Diagnóstico y tratamiento de la estrongiloidosis / Diagnosis and treatment of strongyloidosis

Con el propósito de determinar las evidencias más recientes en torno a la estrongiloidosis, se realizó una revisión en bases de datos electrónicas sobre el tema, particularizando en los trabajos de los últimos 5 años. Strongyloides stercoralis es un nemátodo intestinal de distribución global, particularmente, en regiones tropicales y subtropicales. El parásito presenta un ciclo de vida complejo dada la posibilidad de desarrollarlo de manera directa, indirecta o producir auto- infecciones internas o externas. La infección puede mantenerse por muchos años sin que el individuo afectado refiera manifestaciones clínicas atribuibles al parásito; sin embargo, en algunos casos, especialmente inmunocomprometidos, la parasitosis puede desencadenar manifestaciones clínicas que varían desde cuadros ligeros de dolor abdominal y/o diarrea hasta episodios diarreicos debilitantes que ocasionan malabsorción, pérdida de peso y desgaste crónico. Se expone una revisión sobre el parásito, la forma cómo se relaciona con el humano y consideraciones sobre el diagnóstico, tratamiento y manejo de los pacientes infectados. En Cuba está presente esta entidad y existen los medios apropiados para su diagnóstico y tratamiento

To determine the more current evidences en relation to strongyloidosis, a review in electronic databases on this subject, characterizing on the papers from the past years. Strongyloides stercoralis is an intestinal nematode of global distribution, mainly in tropical and subtropical regions. The parasite has a complex life cycle due to possibility of a direct and indirect development or to produce internal and external autoinfections. The infection may to remains for many years without the involved subject refers clinical manifestations attributable to parasite; however, in some cases, specially those immunocompromised, parasitosis may to trigger clinical manifestations changing from slights pictures of abdominal pain and/or diarrhea up to debilitating diarrheic episodes causing a malabsorption syndrome, loss of weight and chronic wear an tear. It was showed the results of a review on the parasite, the way how it is related to human being and the considerations on the diagnosis, treatment and management of infected patients. In Cuba this entity is present and there are appropriate means for its diagnosis and treatment

Diagnóstico y tratamiento de la estrongiloidosis / Diagnosis and treatment of strongyloidosis

Con el propósito de determinar las evidencias más recientes en torno a la estrongiloidosis, se realizó una revisión en bases de datos electrónicas sobre el tema, particularizando en los trabajos de los últimos 5 años. Strongyloides stercoralis es un nemátodo intestinal de distribución global, particularmente, en regiones tropicales y subtropicales. El parásito presenta un ciclo de vida complejo dada la posibilidad de desarrollarlo de manera directa, indirecta o producir auto- infecciones internas o externas. La infección puede mantenerse por muchos años sin que el individuo afectado refiera manifestaciones clínicas atribuibles al parásito; sin embargo, en algunos casos, especialmente inmunocomprometidos, la parasitosis puede desencadenar manifestaciones clínicas que varían desde cuadros ligeros de dolor abdominal y/o diarrea hasta episodios diarreicos debilitantes que ocasionan malabsorción, pérdida de peso y desgaste crónico. Se expone una revisión sobre el parásito, la forma cómo se relaciona con el humano y consideraciones sobre el diagnóstico, tratamiento y manejo de los pacientes infectados. En Cuba está presente esta entidad y existen los medios apropiados para su diagnóstico y tratamiento(AU)

To determine the more current evidences en relation to strongyloidosis, a review in electronic databases on this subject, characterizing on the papers from the past years. Strongyloides stercoralis is an intestinal nematode of global distribution, mainly in tropical and subtropical regions. The parasite has a complex life cycle due to possibility of a direct and indirect development or to produce internal and external autoinfections. The infection may to remains for many years without the involved subject refers clinical manifestations attributable to parasite; however, in some cases, specially those immunocompromised, parasitosis may to trigger clinical manifestations changing from slights pictures of abdominal pain and/or diarrhea up to debilitating diarrheic episodes causing a malabsorption syndrome, loss of weight and chronic wear an tear. It was showed the results of a review on the parasite, the way how it is related to human being and the considerations on the diagnosis, treatment and management of infected patients. In Cuba this entity is present and there are appropriate means for its diagnosis and treatment(AU)

Effect of pregnancy and human immunodeficiency virus infection on intracellular interleukin-2 production patterns.

Human immunodeficiency virus type 1 (HIV-1) infection decreases the production of interleukin-2 (IL-2) from CD4+ and CD8+ T cells. Recombinant IL-2 (rIl-2) has been given to HIV-infected individuals to generate significant increases in CD4+ T-cell counts. There are limited data regarding the effects of pregnancy and HIV infection on IL-2 production in humans. To investigate the effects of human pregnancy, HIV infection, and HIV therapy on IL-2 production, we evaluated 61 women. Intracellular IL-2 production by CD4+ T cells from nonpregnant HIV-infected women was significantly lower than in that in uninfected women (45% +/- 8% versus 52% +/- 8%, P = 0.04). In contrast, there was no difference in levels of intracellular IL-2 production between HIV-infected and uninfected pregnant women. These observations suggest that pregnancy may down-regulate IL-2 production regardless of HIV infection status. Future studies should evaluate IL-2 production patterns in larger cohorts of women so that the physiological significance of IL-2 down-regulation in pregnancy can be further evaluated. This information is essential to assess the possible use of IL-2 supplementation therapy as a means of enhancing immune responses among HIV-infected pregnant women.

Depressed interleukin-12-producing activity by monocytes correlates with adverse clinical course and a shift toward Th2-type lymphocyte pattern in severely injured male trauma patients.

OBJECTIVE: To determine the effect of major trauma on the cytokine-producing activity of monocytes and CD4+ T cells in a homogeneous cohort of patients as well as to determine the relationship between monocyte and T-lymphocyte responses and clinical outcome. SETTINGS: Surgical intensive care units of a trauma center and flow cytometry and experimental laboratories at a teaching hospital. DESIGN: Prospective cohort clinical study with measurements of white cell cytokine-producing activity on days 2, 5, and 10 postinjury. The number of cytokine-producing CD14+ monocytes, CD4+, and CD8+ T cells were determined in whole blood using flow cytometry combined with the intracellular cytokine staining method. Basal and lipopolysaccharide-stimulated interleukin (IL)-12, tumor necrosis factor-alpha, IL-6, and IL-1alpha production by monocytes as well as basal and phorbol 12-myristate 13-acetate plus ionomycin-stimulated interferon-gamma, IL-4, and tumor necrosis factor-alpha production by T cells were determined on days 2, 5, and 10 postinjury and compared with similar measurements made in healthy control subjects. PATIENTS: Twelve randomly selected black, male patients were enrolled in the study: mean injury severity score, 26; mean age, 35 yrs; mean Glasgow Coma Scale score, 13; systemic inflammatory response syndrome, 92%; sepsis, 42%; bronchial infection, 42%; and adult respiratory distress syndrome 25%. MAIN RESULTS: After lipopolysaccharide stimulation, the number of IL-12-, tumor necrosis factor-alpha-, IL-1alpha-, and IL-6-producing CD14+ monocytes was 40% to 70% lower in trauma patients on postinjury days 2, 5, and 10 than in healthy control subjects. After phorbol 12-myristate 13-acetate stimulation, the number of IL-4-producing CD4+ cells increased three-fold in the trauma patients compared with healthy control subjects. In contrast, the number of interferon-gamma- or tumor necrosis factor-alpha-producing CD4+ and CD8+ T cells was not different between the patients and control subjects. The Th1/Th2 ratio was significantly lower in patients on all postinjury days than in the control subjects. A statistically significant inverse correlation was found between the number of IL-12-producing monocytes and IL-4-producing CD4+ T cells in trauma patients (p =.007, r2 =.47). This correlation was absent in control subjects. The degree of depressed capacity of monocyte IL-12 production on day 2 postinjury showed a statistically significant correlation with the development of adult respiratory distress syndrome, sepsis, or infections and also with the duration of systemic inflammatory response syndrome and sepsis. CONCLUSIONS: Major trauma results in an early and marked decrease in monocyte cytokine-producing activity. The trauma-induced depression in IL-12 production by the mononuclear phagocyte system may promote T-cell commitment toward a Th2 pattern early after trauma. The appearance of the Th2 pattern is the result of elevated numbers of IL-4-producing cells without major alterations in T-cell interferon-gamma-producing capacity. The degree of alterations in monocyte and T-cell responses on day 2 postinjury correlates with the development of adverse clinical outcomes and the subsequent duration of the inflammatory response.