Ernesto Mendes

Impaired delayed hypersensitivity in patients with South American blastomycosis

Fifty-one cases of South American blastomycosis which exhibited a depression of delayed hypersensitivity to infectious antigens and sensitization to dinitrochlorobenzene (DNCB) were investigated. The results showed 54.9 per cent negative intracutaneous reactions to tuberculin, 60.8 per cent to trichophytin, and 64.7 per cent to oidiomycin. These results indicate significantly less reactivity than that in a control group. Sensitization to DNBC was not obtained in 72.6 per cent of the patients, again a significant reduction as compared to that in control subjects. Transfer of tuberculin hypersensitivity by means of lymphocytes from tuberculin-positive individuals was obtained in all 4 South American blastomycosis recipients tested. Based on the above results, some immunological aspects of South American blastomycosis are discussed.

Lymphocyte cultures and skin allograft survival in patients with South American blastomycosis

Abstract Lymphocyte cultures with phytohemagglutinin (PHA), skin allograft survival, intradermal tests with microbial antigens, and sensitization to dinitrochlorobenzene (DNCB) were performed in 10 patients with South American blastomycosis. The lymphocyte stimulation in vitro was depressed in 6 of the patients. Exposure to DNCB resulted in sensitization in 3 of 10 patients. Among the 7 DNCB-negative patients, Mast transformation was depressed in 6, and in 2 of these there was prolonged skin allograft survival. The results suggest a severe impairment of delayed hypersensitivity in some patients with South American blastomycosis.

Collective asthma, simulating an epidemic, provoked by castor-bean dust.

Abstract In August, 1952, in Bauru, a city of 60,000 inhabitants, in the State of Sao Paulo, Brazil, the Public Health Service was notified within a few days of 150 cases of a particular type of bronchial asthma, and nine deaths were attributed to it. The illness simulated an epidemic. Allergic studies in 30 cases revealed that they were cases of bronchial asthma and other allergic manifestations of the upper respiratory tract brought about by allergy to castor-bean (Ricinus communis) dust. The etiologic proof was made by history; strongly positive cutaneous tests; passive transfer of the skin-sensitizing antibodies, and by experimental provocation of symptoms. The experimental reproduction of the symptoms was possible by placing 4 patients in a room in which had been nebulized for an hour a 1:10 solution of the allergen. The four patients had extremely severe attacks of asthma, one to three minutes after they went into the room. The cases of collective asthma coincided with the changes made in the method of extraction of castor-bean oil by hexane, which occurred one day before at the large mill operating for some years in the city of Bauru. A new outbreak of collective asthma identical with the first one was observed about a month later when the mill resumed work after a period of inactivity and observation demanded by the physicians of the Public Health Service. With the closing down of the mill for a year no new cases of asthma of a collective nature were observed. The mill is now working again using a method of catching the dusts in a water reservoir, based on the fact that the allergen is soluble in water and precipitated by alcohol.

Cell-mediated immunity in leprosy and transfer of delayed hypersensitivity reactions

Abstract Eighty-nine patients with leprosy, 65 classified as lepromatous and 24 as tuberculoid, were examined in this study. Skin test responses to protein antigens and dinitrochlorobenzene (DNCB) were depressed in lepromatous patients compared to controls. Tuberculoid patients did not exhibit a significant depression to microbial antigens, but they showed a definite depression in the ability to be sensitized with DNCB. The transfer of delayed hypersensitivity reactions to tuberculin, trichophytin, and lepromin (Fernandez and Mitsuda reactions) was accomplished in lepromatous and indeterminate leprosy patients using viable lymphocytes from donors presenting positive reactions to these antigens. The lepromin reaction was also transferred to patients with South American blastomycosis and cutaneous leishmaniasis. The positive reactions of adoptive immunity were confirmed by histologic examination of skin biopsies.

Immunochemical studies of the asthmatic sputum.

Chemical studies of bronchial sputum by Werner ( 1953 ) , Springer et al. (1954) , Baer (1955) , Bttkantz & Berns (1958) demonstrated the presence of hexosamin, N-acetilhexosamin, uronic and sialic acid, fucose and mucopolysaccharides which exhibit blood group activity. Immunological relationship between bronchial sputum and other human secretions and organ antigens was demonstrated by Mendes et al. (1961), suggesting chemical relations among some components from different sources. The present report is concerned with the results obtained by gel double diffusion and immoelectrophoresis for the identification of protein components of bronchial sputum and their relationship with sertim proteins.

Allergy to snake venoms

Abstract 1.1. Six cases of allergic reactions to inhalation of snake venom, characterized by ocular and respiratory symptoms (conjunctivitis, rhinitis, and asthma), have been studied. 2.2. The patients worked mainly with venoms of the Bothrops and Crotalus genera, in powdered or vapor form, and the outbreak of symptoms occurred from six months to five years after the contact. 3.3. The presence of skin-sensitizing antibodies was demonstrated by means of unquestionably positive intradermal reactions and passive transfer tests. 4.4. It seems that there is a common allergen to all venoms studied (Bothrops, Crotalus, Lachesis, Vipera and Micrurus), since some patients presented positive reactions to intracutaneous or passive transfer tests with venoms with which they had not had any previous contact. 5.5. Snake venom allergens seem to be extremely potent, inasmuch as five of the six patients studied did not present any personal or family record of allergy.

5‐HYDROXYTRYPTAMINE IN THE BRONCHIAL SPUTUM OF ASTHMATIC PATIENTS

The role played by serotonin (5-hydroxytryptamine) in asthma has not yet been sufficiently clarified and concerning this problem there are different opinions. Serotonin is released in the course of certain pathological reactions, mainly after anaphylactic reactions in certain animals. Discussions have been made by Weisshach et al. on the role of serotonin in the pulmonary aspects of hypersensitivity. Humphrey & Jaqttes after in vitro studies found that in the rabbit serotonin takes an active part in anaphylactic phenomena. Identical verifications were made by JVaalkes & Coburn in vivo. Lecomte & Fisher showed that 5-hydroxytryptamine (5—HT) is thereafter catabolized and an excessive amount of 5-hydroxyindol-acetic acid (5-HIAA) is excreted in the urine. According to Herxheimer, guinea-pigs submitted to aerosols of serotonin produced bronchospasm and similar findings might occur in human asthma. Indeed, human beings submitted to aerosols of serotonin showed decrease of vital capacity and respiratory flux, according to Michelson et al. Serotonin is a broncho-constrictor and it is generally admitted that this is the cause of the asthmatiform symptoms in patients with malignant carcinoid.

Experimental asthma of the guinea pig provoked by human lung tissue.

Some workers in asthma and allergy believe that, very soon, bronchial asthma may assume a sifTiiificant role in the picture of the so-called diseases due to autoaggression, to autosensitization or to autoantibodies. Such a prediction stems mainly from the clinical observation of a group of asthmatic patients, classified generally as intrinsic or essential, who, though behaving like those of the so-called allergic group, show no evidences extrinsic allergens causing symptoms. These concepts were rendered more promising when some confused problems of human pathology were explained hy mechanisms of autolmmunization.

AUTOIMMUNITY IN PATIENTS WITH PEMPHIGUS FOLIACEUS

The presence of conventional autoantibodies in the sera from 28 patients with Pemphigus foliaceus (South American pemphigus) was investigated. Gastric parietal cell antibody was found in six patients (21.4 per cent); and in two of them mitochondrial antibody was also detected. Antibody to smooth muscle was found in one patient. Based on the above results, the role of autoimmunity in Pemphigus foliaceus was discussed. Nuclear and rheumatoid factors were not detected, and antibodies against glomerular components, salivary duct and thyreoglobulin were not found.

Transfer of delayed hypersensitivity to leishmanin (Montenegro reaction)

Abstract It was possible to transfer the cutaneous leishmanin hypersensitivity (Montenegro reaction) to 7 out of 12 recipients. The diameter of the indurations observed ranged from 8 to 25 mm. Histological examination of skin biopsies from the site of three positive Montenegro reactions showed intense mononuclear infiltrate of lymphocytes and histiocytes, and one biopsy showed the feature of tuberculoid granuloma. Four recipients retested with leishmanin after 11, 22, 25, and 32 days, still showed positive reactions.