Whipple's disease. Report of five cases with different clinical features.

Whipple's disease (WD) is a rare systemic disease of infectious etiology which involves the small intestine but can virtually affect any organ. We present here five cases (four males and one female) ranging in age from 20 to 59 years. All patients had intestinal involvement associated or not with clinical manifestations linked to this organ. Vegetation in the tricuspid valve was observed in one patient, suggesting endocarditis caused by Tropheryma whippelii, with disappearance of the echocardiographic alterations after treatment. In one of the male patients the initial clinical manifestation was serologically negative spondylitis, with no diarrhea occurring at any time during follow-up. Ocular involvement associated with intestinal malabsorption and significant weight loss were observed in one case. In the other two cases, diarrhea was the major clinical manifestation. All patients were diagnosed by histological examination of the jejunal mucosa and, when indicated, of extraintestinal tissues by light and electron microscopy. After antibiotic treatment, full remission of symptoms occurred in all cases. A control examination of the intestinal mucosa performed after twelve months of treatment with sulfamethoxazole-trimethoprim revealed the disappearance of T. whippelii in four patients. The remaining patient was lost to follow-up.

Coinfection with Toxoplasma gondii inhibits antigen-specific Th2 immune responses, tissue inflammation, and parasitism in BALB/c mice infected with Leishmania major.

Lesion size, cellular infiltration, and tissue parasitism in the footpads of BALB/c mice infected with Leishmania major were all dramatically inhibited during acute but not chronic infection with Toxoplasma gondii. Similarly, acute but not chronic toxoplasmosis at the time of infection with L. major had a strong inhibitory effect on development of acquired immune responses mediated by Th2 lymphocytes. In contrast, no major changes in Leishmania-specific Th1-mediated responses were observed in mice coinfected with T. gondii.

Protection by short-chain fatty acids against 1-beta-D-arabinofuranosylcytosine-induced intestinal lesions in germfree mice.

In germfree mice, the administration of short-chain fatty acids (SCFA) protected the intestinal mucosa from damage produced by 1-beta-D-arabinofuranosylcytosine (Ara-C). Animals receiving SCFA and Ara-C had intestinal morphologies closer to normal than the control animals, which had severe intestinal lesions. We concluded that orally administrated SCFA reduce intestinal lesions, improving the mucosa pattern of the small intestine and colon.

Protective effect of bifidus milk on the experimental infection with Salmonella enteritidis subsp. typhimurium in conventional and gnotobiotic mice.

The ability of Bifidobacterium bifidum from a commercial bifidus milk to antagonize Salmonella enteritidis subsp. typhimurium in vivo, and to reduce the pathological consequences for the host, was determined using conventional and gnotobiotic mice. Conventional animals received daily, by gavage, 0.1 ml bifidus milk containing about 10(9) cfu B. bifidum and germ-free animals received a single 0.1 ml dose. The conventional and gnotobiotic groups were challenged orally with 10(2) cfu of the pathogenic bacteria 5 and/or 10 d after the beginning of treatment. Control groups were treated with milk. Bifidus milk protected both animal models against the challenge with the pathogenic bacteria, as demonstrated by survival and histopathological data. However, to obtain the protective effect in gnotobiotic animals, the treatment had to be initiated 10 d before the challenge. In experimental and control gnotobiotic mice, Salm. enteritidis subsp. typhimurium became similarly established at levels ranging from 10(8) to 10(9) viable cells g-1 of faeces and remained at these high levels until the animals died or were sacrificed. It was concluded that the protection against Salm. enteritidis subsp. typhimurium observed in conventional and gnotobiotic mice treated with bifidus milk was not due to the reduction of the intestinal populations of the pathogenic bacteria.

Evaluation of microbial infiltration in restored cavities--an alternative method.

This work evaluated the efficacy of an improved method used to determine the frequency of bacterial infiltration and bacterial population levels and morphotypes in cavities restored with adhesive composites in conventional mice. By using the alternative methodology suggested in this work, bacteria from microleakage were recovered and identified in cavities subjected to restoration procedures that used acid etching of the dentin and dentin adhesives used with light-curing resin. The methodology presented herein seems to be more effective than the one normally used to investigate the presence of bacteria, which uses acid demineralization of dental structures for the histological processing of tissues. The results suggest that the methodology presented in this work made it possible to recover and identify Gram-negative and Gram-positive bacteria from microleakage. Frequencies of microleakage and bacterial population levels in restored cavities using two different adhesive systems were not statistically different (p < 0.05).

[Cutis laxa associated to cardiac failure] / Cutis Laxa associada à insuficiência cardíaca congestiva.

OBJECTIVE: To focus attention on a rare pathology of the childhood which presents premature aging of the skin and can be lethal. METHODS: The authors present a case of cutis laxa, syndrome of premature aging, in an eight year-old child, and discuss the classification, diagnosis and prognosis of the disease. RESULTS: The child presented signs of premature aging when he was four years-old. The diagnosis of cutis laxa was confirmed by skin biopsy. The patient presented heart failure, a systemic complication different from those previously described, and died at eight years of age. CONCLUSIONS: The importance of the diagnosis of cutis laxa resides in the fact that besides characteristic dermatological findings, there are frequent systemic complications that can be the focus of preventive measures, since there is no specific treatment for this disease. Genetic counseling is another important issue in this condition.

Experimental root canal infections in conventional and germ-free mice.

A small animal model was evaluated to study the interrelationships between microorganisms after their implantation in root canals (inferior central incisors) using germ-free (GF) and conventional (CV) mice. The selected microorganisms were: Porphyromonas endodontalis (ATCC 35406), Eubacterium lentum (ATCC 25559), Peptostreptococcus anaerobius (ATCC 27337), Fusobacterium nucleatum (ATCC 10953), Escherichia coli (ATCC 25922), and Enterococcus faecalis (ATCC 4083). Only P. anaerobius, E. coli, and E. faecalis, respectively, were able to colonize when inoculated alone into the root canal of both CV and GF mice. E. lentum, when inoculated alone colonized only in CV animals. P. endodontalis and F. nucleatum were unable to colonize in CV and GF animals after single inoculation. It is concluded that the experimental animal model presented herein is valuable for ecological studies of root canal infections and that only some strict anaerobic bacteria are able to colonize mice root canals when inoculated by themselves alone in pure culture.

Intracellular signal triggered by cholera toxin in Saccharomyces boulardii and Saccharomyces cerevisiae.

As is the case for Saccharomyces boulardii, Saccharomyces cerevisiae W303 protects Fisher rats against cholera toxin (CT). The addition of glucose or dinitrophenol to cells of S. boulardii grown on a nonfermentable carbon source activated trehalase in a manner similar to that observed for S.cerevisiae. The addition of CT to the same cells also resulted in trehalase activation. Experiments performed separately on the A and B subunits of CT showed that both are necessary for activation. Similarly, the addition of CT but not of its separate subunits led to a cyclic AMP (cAMP) signal in both S. boulardii and S. cerevisiae. These data suggest that trehalase stimulation by CT probably occurred through the cAMP-mediated protein phosphorylation cascade. The requirement of CT subunit B for both the cAMP signal and trehalase activation indicates the presence of a specific receptor on the yeasts able to bind to the toxin, a situation similar to that observed for mammalian cells. This hypothesis was reinforced by experiments with 125I-labeled CT showing specific binding of the toxin to yeast cells. The adhesion of CT to a receptor on the yeast surface through the B subunit and internalization of the A subunit (necessary for the cAMP signal and trehalase activation) could be one more mechanism explaining protection against the toxin observed for rats treated with yeasts.

Influence of dietary protein content on Trypanosoma cruzi infection in germfree and conventional mice.

Germfree (GF) and conventional (CV) mice were fed on diets containing 4.4, 13.2 or 26.4% of protein (weight/weight). CV mice fed on low protein diet did not gain weight during four weeks, whereas the protein deficient diet did not affect the growth of GF mice. After four weeks on these diets, the mice were inoculated with 5 x 10(3) trypomastigotes of Trypanosoma cruzi. The protein deficiency affected less the GF than the CV mice, according to the following parameters: weight gain, hemoglobin, plasma protein and albumin levels and water and protein contents of the carcass. Infection with T. cruzi produced a significant decrease in hemoglobin levels, red blood cell count, and water and protein contents in the carcass. This decrease was more pronounced in the GF mice. Histopathologically, there was no difference between the treatments in animals with the same microbiological status (GF or CV). However, the disease was more severe in the GF than in the CV mice.

Dose effect of oral Saccharomyces boulardii treatments on morbidity and mortality in immunosuppressed mice.

Survival, weight loss, translocation and histological alterations in the terminal ileum, liver and spleen were studied in mice simultaneously immunosuppressed with cyclophosphamide and treated or not with Saccharomyces boulardii until the death of all animals. The animals were divided into five groups: C1 (not immunosuppressed, not treated); C2 (immunosuppressed, not treated); B1 (immunosuppressed, treated with S. boulardii 10.0 mg); B2 (immunosuppressed, treated with S. boulardii 1.0 mg) and B3 (immunosuppressed, treated with S. boulardii 0.1 mg). Survival was higher in group B3 than in the other immunosuppressed groups. Weight loss was observed for all groups except C1. By day 7, some animals from each group were killed by ether inhalation for the determination of bacterial translocation and histopathological examination. Bacterial translocation to the liver was lower in groups C1 and B3 than in the other groups. The highest translocation to the liver and spleen was observed in group B1. Low S. boulardii translocation was observed in some animals, principally to the mesenteric lymph nodes. Histopathological examination showed a decrease in epithelial cell turnover with villus length reduction and loss of brush borders in group C2. Relative protection against these alterations was obtained when the animals were treated with the yeast, independently of the dose. Higher expression of the lymphoid component was also noted in the ileal lamina propria, liver and spleen of mice treated with the yeast, together with activation of the reticulo-endothelial system, when compared with group C2 where lymphocyte depletion was observed. This study suggests a relative protection of immunosuppressed animals by treatment with S. boulardii, but this phenomenon was inversely proportional to the yeast dose.