RESUMO
Analysis of cell-mediated immunity [(CMI) as judged from the Mantoux, Fernandez, and Mitsuda reactions and the presence of granulomas in biopsy material] against humoral immunity (measurements of anti-PGL-I, PGL-Tb1, and SL-IV IgG and IgM antibody titers by ELISA) were performed in selected human populations. The investigations yielded data indicating that humoral (B-cell) responses preceded protective CMI in both tuberculosis and leprosy. The B-cell responses were unrelated to (unfavorable) cell-mediated delayed-type hypersensitivity (DTH). Notwithstanding the difficulty in inferring sequential events from studies in humans, it was shown that in humoral responses there was an initial rise of specific IgM immunoglobulins that switched afterward to IgG production during subclinical tuberculosis and leprosy infections. In patent tuberculosis disease the IgM-to-IgG switch was observed in the majority of patients; in patent leprosy disease the switch was impaired in the majority of patients. The clinical, immunological, and laboratory data indicated that the B-cell responses were suppressed as protective CMI was re-established in the patients during the protracted subclinical infection. According to the data, the diagnosis of subclinical tuberculosis and leprosy may be accomplished using ELISA. The yearly risk of tuberculosis in apparently healthy persons but with significant antibody titers was estimated at 44%; the yearly risk for leprosy has not yet been established. The clinical, epidemiologic, and diagnostic implications of these findings are discussed.
Assuntos
Anticorpos Antibacterianos/biossíntese , Hanseníase/imunologia , Mycobacterium leprae/imunologia , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/imunologia , Vacina BCG , Brasil , Ensaio de Imunoadsorção Enzimática , França , Glicolipídeos/imunologia , Pessoal de Saúde , Humanos , Imunidade Celular , Hanseníase/diagnóstico , Hanseníase/microbiologia , Militares , Mycobacterium leprae/crescimento & desenvolvimento , Mycobacterium tuberculosis/crescimento & desenvolvimento , Doenças Profissionais/diagnóstico , Doenças Profissionais/imunologia , Doenças Profissionais/microbiologia , Sensibilidade e Especificidade , Testes Cutâneos , Especificidade da Espécie , Tuberculose/diagnóstico , Tuberculose/microbiologia , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/imunologia , Tuberculose Cutânea/microbiologiaRESUMO
Disseminated Mycobacterium avium infection is common in patients with acquired immune deficiency syndrome (AIDS), but no drug studies have been reported establishing antimicrobial activity against this organism in a controlled, randomized trial. Clarithromycin, a new macrolide, has activity against M. avium in vitro and in animals, but it has not been studied in humans. In this randomized, double-blind, placebo-controlled trial, we measured the ability of clarithromycin to reduce M. avium bacteremia in patients with AIDS and disseminated infection. Of 23 patients initially enrolled, 15 men with late-stage AIDS qualified for the study. One group received clarithromycin alone for 6 wk, then placebo plus rifampin, isoniazid, ethambutol, and clofazimine for 6 wk. The other group received placebo alone, then clarithromycin plus the other four drugs. Colony-forming units (CFU) of M. avium per milliliter of blood were determined by quantitative cultures taken at baseline and every 2 wk thereafter. Minimum inhibitory concentration of clarithromycin for 90% of the strains isolated from patients at baseline, as measured on 7H11 agar at pH 6.6, was 8 micrograms/ml. Eight eligible patients with initial positive cultures who were initially receiving clarithromycin alone had marked declines in blood M. avium CFU; in six cases, CFU decreased to zero. When seven patients were switched to placebo plus the other four drugs, CFU rose in four patients and remained undetectable in three. The five eligible patients initially treated with placebo had progressive CFU increases; when three were switched to clarithromycin plus the four drugs, their CFU declined.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Eritromicina/análogos & derivados , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Adulto , Claritromicina , Contagem de Colônia Microbiana , Método Duplo-Cego , Quimioterapia Combinada , Eritromicina/efeitos adversos , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Humanos , Isoniazida/administração & dosagem , Isoniazida/uso terapêutico , Testes de Sensibilidade Microbiana , Complexo Mycobacterium avium/efeitos dos fármacos , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/microbiologia , Rifampina/administração & dosagem , Rifampina/uso terapêuticoRESUMO
At a predetermined specificity of 100.0%, the sensitivity of ELISA using the PGL-Tb1 and SL-IV antigens and IgG assays was 35.0% for the diagnosis of tuberculosis in AIDS patients (44.1% when tuberculosis was diagnosed before AIDS, 21.7% when AIDS was diagnosed before tuberculosis). Serial assays in sera collected from 11 AIDS patients before tuberculosis was diagnosed indicated that significant antibody titres were detected 10 months before the onset of clinical tuberculosis. Consequently, it was proposed that serodiagnosis using the glycolipid specific antigens should help in deciding on preventive antituberculosis treatment in these patients.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Antígenos de Bactérias , Glicolipídeos , Mycobacterium tuberculosis/imunologia , Tuberculose/diagnóstico , Anticorpos Antibacterianos/sangue , Reações Cruzadas , Ensaio de Imunoadsorção Enzimática , Glicolipídeos/imunologia , Humanos , Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/complicações , Valor Preditivo dos Testes , Tuberculose/complicaçõesRESUMO
VIH 1 antigenaemia has a significant value in the follow-up of patients treated with AZT. This study of 90 patients (55 ARC - 35 AIDS), each receiving AZT for more than a year, 200 mg every 4 hours, demonstrates the prognosis value of antigenaemia at Day 0, as well as its therapeutic indication value. However, at term and under this treatment, the significance of this virological data has to be reconsidered. Various kinetic patterns are described according to the clinical status and the CD4+ cells count.