Pathogenic Th17 and Th22 cells are increased in patients with autoimmune thyroid disorders.

PURPOSE: To study the levels of pathogenic and non-pathogenic Th17 and Th22 cells in autoimmune thyroid disorders patients. Although Th17 cells seem to play an important role in the pathogenesis of thyroid autoimmune disorders, the specific subsets of these lymphocytes have not been analyzed in this condition. METHODS: We assessed the levels of Th17 (pathogenic and non-pathogenic) and Th22 cells in peripheral blood and thyroid glands of autoimmune thyroid disorders patients (n = 26, 16 with Graves' disease and 10 with Hashimoto's thyroiditis) and 15 healthy controls by multi-parametric flow cytometry and immunofluorescence microscopy. RESULTS: We found increased levels of pathogenic Th17 lymphocytes and Th22 cells in peripheral blood from autoimmune thyroid disorders patients. In addition, these cells were detected in thyroid glands from HT patients. Furthermore, we found significant correlations between the levels of these cells and disease activity, disease duration, and the presence of ophthalmopathy. CONCLUSIONS: The increased levels of pathogenic Th17 lymphocytes and Th22 cells in autoimmune thyroid disorders suggest their involvement in the pathogenesis of this condition.

Atypical lymphocytosis in leptospirosis: a cohort of hospitalized cases between 1996 and 2009 in State of Rio de Janeiro, Brazil / Linfócitos atípicos na leptospirose: coorte de pacientes hospitalizados entre 1996 e 2009, Estado do Rio de Janeiro

INTRODUCTION: Leptospirosis is a zoonotic disease found in tropical and temperate countries, and its clinical diagnostic confusion with arboviruses (dengue fever, oropouche fever and yellow fever), Brazilian spotted fever, viral hepatitis and hantaviruses has been an ongoing public health concern. The aim of this observational study was to demonstrate an association between findings of atypical lymphocytosis and the progression of endemic leptospirosis. METHODS: A retrospective analysis was performed on the demographic, epidemiological, clinical and laboratory aspects of 27 human leptospirosis cases that occurred over a period of 13 years (1996-2009) with no reported epidemic outbreaks in Rio de Janeiro, Brazil. RESULTS: The overall mortality rate was 11.1 percent in our cohort of hospitalized cases. However, there was no mortality among patients with atypical lymphocytosis (OR = 11.1; 95 percent CI = 1.12-110.9; p = 0.04). Two patients who were in the septicemic phase showed signs of expansion of γδ T cell responses in peripheral blood. CONCLUSIONS: Atypical lymphocytosis may be observed in patients with leptospirosis. Our observations suggest that these atypical leukocyte subsets are associated with partial protection during the disease course of leptospirosis.

INTRODUÇÃO: Leptospirose é uma zoonose que permanece endêmica em regiões tropicais e temperadas. A dificuldade no diagnóstico clínico diferencial entre os quadros de leptospirose humana e as várias arboviroses (dengue, febre amarela, febre de oropouche), febre maculosa brasileira, hepatite viral e hantavirose permanece um problema na Saúde Pública. MÉTODOS: No presente estudo, foi realizada análise retrospectiva de características demográficas, epidemiológicas, clínicas e laboratoriais de 27 casos de leptospirose humana que ocorrerem durante um período de 13 anos sem ocorrência de notificação de surtos epidêmicos no Rio de Janeiro, Brasil (1996-2009). RESULTADOS: A mortalidade da coorte de pacientes com leptospirose correspondeu a 11,1 por cento, sem embargo, o grupo de pacientes com atipia linfocitária não evoluiu para o óbito (OR = 11,1; 95 por cento CI = 1,12-110,9; p = 0.04). Em duas oportunidades, foi observada uma expansão dos linfócitos T gama-delta no sangue periférico de pacientes na fase septicêmica da leptospirose. CONCLUSÕES: Atipia linfocitária pode ocorrer em pacientes com leptospirose. Nossos dados também sugerem que os linfócitos atípicos podem estar envolvidos na patogênese da leptospirose.

Atypical lymphocytosis in leptospirosis: a cohort of hospitalized cases between 1996 and 2009 in State of Rio de Janeiro, Brazil.

INTRODUCTION: Leptospirosis is a zoonotic disease found in tropical and temperate countries, and its clinical diagnostic confusion with arboviruses (dengue fever, oropouche fever and yellow fever), Brazilian spotted fever, viral hepatitis and hantaviruses has been an ongoing public health concern. The aim of this observational study was to demonstrate an association between findings of atypical lymphocytosis and the progression of endemic leptospirosis. METHODS: A retrospective analysis was performed on the demographic, epidemiological, clinical and laboratory aspects of 27 human leptospirosis cases that occurred over a period of 13 years (1996-2009) with no reported epidemic outbreaks in Rio de Janeiro, Brazil. RESULTS: The overall mortality rate was 11.1% in our cohort of hospitalized cases. However, there was no mortality among patients with atypical lymphocytosis (OR = 11.1; 95% CI = 1.12-110.9; p = 0.04). Two patients who were in the septicemic phase showed signs of expansion of γδ T cell responses in peripheral blood. CONCLUSIONS: Atypical lymphocytosis may be observed in patients with leptospirosis. Our observations suggest that these atypical leukocyte subsets are associated with partial protection during the disease course of leptospirosis.

Status epilepticus and lymphocytic pneumonitis following hepatitis B vaccination.

The case reported refers to a patient who developed status epilepticus in the day of her third dose of hepatitis B vaccination and we review the literature on this subject. A 12 year-old girl, without a relevant previous history, taking no drugs, developed a seizure attack followed by unconsciousness, and eventually died after three days of her third dose of hepatitis B (HB) vaccination. Autopsy study revealed cerebral edema with congestion and herniation and diffuse interstitial type pneumonitis. There seem to be a straight forward time relationship between the third HB vaccine, the event of convulsion and the sudden death of the patient. We suggest that, in some cases, vaccination may be the triggering factor for autoimmune and neurological disturbances in genetically predisposed individuals and physicians should be aware of this possible association.

[Pseudomigraine with pleocytosis]. / Pseudomigraña con pleocitosis linfocitaria.

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis or pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (HaNDL) is a syndrome consisting of recurrent headaches, reversible neurological deficit, lymphocytic pleocytosis in cerebrospinal fluid (CSF), variable duration over time and spontaneous resolution. Although several etiopathogenic mechanisms have been suggested (vascular, infectous, immunological and calcium channelopthy), its etiology remains unknown. We describe a 28 year old female, with recurrent migraine with pleocytosis, confusional syndrome and transient neurological deficit. The clinical remission was achieved within two months. Although its etiology remains unknown the differential diagnosis is discussed in order to keep in mind this syndrome.

Pseudomigraña con pleocitosis linfocitaria / Pseudomigraine with pleocytosis

El síndrome de cefalea y déficit neurológico transitorio con pleocitosis en el liquido cefalorraquídeoo pseudomigraña con síntomas neurológicos temporarios y pleocitosis linfocítica (HaNLD), es uncuadro de cefaleas recurrentes, déficit neurológico reversible y pleocitosis linfocitaria en el líquido cefalorraquídeo(LCR), de duración variable y resolución espontánea. Si bien se han propuesto múltiples mecanismosetiopatogénicos (vascular, infeccioso, inmunológico y alteración de los canales de calcio), su etiología es aúndesconocida. Describimos el caso de una mujer de 28 años de edad, con episodios recurrentes de migraña conpleocitosis, síndrome confusional y déficit neurológico transitorio, con remisión clínica dentro de los dos meses.Si bien la etiología sigue siendo desconocida. Presentamos los diagnósticos diferenciales a tener en cuenta ante este síndrome

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis or pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (HaNDL) is a syndrome consisting of recurrent headaches, reversible neurological deficit, lymphocytic pleocytosis in cerebrospinal fluid (CSF), variable duration over time and spontaneous resolution. Although several etiopathogenic mechanisms have been suggested (vascular, infectous, immunological and calciumchannelopthy), its etiology remains unknown. We describe a 28 year old female, with recurrent migrainewith pleocytosis, confusional syndrome and transient neurological deficit. The clinical remission was achievedwithin two months. Although its etiology remains unknown the differential diagnosis is discussed in order to keepin mind this syndrome

Pseudomigraña con pleocitosis linfocitaria / Pseudomigraine with pleocytosis

El síndrome de cefalea y déficit neurológico transitorio con pleocitosis en el liquido cefalorraquídeoo pseudomigraña con síntomas neurológicos temporarios y pleocitosis linfocítica (HaNLD), es uncuadro de cefaleas recurrentes, déficit neurológico reversible y pleocitosis linfocitaria en el líquido cefalorraquídeo(LCR), de duración variable y resolución espontánea. Si bien se han propuesto múltiples mecanismosetiopatogénicos (vascular, infeccioso, inmunológico y alteración de los canales de calcio), su etiología es aúndesconocida. Describimos el caso de una mujer de 28 años de edad, con episodios recurrentes de migraña conpleocitosis, síndrome confusional y déficit neurológico transitorio, con remisión clínica dentro de los dos meses.Si bien la etiología sigue siendo desconocida. Presentamos los diagnósticos diferenciales a tener en cuenta ante este síndrome(AU)

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis or pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (HaNDL) is a syndrome consisting of recurrent headaches, reversible neurological deficit, lymphocytic pleocytosis in cerebrospinal fluid (CSF), variable duration over time and spontaneous resolution. Although several etiopathogenic mechanisms have been suggested (vascular, infectous, immunological and calciumchannelopthy), its etiology remains unknown. We describe a 28 year old female, with recurrent migrainewith pleocytosis, confusional syndrome and transient neurological deficit. The clinical remission was achievedwithin two months. Although its etiology remains unknown the differential diagnosis is discussed in order to keepin mind this syndrome(AU)

Pseudomigraña con pleocitosis linfocitaria / Pseudomigraine with pleocytosis

El síndrome de cefalea y déficit neurológico transitorio con pleocitosis en el liquido cefalorraquídeoo pseudomigraña con síntomas neurológicos temporarios y pleocitosis linfocítica (HaNLD), es uncuadro de cefaleas recurrentes, déficit neurológico reversible y pleocitosis linfocitaria en el líquido cefalorraquídeo(LCR), de duración variable y resolución espontánea. Si bien se han propuesto múltiples mecanismosetiopatogénicos (vascular, infeccioso, inmunológico y alteración de los canales de calcio), su etiología es aúndesconocida. Describimos el caso de una mujer de 28 años de edad, con episodios recurrentes de migraña conpleocitosis, síndrome confusional y déficit neurológico transitorio, con remisión clínica dentro de los dos meses.Si bien la etiología sigue siendo desconocida. Presentamos los diagnósticos diferenciales a tener en cuenta ante este síndrome(AU)

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis or pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (HaNDL) is a syndrome consisting of recurrent headaches, reversible neurological deficit, lymphocytic pleocytosis in cerebrospinal fluid (CSF), variable duration over time and spontaneous resolution. Although several etiopathogenic mechanisms have been suggested (vascular, infectous, immunological and calciumchannelopthy), its etiology remains unknown. We describe a 28 year old female, with recurrent migrainewith pleocytosis, confusional syndrome and transient neurological deficit. The clinical remission was achievedwithin two months. Although its etiology remains unknown the differential diagnosis is discussed in order to keepin mind this syndrome(AU)

Primary angiitis of the central nervous system: report of five biopsy-confirmed cases from Colombia.

INTRODUCTION: Primary (isolated) angiitis of the central nervous system (PACNS) is a rare cause of cerebrovascular disease (CVD), and few leptomeningeal and brain biopsy (LBB)-confirmed cases have been reported from South America. METHODS: We retrospectively reviewed charts of patients with diagnosis of cerebral angiitis admitted between March 1991 and July 2001 to a single university hospital in Medellin, Colombia. Patients with definitive diagnosis of PACNS by Alrawi et al.'s LBB criteria were selected. We excluded other causes of cerebral angiitis as well as cases without LBB confirmation. RESULTS: We report five patients, four men and one woman, with a mean age at onset of 24.4 years, and an average disease progression of 12.4 days. Four presented with headache and motor weakness, three had seizures, and two had alterations of consciousness. Cerebral MRI was abnormal in all five cases; brain CT in four, and cerebral angiography in two. The cerebrospinal fluid (CSF) was abnormal in two patients. Leptomeningeal and brain biopsies revealed mononuclear infiltration in the wall of small blood vessels in all. Three had concurrent meningeal and cerebral involvement, two had necrotizing angiitis, and one had vascular and encephalitic lesions. All received only steroid treatment; the 1-year follow-up revealed good prognosis without relapses. CONCLUSION: We report five biopsy-proven cases of PACNS from Colombia associated with neurological and neuroimaging abnormalities; these patients presented a mild inflammatory disease that was correlated with few CSF abnormalities and good response to single steroid treatment without relapses. Leptomeningeal and brain biopsy is mandatory for a definitive diagnosis.

Compromiso de las glándulas salivales en la enfermedad HIV/Sida / Salivary glands involvement in HIV/AIDS disease

La enfermedad de las glándulas salivales asociada al HIV es definida como la presencia de aumento del tamaño de la glándula asociado o no a xerostomía. Esta patología es más habitual en niños que en adultos. La enfermedad de las glándulas salivales asociada al HIV incluye lesiones linfoepiteliales y quistes que comprometen el tejido glandulas y/o los ganglios linfáticos, síndrome símil-Sjogren, síndrome de linfocitosis T CD8 difuso y neoplasias. Este artículo incluye una revisión de la epidemiología, la fisiopatología, las manifestaciones clínicas, la metodololgía diagnóstica y los diagnósticos diferenciales de la enfermedad de las glándulas salivales asociada al HIV (AU)

Síndrome de Gianotti-Crosti: informe de 18 casos / Gianotti-Crosti syndrome: report of 18 cases

En el presente estudio se presentan 18 casos de síndrome de Gianotti-Crosti, que se documentaron de marzo de 1987 a noviembre de 1994, en el Hospital Regional No. 1 de Acapulco, y en el hospital General de Zona No. 14 de guadalajara del Instituto Mexicano del Seguro Social (IMSS). Se describen algunas características epidemiológicas, las manifestaciones clínicas y morfológicas y los hallazgos histipatológicos de laboratorio de la enfermedad

Lymphomatous meningoencephalitis in a patient with HAM/TSP.

A case of lymphomatous meningoencephalitis in a 23 year old Brazilian patient with HTLV-I/II associated myelopathy is reported. The patient was admitted to the hospital with a clinical picture of decreased consciousness level, stiffness of the neck and previous diagnosis of myeloneuropathy. CSF examination showed lymphocytosis with blastic cells and antibodies against HTLV-I/II.

Lymphomatous meningoencephalitis in a patient with HAM/TSP

É descrito o caso de um paciente de 23 anos, com diagnóstico prévio de mielorradiculopatia que desenvolveu diminuiçäo gradual do nível de consciência, rigidez de nuca e cefaléia. O exame do LCR mostrou linfocitose com presença de células blásticas, hiperproteinorraquia e anticorpos para HTLV-I/II