RESUMO
One hundred sixty-six cases of primary immunodeficiency diseases (PID) (95 males, 71 females), diagnosed according to WHO criteria, have been registered at the Children's Hospital, University of São Paulo, Brazil. The following frequencies were found: predominantly humoral defects, 60.8% (n = 101); T cell defects, 4.9% (n = 8); combined ID, 9.6% (n = 16); phagocyte disorders, 18.7% (n = 31); and complement deficiencies, 6% (n = 10). IgA deficiency was the most frequent disorder (n = 60), followed by transient hypogammaglobulinemia (n = 14), chronic granulomatous disease (n = 14), and X-linked agammaglobulinemia (n = 9). In comparison to other (national) reports, we observed higher relative frequencies of phagocyte and complement deficiencies. Recurrent infections were the cause of death in 12.7%. Allergic symptoms were observed in 41%, mainly in IgA-deficient, hypogammaglobulinemic, or hyper-IgE patients, and autoimmune disorders in 5%, predominantly in IgA and complement deficiencies. Five patients suffered from BCG dissemination; two of them died. This is the first Brazilian report on PID over an observation time of 15 years.
PIP: Over a 15-year observation period (1981-96), 166 cases of primary immunodeficiency disease (PID) were registered at the Department of Pediatrics, University of Sao Paulo, Brazil. PID was diagnosed according to World Health Organization criteria and only children with well-established deficiencies were included. The following frequencies were noted by PID classification: predominantly humoral defects (60.8%), T cell defects (4.9%), combined immunodeficiency (9.6%), phagocyte disorders (18.7%), and complement deficiencies (6%). The male to female ratio was 1.3 to 1. Immunoglobin A deficiency was the most frequent disorder (60 cases), followed by transient hypogammaglobulinemia (14 cases), chronic granulomatous disease (14 cases), and X-linked agammaglobulinemia (9 cases). Allergic symptoms occurred in 41% of cases. During the observation period, 23 children (13.8%) died, primarily of recurrent infections. Although improved diagnostic facilities have facilitated the recognition of immunodeficient children, the true incidence is likely to be higher than that detected in this study. Increased international collaboration is urged to improve the early detection of PID.
Assuntos
Síndromes de Imunodeficiência/epidemiologia , Adulto , Brasil/epidemiologia , Criança , Proteínas Inativadoras do Complemento 1/deficiência , Feminino , Seguimentos , Humanos , Síndromes de Imunodeficiência/mortalidade , Síndromes de Imunodeficiência/terapia , Masculino , Disfunção de Fagócito Bactericida/etiologia , Imunodeficiência Combinada Severa/epidemiologia , Fatores de TempoRESUMO
In January and February 1992, an assessment was conducted of the safety and immunogenicity of two doses of a new oral cholera vaccine prepared from the recombinant B subunit of the toxin and from killed whole cells (rBS/WC) in 1,165 individuals between the ages of 12 months and 64 years in Barranquilla, Colombia. This was a randomized, double-blind placebo-controlled study. Participants received two doses of either the vaccine or a placebo (killed Escherichia coli K12) over a two-week interval. Few symptoms were detected during the three days following administration of the initial dose and even fewer following the second. Sera obtained upon administration of the first dose and two weeks after administration of the second were tested for Vibrio cholerae 01 Inaba vibriocidal antibodies and antitoxins. Geometric mean titers (GMT) of vibriocidal antibodies were found to increase two-fold in subjects receiving the vaccine. In the paired samples taken from vaccinated subjects, two-fold or greater increases were observed in 44% and four-fold or greater increases were observed in 34%, as compared to similar increases in 9.2% and 2.2% of the sera taken from those receiving the placebo (P < 0.05). The GMTs of IgG and IgA antitoxins, as determined by ELISA, increased by factors of 4 and 3.2, respectively, in those receiving the vaccine, as compared to factors of 1.1 and 1.1 in those given the placebo (P < 0.001 for IgG, P < 0.01 for IgA). Approximately 80% of the paired samples from the vaccinated group showed an increase of both IgG and IgA antitoxins > or = 1.5, as compared to only about 20% of those in the placebo group (P < 0.000001). Belonging to the O blood group did not significantly affect the immune response. Children under age four tended to show a weaker vibriocidal antibody response and a stronger antitoxin response than older subjects. The two doses of oral vaccine were found to be safe and without attributable side-effects. The vibriocidal antibody and antitoxin responses were similar to those obtained previously with the conventional oral killed whole cell B subunit cholera vaccine.
PIP: In a randomized, double-blind, placebo-controlled study in January and February 1992, the safety and immunogenicity of two doses of a new oral cholera vaccine was assessed. The vaccine was prepared from the recombinant B subunit of the toxin and from killed whole cells (rBS/WC) in 1165 individuals between the ages of 12 months and 64 years in Barranquilla, Colombia. Participants received two doses of either the vaccine or a placebo (killed Escherichia coli K12) over a 2-week interval. Few symptoms were detected during the 3 days following administration of the initial dose and even fewer following the second one. Sera obtained upon administration of the first dose and 2 weeks after administration of the second dose were tested for Vibrio cholera 01 Inaba vibriocidal antibodies and antitoxins. Geometric mean titers (GMTs) of vibriocidal antibodies were found to increase two-fold in subjects receiving the vaccine. In the paired samples taken from vaccinated subjects, two-fold or greater increases were observed in 44% and four-fold or greater increases were observed in 34%. In comparison, similar increases were found only in 9.2% and 2.2% of the sera taken from those receiving placebo (p .05). The GMTs of IgG and IgA antitoxins, as determined by ELISA, increased by factors of 4 and 3.2, respectively, in those receiving the vaccine as compared with factors of 1.1 and 1.1, respectively, in those given the placebo (p .001 for IgG and p .01 for IgA). Approximately 80% of the paired samples from the vaccinated group showed an increase of both IgG and IgA antitoxins or= 1.5 as compared with only about 20% of those in the placebo group (p .000001). Belonging to the O blood group did not significantly affect the immune response. Children under the age of 4 years tended to show a weaker vibriocidal antibody response and stronger antitoxin response than did older subjects. The two doses of oral vaccine were found to be safe and without attributable side effects.
Assuntos
Anticorpos Antibacterianos/sangue , Toxina da Cólera/imunologia , Vacinas contra Cólera/imunologia , Vacinas Sintéticas/imunologia , Vibrio cholerae/imunologia , Administração Oral , Adolescente , Adulto , Criança , Pré-Escolar , Vacinas contra Cólera/efeitos adversos , Colômbia , Método Duplo-Cego , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Lactente , Pessoa de Meia-Idade , Vacinas de Produtos Inativados , Vacinas Sintéticas/efeitos adversosRESUMO
Schistosoma mansoni was introduced in the Senegal basin around 1988, due to man-made ecological changes. Since 1991, we investigate a recent but very intense focus, Ndombo, a village near the city of Richard Toll where the outbreak was first described. Four cohorts, each a random sample (+/- 400 subjects each) from this community, were examined and followed up after treatment, starting at 8 month intervals over a 2-year period. Each cohort is examined parasitologically (Kato-Katz), clinically, serologically (circulating antigen and antibody profiles); treated with praziquantel 40 mg/kg; followed up 6-10 weeks, one and two years after treatment; and monitored for water contact patterns and local snail densities. In the first cohort, the prevalence was 91%, with a mean egg count of 663 epg. Prevalences are near 100% in all age groups, but egg counts decline strongly in adults. Antigen detection in serum and urine confirmed that the egg counts genuinely reflect variations of worm burdens, not e.g. of worm fecundity. This is surprising, as in this focus acquired immunity in adults should not have yet developed according to current hypothesis. The antigen detection assays (CAA/CCA) showed high sensitivity and quantitative power, and promising perspectives as a research tool and possibly as a method for non-invasive diagnosis and screening in urine. Epidemiological in subsequent cohorts were highly similar, although seasonal variations were observed possibly due to transmission fluctuations. Anti-AWA and anti-SEA IgE levels increased with age, while IgG4 peaked in the age-group 10 years and correlated well with egg counts.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: A cohort analysis was performed in Ndombo, Senegal, a community of about 4000, in the epicenter of the schistosomiasis outbreak. Four randomly selected cohorts of +or- 400 subjects were surveyed. Each cohort was examined parasitologically, clinically, and serologically (circulating antigen and antibody profiles); treated with praziquantel 40 mg/kg; and followed up at 6-12 weeks and at 1 and 2 years after treatment. The first cohort numbered 422 individuals, of which 91% had positive egg counts, with a mean egg count of 663 eggs per gram feces (epg). Quantitative egg counts in those aged 10-14 were 1409 epg and then declined to 632 epg in the age group 20-29 and to 266 epg in the age group over 40. In cohorts 2 and 3, examined in the spring and autumn, egg counts were substantially lower, particularly in adults, as compared with cohorts 1 and 4, which were both examined in the summer season. 94% of the subjects were positive in the serum circulating anodic antigen (CAA) ELISA, 83% in the serum CAA ELISA, and 95% in the urine circulating cathodic antigen (CCA) ELISA; CAA in urine was less sensitive, and was negative in half of the urine samples. Positivity rates for all assays increased with rising egg counts, and circulating antigen concentrations in both serum and urine correlated well with egg counts. IgE showed a significant increase with age, while IgG4 peaked in the age groups 10-15 and/or 15-19 years. A strong correlation between IgG, IgGl, and IgG4 against both crude antigens with pretreatment egg load was observed. Of the subjects in the first cohort, 61% reported abdominal pain, 33% diarrhea; only 16% showed mild hepatomegaly and only a few children had mild splenomegaly. In the first cohort, 82% of 298 reexamined subjects were still positive for S. mansoni 12 weeks after treatment with praziquantel 40 mg/kg. One year after treatment, cohort 1 showed mean egg counts in children (5-19 years) at 358 epg as compared with 1188 epg pretreatment.
Assuntos
Serviços de Saúde Comunitária , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/imunologia , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Estudos de Coortes , Fezes/parasitologia , Feminino , Humanos , Imunidade , Masculino , Pessoa de Meia-Idade , Contagem de Ovos de Parasitas , Prevalência , Esquistossomose mansoni/tratamento farmacológico , Estações do Ano , Senegal/epidemiologiaRESUMO
PIP: 50 children under the age of 15 years were studied who had been hospitalized in two hospitals in the Dominican Republic with HIV diagnosed by the presence of biphasic hyperbilirubinemia and elevation of glutamic-pyruvic and glutamic-oxalacetic transaminases. The sera of the patients were examined for the presence of leptospirotic immunoglobulin M (IgM) antibodies by means of the enzymatic immunoassay method (UREASA-ELISA). The Leptospira-positive sera were also investigated for the presence of hepatitis B surface antigen (HBsAg) and for the IgM antibody (ab) of the hepatitis A virus (ab-HAV) by ELISA. 5 cases were positive for IgM Leptospira antibodies (10%), not finding in this percentage the presence of HBsAg; 3 of the 5 Leptospira-positive samples demonstrated the presence of ab-HVA-IgM. Only 2 cases (4%) presented IgM Leptospira antibodies. Out of the 5 cases with IgM antibodies, males predominated (3/5). When compared to negative cases, however, there were more rural elements among them than in negative cases: regarding origins (10% vs. 16%), agricultural workers (40% vs. 20%), contact with cattle and fresh water (80% vs. 40%), and daily contact with humid soil in living quarters (60% vs. 48%). The clinical picture of the 5 positive cases featured myalgia (p = 0.05) and abdominal pain (p = 0.05). The stiffness of neck was relatively more frequent in positive cases (20%) than in negative cases (7%); also, fever (100% vs. 80%), vomiting (60% vs. 22%), headache (80% vs. 56%), constipation (20% vs. 9%), and hepatomegaly (100% vs. 71%). There was clear evidence that leptospirotic infection must be watched and also its association with acute infectious hepatitis.^ieng
Assuntos
Grupos de População Animal , Reações Antígeno-Anticorpo , Proteção da Criança , Infecções por HIV , Hepatite , Imunoglobulinas , Sinais e Sintomas , América , Anticorpos , Biologia , Sangue , Região do Caribe , Conservação dos Recursos Naturais , Países em Desenvolvimento , Doença , República Dominicana , Meio Ambiente , Saúde , Imunidade , Fatores Imunológicos , América Latina , América do Norte , Fisiologia , VirosesRESUMO
Specific antibody production was assessed in six young children with the acquired immune deficiency syndrome (AIDS). All patients were immunized with bacteriophage phi X 174, a T cell-dependent neoantigen. In addition, antibody responses to pneumococcal vaccine and tetanus toxoid, lymphocyte responses to mitogens, and serum immunoglobulin levels were determined. Polyclonal hypergammaglobulinemia was documented in three patients. Responses to bacteriophage phi X 174 were abnormal in all patients: primary responses were blunted, secondary responses were markedly decreased, and the class switch (IgM-IgG) was absent in five of six patients. Antibody formation to pneumococcal vaccine and tetanus toxoid was also diminished. Lymphocyte mitogenic responses to phytohemagglutinin, concanavalin A, pokeweed mitogen, and staphylococcal Cowan A were generally decreased. These findings confirm that pediatric patients with AIDS have significant abnormalities in humoral immunity. Dysfunction of both T cells and B cells plays a role in the resultant poor specific antibody production.
Assuntos
Síndrome da Imunodeficiência Adquirida/imunologia , Anticorpos Antibacterianos/biossíntese , Antígenos de Bactérias/imunologia , Vacinas Bacterianas/imunologia , Pré-Escolar , Feminino , Humanos , Imunidade Celular , Imunoglobulina G/biossíntese , Imunoglobulina M/biossíntese , Lactente , Masculino , Vacinas Pneumocócicas , Fagos T/imunologia , Toxoide Tetânico/imunologiaRESUMO
PIP: This study investigates the presence of antibodies against food products in milk samples from 30 Guatemalan women of 3 different socioeconomic status: 10 rural poor, 10 urban poor, and 10 urban privileged. The 3 groups had varied dietary habits. Both the rural and urban poor mothers do not consume cow's milk. Black beans are consumed more often by the urban groups while soy bean products are consumed by both rural and urban poor regularly. Milk samples were collected from the mothers. The volume of milk produced in a 24-hour period was estimated by weighing the children before and after every meal. The enzyme-linked immunosorbent assay (ELISA) described by Sohe-Akerlund et.al. was used in quantitating milk secretory immunoglobulin A (SIgA). A modification of the ELISA method was used to determine levels of specific IgA antibodies directed against cow's milk, black beans and soybeans. The Wilcoxon rank sum test was used in statistical analysis. Comparable amounts of SIgA were produced by the 3 groups of mothers in a 24-hour period (p0.1). The urban privileged mothers exhibited significantly higher antibody levels against cow's milk (p0.01) and black beans (p0.05) compared to the other 2 groups. There were no differences in the level of anti-soybean antibodies among the 3 groups. The notion that antibodies found in the breast milk reflect the mother's intestinal antigenic experience is supported by this study. It has been suggested that anti-food protein antibodies contribute in the prevention of allergies. If so, cow's milk fed among the rural and urban poor children may be expected to produce negative reactions. This negative reaction can be prevented by feeding the mother, before delivery, cow's milk products to induce them to produce milk antibodies against cow's milk.^ieng
Assuntos
Anticorpos/análise , Alimentos , Leite Humano/imunologia , Animais , Bovinos , Fabaceae/imunologia , Feminino , Guatemala , Humanos , Imunoglobulina A Secretora/análise , Leite/imunologia , Plantas Medicinais , Gravidez , Glycine max/imunologiaRESUMO
PIP: In order to study the cyclic variations in the immunoglobulins of the human vaginal fluid, vaginal secretions were obtained from 12 volunteers during the follicular phase (Days 7-12 of cycle) and from 12 during the luteal phase (Days 18-25 of cycle). At follicular phase, immunoglobulin G was present in all samples, and immunoglobulin A similar to serum immunoglobulin A was found occasionally. At luteal phase, immunoglobulin G apparently occurred at a greater concentration, and another immunoglobulin A, different from the serum type, was found. No immunoglobulin M was detected in any sample. It is postulated that the cyclic variations in immunoglobulins of human vaginal fluid, which occur under normal conditions could be 1) related to the plasma cells found in the vaginal mucosa and 2) mediated by the ovarian hormones.^ieng