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1.
Rev Inst Med Trop Sao Paulo ; 59: e6, 2017 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-28380117

RESUMO

Rheumatoid arthritis (RA) is a chronic condition that is frequent in patients living in tropical areas exposed to leishmaniasis. RA therapy involves immunosuppressant drugs such as methotrexate (MTX), monoclonal antibodies (mAbs) and prednisone. We report an unusual presentation of cutaneous (CL) or mucocutaneous leishmaniasis (ML) in RA patients from an endemic area of leishmaniasis. A 51-year-old woman noted a cutaneous ulcer on her left ankle during MTX and prednisone RA therapy. Initially diagnosed as a venous stasis ulcer, the aspirate of the injury revealed the presence of Leishmania DNA. A 73-year-old woman presenting non-ulcerated, infiltrated and painful erythematous nodules inside her nostrils while receiving MTX, anti-TNF mAb, and prednisone for RA, had also the aspirate of injuries showing the presence of Leishmania DNA. Both patients healed after the therapy with liposomal amphotericin. The RA therapy has changed to low-dose prednisone, without further reactivation episodes. Both cases suggest that CL or ML can reactivate after administration of an immunosuppressant for RA treatment. Therefore, immunosuppressive treatments for RA should be carefully prescribed in patients from endemic areas or with a history of CL and ML.


Assuntos
Antirreumáticos/efeitos adversos , Imunossupressores/efeitos adversos , Leishmania/isolamento & purificação , Leishmaniose Cutânea/etiologia , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , DNA de Protozoário/análise , Feminino , Humanos , Imunossupressores/uso terapêutico , Leishmania/genética , Leishmaniose Cutânea/diagnóstico , Leishmaniose Mucocutânea/imunologia , Pessoa de Meia-Idade , Recidiva
3.
Rev Inst Med Trop Sao Paulo ; 57(5): 369-76, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26603222

RESUMO

Toxoplasmosis, a worldwide highly prevalent zoonotic infection, is transmitted either by the oocysts, from water and soil, or the tissue cysts, in raw or undercooked infected meat, of Toxoplasma gondii. An ongoing debate is whether there are differences between the clinical and epidemiological characteristics of the outbreaks due to one or the other infective form of the agent. We performed a systematic review, recovering 437 reported outbreaks of which 38 were selected. They were complete reports containing ascribed Toxoplasma infecting form, and clinical and demographic data. There was no gender or age group selection in the outbreaks, which were described more often in the Americas. A large number of individuals were affected when oocysts, associated with soil and water contaminated with cat feces, were considered the transmission source. Onset of symptoms occurred early when the infection was ascribed to meat tissue cysts (11.4 ± 6.7 days) with sharpened temporal distribution of cases, while a broader and prolonged appearance of new cases was observed when oocysts in water were the source of the infection (20 ± 7 days, p < 0.001). Such information may be useful in the design and implementation of control strategies.


Assuntos
Surtos de Doenças , Toxoplasmose/epidemiologia , Toxoplasmose/transmissão , Animais , Gatos , Fezes/parasitologia , Feminino , Parasitologia de Alimentos , Humanos , Masculino , Carne/parasitologia , Oocistos , Toxoplasma , Água/parasitologia
4.
Mem Inst Oswaldo Cruz ; 108(5): 623-30, 2013 08.
Artigo em Inglês | MEDLINE | ID: mdl-23903979

RESUMO

Pentavalent antimonials such as meglumine antimoniate (MA) are the primary treatments for leishmaniasis, a complex disease caused by protozoan parasites of the genus Leishmania . Despite over 70 years of clinical use, their mechanisms of action, toxicity and pharmacokinetics have not been fully elucidated. Radiotracer studies performed on animals have the potential to play a major role in pharmaceutical development. The aims of this study were to prepare an antimony radiotracer by neutron irradiation of MA and to determine the biodistribution of MA in healthy and Leishmania (Leishmania) infantum chagasi-infected mice. MA (Glucantime®) was neutron irradiated inside the IEA-R1 nuclear reactor, producing two radioisotopes, ¹²²Sb and ¹²4Sb, with high radionuclidic purity and good specific activity. This irradiated compound presented anti-leishmanial activity similar to that of non-irradiated MA in both in vitro and in vivo evaluations. In the biodistribution studies, healthy mice showed higher uptake of antimony in the liver than infected mice and elimination occurred primarily through biliary excretion, with a small proportion of the drug excreted by the kidneys. The serum kinetic curve was bi-exponential, with two compartments: the central compartment and another compartment associated with drug excretion. Radiotracers, which can be easily produced by neutron irradiation, were demonstrated to be an interesting tool for answering several questions regarding antimonial pharmacokinetics and chemotherapy.


Assuntos
Antiprotozoários/farmacocinética , Leishmania infantum , Leishmaniose , Meglumina/farmacocinética , Compostos Organometálicos/farmacocinética , Animais , Antimônio , Antiprotozoários/efeitos da radiação , Cricetinae , Feminino , Meglumina/efeitos da radiação , Antimoniato de Meglumina , Camundongos Endogâmicos BALB C , Compostos Organometálicos/efeitos da radiação , Radioisótopos , Compostos Radiofarmacêuticos , Fatores de Tempo , Distribuição Tecidual
5.
Rev Inst Med Trop Sao Paulo ; 52(6): 291-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21225211

RESUMO

Toxoplasmosis, a protozoan disease, causes severe disease in fetuses during pregnancy and deadly encephalitis in HIV patients. There are several studies on its seroprevalence around the world, but studies focusing on African countries are limited in number and mostly anecdotal. We studied two groups of samples from Mozambique by ELISA, using serum samples from 150 pregnant women and six Cerebrospinal fluid (CSF) samples from AIDS patients with encephalitis. HIV status was confirmed, and CD4 blood counts were obtained from HIV-positive pregnant women. IgG seroprevalence of the group as a whole was 18.7% (28/150), with a higher prevalence in HIV-positive individuals compared to those who were HIV-negative (31.3%, [18/58] vs. 10.9%, [10/92]) patients. These data may be biased due to cumulative effects of exposition affecting disease prevalence. If corrected, this data may indicate an interaction of HIV and T. gondii. Prevalence of both diseases increases with age, but this is more clearly seen for toxoplasmosis (p < 0.005) than HIV infection, possibly explained by higher transmission of HIV after childhood. In HIV patients suffering from encephalitis, CSF serology showed that 33% of specific IgG CSF had a high avidity, which was in accordance with the data from the group of pregnant women. Lower prevalence rates of both infections in older groups could be explained by more deaths in the infected groups, resulting in an artificially lower prevalence. Using CD4 counts as a marker of time of HIV infection, and correcting for age, patients with contact with T. gondii had fewer CD4 cells, suggesting prolonged HIV disease or other causes. Toxoplasma IgG prevalence is higher in HIV+ groups, which could be ascribed to HIV- and T. gondii-associated risk factors, such as exposure to higher and more diverse social contacts. The low incidence of Toxoplasma IgG in younger age groups shows that transmission could be related to better access to cyst-containing meat in adulthood, as environmental transmission due to oocysts is usually blamed for higher incidence in children. Taken together, these data support the urgent need of research in toxoplasmosis in Africa, especially in the presence of HIV epidemics.


Assuntos
Complexo AIDS Demência/epidemiologia , Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Toxoplasmose/epidemiologia , Complexo AIDS Demência/líquido cefalorraquidiano , Adolescente , Adulto , Fatores Etários , Anticorpos Antiprotozoários/sangue , Linfócitos T CD4-Positivos , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Imunoglobulina G/sangue , Incidência , Contagem de Linfócitos , Pessoa de Meia-Idade , Moçambique/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Fatores de Risco , Toxoplasma/imunologia , Toxoplasmose/complicações , Toxoplasmose/diagnóstico , Adulto Jovem
6.
Rev Inst Med Trop Sao Paulo ; 51(5): 283-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19893982

RESUMO

Toxoplasma gondii causes severe fetal disease during acute infection in pregnant women, thus demanding early diagnosis for effective treatment and fetus preservation. Fetal tests are inefficient and risky, and diagnosis is based on maternal IgM serology, which had weak screening ability due to increased sensitivity, with alternative IgG avidity tests. Here, we performed ELISA and avidity assays using a recombinant T. gondii antigen, rROP2, in samples from 160 pregnant women screened from a large public hospital who were referred due to positive IgM assays. IgG serology and avidity assays were compared using whole T. gondii extract or rROP2. ELISA IgG detection with rROP2 showed good agreement with assays performed with T. gondii extract, but rROP2 IgG avidity assays were unrelated to whole extract antigen IgG avidity, regardless of the chaotrope used. These data show that avidity maturation is specific to individual antigen prevalence and immune response during infection. ELISA rROP2 IgG assays may be an alternative serological test for the diagnosis of toxoplasmosis during pregnancy, although our data do not support their use in avidity assays.


Assuntos
Anticorpos Antiprotozoários/imunologia , Antígenos de Protozoários , Imunoglobulina G/imunologia , Complicações Parasitárias na Gravidez/diagnóstico , Toxoplasma/imunologia , Toxoplasmose/diagnóstico , Animais , Afinidade de Anticorpos , Ensaio de Imunoadsorção Enzimática , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Valor Preditivo dos Testes , Gravidez , Sensibilidade e Especificidade
7.
Rev Inst Med Trop Sao Paulo ; 50(3): 187-90, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18604418

RESUMO

We detected Toxoplasma gondii oocysts in feces of experimentally infected cats, using a Kato Katz approach with subsequent Kinyoun staining. Animals serologically negative to T. gondii were infected orally with 5 x 10(2) mice brain cysts of ME49 strain. Feces were collected daily from the 3rd to the 30th day after challenge. Oocysts were detected by qualitative sugar flotation and the quantitative modified Kato Katz stained by Kinyoun (KKK). In the experimentally infected cats, oocysts were detected from the 7th to 15th day through sugar flotation technique, but oocysts were found in KKK from the 6th to 16th day, being sensitive for a larger period, with permanent documentation. The peak of oocysts excretion occurred between the 8th to 11th days after challenge, before any serological positive result. KKK could be used in the screening and quantification of oocysts excretion in feces of suspected animals, with reduced handling of infective material, decreasing the possibility of environmental and operator contamination.


Assuntos
Fezes/parasitologia , Oocistos , Toxoplasma/isolamento & purificação , Toxoplasmose Animal/parasitologia , Animais , Gatos , Contagem de Ovos de Parasitas/métodos , Contagem de Ovos de Parasitas/veterinária , Coloração e Rotulagem/métodos , Coloração e Rotulagem/veterinária , Fatores de Tempo
8.
Rev Inst Med Trop Sao Paulo ; 49(6): 371-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18157404

RESUMO

BACKGROUND: The pathogenesis of chronic hepatitis C is still a matter of debate. CD4+ and CD8+ T lymphocytes (TL) are typically observed within the portal and periportal spaces of affected livers, but their functional role in hepatitis C progression has not been fully elucidated. METHODS: CD4+ and CD8+ TL were quantified by immunohistochemistry in portal and periportal spaces of 39 liver biopsies from patients with chronic hepatitis C. They were associated to demographic data, histological parameters, laboratory findings of patients and hepatitis C genotypes. RESULTS: There was high numbers of CD4+ and CD8+ TL from which the density of CD4+ T was higher than CD8+ TL in portal and periportal spaces. CD4+ and CD8+ TL were directly correlated to intensity of interface hepatitis. CD8+ TL correlated to serum enzyme levels. CONCLUSION: The high numbers of CD4+ and CD8+ TL in portal and periportal spaces and their correlation to interface hepatitis suggest that hepatitis C evolution depends on the action of intrahepatic T lymphocytes, lending support to the notion of an immune-mediated mechanism in the pathogenesis of chronic hepatitis C.


Assuntos
Relação CD4-CD8 , Hepacivirus/imunologia , Hepatite C Crônica/imunologia , Fígado/virologia , Adolescente , Adulto , Progressão da Doença , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/patologia , Humanos , Imuno-Histoquímica , Fígado/irrigação sanguínea , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
9.
Rev Inst Med Trop Sao Paulo ; 46(6): 335-8, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15654480

RESUMO

In Brazil, the main etiologic agent of Leishmaniasis that frequently presents with mucosal involvement belongs to the Viannia subgenus. The therapeutic conduct in this disease depends on the parasitological diagnosis, and classical methods are restricted in identifying the agent. In this paper we describe a polymerase chain reaction (PCR), which uses primers designed from mini-exons repetitive sequences. The PCR amplifies a 177bp fragment that can distinguish (Viannia) from (Leishmania) subgenus. This test could be a useful diagnostic tool.


Assuntos
Leishmania/genética , Leishmaniose/parasitologia , Reação em Cadeia da Polimerase/métodos , Animais , DNA de Protozoário/análise , DNA de Protozoário/genética , Éxons/genética , Humanos , Leishmania/classificação , Leishmaniose/diagnóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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