In vitro and in situ activation of the complement system by the fungus Lacazia loboi

Since there are no studies evaluating the participation of the complement system (CS) in Jorge Lobo's disease and its activity on the fungus Lacazia loboi, we carried out the present investigation. Fungal cells with a viability index of 48% were obtained from the footpads of BALB/c mice and incubated with a pool of inactivated serum from patients with the mycosis or with sterile saline for 30 min at 37 ºC. Next, the tubes were incubated for 2 h with a pool of noninactivated AB+ serum, inactivated serum, serum diluted in EGTA-MgCl2, and serum diluted in EDTA. The viability of L. loboi was evaluated and the fungal suspension was cytocentrifuged. The slides were submitted to immunofluorescence staining using human anti-C3 antibody. The results revealed that 98% of the fungi activated the CS by the alternative pathway and no significant difference in L. loboi viability was observed after CS activation. In parallel, frozen histological sections from 11 patients were analyzed regarding the presence of C3 and IgG by immunofluorescence staining. C3 and IgG deposits were observed in the fungal wall of 100% and 91% of the lesions evaluated, respectively. The results suggest that the CS and immunoglobulins may contribute to the defense mechanisms of the host against L. loboi

Influence Of The Rapid Acetylator Phenotype On The Emergence Of Dds Resistant Mycobacterium Leprae

Twenty one lepromatous cases with suspected diaminodiphenyl sulfone (DDS) resistance had their isoniazid acetylator phenotype determined. The resistance of Mycobacterium leprae to this sulfone was investigated by means of foot pad tests in BALB/c mice. Results indicate that the emergence of complete resistance to DDS in M. leprae is more probable in rapid than in slow acetylators. It appears that rapid acetylators require higher doses of DDS than slow acetylators since the bacillary concentration in the lesions of the patients with DDS sensitive M. leprae was more than 17 times higher among rapid than among slow acetylators.1641029103

Dapsone hypersensitivity syndrome in an adolescent during treatment during of leprosy Síndrome de hipersensibilidade à dapsona em uma adolescente durante tratamento de hanseníase

A 12 y old girl was admitted 24 days after start a WHO multidrug therapy scheme for multibacillary leprosy (dapsone, clofazimine and rifampicin) with intense jaundice, generalized lymphadenopathy, hepatoesplenomegaly, oral erosions, conjunctivitis, morbiliform rash and edema of face, ankles and hands. The main laboratory data on admission included: hemoglobin, 8.4 g/dL; WBC, 15,710 cells/mm³; platelet count, 100,000 cells/mm³; INR = 1.49; increased serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transpeptidase, alkaline phosphatase, direct and indirect bilirubin. Following, the clinical conditions had deteriorated, developing exfoliative dermatitis, shock, generalized edema, acute renal and hepatic failure, pancytopenia, intestinal bleeding, pneumonia, urinary tract infection and bacteremia, needing adrenergic drugs, replacement of fluids and blood product components, and antibiotics. Ten days after admission she started to improve, and was discharged to home at day 39th, after start new supervised treatment for leprosy with clofazimine and rifampicin, without adverse effects. This presentation fulfils the criteria for the diagnosis of dapsone hypersensitivity syndrome (fever, generalized lymphadenopathy, exfoliative rash, anemia and liver involvement with mixed hepatocellular and cholestatic features). Physicians, mainly in geographical areas with high prevalence rates of leprosy, should be aware to this severe, and probably not so rare, hypersensitivity reaction to dapsone.<br>Menina, 12 anos, foi admitida referindo o uso de esquema de poliquimioterapia preconizado pela OMS para tratamento de hanseníase forma multicibacilar (dapsona, rifampicina e clofazimina) há 24 dias, apresentando icterícia, linfadenomegalia generalizada, hepatoesplenomegalia, conjuntivite, úlceras orais, exantema morbiliforme e edema de face, mãos e tornozelo. Os principais achados laboratoriais à admissão incluíam: hemoglobina, 8,4 g/dl; leucograma, 15.710 céls/mm³; contagem de plaquetas, 100.000 céls/mm³; RNI = 1,49; aumento dos níveis séricos da alanino e aspartato aminotransferases, gama-glutamil transpeptidase, fosfatase alcalina e bilirrubinas. Em seqüência, ocorreu piora do quadro, desenvolvendo dermatite esfoliativa, choque, edema generalizado, insuficiências renal e hepática, pancitopenia, sangramento intestinal, pneumonia, infecção urinária e bacteremia, necessitando de drogas adrenérgicas, antibióticos, infusão de líquidos e hemoderivados. Iniciou melhora no 10º dia de internação, recebendo alta hospitalar no 39º dia, tendo iniciado novo tratamento supervisionado para hanseníase com rifampicina e clofazimina, sem efeitos adversos. O caso relatado preenche os critérios para o diagnóstico de síndrome de hipersensibilidade à dapsona (febre, dermatite esfoliativa, linfadenopatia, anemia e acometimento hepático com necrose hepatocítica e colestase). Os médicos, principalmente em regiões com alta prevalência de hanseníase, devem estar atentos para esta grave, e provavelmente não tão rara, reação de hipersensibilidade à dapsona

Efeito adverso do uso intermitente de rifampicina para tratamento de hanseníase

Os autores apresentam um caso de insuficiência renal aguda, hemólise aguda e trombocitopenia relacionada ao uso intermitente de Rifampicina para tratamento da Hanseníase. Estas reações adversas são observadas com extrema raridade na literatura mundial. A evolução da paciente foi benigna havendo recuperação total da função renal e regressão completa das alterações hematológicas. Este foi o primeiro registro no Brasil dos efeitos adversos da Rifampicina no tratamento de Hanseníase. São discutidos os principais aspectos patogênicos das alterações apresentadas e fez-se revisão da literatura existente sobre o assunto