10 research outputs found
NON-TOXIC GOITRE: DIAGNOSTIC ROLE OF ASPIRATION CYTOLOGY, ANTIBODIES AND SERUM THYROTROPHIN
Cardiac arrhythmias following the creation of an atrial septal defect in patients with transposition of the great arteries
An ultrastructural and histochemical study of autoimmune aspermatogenesis in the rat testis
Immunological status of ENL (Erythema Nodosum Leprosum) patients: its relationship to bacterial load and levels of circulanting IL-2R Perfil imunolĂłgico de pacientes com ENL (Erythema Nodosum Leprosum): relação entre carga bacilar e os nĂveis de IL-2R circulantes
Recent data suggest that the clinical course of reactional states in leprosy is closely related to the cytokine profile released locally or systemically by the patients. In the present study, patients with erythema nodosum leprosum (ENL) were grouped according to the intensity of their clinical symptoms. Clinical and immunological aspects of ENL and the impact of these parameters on bacterial load were assessed in conjunction with patients' in vitro immune response to mycobacterial antigens. In 10 out of the 17 patients tested, BI (bacterial index) was reduced by at least 1 log from leprosy diagnosis to the onset of their first reactional episode (ENL), as compared to an expected 0.3 log reduction in the unreactional group for the same MDT (multidrug therapy) period. However, no difference in the rate of BI reduction was noted at the end of MDT among ENL and unreactional lepromatous patients. Accordingly, although TNF-alpha (tumor necrosis factor) levels were enhanced in the sera of 70.6% of the ENL patients tested, no relationship was noted between circulating TNF-alpha levels and the decrease in BI detected at the onset of the reactional episode. Evaluation of bacterial viability of M. leprae isolated from the reactional lesions showed no growth in the mouse footpads. Only 20% of the patients demonstrated specific immune response to M. leprae during ENL. Moreover, high levels of soluble IL-2R (interleukin-2 receptor) were present in 78% of the patients. Circulating anti-neural (anti-ceramide and anti-galactocerebroside antibodies) and anti-mycobacterial antibodies were detected in ENL patients' sera as well, which were not related to the clinical course of disease. Our data suggest that bacterial killing is enhanced during reactions. Emergence of specific immune response to M. leprae and the effective role of TNF-alpha in mediating fragmentation of bacteria still need to be clarified.<br>Dados recentes sugerem que o curso clĂnico dos estados reacionais na lepra está estritamente relacionado Ă liberação local ou sistĂŞmica de citocinas. Neste estudo, pacientes com ENL (erythema nodosum leprosum) foram grupados segundo a intensidade de seus sintomas clĂnicos. Os aspectos clĂnicos e imunolĂłgicos do ENL e os efeitos desses parâmetros na carga bacilar foram estabelecidos em conjunção com a resposta imune in vitro desses pacientes, a antĂgenos microbacterianos. Em 10 de 17 pacientes testados, o Ăndice bacteriano (IB) foi reduzido cm pelo menos 1 log desde o diagnĂłstico da lepra atĂ© o aparecimento do primeiro episĂłdio reacional, comparado a uma redução esperada de 0.3 log no grupo nĂŁo reacional no mesmo perĂodo de MDT (multidrogaterapia). Entretanto, nenhuma diferença na taxa de redução do IB foi notada no final da MDT entre os pacientes ENL e os lepromatosos nĂŁo reacionais. Assim tambĂ©m, embora os nĂveis de TNF-alfa (fator de necrose tumoral) estivessem aumentados no soro de 70,6% dos pacientes com ENL testados, nenhuma relação foi notada entre os nĂveis circulantes de TNF-alfa e a diminuição do IB detectada no aparecimento do primeiro episĂłdio reacional. A avaliação da viabilidade bacteriana do M. leprae isolado de lesões reacionais nĂŁo mostrou crescimento na pata de camundongo. Somente 20% dos pacientes demonstraram resposta imune especĂfica ao M. leprae durante o ENL. AlĂ©m disso altos nĂveis de IL-2R (receptor de interleucina 2) solĂşvel estiveram presentes em 78% dos pacientes. Anticorpos circulantes anti-nervo (anti-ceramĂdio e anti-galactocerebrosĂdio) e anti-micobacterianos foram tambĂ©m detectados no soro dos pacientes, e nĂŁo estiveram relacionados ao curso clĂnico da doença. Nossos dados sugerem que a morte bacteriana está aumentada durante as reações. A emergĂŞncia de resposta imune especĂfica ao M. leprae e o papel efetivo do TNF-alfa na mediação de fragmentação bacteriana necessita ainda ser esclarecid