Refractory and/or Relapsing Cryptococcosis Associated with Acquired Immune Deficiency Syndrome: Clinical Features, Genotype, and Virulence Factors of Cryptococcus spp. Isolates.

Refractory and relapsing crytocococcosis in acquired immune deficiency syndrome (AIDS) patients have a poor prognosis. The risk factors for this complicated infection course were evaluated by comparing refractory and/or relapsing cryptococcosis in human immunodeficiency virus-coinfected patients (cohort 1) with another group of AIDS patients who adequately responded to antifungals (cohort 2). Except for one isolate of Cryptococcus gattii from a cohort 2 case, all other isolates were identified as Cryptococcus neoformans var. grubii, sex type α, genotype VNI, including Cryptococcus reisolated from the relapse or in the refractory state. No differences were observed with respect to Cryptococcus capsule size and in the melanin and phospholipase production. The cohort 1 patients presented higher prevalence of cryptococcemia, cerebral dissemination, chronic liver disease, and leucopenia, and have increased death rate. Apparently, the refractory and/or relapsing cryptococcosis in the AIDS patients were more related to the host and the extent of the infection than to the fungal characteristics.

Systemic and local characterization of regulatory T cells in a chronic fungal infection in humans.

The long-term persistence of pathogens in a host is a hallmark of certain infectious diseases, including schistosomiasis, leishmaniasis, and paracoccidioidomycosis (PCM). Natural regulatory T (Treg) cells are involved in control of the immune responses, including response to pathogens. Because CTLA-4 is constitutively expressed in Treg cells and it acts as a negative regulator of T cell activation in patients with PCM, here we investigated the involvement of Treg cells in the control of systemic and local immune response in patients with PCM. We found that the leukocyte subsets were similar in patients and controls, except for CD11c+CD1a+ cells. However, a higher frequency of CD4+CD25+ T cells expressing CTLA-4, glucorticoid-inducible TNFR, membrane-bound TGF-beta, and forkhead-box 3 were observed in PBMC of patients. In accordance, these cells exhibited stronger suppressive activity when compared with those from controls (94.0 vs 67.5% of inhibition of allogeneic T cell proliferation). In addition, the data showed that CD4+CD25+ T cells expressing CTLA-4+, glucocorticoid-inducible TNFR positive, CD103+, CD45RO+, membrane-bound TGF-beta, forkhead-box 3 positive, and the chemokines receptors CCR4 and CCR5 accumulate in the Paracoccidioides brasiliensis-induced lesions. Indeed, the secreted CCL17 and CCL22, both associated with the migration of Treg cells to peripheral tissues, were also detected in the biopsies. Moreover, the CD4+CD25+ T cell derived from lesions, most of them TGF-beta+, also exhibited functional activity in vitro. Altogether, these data provide the first evidence that Treg cells play a role in controlling local and systemic immune response in patients with a fungal-induced granulomatous disease advancing our understanding about the immune regulation in human chronic diseases.

[A serological survey of the infection by Echinococcus sp. in the municipality of Sena Madureira, AC]. / Inquérito sorológico da infecção pelo Echinococcus sp no município de Sena Madureira, AC.

A serological inquiry was performed in the municipality of Sena Madureira, Acre State, Brazil, to evaluate the individual contact with Echinococcus sp. The participants were recruited from two distinct populations: residents in the urban and rural areas, the latter distributed among riverside communities of the region. A total of 1,064 individuals were evaluated: 851 from the urban zone and 213 from the rural area. The study was divided into two phases: a serological screening, in which the blood samples were collected and then sent to the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (Serology Laboratory), Ribeirão Preto, SP, Brazil, for the serological test by counterimmunoelectrophoresis technique; and secondly an epidemiological inquiry for evaluating the individuals and their dwelling conditions and customs. Comparing the results of serological tests, the prevalence in the rural area was 6% against 3.5% in the urban area. The overall prevalence was 4%. The possibility of the existence of another intermediate host in the life cycle of Echinococcus vogeli was analyzed and the findings indicated the domestic pig as being the most probable.

Inquérito sorológico da infecçäo pelo Echinococcus sp no município de Sena Madureira, AC / A serological survey of the infection by Echinococcus sp. in the municipal ity of Sena Madureira, AC

Foi realizado no município de Sena Madureira, Acre, um inquérito soroepidemiológico para avaliar o contato de indivíduos com o Echinococcus sp. Escolheu-se duas populações distintas, uma residente na área urbana e a outra na área rural do município, distribuída em comunidades ribeirinhas da regiäo. Foram avaliados no total 1.064 indivíduos, dos quais 851 pertencentes à área urbana e 213 à área rural. O estudo foi dividido em duas partes: inquérito sorológico, no qual foram coletadas e enviadas amostras de sangue ao Laboratório de Sorologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, onde foram realizados os testes imunológicos pela técnica de contraimunoeletroforese; inquérito epidemiológico para avaliaçäo individual, além de as condições de moradia e hábitos dos indivíduos. A prevalência sorológica na área rural foi 6 por cento, enquanto na urbana fomos 3,5 por cento. A prevalência geral foi 4 por cento. Quando analisada a possibilidade da existência de outros hospedeiros intermediários no ciclo do Echinococcus vogeli, foram encontrados resultados que sugerem ser o porco doméstico o mais provável

[Polycystic hydatid disease: report of two cases from the city of Sena Madureira, Acre, in Brazilian Amazon]. / Hidatidose policística: relato de dois casos procedentes de Sena Madureira, Acre, na Amazônia brasileira.

Two cases of Polycystic hydatid disease (PH) are reported from the same municipal district of the Brazilian Amazon region (Sena Madureira, Acre). Both had a similar clinical presentation and course over two years of follow-up. Initially the patients complained of pain in the right hypochondrium or upper abdomen and presented obstructive jaundice, fever, increased abdominal volume and weight loss. By image analysis, in addition to splenomegaly, multiple and coalescent cysts were detected in the liver. Serum samples were reactive by counterimmunoelectrophoresis. Treatment with albendazole resulted in partial improvement, with symptomatic relief and reduction in size of the lesions. This report stresses the importance of performing clinical-epidemiological studies of polycystic hydatid disease in the Brazilian Amazon and especially in the municipality of Sena Madureira where many other cases of PH may remain undiagnosed.

Hidatidose policística: relato de dois casos procedentes de Sena Madureira, Acre, na Amazônia brasileira / Polycystic hydatid disease: report of two cases from the city of Sena Madureira, Acre, in Brazilian Amazon

Dois casos de hidatidose policística (HP) säo relatados, oriundos do mesmo município da regiäo amazônica brasileira (Sena Madureira, Acre). Ambos tiveram a mesma apresentaçäo e evoluçäo clínica ao longo de dois anos de acompanhamento. Inicialmente os pacientes queixaram-se de dor abdominal no andar superior ou no hipocôndrio direito e apresentaram icterícia obstrutiva, febre, aumento de volume abdominal e emagrecimento. Por exame de imagem, além de esplenomegalia, cistos múltiplos e coalescentes foram detectados no fígado. Amostras de soro foram reagentes por contraimunoeletroforese. O tratamento com albendazol resultou em melhora parcial, com alívio sintomático e reduçäo no tamanho das lesöes. Este relato reforça a importância de estudos clínico-epidemiológicos da hidatidose policística na regiäo amazônica brasileira, especialmente no município de Sena Madureira, onde outros pacientes com HP podem estar sem diagnóstico

Determinaçäo de macronutrientes em alimentos normalmente consumidos pela populaçäo brasileira / Determination of macronutrient and energy content levels in common brazilian foods

Em nosso meio, o planejamento de dietas e o cálculo dos diferentes nutrientes é, em geral, feito com o uso de tabelas internacionais de composiçäo de alimentos. Além deste fato, as tabelas disponíveis no Brasil säo comumente compiladas e/ou traduzidas de tabelas oriundas do exterior. Desta maneira, os resultados obtidos ou a composiçäo da dieta nem sempre correspondem à realidade local. Considerando a necessidade de se conhecer a composiçäo em macronutrientes dos alimentos normalmente consumida pela populaçäo brasileira, o presente trabalho teve por objetivo determinar o teor calórico(calorimetria direta), de nitrogênio, o extrato etéreo, cinzas, umidade e de hidratos de carbono(por diferença) dos seguintes alimentos: açúcar refinado, alface, arroz polido, banana, batata-inglesa, café em pó, café infusäo, carne bovina, cenoura, chuchu, farinha de mandioca, farinha de trigo, feijäo, feijäo preto, fubá, laranja, mandioca, mandioquinha, salsa, leite em pó, leite pasteurizado, óleo de soja, ovo de galinha, päo e tomate. Os resultados foram discutidos e comparados com os de tabelas internacionais. Recomenda-se o uso dos valores obtidos no presente trabalho quando for necessário determinar a composiçäo de alimentos de uso no Brasil