Immunological correlates of cure in the first American Cutaneous Leishmaniasis patient treated by immunotherapy in Argentina: A case report. / Correlatos inmunológicos de curación en el primer paciente con Leishmaniasis Cutánea Americana tratado con inmunoterapia en Argentina: Reporte de un caso

A patient with localized cutaneous leishmaniasis due to Leishmania (Leishmania) amazonensis infection was treated with an antigen containing heat-killed L. (L.) amazonensis promastigotes plus BCG. Expression of T-cell differentiation, memory and senescence receptors markers were analyzed on T cell subpopulations, in order to establish the correlation between the percentages of expression of these receptors and his clinical status, at different stages of his follow up. The following case reports on the achievement of a successful clinical outcome with complete resolution after receiving immunotherapy. A thorough clinical and immunological follow up supporting the healing process of this patient’s lesion is presented in detail.

Un paciente con leishmaniasis cutánea localizada producida por Leishmania (Leishmania) amazonensis fue tratado con un antígeno compuesto por promastigotes de L. (L.) amazonensis muertos por calor combinado con BCG. Se analizó la expresión de distintos receptores de diferenciación, de memoria y de senescencia en las subpoblaciones de células T, con el fin de establecer una relación entre los porcentajes de expresión de dichos receptores y la clínica del paciente en diferentes momentos del seguimiento. Se reporta en este caso un resultado exitoso, con resolución completa de la lesión después de recibir la inmunoterapia, y se presenta en detalle un seguimiento clínico e inmunológico completo durante el proceso de curación.

Morbidade da doença de Chagas em pacientes autóctones da microrregião do Rio Negro, Estado do Amazonas / Morbidity of Chagas disease among autochthonous patients from the Rio Negro microregion, State of Amazonas

INTRODUÇÃO: Foi realizado um estudo soroepidemiológico e clínico em 152 indivíduos residentes no município de Barcelos, Estado do Amazonas. Avaliou-se a soroprevalência da infecção chagásica e a morbidade da doença de Chagas. MÉTODOS: Os testes sorológicos foram a imunofluorescência indireta, ELISA convencional e recombinante e o Tesa-blot. Foram considerados soropositivos 38 pacientes, duvidosos 31 e soronegativos negativos 83. Os 38 casos soropositivos foram pareados com 38 controles soronegativos da mesma idade, sexo e submetidos à avaliação epidemiológica, clínica, eletro e ecocardiográfica, sendo que, 29 pares fizeram exame radiológico do esôfago. RESULTADOS: A soropositividade foi 19,9 vezes mais frequente nos trabalhadores do extrativismo em geral e 10,4 vezes mais frequente no extrativismo da piaçaba. Aplicou-se o teste de reconhecimento com o vetor local do gênero Rhodnius e 86,7 por cento dos pacientes soropositivos o reconheceram, enquanto somente 34,2 por cento dos soronegativos o fizeram. O ECG mostrou-se alterado em 36,8 por cento nos soropositivos e em 21,5 por cento nos soronegativos, enquanto o ecocardiograma mostrou alterações em 31,6 por cento nos soropositivos e 18,4 por cento nos soronegativos. Precordialgia e palpitações foram mais frequentes nos soropositivos. O estudo clínico do aparelho digestivo e radiológico do esôfago não mostrou alterações significativas. CONCLUSÕES. A doença de Chagas na região estudada pode ser considerada uma doença ocupacional.

INTRODUCTION: A seroepidemiological and clinical study was conducted on 152 autochthonous individuals living in the district of Barcelos, State of Amazonas, to evaluate the seroprevalence of Chagas infection and morbidity of Chagas disease. METHODS: The serological tests used were indirect immunofluorescence, conventional and recombinant ELISA and immunoblot (Tesa-blot). Thirty-eight patients were considered seropositive; 31 were considered serodoubtful; and 83 were considered seronegative. The 38 seropositive cases were paired with 38 seronegative controls of the same age and sex, and underwent epidemiological and clinical evaluations, electrocardiograms and echocardiograms. Twenty-nine pairs underwent radiological examinations of the esophagus. RESULTS: Seropositivity was 19.9 times more frequent among workers gathering plant materials from the forests and 10.4 times more frequent among piassaba gatherers. Eighty six point seven percent of the seropositive individuals recognized the genus Rhodnius as the local vector, while only 34.2 percent of the seronegative individuals recognized this. The EKG was abnormal in 36.8 percent of the seropositive individuals and in 21.5 percent of the seronegative individuals, while the echocardiogram showed abnormalities in 31.6 percent of the seropositive and 18.4 percent of the seronegative individuals. Precordialgia and palpitation were more frequent among the seropositive individuals. Clinical evaluation on the digestive system and X-ray on the esophagus did not show significant abnormalities. CONCLUSIONS: Chagas disease in the study region can be considered to be an occupational disease.

Immunoparasitological diagnosis of Strongyloides stercoralis in garbage collectors in Uberlândia, MQ Brazil

The objective of this study was to determine the presence of Strongyloides stercoralis in urban garbage collectors through the use of immunological and parasitological methods. A total of 92 individuals were evaluated from August, 1997, to June, 1998. For the parasitological diagnosis Baermann and Lutz' methods were applied. The immunological diagnosis involved the indirect fluorescence antibody test (IFAT) and the enzyme-linked immunosorbent assay (ELISA) to detect specific IgG antibodies. Of the 92 workers examined, six (6.5 percent) were infected with larvae of S. stercoralis. The IFAT detected 19 (16.3 percent) and the ELISA 17 (18.5 percent) positive serum samples. The differences between the results of parasitological and immunological methods were statistically significant (p<0.05). These results demonstrate that there is a need to improve the health conditions of this category of city employees.

Activity of bristles from an Amazonian lepidoptera, "Premolis semirufa", on the human complement system

O lepidóptero Premolis semirufa habita os seringais da regiao Amazônica. Os seringueiros denominam pararama a forma larval do inseto e pararamose a doença ocupacional causada pelo contato acidental com cerdas da larva ou casulo durante a coleta do látex. Os sintomas imediatos que se seguem ao contato sao locais e consistem em prurido intenso, edema e dor, que sao geralmente transitórios e desaparecem em poucos dias. Entretanto, em algumas circunstâncias, o processo torna-se crônico, podendo evoluir para a deformidade e imobilizaçao da articulaçao afetada, lembrando, sob alguns aspectos, artrite reumatóide. O estudo da açao in vitro de cerdas e substâncias solúveis associadas sobre o sistema complemento humano mostrou que tanto cerdas quanto extrato salino inativam complemento total e o componente C2, geram C3d a partir de C3, sem afetar os níveis de Clq. Estes resultados sugerem que a via clássica de ativaçao do complemento nao está envolvida no processo. A inativaçao direta de C2 e a geraçao de C3d sao compatíveis com a presença de substâncias solúveis com açao lítica associadas às cerdas, embora nao tenha sido excluída ativaçao paralela da via alternativa como mecanismo de produçao de C3d

"Pararamose": an occupational arthritis caused by lepidoptera (Premolis semirufa): an epidemiological study

The frequency of "pararama" occupational accidents between 1988 and 1990 as well as some associated clinical manifestations are herein reported. Data were collected at an industrial rubber tree plantation, in the northern part of Brazil and compared with data similarly collected from 1971 to 1974 on the same plantation, before starting protective measures. "Pararama" is the popular name of the larval form of a native insect of the Amazonian region, Premolis semirufa. During the study period, the annual average of latex extractors was 337 and 60 accidents caused by "pararama" were registered. The annual average number of accidentes per worker from 1971 to 1974 was 0.117 and in the period of this study, 0.063(p=0.061). Nineteen injured subjects were clinically evaluated and 13 of them were symptomic. There was a statistically significant association between multiple accidents and the presence of symptoms (p=0.001). "Pararamose", an occupational arthropathy, which may evolve with functional impairment of the affected joint, can be prevented with the latex extractors education and the institution of prophylactic measures, such as the use of gloves, boots and protective glasses