Algunos factores epidemiológicos relacionados con la tuberculosis en la provincia de Santiago de Cuba (2005-2007) / Some epidemiologic factors related to tuberculosis in Santiago de Cuba province 2005-2007

Se realizó un estudio descriptivo y transversal para caracterizar a los 155 pacientes con tuberculosis en la provincia de Santiago de Cuba durante los años 2005-2007. Hubo un ligero incremento de la tasa de incidencia de la enfermedad en ese trienio, con predominio en los municipios de Santiago de Cuba, Palma Soriano y Julio Antonio Mella (en este último aumentó de forma significativa en el 2007). Se observó, de forma general, que los afectados tenían entre 2 y 3 factores de riesgo y la mayoría pertenecieron a los grupos etarios de más de 55 años. Primaron la tuberculosis pulmonar y la positividad del bacilo ácido-alcohol resistente. En la atención primaria se diagnosticó el mayor número de personas infectadas, las cuales tenían menos de 23 días de haber estado experimentando los síntomas. Hubo 5 pacientes que presentaron coinfección con el virus de inmunodeficiencia adquirida.

A descriptive and cross-sectional study was carried out to characterize the 155 patients with tuberculosis in Santiago de Cuba province during the years 2005-2007. There was a slight increase of the incidence rate of the disease in that triennium, with prevalence in Santiago de Cuba, Palma Soriano and Julio Antonio Mella municipalities (in this last one it increased in a significant way in 2007). In general it was observed, that the affected ones had between 2 and 3 risk factors and most of them were in the age group of more than 55 years. The lung tuberculosis and the positivity of the acid-alcohol resistant bacillus prevailed. The highest number of infected people who had less than 23 days of experiencing the symptoms, was diagnosed in the primary care. There were 5 patients that presented co-infection with the acquired immunodeficiency virus.

Analysis of the sputum and inflammatory alterations of the airways in patients with common variable immunodeficiency and bronchiectasis

INTRODUCTION: Common variable immunodeficiency is characterized by defective antibody production and recurrent pulmonary infections. Intravenous immunoglobulin is the treatment of choice, but the effects of Intravenous immunoglobulin on pulmonary defense mechanisms are poorly understood. OBJECTIVE: The aim of this study was to verify the impact of intravenous immunoglobulin on the physical properties of the sputum and on inflammatory alterations in the airways of patients with Common variable immunodeficiency associated with bronchiectasis. METHOD: The present study analyzed sputum physical properties, exhaled NO, inflammatory cells in the sputum, and IG titers in 7 patients with Common variable immunodeficiency and bronchiectasis with secretion, immediately before and 15 days after Intravenous immunoglobulin. A group of 6 patients with Common variable immunodeficiency and bronchiectasis but no sputum was also studied for comparison of the basal IgG level and blood count. The 13 patients were young (age=36±17 years) and comprised predominantly of females (n=11). RESULTS: Patients with secretion presented significantly decreased IgG and IgM levels. Intravenous immunoglobulin was associated with a significant decrease in exhaled NO (54.7 vs. 40.1 ppb, p<0.05), sputum inflammatory cell counts (28.7 vs. 14.6 cells/mm³, p<0.05), and a significant increase in respiratory mucus transportability by cough (42.5 vs. 65.0 mm, p < 0.05). CONCLUSION: We concluded that immunoglobulin administration in Common variable immunodeficiency patients results in significant improvement in indexes of inflammation of the airways with improvement in the transportability of the respiratory mucus by cough.

Inflammatory cytokine levels in induced sputum and bronchoalveolar lavage fluid in pulmonary sarcoidosis.

BACKGROUND: The immune inflammatory process in patients with sarcoidosis is not only compartmentalized within the alveolar walls, but also involves the bronchial airways. Analysis of induced sputum has been used as a non-invasive tool for investigating the airways and may reflect the endobronchial and parenchymal inflammation in patients with sarcoidosis. This present study was designed to measure the soluble pro-inflammatory cytokine levels interleukin-1 (IL-1), interleukin-6 (IL-6), tumuor necrosis factor-alpha (TNF-alpha) and percentage of macrophages expressing these cytokines in induced sputum and bronchoalveolar lavage (BAL) fluid in patients with pulmonary sarcoidosis. METHODS: Sputum induction and BAL was carried out in 27 patients with newly diagnosed sarcoidosis. Control group consisted of six patients with a normal chest radiograph (three patients with carcinoma esophagus and three patients with doubtful history of hemoptysis). Induced sputum was also obtained from 10 non-smoking, non-atopic healthy controls. RESULTS: Percentage of macrophages expressing pro-inflammatory cytokines and soluble cytokine levels in induced sputum were higher in patients with sarcoidosis compared to both groups of controls. There was good correlation between IL-6 and TNF-alpha levels (r = 0.49, 0.58 p < 0.05) and percentage of macrophages expressing all three cytokines (r = 0.56-0.71, p < 0.01) between induced sputum and BAL fluid. Mild positive correlation between cytokine levels in sputum and age was also noted (r = 0.33-0.38, p < 0.05). CONCLUSIONS: Induced sputum may reflect changes in cytokine milieu in BAL in sarcoidosis.

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6 percent) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59 percent, range 3.2-50 vs 5.46 percent, 0-26.92 percent, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88 percent, range 12.87-50 vs 10.48 percent, 3.2-21.69 percent; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.

Levels of antibody, free antigen and immune-complexed antigen by ELISA in different grades of sputum positive patients of pulmonary tuberculosis.

The ES-31 (31 kDa protein) antigen was isolated from culture filtrate of Mycobacterium tuberculosis H37Ra and was shown to have potential in immunodiagnosis of pulmonary tuberculosis. Serum samples from 38 confirmed sputum positive pulmonary tuberculosis patients were grouped into AFB+, AFB++, AFB+++ based on sputum bacillary load. Analysis of tubercular antibody, circulating free and immune complexed antigen (CIC-Ag) was done in serum samples by Indirect and Sandwich ELISA using ES-31 antigen and affinity purified anti ES-31 antibody respectively. The analysis of Geometric mean titre (GMT) of all the three groups showed that GMT of tubercular antibody was considerably decreased compared to elevated levels of CIC-Ag (Antibody: 1360 to 816 and CIC-Ag: 534 to 1744) from low bacillary sample to high bacillary samples, whereas there is no significant change in the titre of circulating free antigen. Low levels of detectable antibody is observed possibly due to removal of antibody from circulation by immune complex formation as confirmed by its elevated levels in sputum AFB+++ positive patients.

Study of sputum level of interleukin-8 in COPD patients

The present study was conducted to assess the characteristics of airway inflammation in patients with COPD by measuring the sputum level of IL-8. Eighty subjects were included in this study. 40 patients with COPD, 30 patients with bronchial asthma and 10 healthy control. All of studied groups were subjected to full history, ventilatory pulmonary function tests and measurement of IL-8 in sputum supernant by enzyme linked immunosorbent assay [ELISA]. The study elucidated significant higher level of IL-8 in COPD patients than in bronchial asthma patients or in the control subjects. There was significant negative correlation between sputum level of IL-8 and pulmonary function parameters. Also it was found that EFV1% was the only parameter of pulmonary function test which could significantly predict the sputum level of IL-8. It is concluded that IL-8 may serve as a marker in evaluation of the severity of airway inflammation and its sputum level was closely related to the severity of airway obstruction in COPD patients

Effects of prednisolone on eosinophils, IL-5, eosinophil cationic protein, EG2+ eosinophils, and nitric oxide metabolites in the sputum of patients with exacerbated asthma

Corticosteroids are considered to be one of the most effective medicine for asthma by suppressing airway inflammation. This study was carried out to investigate the effects of prednisolone in the sputum of exacerbated asthmatics. Clinical severity, cell differentials, levels of interleukin (IL)-5, eosinophil cationic protein (ECP), EG2+ eosinophils, and nitric oxide (NO) metabolites were measured. Sputum was examined 2 weeks apart in 13 exacerbated asthmatics before and after prednisolone treatment, and once in 12 stable asthmatics. We used a sandwich ELISA for IL-5, fluoroimmunoassay for ECP, immunohistochemical staining for EG2+ eosinophils, a NO metabolites assay using modified Griess reaction. Exacerbated asthmatics, in comparison with stable asthmatics, had significantly higher proportion of eosinophils, higher level of ECP, higher percentage of EG2+ eosinophils, and NO metabolites. Exacerbated asthmatics after treatment with prednisolone had reduced the proportions of eosinophils, reduced level of IL-5, ECP and percentage of EG2+ eosinophils. FEV1 was correlated with the proportion of eosinophils, ECP, and IL-5 respectively. These findings suggest that prednisolone is considered to be effective medicine for asthma by suppressing eosinophil activation through IL-5.

Estudio comparativo de la IgA secretora / Comparative study of secretor IgA

Objetivo: medir y comparar los niveles de IgA secretora (SIGA) en la mucosa del árbol respiratorio. Diseño: estudio transversal descriptivo. Lugar de realización: Departamento de Neumología, Hospital General del CMN L Raza, IMSS. Material y métodos: se incluyeron 35 sujetos voluntarios con consentimiento informado para someterse a lavado nasal y lavado bronquial, cuyas mustras junto con la expectoración se analizaron para determinar niveles de SIgA por el método nefelométrico, reportándose como la concentración relativa de SIgA/concentración entre los tres tipos de muestras. Resultados: los valores de SIgA en expectoración, lavado nasofaríngeo y lavado bronquial fueron similares. La media y error estándar a nivel nosofaríngeo fue 0.ñ064 0.007, a nivel de esputo 0.073 ñ 0.01 y a nivel bronquial 0. 082 ñ 0.017. La correlación obtuvo r= 0.508 (p < 0.01)

HLA class I profile in Asian Indian patients with pulmonary tuberculosis.

HLA class I antigen profile was studied in 153 unrelated patients with pulmonary tuberculosis (PTB), 40 family contacts and 289 healthy individuals by the NIH microlymphocytotoxicity test to find out the role of HLA-A, -B, -C alleles in influencing susceptibility to PTB and its various clinical groups. HLA-A2 was found to be significantly increased in the total patient group as compared to controls (38.6% vs 26.3%, p < 0.01, RR = 1.76). The increase of HLA-A2 was more pronounced in the sputum negative patients (59.4%, pc < 0.001, RR = 4.1) suggesting its possible role in the mediation of CD8+ suppressor T cell activity against Mycobacterium tuberculosis, resulting in the development of limited disease in these patients. Further, HLA-B18 was found to be decreased in patients as compared to controls (2.6% vs 7.3%, p < 0.05, RR = 0.34). None of the class I antigens was associated with the dynamics of chemotherapy or disease severity as assessed by the extent of lung involvement on chest X-ray examination.

Cunatificación de la SIgA en pacientes con bronquitis crónica estable / Quantification of the secretory IgA in patients with acute bronchitis

Basados en el hecho de la importancia de la inmunología de las mucosas y del papel que juega la IgA secretora en el aparato respiratorio y ante el hecho de la carencia de datos al respecto en población bronquítica crónica se realizó un estudio clínico porspectivo y transversal en 100 pacientes, mismos que se dividieron en dos grupos: 50 pacientes sanos y 50 con bronquitis crónica estable. a todos ellos se les diagnósticó con los estándares para confirmación y se recolectó la muestra a través de lavado nasal en los pacientes sanos y por expectoración en los bronquítico-crónicos. Se estudiaron por nefelometría por rayos láser. Las concentraciones de IgA se expresaron como resultado de dividir la concentración de IgA entre la concentración total de proteínas de la muestra. El análisis se efectuó por medio de la t de Student. Los resultados demostraron un ligero incremento no significativo a favor de los pacientes bronquítico crónicos. se concluye que tal incremento se deve a un estado de estimulación continua de las mucosas lo que eleva la concentración de IgA como un mecaismo de defensa

Estudio de micobacterias no tuberculosas aisladas en Cuba durante el período 1985-1989. Reporte preliminar / Study of non-tuberculous mycobacteria isolated in Cuba during 1985-1986. A preliminary report

Se estudiaron 1 061 cepas de micobacterias no tuberculosas referidas al Instituto de Medicina Tropical "Pedro Kourí" , en el período de 1985 a 1989. Las cepas procedían de los Centros Provinciales de Higiene y Epidemiología del país. Según los resultados globales obtenidos, la mayoría de las cepas clasificadas se ubican en los grupos III y IV de acuerdo con el criterio de Runyon (54,76 y 36 por ciento , respectivamente). Así mismo las especies de mayor frecuencia corresponden al complejo MAI y M. fortuitum