DISSEMINATED FUNGAL INFECTION WITH ADRENAL INVOLVEMENT: REPORT OF TWO HIV NEGATIVE BRAZILIAN PATIENTS / Infecções fúngicas disseminadas com acometimento das supra-renais: descrição de dois pacientes brasileiros HIV-negativos

Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.

A paracoccidioidomicose e a histoplasmose são infecções fúngicas sistêmicas endêmicas no Brasil. As formas clínicas disseminadas são incomuns em pacientes imunocompetentes. Nós descrevemos dois pacientes HIV-negativos com infecções fúngicas disseminadas, paracoccidioidomicose e histoplasmose, que foram diagnosticadas por biópsias de lesões de supra-renal. Ambos foram tratados por períodos prolongados com antifúngicos orais, evoluindo com boa resposta terapêutica.

Contagens leucocitárias e sintomas de infecções respiratórias após curto período de treinamento concorrente / Leukocyte counts and symptoms of upper respiratory tract infections after a short period of concurrent training

Introdução: Pessoas comumente iniciam a prática de exercícios por períodos não compatíveis com o nível de treinabilidade, podendo induzir diminuição da competência imunológica. Objetivos: Analisar as possíveis modulações nas contagens dos leucócitos circulantes e incidência de sintomas de infecções do trato respiratório superior, ao final de uma semana de treinamento concorrente. Métodos: Participaram dez voluntários do gênero masculino e sedentários, submetidos a uma semana de treino concorrente com cinco sessões em dias sequenciais, apresentando intensidades moderadas e duração de cem minutos. Resultados: Não foram observadas alterações nas contagens dos leucócitos. Quanto aos sintomas de infecções do trato respiratório superior, 10% dos voluntários apresentaram coriza, 20% congestão nasal e 40% dor de cabeça ao final da intervenção. Conclusões: A referida intervenção não apresenta potencial para modular negativamente as contagens dos leucócitos. Contudo, a incidência de sintomas de infecções do trato respiratório superior pode estar associada à diminuição da funcionalidade celular, possivelmente decorrente do volume delineado nas sessões.

Introduction: People often begin to practice exercises for periods not compatible with their level of trainability, and this could to induce a decrease in immune competence. Objective: To analyze the possible modulations in counts of circulating leukocytes and incidence of infections of the upper respiratory tract symptoms at the end of a week of concurrent training. Methods: A total of ten volunteers and sedentary male gender underwent a week of concurrent training sessions with five sequential days, with moderate intensity and duration of hundred minutes. Results: No changes were observed in leukocyte counts. As symptoms of upper respiratory tract infections, 10% of the volunteers had coryza, 20% nasal congestion, and 40% headache at the end of intervention. Conclusions: Such intervention has no potential to negatively modulate leukocyte counts. However, the incidence of symptoms of upper respiratory tract infections may be associated with decreased cellular functionality, possibly due to the volume outlined in the sessions.

Insufficient Knowledge of Korean Gastroenterologists Regarding the Vaccination of Patients with Inflammatory Bowel Disease

BACKGROUND/AIMS: There is an increased risk for inflammatory bowel disease (IBD) patients to develop infections due to the use of immunomodulators and biologics. Several infections are preventable by immunizations. This study investigated the knowledge and awareness of Korean gastroenterologists regarding the vaccination of patients with IBD. METHODS: A self-reported questionnaire was sent by e-mail to the faculty members of tertiary hospitals. Gastroenterologists were asked ten questions regarding the immunization of patients with IBD. A total of 56 gastroenterologists completed the questionnaire. RESULTS: A majority of gastroenterologists (>60%) had rarely or never recorded an immunization history from their patients with IBD. Moreover, 50% to 70% of the gastroenterologists did not know that live vaccines should be avoided in immunosuppressed patients. The most commonly mentioned resistance to vaccinations was "the lack of concern and knowledge regarding vaccination." Gastroenterologists more frequently asked about the immunization history of influenza, pneumococcal, hepatitis A, and hepatitis B vaccines and recommended these vaccines more often than others. CONCLUSIONS: Korean gastroenterologists' awareness and knowledge regarding the vaccination of patients with IBD were very poor. Intensive educational programs on immunization guidelines directed toward gastroenterologists who care for patients with IBD are required to ensure that these patients receive the necessary vaccinations.

Changes of immune system in military recruits after the training program.

The aim of the exercise was to improve body health including the immune system function. However, several studies have observed the suppression of immune response in athletes who were trained with strenuous exercise. Recruits who have been in the recruitment-training program for 8 weeks might also have immune suppression. Twenty males, aged from 21 to 23 years in Chulachomklao Royal Military Academy infantry battalion volunteered to participate in this study. They were asked to wear a Polar Accurex Plus Telemetric heart rate monitor during the training period. Tuberculin skin test which is the screening method for cellular immune responses was significantly decreased at post-training compared to the pre-training (p<0.02). The levels of serum IgG and IgM at pre-training, 4th week, 8th week and one week post-training were significantly decreased at the initiation period, which were compared with pre-training and 4th week of training (p<0.01), and returned to normal at the 8th week of training and one week post-training. The level of circulating immune cells and number of CD markers (CD3, CD4, CD8, and CD56) were not significantly changed throughout the training period. This study demonstrated that subjects who underwent the recruit-training program were able to improve their health after the period of training i.e., in the adaptation period. The decrease in the initiation period could be compensated with proper diet and enough rest.

Respuesta inmune disminuída por estrés académico intenso: cambios de la proliferación linfocitaria en estudiantes de medicina / Decreased immune response by acute academic stress: changes in lymphocyte proliferation in medical students

Blood samples were obtained from 42 medical students during a period of moderate academic stress, immediately before a final examination and after their summer vacations. T lymphocyte proliferation in response to 5, 10 and 20 mg/ml phytohemagglutinin was measured by the incorporation of 3H-thymidine, and plasma cortisol was measured by RIA. Results: T lymphocyte stimulation index in response to all phytohemagglutinin concentrations was significatively lower in the period before examination than in the other two periods.There were no differences in the index between the period of moderate stress and after summer vacations. Plasma cortisol levels were 15.6 ñ 4.3, 18.6 ñ 5.8 and 16.7 ñ 5.1 mg/dl during the periods of moderate stress, before the examination and after vacations, respectively (p < 0.05 for the difference between examination and the other two periods). Conclusions: There is a decrease in lymphocyte proliferation and an increase in cortisol levels during a period of acute academic stress in medical students, suggesting that, the exposure of healthy subjects to common stress ful stimuli, may affect their immunocompetance

Infección por bartonella henselae en pacientes inmunocompetentes: enfermedad por arañazo de gato / Infection by bartonella henselae in immunocompetent patients: cat scratch disease

Ten children (7 males), aged between 6 and 13 years old, with histologically or serologically confirmed cat scratch disease are reported. Lympadenopathy location was pre auricular in four cases, axillary in two, inguinal in 2 and epitrochlear in 2. Three children had fever over 39ºC and 2 had a Parinaud syndrome. Nine children had a history of cat scratch and one of a cat byte. Six had an arythrocyte sedimentation rate over 40. Lymph node ultrasound examination was a useful diagnostic tool. Two patients had splenic granulomas. Lymph node biopsies were obtained in 4 cases, showing a suppurative granulomatous lymphadenitis in all and positive Warthin-Starry stain in 2. Serology, done in patients without histological confirmation was positive with titles ranging from 1:64 to 1:8192. All patients had a satisfactory outcome with regression of lymphadenopathy. Infection by bartonella henselae occur in the Chilean population and must be considered in the differential diagnosis of regional lymph node enlargement

Nocardiosis diseminada en tres pacientes inmunocompetentes / Disseminated nocardiosis in 3 immunocompetent patients

Nocardia asteroide infections, an aerobic actinomycete, have several forms and lungs, skin and brain are the organs most frequently involved. When the infection suspected, special staining methods must be ordered to identify the agent. We report three immunocompetent patients with disseminated nocardiosis, 2 presenting with nodular lesions of skin and lungs and one presenting with pulmonary involvement and brain abscesses. The importance of clinical suspicion and early diagnosis of nocardiosis is emphasized

Absceso esplénico: presentación de un caso en un paciente inmunocompetente / Splenic absces: presentation of the a case in an immunocompetent patient

El absceso esplénico es una entidad poco común que se presenta en pacientes con factores predisponentes o con alguna condición de inmunosupresión. Durante las últimas décadas se han mejorado los procedimientos diagnósticos que han permitido una conducta terapéutica precoz a través de la esplenectomía o el drenaje percutáneo en combinación con la antibioticoterapia sistémica. Los autores presentan un caso de absceso esplénico único por enterococcus spp, en un paciente inmunocompetente, tratado mediante drenaje percutáneo dirigido por tomografía computarizada y seis semanas de antibioticoterapia

Determinacao dos valores de referencia para a regiao da atividade hemolitica do complemento serico pelo metodo cinetico / Determining reference values of the hemolytic activity of the serous complement through the kinetic method

Foi avaliada a capacidade litica do soro em 100 amostras provenientes de individuos de ambos os sexos e em bom estado nutricional para se verificar a atividade do sistema complemento. Os individuos foram agrupados dentro de uma ampla abrangencia de faixa etaria (15 a 90 anos), ressalvando-se criancas. Foi utilizado o metodo cinetico proposto por J.E. Barbosa; V.P.L. Ferriani e I.F. de Carvalho (1). Os resultados variaram de 1 a 5 minutos, todos dentro da normalidade. Segundo os autores e tempo de lise nao ultrapassa a 5 minutos. Os valores encontrados para o sexo feminino, mesmo dentro da normalidade, foram superiores ao do sexo masculino, nao sendo determinado neste trabalho sua causa.