Cristóvão Figueiredo

Nocardia-Induced Granulocyte Macrophage Colony-Stimulating Factor Is Neutralized by Autoantibodies in Disseminated/Extrapulmonary Nocardiosis

BACKGROUND Nocardia species cause infections in both immunocompromised and otherwise immunocompetent patients, although the mechanisms defining susceptibility in the latter group are elusive. Anticytokine autoantibodies are an emerging cause of pathogen-specific susceptibility in previously healthy human immunodeficiency virus-uninfected adults, including anti-granulocyte macrophage colony-stimulating factor (GM-CSF) autoantibodies with cryptococcal meningitis. METHODS Plasma from patients with disseminated/extrapulmonary nocardiosis and healthy controls was screened for anticytokine autoantibodies using a particle-based approach. Autoantibody function was assessed by intranuclear staining for GM-CSF-induced STAT5 phosphorylation in normal cells incubated with either patient or normal plasma. GM-CSF-mediated cellular activation by Nocardia was assessed by staining for intracellular cytokine production and intranuclear STAT5 phosphorylation. RESULTS We identified neutralizing anti-GM-CSF autoantibodies in 5 of 7 patients studied with central nervous system nocardiosis and in no healthy controls (n = 14). GM-CSF production was induced by Nocardia in vitro, suggesting a causative role for anti-GM-CSF autoantibodies in Nocardia susceptibility and dissemination. CONCLUSIONS In previously healthy adults with otherwise unexplained disseminated/extrapulmonary Nocardia infections, anti-GM-CSF autoantibodies should be considered. Their presence may suggest that these patients may be at risk for later development of pulmonary alveolar proteinosis or other opportunistic infections, and that patients may benefit from therapeutic GM-CSF administration.

Primary drug resistance at diagnosis of HIV-1 infection: a Portuguese cohort.

Presence of viral mutations conferring resistance to antiretroviral drugs has potential impact on success of antiretroviral therapy (ART). The aim of this study was to describe the prevalence of resistance‐associated mutations in HIV‐infected patients without prior ART in a Portuguese cohort.

Prevention of mother-to-child transmission: experience of a Portuguese centre.

HIV infection during pregnancy still raises controversial issues. Combined antiretroviral therapy (cART) has been successful in reducing mother‐to‐child transmission (MTCT). Routine screening in pregnancy and in pre‐conception consultation proved to be one of the best methods able to get this treatment on time. We review our experience with pregnant patients with HIV infection.

An unusual cause of chest discomfort: case report of oesophageal hirudiniasis

Hirudiniasis is caused by sanguivorous leeches feeding on mucous membranes with possible severe obstructive or haemorrhagic manifestations. Few cases have been reported in humans, and most occur in tropical countries. A seventy-year-old female patient presented to our Emergency Department (ED) with retrosternal discomfort. She was taking warfarin for a mechanical prosthetic heart valve. While in the ED, a leech was spontaneously extruded from her mouth, with symptomatic resolution. Endoscopy revealed an area of previous leech attachment in the distal oesophageal, without severe bleeding. Albeit uneventful, this case could have had a devastating outcome.

Factors associated with immune status in the diagnosis of HIV infection

Current guidelines recommend the start of antiretroviral therapy before advanced immunosuppression, which is not always possible. The purpose of this study is to evaluate factors associated with the degree of immunosuppression at the diagnosis of HIV infection.