Adhemar Mário Fiorillo

Níveis de anticorpos para arbovírus em indivíduos da região de Ribeirão Preto, SP (Brasil)

Com o objetivo de conhecer os niveis de anticorpos para arbovirus, foram estudados 302 individuos da regiao de Ribeirao Preto (Brasil), moradores em 3 tipos de locais com distintas formas de organizacao do espaco: proximos a area de paisagem natural; com paisagem modificada para a agropecuaria; comunidades urbanas. Foram efetuados testes sorologicos de inibicao da hemaglutinacao, neutralizacao e fixacao do complemento para 21 arbovirus. Os resultados mostraram que 19,9% dos individuos investigados apresentaram anticorpos, sugerindo infeccoes pregressas por varios arbovirus. A maior percentagem de habitantes que se infectaram por estes agentes foi observada em locais proximos a area de paisagem natural, 38,5%. O vesiculovirus Piry foi o agente para o qual se encontrou o maior numero de soros reagentes, 12,5%. A maior ocorrencia de portadores de anticorpos para o virus Piry foi observada nos individuos: do sexo masculino; com idade superior a 40 anos; guardas-florestais, lavradores e profissionais com atividades ligadas ao rio.Com o objetivo de conhecer os niveis de anticorpos para arbovirus, foram estudados 302 individuos da regiao de Ribeirao Preto (Brasil), moradores em 3 tipos de locais com distintas formas de organizacao do espaco: proximos a area de paisagem natural; com paisagem modificada para a agropecuaria; comunidades urbanas. Foram efetuados testes sorologicos de inibicao da hemaglutinacao, neutralizacao e fixacao do complemento para 21 arbovirus. Os resultados mostraram que 19,9% dos individuos investigados apresentaram anticorpos, sugerindo infeccoes pregressas por varios arbovirus. A maior percentagem de habitantes que se infectaram por estes agentes foi observada em locais proximos a area de paisagem natural, 38,5%. O vesiculovirus Piry foi o agente para o qual se encontrou o maior numero de soros reagentes, 12,5%. A maior ocorrencia de portadores de anticorpos para o virus Piry foi observada nos individuos: do sexo masculino; com idade superior a 40 anos; guardas-florestais, lavradores e profissionais com atividades ligadas ao rio.

A tomografia computadorizada na avaliação do comprometimento abdominal na paracoccidioidomicose

Computerised tomography was utilized in 25 paracoccidioidomycosis patients to evaluate abdominal involvement. This was observed in patients, 75% of acute (juvenile type) and 23% of chronic (adult type) patients. The most frequent alteration was abdominal lymphnode enlargement (12/25 cases). Other lesions consisted of lymphnode calcification in 4 cases, biliary tract obstruction in 5 icteric patients, splenic abscess or calcification in 3 cases. Two patients had unusual lesions: one with pancreatic enlargement and irregularity and other with multiple abscesses in both psoas muscles. It was concluded that computerised tomography is a useful procedure for evaluating paracoccidioidomycosis dissemination to the abdomen and for the diagnosis of its abdominal complications.

Lymphocyte transformation test in patients with paracoccidioidomycosis

The lymphocyte transformation test (LTT) by phytohemagglutinin was carried out on lymphocyte cultures from patients with paracoccidioidomycosis, in medium with autologous plasma (from the patient) or homologous plasma (from an unaffected individual), and lymphocyte cultures from unaffected and apparently normal individuals, in medium with autologous plasma (from the individual) or homologous plasma (from a patient with paracoccidioidomycosis). Blastogenesis was evaluated morphologically by ‘blast’ percentage, and the results analyzed according to clinical form of the disease and general condition of the patient. In the medium containing autologous plasma, percentages below the lower limit of the confidence interval for the distribution of the values for apparently normal individuals were encountered more frequently among patients with diffuse extrapulmonary paracoccidioidomycosis and in poor general condition. When the lymphocytes from patients with the disease were cultured in medium containing homologous plasma, blastogenesis increased in most cases. The lymphocytes of unaffected individuals exhibited a lower response more frequently when cultured in medium containing plasma from patients with the disease than when cultured in medium containing their own plasma. These results suggest the existence of factor(s) inhibiting blastogenesis in the plasma of these patients. In addition to such factor(s), an intrinsic lymphocyte defect may also occur in some patients, which might prevent a greater response to phytohemagglutinin even in homologous plasma. Smears of lymphocytes cultured in autologous plasma and obtained from patients, especially those with diffuse extrapulmonary diasease and in regular or poor general condition, and smears from most of the controls whose lymphocytes were cultured in the plasma of these patients revealed deeply stained cells with altered morphology and considerably reduced in number. The decreased blastic transformation might be linked with these abnormalities, possibly caused by factor(s) inhibiting blastogenesis in the culture medium containing patient plasma.

Meningite criptocócica: aspectos clínicos, evolutivos e histopatológicos segundo a condiçäo predisponente

Seventeen consecutive cases of cryptococcal meningitis diagnosed at Hospital das Clinicas of Ribeirao Preto Medical School (Sao Paulo State- Brazil) between 1969 and 1985 were reviewed. For analysis the patients were separated in 3 groups: I. three patients without immunodeficiency; II. six patients with associated disease: cancer (3), diabetes (1) and alcoholism (1); III. Eight renal transplant recipients that developed cryptococcosis after 18 to 67 months of immunosupression with steroids and azathioprine. The median interval between onset of symptoms and diagnosis of infection was greater in Group II (53 days) than in Groups I (25 days) or III (28 days). Neck stiffness, cranial nerve involvement and papilledema were more frequent in Group I than in Group II or III, but fever and focal neurological signs were observed only in patients of two last groups. Cerebrospinal fluid examination showed a mild lymphocytic pleocytosis in most patients, but transplant cases had polymorphonuclear cells more frequently. Late mortality was higher in patients with underlying disease and the prognosis was better for transplant patients that received effective antifungal therapy. Besides cryptococci, autopsy findings in 8 cases revealed granuloma formation in tissues, except in patients of Group II (2 cases). The differences between the groups suggest that clinical characteristics, evolution and postmortem findings of the cryptococcal meningitis are changed according to type of immunodeficiency presented by the patient.

Prevalência de anticorpos neutralizantes para o arbovirus Piry em individuos da região de Ribeirão Preto, Estado de São Paulo

Como parte de um inquerito sorologico pesquisando anticorpos para arbovirus, em habitantes da regiao de Ribeirao Preto, 202 soros foram testados por neutralizacao em camundongos, para o virus Piry. Trata-se de um vesiculo-virus (Rhabdoviridae) isolado em Belem do Para, das visceras de um marsupial e do sangue de um caso humano. O Piry e causa de doenca humana aguda febril. Desconhece-se seus reservatorios animais, vetores e seu ciclo biologico. Os 202 soros testados foram obtidos por venopuncao, de moradores adultos em areas rurais e urbana da cidade de Ribeirao Preto. Os resultados mostraram prevalencia de 14,3% de anticorpos neutralizantes para o virus Piry. Conclui-se que infeccoes pelo Piry, ou outro agente antigenicamente relacionado, ocorram endemicamente nesta regiao.A serological survey for neutralizing antibodies to Piry (AN Be 24232) was carried out on 202 residents of the rural and urban zones of Ribeirao Preto region, State of Sao Paulo, Brazil. Piry are classified as vesicular stomatitis virus (Rhabdoviridae family). Several human cases of Piry virus infection have resulted from laboratory exposures. Fever, back pain, chills and headache are the symptoms of Piry infection. It is postulated that the virus is maintained in a host-vector cycle but the importance of hosts and possible vectors have yet to be determined. It was discovered that 14.3% of the sample population of Ribeirao Preto region presented neutralizing antibodies to Piry. The antibody prevalence was greater in rural zones. This sorological evidence suggests that there are endemic Piry human infections in this region.

Natureza de anticorpos precipitantes específicos da paracoccidioidomicose (blastomicose Sul-Americana), revelados por contra-imunoeletroforese

Os Autores estudaram soros de 20 pacientes, portadores de paracoccidioidomicose (blastomicose Sul-Americana), utilizando coluna de Sephadex G-200 para a separacao das imunoglobulinas e o metodo de contra-imunoeletroforese em agarose para a verificacao de anticorpos especificos aos fungos. Como antigeno usaram culturas de Paracoccidioides em fase de levedura, tratadas por ultra-som. Os soros dos pacientes que apresentaram 1, 2, 3 ou 4 linhas de precipitacao foram separados em coluna e as fracoes obtidas foram concentradas e examinadas em contra-imunoeletroforese, com o antigeno citado. Verificaram, assim, que apenas as fracoes com teor conveniente de imunoglobulinas IgG reproduziram os achados obtidos com os soros totais correspondentes; as fracoes com teor normal de IgA e IgM e com quantidade pequena ou nula de IgG nao produziram linha de precipitacao. Concluem que os anticorpos precipitantes em gel especificos do Paracoccidioides sao do tipo IgG.