RESUMO
Aspergillosis usually compromises the respiratory system, but can also affect others. We report a 46 yo female with acute myeloid leukemia, developed febrile neutropenia and dysphagia. Endoscopy revealed esophageal cytomegalovirus-like ulcers, but biopsies showed Aspergillus spp. It's important to consider aspergillosis in the differential diagnosis of esophageal lesions in high-risk patients.
Assuntos
Aspergilose/etiologia , Doenças do Esôfago/etiologia , Leucemia Mieloide Aguda/complicações , Aspergilose/diagnóstico , Aspergilose/imunologia , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/imunologia , Neutropenia Febril , Feminino , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/imunologia , Pessoa de Meia-IdadeRESUMO
The production of cytokines (MIG, IFN-gamma, TNF-alpha, IL-4, IL-5, and IL-10) was studied in 39 individuals, including 28 with chagasic esophagopathy and 11 nonchagasic patients with gastroesophageal reflux disease. A sandwich enzyme immunoassay employing monoclonal antibody pairs specific for each cytokine was used. IFN-gamma and MIG production was significantly higher in patients with megaesophagus compared to control. Furthermore, in the absence of stimulation TNF-alpha levels were lower in the chagasic group than in the control group. In addition, significantly lower TNF-alpha levels were observed for the advanced form of the disease compared to the nonadvanced form. These results support the hypothesis that, although patients with advanced phase of megaesophagus present low number of CD4+ T lymphocytes, PBMC from this patients are able to respond up specific antigen stimulation.
Assuntos
Doença de Chagas/imunologia , Doença de Chagas/metabolismo , Citocinas/biossíntese , Doenças do Esôfago/imunologia , Doenças do Esôfago/parasitologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Chagas/complicações , Doença de Chagas/patologia , Quimiocina CXCL9 , Quimiocinas CXC/biossíntese , Doenças do Esôfago/etiologia , Doenças do Esôfago/patologia , Feminino , Humanos , Interferon gama/biossíntese , Interleucina-10/biossíntese , Interleucina-4/biossíntese , Interleucina-5/biossíntese , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fator de Necrose Tumoral alfa/biossínteseRESUMO
Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials. Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis. Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Candidíase/imunologia , Doenças do Esôfago/microbiologia , Imunocompetência/imunologia , /imunologia , Candidíase/complicações , Doenças do Esôfago/imunologia , Gastroscopia , Hipersensibilidade Tardia , Estudos ProspectivosRESUMO
BACKGROUND: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials. AIM: To report the features of 10 immunocompetent patients with esophageal candidiasis. PATIENTS AND METHODS: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, lymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. RESULTS: Six patients had a low CD4 lymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. CONCLUSIONS: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated.
Assuntos
Candidíase/imunologia , Doenças do Esôfago/imunologia , Imunocompetência/imunologia , Idoso , Idoso de 80 Anos ou mais , Contagem de Linfócito CD4 , Linfócitos T CD8-Positivos/imunologia , Candidíase/complicações , Doenças do Esôfago/microbiologia , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The relationship of symptoms and radiographic abnormalities suggestive of esophageal motility disorders with electrocardiographic (ECG) alterations and seroreactivity to Trypanosoma cruzi was studied in a defined population in a rural area endemic for Chagas' disease in Bahia, Brazil. Between January and June 1981, 680 individuals 5 years of age or older were examined with serologic tests, ECGs and questionnaires for esophageal motility disorder. Of these, 39.9% were seropositive for Chagas' disease. Symptoms of dysphagia occurred 2.5 times more frequently among seropositive individuals than among seronegative individuals. Radiographic esophageal abnormalities were 3.6 times more frequent among seropositive individuals than among seronegative individuals in the symptomatic group. Symptoms and radiographic abnormalities were more common in men than in women although this was not statistically significant. Among seropositive individuals the percentage with symptoms of dysphagia increased with age, with a peak prevalence rate of 23.9% in the 45- to 64-year-old age group. Also, in the seropositive group, 41.7% with X-ray abnormalities of the esophagus and 26.3% with symptoms of dysphagia presented an abnormal ECG.