Síndrome DRESS secundária ao uso de alopurinol: um relato de caso / DRESS syndrome secondary to the use of allopurinol: a case report

A Síndrome de DRESS (do inglês, Drug Rash with Eosinophilia and Systemic Symptoms) é uma patologia rara que consiste em uma severa reação medicamentosa mediada por células T. O presente relato de caso retrata uma paciente do sexo feminino, 59 anos, que apresentou icterícia, febre não termometrada, acolia, colúria, mialgia, placas hipercrômicas e lesões pruriginosas. Referiu uso recente de alopurinol, paracetamol e nimesulida, apresentando melhora importante e espontânea após a suspensão das medicações. A extensão do tempo de exposição ao medicamento agressor ocasiona um maior período de internação e risco de mortalidade. Além disso, os dados restritos sobre a Síndrome de DRESS impõe desafios ao seu diagnóstico. Sendo assim, este estudo busca destacar a importância do diagnóstico clínico precoce, a suspensão do medicamento agressor e a instituição da terapêutica adequada para um prognóstico favorável

The Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a rare pathology that consists of a severe drug reaction mediated by T cells. The present case report depicts a female patient, 59 years old, who presented jaundice, non thermometered fever, acholia, choluria, myalgia, hyperchromic plaques and pruritic lesions. She mentioned recent use of allopurinol, paracetamol and nimesulide, showing significant and spontaneous improvement after discontinuation of medications. The extension of time of exposure to the offending drug causes a longer period of hospitalization and risk of mortality. In addition, the restricted data on DRESS Syndrome poses challenges to its diagnosis. Therefore, this study seeks to highlight the importance of early clinical diagnosis, suspension of the offending drug and the institution of appropriate therapy for a favorable prognosis

Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico / Eosinophilic enteritis, a strange cause of acute abdomen Clinical case report

La enteritis eosinofílica, es una patología rara, caracterizada por infiltración de eosinófilos en una o más capas histológicas en diferentes niveles del tracto gastrointestinal, siendo el estómago e intestino delgado los más afectados; su cuadro clínico, inespecífico, caracterizado por dolor abdominal, náusea, vómito, diarrea o estreñimiento, pérdida de peso y ascitis, con presencia o ausencia de eosinofilia en la biometría. Reporte de caso Paciente masculino de 51 años de edad, acudió a emergencia por distensión abdominal y náusea, al examen físico en la palpación intenso dolor y distención abdominal, percusión timpánico y abolición de ruidos hidroaéreos. La analítica reportó leucocitosis con neutrofilia, radiografía de abdomen íleo adinámico, en la ecografía abdominal presencia de imágenes tubulares con aspecto de diana, asociado a líquido libre purulento en fosa ilíaca derecha y fondo de saco vésico rectal. Un cuadro clínico compatible con abdomen agudo de resolución quirúrgica, se realizó laparotomía exploratoria (AU);

The eosinophilic enteritis is a rare pathology, characterized by infiltration of eosinophils in one or more histological layers at different levels of the gastrointestinal tract, the stomach and small intestine being the most affected; its nonspecific clinical picture, characterized by abdominal pain, nausea, vomiting, diarrhea or constipation, weight loss and ascites, with the presence or absence of eosinophilia in the biometry. Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico Eosinophilic enteritis, a strange cause of acute abdomen year-old male patient came to the emergency room due to abdominal distention and nausea, to physical examination on palpation, intense abdominal pain and distention, tympanic percussion and abolition of air-fluid sounds. Laboratory analysis reported leukocytosis with neutrophilia, abdominal ileus adynamic radiography, abdominal ultrasound presence of tubular images with a target appearance, associated with free purulent fluid in the right iliac fossa and rectal vesicum fundus. A clinical picture compatible with an acute abdomen with surgical resolution, an exploratory laparotomy was performed (AU);

Obesity and asthma: clinical and laboratory characterization of a common combination / Obesidade e asma: caracterização clínica e laboratorial de uma associação frequente

ABSTRACT Objective: To evaluate the relationship between obesity and asthma. Methods: This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. Results: Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). Conclusions: Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.

RESUMO Objetivo: Avaliar a relação entre obesidade e asma. Métodos: Análise preliminar transversal de dados de um estudo de caso-controle com 925 pacientes com asma leve a moderada ou grave, avaliados entre 2013 e 2015. A classificação de obesidade levou em conta o índice de massa corpórea (IMC) e a circunferência abdominal. Foram coletados parâmetros clínicos, laboratoriais, medidas antropométricas e de função pulmonar, assim como resultados de questionários de controle da asma e de qualidade de vida e presença de comorbidades. Resultados: Os indivíduos obesos apresentaram um número significativamente maior de neutrófilos no sangue periférico que os não obesos (p = 0,01). Entre os obesos, 163 (55%) apresentaram positividade no teste alérgico, enquanto os grupos com sobrepeso e IMC normal apresentaram positividade em 62% e 67%, respectivamente. Os parâmetros espirométricos dos indivíduos obesos foram mais baixos que os dos não obesos, e 97 obesos (32%) apresentaram asma não controlada, uma proporção significativamente maior do que a observada nos demais grupos de estudo (p = 0,02). Conclusões: Indivíduos asmáticos e obesos têm pior controle da asma e valores mais baixos de parâmetros de função pulmonar que os não obesos. A proporção de pacientes sem atopia entre asmáticos obesos foi maior que entre os não obesos. Nossos resultados sugerem que indivíduos asmáticos obesos podem apresentar um padrão inflamatório diferente do habitual e doença de mais difícil controle quando comparados com indivíduos asmáticos não obesos.

Eosinofilia no sangue periférico de mulheres com candidiase vaginal recorrente / Eosinophilia in peripheral blood of women with recurrent vaginal candidiasis

OBJETIVO: Quantificar o número de células de defesa e os níveis de imunoglobulina E (IgE) no sangue periférico em amostra de mulheres com candidíase vaginal recorrente. MÉTODOS: Estudo de corte transversal com 60 mulheres, 40 com candidíase vulvovaginal e 20 do grupo controle (sem doença). As células de defesa foram identificadas utilizando um sistema de impedância combinada com a citometria de fluxo, os níveis de IgE total e específica foram medidos por meio de técnicas de quimiluminescência, o teste de Mann-Whitney foi utilizado para variáveis nominais e do teste de Spearman para correlações das concentrações de IgE e de eosinófilos no sangue periférico. RESULTADOS: O número de eosinófilos no sangue periférico de pacientes com candidíase vulvovaginal, 302,60 (±253,07), foi significativamente maior do que o grupo controle, 175,75 (±109,24) (p=0,037). Os níveis séricos de IgE total e específica foram semelhantes em ambos os grupos de mulheres com e sem candidíase vulvovaginal recorrente (p=0,361). Entretanto, observou-se uma correlação positiva moderada entre eosinofilia e níveis de IgE total no sangue periférico de mulheres com candidíase vaginal recorrente (r=0,25). CONCLUSÃO: Mulheres com candidíase vaginal recorrente parecem ter maior concentração de eosinófilos no sangue periférico que as assintomáticas.

PURPOSE: To quantify the number of defense cells and immunoglobulin E (IgE) levels in peripheral blood sampled from women with recurrent vulvovaginal candidiasis. METHODS: A cross-sectional study was conducted on 60 women, 40 with vulvovaginal candidiasis and 20 controls. The defense cells were identified using an impedance system combined with flow cytometry and total and specific IgE was measured by chemiluminescence. The Mann-Whitney test was used for nominal variables and the Spearman test was used to determine the correlation of IgE concentration and eosinophils in peripheral blood. RESULTS: The number of eosinophils in peripheral blood from patients with recurrent vulvovaginal candidiasis, 302.60 (±253.07), was significantly higher compared to control, 175.75 (±109.24) (p=0.037). Serum levels of total and specific IgE were similar in the groups of women with and without recurrent vulvovaginal candidiasis (p=0.361). However, there was a moderate positive correlation between eosinophils and total serum IgE in the candidiasis group (r=0.25). CONCLUSION: Women with recurrent vulvovaginal candidiasis are more likely to have eosinophils in peripheral blood.

Epidemiological analysis of eosinophilia and elevation of immunoglobulin E as a predictable and relative risk of enteroparasitosis / Análisis epidemiológico de eosinofilia y la elevación de inmunoglobulina E como riesgo relativo y predecible de enteroparasitosis

Introduction: among the intestinal parasites, the helminthiasis occupies a prominent position in Brazil, since it worsens malnutrition and the gives rise to neurovegetative disorders. Helminths like Ascaris lumbricoides, Enterobius vermicularis, hookworm, Trichuris trichiura and Strongyloides stercoralis stand out due to several factors that modulate the immune response of individuals. Among the protozoa are Giardia lamblia, Entamoeba histolytica/E. dispar. Parasitic helminth antigens are important to stimulate the production of cytokines such as interleukin-4 and interleukin-5, which act through the induction of IgE synthesis and activation of eosinophils. Eosinophilia is usually detectable in pre-patent period of parasitism, initially linked to B lymphocytes, under the command of Th-2 lymphokines (IL-4 and IL-5), producing IgE in response to initial exposure to an antigen or allergen. Serum IgE high levels occur in tissue migration of larvae or harboring of parasites in tissues. Objective: to determine the presence of eosinophils and IgE elevation in children with intestinal parasites. Methods: high levels of IgE and eosinophils were observed in groups infected and not infected (allergic) to calculate the relative risk of intestinal parasites presumptive differentiated between protozoa and helminths and check what values of these indicators are observed in the epidemiological profile of the surveyed population. Results: the values obtained by calculating the relative risk for eosinophilia, compared with helminths and allergies was 11.71, but when examined by giardiasis compared with other diseases, the relative risk was 0.75. Since the comparison of helminths and giradiase, the relative risk was 27.33. Since IgE and its parameters were appropriate commit Helminth relative risk 0.39; Giardiasis had relative risk 8.18 and Helminths compared with giardiasis had 0.03. Conclusion: in this study it was possible to observe that helminthiasis is connected with cases of eosinophilia with alteration of IgE, which in turn contributes to the presence of IgE eosionofilia and has an effector response against helminths that provides the expulsion of its larvae.

Introducción: entre los parásitos intestinales, la helmintiasis ocupa un lugar destacado en Brasil, porque causa malnutrición y la instalación de cuadros de trastornos neurovegetativos. Helmintos como Ascaris lumbricoides, Enterobius vermicularis, anquilostoma, Trichuris trichiura y Strongyloides stercoralis se destacan debido a varios factores que modulan la respuesta inmune de los individuos. Entre los protozoos, los más destacados son Giardia lamblia y Entamoeba histolytica/E. dispar. Los antígenos de helmintos parásitos son importantes para estimular la producción de citocinas como la interleucina-4 e interleucina-5, que actúan a través de la inducción de la síntesis de IgE y la activación de los eosinófilos. La eosinofilia es detectable por lo general en el período pre-patente de parasitismo, inicialmente vinculada a los linfocitos B, bajo el mando de Th-2 linfocinas (IL-4 e IL-5), la producción de IgE en respuesta a la exposición inicial a un antígeno o alergeno. Los niveles séricos de IgE se producen en la migración de las larvas de los tejidos o la acogida de los parásitos en estos. Objetivo: determinar la presencia de eosinófilos y la elevación de IgE en niños con parásitos intestinales y cuantificar el riesgo relativo de estos parámetros biológicos. Methods: se observaron altos niveles de IgE y de eosinófilos en grupos infectados y no infectados (alergias) a fin de calcular el riesgo relativo (RR) de parásitos intestinales presuntamente diferenciados entre protozoos y helmintos, así como chequear qué valores de estos indicadores se observan en el perfil epidemiológico de la población estudiada. Resultados: los valores obtenidos mediante el cálculo del riesgo relativo para la eosinofilia, en comparación con helmintos y otras enfermedades fue 11,71, pero cuando se examina por la giardiasis en comparación con alergias resultó de 0,75. En la comparación de los helmintos y la giardiasis, el riesgo relativo fue de 27,33. Dado que la IgE y sus parámetros eran adecuados, entonces helmintos RR 0,39; giardiasis RR 8,18; y helmintos en comparación con giardiasis 0,03. Conclusión: con este estudio se pudo observar que las helmintiasis están relacionadas con casos de eosinofilia con alteración de la IgE; este último, que a su vez contribuye a la presencia de IgE eosionofilia y a tener una respuesta efectora frente a helmintos que causan la expulsión de sus larvas.

Seroprevalence of human toxocariasis [visceral larva migrans]

A total of 455 patients who fulfilled the inclusion criteria were included in the study. The enrolled patients were subjected to a questionnaire [including sociodemographic and other risk factors] and thorough clinical examination was done for the patients. Sera were collected from patients and tested for anti-Toxocara IgG antibodies using ELISA. The overall and- Toxocara sero-positive was [7.7%]. It was significantly higher than among the randomly selected 30 healthy controls. There were no significant differences between the seropositive and seronegative patients regarding age, sex, educational level and monthly family income of the patient. However, rural residence, poor house, pet's ownership and frequent contact with soil were found to be significant. Patients who had confirmed bronchial asthma were more than 2 times at higher risk of developing toxocariasis [OR, 2.33; 95% CL 1.09-4.98] than those with other clinical diagnosis [PUO, hepato-megaly or heptosplenomegaly, lympha-denopathy, neurological disorders, gastrointestinal troubles and dermatitis]. Patients with eosinophilia were at 149 times greater risk of being Toxocara seropositive compared to those without eosinophilia [OR, 148.7; 95% CI: 53.5-413.3]. Multivariate regression analysis showed eosinophilia and contact with soil were the most important predictors of toxocariasis. OD of anti-Toxocara antibodies [ELISA] was significantly positive with eosinophilia level

Treatment of eosinophilia with albendazole.

Twenty-five patients with eosinophil counts > 1,000/mm3 of unknown etiology were treated with albendazole 400 mg twice daily for 7 days were compared with 25 eosinophilic control patients who were not treated. The average eosinophil count in the treated group was 2,079/mm3 (range 1,002-7,629/mm3) and in the control group was 2,047/mm3 (range 1,002-6,468/mm3). One month later the eosinophil counts of both groups were re-evaluated. Effective treatment was defined as an eosinophil count < 1,000/mm3. In the treatment group, 80% had a reduction in the eosinophil count to < 1,000/mm3 while only 12% of the control had a reduction to this level. No side effects were observed in either group. In conclusion, albendazole was found to be highly-effective in the management of patients with eosinophilia without obvious causes.

sICAM-1 in meningoencephalitis due to Angiostrongylus cantonensis / sICAM-1 en meningoencefalitis por Angiostrongylus cantonensis

INTRODUCTION: Angiostrongylus cantonensis meningoencephalitis is an emergent disease in the Americas. METHOD: Twelve children suffering from eosinophilic meningoencephalitis due to this parasite aged between 6-10 years were studied. Cerebrospinal fluid (CSF) and serum samples were taken simultaneously in the first diagnostic puncture at admission. RESULTS: All cases showed typical findings on the routine CSF and serum analysis: increased CSF total protein, increased Q (CSF/serum) albumin accompanied by eosinophilia in CSF. No intrathecal synthesis of immunoglobulins was found. Mean serum and CSF sICAM-1 values were 337.4 and 3.97 ng/mL. Qalbumin and QsICAM-1 mean values were 4.1 and 6.2 respectively. In 50 percent of the patients an increased brain-derived fraction of sICAM-1 was found. CONCLUSION: It may be suggested that a dynamic of the sICAM-1 brain derived fraction is perhaps associated to the immune response in the evolution of the disease.sICAM-1 may be an agent in negative feedback for eosinophils passage through the blood-CSF barrier into the inflammatory brain response.

INTRODUCCION: La meningoencefalitis por Angiostrongylus cantonensis es una enfermedad emergente en las Américas. MÉTODO: Doce niños con meningoencefalitis eosinofílica por Angiostrongylus cantonensis con edades entre 6 y 10 años fueron estudiados. Se tomaron muestras simultáneas de suero y líquido cefalorraquídeo (LCR) en la primera punción lumbar diagnóstica. RESULTADOS: Todos los casos evidenciaron hallazgos típicos en los análisis de rutina del LCR y suero: incremento de proteínas totales, aumento de la razón albúmina Q (LCR/suero) acompañado de eosinofilia en LCR. No se encontró síntesis intratecal de inmunoglobulinas. Los valores medios de sICAM-1 en suero y LCR fueron de 337,4 y 3,97 ng/mL respectivamente. Los valores medios de Q albúmina y Q sICAM-1 fueron de 4,1 y 6,2 respectivamente. En el 50 por ciento de los pacientes se encontró un incremento de la fracción de sICAM-1 derivado del cerebro. CONCLUSION: Se puede sugerir que la dinámica de la fracción sICAM-1 derivada del cerebro ocurre quizas asociada a la respuesta inmune frente a la enfermedad. sICAM-1 puede ser un agente de retroalimentación negativa para el paso de eosinófilos de la sangre a través de la barrera sangre-LCR en el cerebro inflamado.

A Case of Acute Eosinophilic Myopericarditis Presenting with Cardiogenic Shock and Normal Peripheral Eosinophil Count

Eosinophilic myocarditis usually results from myocardial damage as a result of drugs or parasites, and is generally associated with increased peripheral eosinophil count. This form of myocarditis is difficult to diagnose clinically. A 25 year-old previously healthy woman was transferred from a local clinic because of hypotension and dyspnea with sudden cardiogenic shock after a three day history of gastrointestinal illness. Echocardiography revealed concentric left ventricular wall thickening with moderate pericardial effusion. Biopsy of endomyocardial tissue from the right ventricle showed diffuse infiltration of inflammatory cells, mostly eosinophils, even though the patient had a peripheral eosinophil count that was normal at the time of biopsy. The patient was treated with corticosteroids for the symptoms of pericarditis, and she recovered without cardiac sequelae, clinically and echocardiographically. We here report a case of acute eosinophilic myopericarditis, with cardiogenic shock, diagnosed by endomyocardial biopsy with normal peripheral eosinophil count at the time of biopsy, and complete recovery without sequelae.

Assessment of transforming growth factor -beta [TGF-beta] and auto antibodies in human fascioliasis

Seventy individuals were included in this study, sixty of them suffering from fascioliasis: thirty with acute and the other thirty with chronic fascioliasis. Ten individuals were taken as a control group. All patients and controls were subjected to clinical, stool, urine and blood examination, abdominal ultrasonography and estimation of TGF-beta and non-organ specific autoantibodies in their serum. The presenting symptoms were abdominal pain [93.3% and 30%], fever [100% and 10%], urticaria [40% and 16.7%] and diarrhoea [53.3% and 3.3%] in acute and chronic stages of fascioliasis respectively. Among the acute and chronic cases of fascioliasis, the following signs wcre presented: hepatomegaly [100% and 66.7%], splenomegaly [63.3% and 16.7%], pallor [80% and 43.3%], fever [100% and 10%] and jaundice [0% and 16.7%]. Abdominal ultrasonography revealed hepatomegaly and splenomegaly in patients with acute fascioliasis while in chronic patients there were common bile duct dilatation, intrahepatic biliary radical dilatation and echogenic shadows in biliary system in 16.7%, 16.7% and 23.3% respectively. During the acute stage a significant increase was observed in TGF-beta level comparing to the chronic and normal control groups. The present study also found that the percent positivity of auto-antibodies increased with the chronicity of the disease; anti-nuclear antibodies [0% and 60%], anti-deoxyribonucleic acid [0% and 20%], anti-smooth muscles [3.3% and 70%] and anti-mitochondrial [6.6% and 26.6%] in acute and chronic stages respectively. It can be concluded that TGF-beta elevation and absence of antinuclear and anti deoxyribonucleic acid antibodies in patients with acute infection can be used as diagnostic markers and monitor for early infection

A case of eosinophilic meningitis.

A case of eosinophilic meningitis is reported, a condition not previously reported from Sri Lanka. We propose Angiostrongylus cantonesis to be the most likely causative agent in this patient.

Serum interleukin-6, immunoglobulin-E levels and eosinophil count in children with atopy

The cytokine cascade involved in IgE production has implications in allergic inflammation. For this purpose, changes in IL-6 and IgE levels and eosinophilic count were evaluated in sixty children with atopy. They included thirty patients with atopic dermatitis [AD], and thirty with bronchial asthma [BA]. Twenty age- matched apparently healthy children were chosen as control group. The mean serum IL-6 Level was significantly higher in AD [18.85 +/- 17.79 Pg/ml] and BA [45 +/- 38.79 Pg/ml] than the control group [10.28 +/- 7.02 Pg/ml], [p<0.01 and <0.001 respectively]. Higher values for IgE and eosinophil count were also demonstrated among AD [681.9 +/- 555.79 Iu/ml] and [0.69 +/- 0.5 count x 10[2]/L] and BA [2122.9 +/- 1636.86 Iu/ml] and [0.52 +/- 0.38 count x 10[2]/L] as compared to controls [75 +/- 23.8 Iu/ml] and [0.15 +/- 0.11 count x 10[2]/L], [P<0.001 for both]. In addition, serum IL-6 and IgE values were significantly higher in BA than AD group [P<0.01 and <0.001 respectively]. Correlation studies revealed a highly significant positive correlation between serum IL-6 and IgE in both AD [r = 0.79] and BA [r = 0.76] groups, [P<0.001 for both]. Furthermore, among AD group, IL-6 and IgE levels differed grossly with the degree of severity of the disease. By using Z-score, IgE level was the most sensitive estimated parameter to discriminate AD and BA from control group. IL-6 was the second one in BA, while eosinophilic count was the second discriminative parameter in AD. We concluded that IL-6 may be used a sensitive marker of disease activity, beside its possible role in the pathophysiology of bronchial asthma and atopic dermatitis

potential role of macrophage migration inhibitory factor in house dust nasal allergy

The role of macrophage migration inhibitory factor [MIF] was studied in patients with house dust nasal allergy. Macrophage migration inhibition test [MIT] was done for 30 patients with house dust nasal allergy. In 43% of the patients; nasal allergy was associated with other atopic diseases as bronchial asthma, atopic dermatitis and allergic conjunctivitis. Patients were clinically classified into: seasonal, perennial allergic rhinitis and perennial with seasonal exacerbation groups. 20 healthy subjects served as a control group. Eosinophilia was detected in all patients. 80% of the patients had positive MIT as compared to 60% in healthy individuals. The difference between the two groups was statistically insignificant [p > 0.05], while there was a significant difference in the mean value of MIT results between the two groups [p < 0.05]. In addition, there was significant association between the production of MIF and the severity of allergic manifestations and the presence of other atopic disease. On the other hand there was no significant association between the production of MIF and the type of nasal allergy. It is concluded that the production of MIF by allergen-stimulated T-Iymphocytes may be a useful laboratory parameter to comprehend the clinical course of the disease

Fasceítis eosinofílica con polineuropatía autoinmune y mucinosis papulosa / Eosinophylic fasceitis with autoimmune polyneuropathy and papular mucinosis

La fasceítis eosinofílica es un cuadro clínico de curso benigno que aparece en general tras un esfuerzo físico importante. Se presenta un paciente de 60 años, sexo masculino, con una fasceítis eosinofílica de extenso compromiso cutáneo, polineuropatía y mucinosis papulosa, con buena respuesta al tratamiento combinado con corticoides y cimetidina

Sensibilizaçäo a aeroalérgenos em indivíduos com asma brônquica e/ou rinite crônica em Salvador, Bahia / Sensitization to allergens in people with bronchial asthma and/or chronic rhinitis in Salvador, Bahia

Os alérgenos de ácaros, baratas, fungos e epitélios de animais estäo relacionados à patogenia das doenças alérgicas respiratórias. O objetivo deste estudo foi o de observar, em Salvador, em amostra de indivíduos portadores de asma brônquica (AB) e/ou rinite crônica (RC), a freqüência de reatividade aos testes cutâneos (TC) com esses aeroalérgenos mais comuns. Cento e cinqüenta e sete indivíduos portadores de AB e/ou RC e 31 indivíduos näo-atópicos, residentes em Salvador, além de 31 indivíduos näo-atópicos, infectados por S. mansoni e residentes em Caatinga do Moura, foram submetidos a TC realizados pela técnica de puntura modificada, com diferentes aeroalérgenos. Paralelamente, foram também estudadas outras variáveis, como níveis séricos de IgE, anticorpos específicos deste isótipo, eosinofilia em sangue periférico, infestaçäo parasitária intestinal e exposiçäo a aeroalérgenos. Foi observada freqüência de 80,3 por cento de pelo menos um TC positivo no grupo de indivíduos com AB e/ou RC, comparada a 19,3 por cento de TC positivos nos grupos controle. Nos indivíduos com AB e/ou RC os ácaros foram responsáveis pela maior freqüência de positividade aos TC, 86,6 por cento, com intervalo de confiança de 95 por cento (IC 95 por cento), variando entre 79,9 a 91,7. Nesses indivíduos, as espécies D. pteronyssinus e B. tropicalis foram as que mostraram maior percentual de positividade, 62,7 por cento, com IC 95 por cento de 54,2 a 70,6. Adicionalmente, nesses indivíduos com AB e/ou RC, näo foram observadas associaçöes estatisticamente significantes entre os níveis de IgE total e TC positivos (p=0,63), eosinofilia e helmintíase intestinal (p=0,35) e entre esta última e TC positivos (p= 0,50). Houve correlaçäo positiva entre os resultados de TC positivos apenas para antígenos de D. farinae e presença de IgE específica para este alérgeno (r=0,63). Os resultados deste estudo demonstram que, em Salvador, na amostra de indivíduos com AB e/ou RC avaliada, os ácaros, principalmente as espécies D. pteronyssinus e B. Tropicalis, säo os alérgenos mais importantes.

Contagem de eosinófilos circulantes e níveis séricos de proteína catiônica eosinofílica em asmático / Peripheral blood eosinophils and serum level of eosinophil cationic protein in asthmatics

Objetivo: Determinar o número de eosinófilos em sangue periférico e níveis séricos de proteína catiônica eosinofílica em asmáticos e a relaçäo entre eosinófilos e a liberaçäo deste mediador químico. Métodos: Foram estudados 26 asmáticos atópicos, com idade entre 7 e 16 anos, divididos em dois grupos pela gravidade da asma. A contagem de eosinófilos se obteve multiplicando-se o número de leucócitos pelo Sistema de Coulter pelo percentual de eosinófilos em esfregaços de sangue. os níveis de proteína catiônica eosinofílica foram determinados por métodos fluoroenzimático, CAP System de Pharmacia Diagnostics. Resultados: os asmáticos apresentaram eosinofilia significativa (810 +- 103/mcl) comparados a indivíduos normais (158 +- 30/mcl)...

Eosinófilos hipodensos no sangue de pacientes pediátricos com asma / Hypodense eosinophils in blood of pediatric patients with asthma

Objetivo: Determinar o número de eosinófilos hipodensos no sangue de asmáticos atópicos. Métodos: A hipótese inicial era que os eosinófilos hipodensos, forma ativda destas células, encontravam-se em número maior em asmáticos do que em crianças näo atópicas. Os granulócitos foram separados das células mononucleares pelo Ficoll-Hypaque. Através de diluiçöes de Percoll foram criados gradientes de densidade para fracionamento de eosinófilos. Resultados: Os asmáticos tinham eosinofilia significativa (768 +- 75/mcl) comparados aos normais (200 +- 28/mcl). A média de eosinófilos hipodensos era superior em asmáticos (39 por cento) do que em indivíduos normais (11,7 por cento). Conclusäo: Os eosinófilos se acumulam em indivíduos com asma, especialmente a forma ativada de baixa densidade, sugerindo sua participaçäo no processo inflamatório alérgico.

Clon transitorio estimulador de la eosinopoyesis en un linfoma de hodgkin consideraciones generales / Transitory clon stimulator of the eosinopoiesis in a lymphoma hodgkin: generals consideration

La asociación entre Eosinofilia y Linfoma de Hodgkin está ampliamente documentada en la literatura. Generalmente los linfomas que cursan con ella es de manera permanente mientras está activa la enfermedad. Se reporta caso inusual de un Clon Transitorio de Linfocito T que estimuló la Eosinopoyesis hasta llegar a un 92 por ciento con un contaje absoluto de 53000 Leucocitos/mm. Una vez extraído este Clon, descendió la Eosinofilia sin volver a presentarla en ninguno de los estadios de la enfermedad, destacándose el efecto morfológico de la fibrosis perifolicular con lesión residual entre la interacción del eosinófilo, inmunoblasto y Linfoma de Hodgkin. A la fecha no hemos encontrado un reporte similar con esta secuencia citoinmunomorfológica.

Infección por virus de la inmunodeficiencia humana: aumento de eosinófilos en sangre periférica durante la progresión de la infección / Human immunodeficiency virus infection: increse of eosinophils in peripheralblood during progress of the infection

En este estudio se evaluó el nivel de eosinófilos en sangre periférica de individuos HIV-seropositivos y su relación con el estado inmune y las manifestaciones clínicas. Se incluyeron 79 pacientes agrupados según el nivel absoluto de linfocitos (L) CD4+ y manifestaciones clínicas asociadas en; 1) 23 pacientes con infección asintomática (IA) y > 500 L.CD4+/mm3, 2) 24 pacientes con < 200 L.CD4+/mm3 y manifestaciones clínicas asociadas (SIDA) y 3) 32 pacientes con IA y > 500 L.CD4+/mm3 que durante el estudio evolucionaron a SIDA. Los pacientes fueron evaluados durante un período medio de 27 meses. Se consideró aumento de eosinófilos a cifras porcentuales ò 5 por ciento que persistieron en tres o más estudios consecutivos, debido a que la leucopenia presente en pacientes con SIDA no permitió evidenciar el aumento absoluto de eosinófilos. En pacientes con SIDA (Grupo 2) hubo un aumento significativo del porcentaje de eosinófilos respecto de pacientes con IA (Grupo 1) (6,0 ñ 0,7 por ciento vs. 3,3 ñ 0,2 por ciento, p < 0,05). La incidencia de cifras porcentuales ò 5 por ciento de eosinófilos fue de 37,5 por ciento en pacientes con SIDA y 21,7 por ciento en pacientes con IA. En estos pacientes, las cifras porcentuales fueron de 10,0 ñ 1,2 por ciento y 6,3 ñ 0,6 por ciento respectivamente. En pacientes con IA y que durante el estudio evolucionaron a SIDA (Grupo 3) hubo un comportamiento similar en los niveles de eosinófilos como el observado en pacientes con IA y pacientes con SIDA. En pacientes con IA y aumento de eosinófilos hubo una disminución significativa (p < 0,05) de inmunoglobulinas A y E séricas respecto de pacientes sin aumento de eosinófilos. El aumento de eosinófilos no estuvo relacionado con las manifestaciones clínicas y tratamientos. En conclusión, estos hallazgos indican que el aumento de eosinófilos durante la evolución de la infección por HIV tiene un significado variado y puede ser considerado en el contexto del estado de inmunodeficiencia y las manifestaciones clínicas asociadas

Eosinofilia en enfermos de uveitis anterior aguda / Eosinophilia in patients presenting with acute anterior uveitis

Se realizo un estudio prospectivo en 50 enfermos de uveitis anterior aguda con el proposito de describir en los mismos la eosinofilia ocular y en sangre. En el estudio se corrobora que en la totalidad de los casos con sensibilidad alergica demostrada, aparece eosinofilia ocular y en sangre. Sin embargo, en aquellos en que la etiologia fue una colecistopatia con giardiasis cronica asociada, aparece eosinofilia ocular en el 79,0 por ciento. Es destacable que en los pacientes cuya causa fue un poco septico,toxoplasmosis o enfermedad autoinmune, no se contato eosinofilia. En dicha investigacion se valora la importancia del eosinofilo en los pacientes con uveitis anterior aguda, cuya causa probable es alergica, infecciosa o autoinmunitaria