Carla C. Romano

Characterization of the cellular immune function of patients with chronic mucocutaneous candidiasis

Chronic mucocutaneous candidiasis (CMC) is a rare syndrome characterized by persistent and refractory infections of the skin, nails and mucosal tissues by yeasts of the genus Candida. Defects in the cellular limb of the immune system are well documented in CMC patients, but non‐specific immune defects, such as myeloperoxidase deficiency or phagocyte chemotaxis disorders, have also been described. Nonetheless, the underlying defect(s) remains poorly understood, and further studies are required. We studied eight CMC patients without endocrinopathies, who showed (i) low normal proliferative response to phytohaemagglutinin (PHA), (ii) partially defective response to pokeweed mitogen (PWM), and (iii) impaired response to Candida and PPD antigens. Furthermore, peripheral blood mononuclear cells (PBMC) from CMC patients produced lower levels of type‐1 cytokines (IL‐2 and interferon‐gamma) in response to Candida antigens, compared with control individuals. Conversely, we did not observe an enhancement of IL‐4 and IL‐10 in the patients, suggesting that, even though Th1 cytokines are decreased, the Th2 response is not increased in CMC. Nevertheless, the synthesis of these cytokines was normal when induced by PHA. We also observed an increased antigen‐induced apoptosis in lymphocytes from the patients compared with controls, and this applied both to Candida and PPD antigens. Lastly, innate immunity defects were investigated. We observed an impairment of natural killer activity against K‐562 target cells in half of the studied patients. These findings corroborate the extensive clinical and laboratory variability of CMC, which requires further studies on a larger number of patients to be better understood.

Compartmentalization of Interleukin-6 Response in a Patient with Septic Meningococcal Peritonitis

ABSTRACT We report the first case of Neisseria meningitidis-induced septic peritonitis diagnosed by PCR assay of peritoneal fluid. Concentrations of interleukin-6 were notably higher in the peritoneal fluid than in the blood. PCR diagnosis of septic meningococcal peritonitis and the pathogenesis of the disease are discussed.

Primeiro escore de risco inflamatório das endopróteses de aorta

OBJETIVO: Propor um escore de risco inflamatorio para tratamento endovascular dos aneurismas da aorta. METODOS: Vinte e cinco pacientes foram seguidos do periodo pre-operatorio ate 3o mes de pos-operatorio (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mes, 2 meses e 3 meses). Variaveis inflamatorias avaliadas foram proteina C reativa, velocidade de hemossedimentacao, interleucinas (IL-6, IL8), fator de necrose tumoral alfa, L-selectina, molecula de adesao intercelular (ICAM-1), transfusao de hemaceas, volume de cristaloide, volume de contraste, material da protese, numero de proteses, contagem total de leucocitos e linfocitos. O teste de Spearman apontou as variaveis candidatas ao maior risco inflamatorio, segundo P < 20%. A regressao logistica apontou variaveis selecionaveis para escore final segundo P < 10%. A analise da curva ROC revelou valores de corte para variaveis selecionadas pela regressao logistica. RESULTADOS: Variaveis apresentadas pelo teste de Spearman foram: volume de cristaloide (P = 0,04), material da protese (P = 0,04), volume de contraste (P=0,02), IL-8 preoperatoria (P= 0,10), ICAM-1 1 mes (P=0,03) e L-selectina 1 mes (P = 0,06). A regressao logistica revelou que os valores do volume de cristaloide e IL-8 pre-operatoria sao primordiais para constituicao do escore de risco inflamatorio para tratamento endovascular dos aneurismas da aorta. O escore de risco seria dividido em tres categorias (leve, moderado e grave), com base em intervalos numericos das duas variaveis selecionadas e as categorias seriam correlacionadas com achados clinicos CONCLUSA: Volume de cristaloide e IL-8 pre-operatoria sao variaveis que poderiam contribuir para categorizar risco inflamatorio e, desse modo, ter um papel prognostico no tratamento endovascular dos aneurismas da aorta.