most children, but nasopharyngeal aspirates were of limited value in detecting the organism. In contrast, serological responses commonly occurred, and higher levels only to MsgC were significantly related to the number of infections. CONCLUSIONS: Serological responses to recombinant Msg fragments provide new insights into the epidemiological and clinical features of P. jirovecii infection of early childhood. MsgA, the amino terminus fragment, is more sensitive in detecting seasonal influences on antibody levels, whereas MsgC is better able to detect changes in antibody levels in response to clinical infection.
Assuntos
Anticorpos Antifúngicos/sangue , Glicoproteínas de Membrana/imunologia , Infecções por Pneumocystis/epidemiologia , Pneumocystis carinii/imunologia , Proteínas Recombinantes/imunologia , Pré-Escolar , Chile/epidemiologia , Proteínas Fúngicas/genética , Proteínas Fúngicas/imunologia , Humanos , Lactente , Glicoproteínas de Membrana/genética , Infecções por Pneumocystis/imunologia , Infecções por Pneumocystis/microbiologia , Proteínas Recombinantes/genética , Estudos SoroepidemiológicosRESUMO
OBJECTIVE: Immunocompromised children are at high risk for developing pneumonia due to opportunistic pathogens. The role of bronchoalveolar lavage (BAL) in the evaluation of such patients is still controversial. MATERIAL AND METHOD: We reviewed the hospital records of immunosuppressed patients with respiratory symptoms who had undergone BAL in the pediatric department of the Hospital Clinico de la Pontificia Universidad Católica of Chile. RESULTS: Sixty-eight BAL were performed on 54 children (mean age: 7.5 years) receiving wide-spectrum antibiotic treatment. The most frequent respiratory signs and symptoms were fever (90%) and cough and respiratory distress (81%); 18% had neutropenia and 43% thrombocytopenia. A specific pathogen was identified in BAL samples for 25 patients (37%). The pathogens isolated were bacteria in 21 cases, viruses in 6, Pneumocystis carinii in 5, fungi in 4, and Mycobacterium tuberculosis in one. Fourteen (19%) of the children who underwent BAL were on mechanical ventilation. Outcome was satisfactory in all cases. Twenty-one complications were recorded, 17 of which were minor (mild hypoxemia or fever) and 4 major, requiring tracheal intubation. No deaths were recorded. CONCLUSIONS: Evaluation by fiberoptic bronchoscopy together with BAL proved to be a safe procedure with an adequate diagnostic yield that made it possible to determine the etiology of the pulmonary infiltrates seen in chest x-rays. Both positive and negative results of BAL were useful for treating the patients.
Assuntos
Lavagem Broncoalveolar/efeitos adversos , Lavagem Broncoalveolar/estatística & dados numéricos , Febre/etiologia , Hipóxia/etiologia , Hospedeiro Imunocomprometido/imunologia , Pneumonia/diagnóstico , Pneumonia/imunologia , Adolescente , Broncoscopia , Criança , Pré-Escolar , Feminino , Tecnologia de Fibra Óptica , Humanos , Hipóxia/epidemiologia , Lactente , Masculino , Infecções por Mycobacterium/epidemiologia , Infecções por Mycobacterium/imunologia , Infecções por Mycobacterium/microbiologia , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Infecções por Pneumocystis/epidemiologia , Infecções por Pneumocystis/imunologia , Infecções por Pneumocystis/microbiologia , Pneumonia/microbiologiaRESUMO
Para determinar la frecuencia con la que se encuentran anticuerpos contra Pneumocystis carinii en un grupo de 58 mujeres embarazadas sanas, y la frecuencia con la que transfieren estos anticuerpos al producto, se utilizaron muestras de suero tomadas de la madre al momento del parto y del cordón umbilical para búsqueda de anticuerpos por la técnica de Western blot (inmunotransferencia). Se utilizó como fuente de antígeno P. carinii derivado de rata inmunosuprimida. En 28 (48 por ciento) sueros se identificó la presencia de anticuerpos contra P. carinii; existió prueba de transferencia en 21 (75 por ciento) de las muestras tomadas del cordón umbilical. El antígeno más reconocido estuvo entre 45-55 kDa. En 20 por ciento de las muestras maternas, se encontró reconocimiento al antígeno de 95 kDa, a diferencia de las muestras tomadas del cordón umbilical, en las cuales no se identificó respuesta contra este antígeno, que suponemos puede der detectado en la primoinfección natural