Fausto Edmundo Lima Pereira

Intestinal nematodes and pulmonary tuberculosis

We report a significantly higher prevalence of intestinal nematodes in patients with pulmonary tuberculosis (TB) compared to a matched control group: 33/57 (57.8%) in patients with TB and 18/86 (20.9%) in the control group; OR = 5.19; 95% CI = 2.33-11.69; p = 0.000). When TB patients eosinophilia was also significantly higher among those with intestinal parasites (69.8%) compared to those without this condition (45.6%). We hypothesized that the immune modulation induced by nematodes is a factor that enhances TB infection/progression and that eosinophilia seen in TB patients is a consequence of helminth infection.

Macrophage‐derived hedgehog ligands promotes fibrogenic and angiogenic responses in human schistosomiasis mansoni

Schistosomiasis mansoni is a major cause of portal fibrosis and portal hypertension. The Hedgehog pathway regulates fibrogenic repair in some types of liver injury.

Presence of intestinal helminths decreases T helper type 1 responses in tuberculoid leprosy patients and may increase the risk for multi-bacillary leprosy

Resistance to intracellular pathogens such as Mycobacterium leprae is dependent upon an effective T helper type 1 (Th1)‐type immune response. On the other hand, intestinal helminths are known to subvert the hosts immune response towards to either a Th2‐type immune response or a regulatory T cell up‐regulation, which may affect the hosts ability to mount an effective response to mycobacteria. Here, we report a significant association between intestinal helminth infections and lepromatous leprosy [odds ratio (OR), 10·88; confidence interval (CI) 95%: 4·02–29·4; P < 0·001]. We also observed that the frequency of intestinal helminths correlated strongly with the mycobacterial index (r = 0·982, P < 0·01). Corroborating with our hypothesis, intracellular levels of interferon‐γ were decreased significantly in leprosy patients co‐infected with intestinal helminths when compared to leprosy patients without worms. Conversely, lepromatous leprosy patients with intestinal worms produced higher levels of both interleukin (IL)‐4 and IL‐10. Our results suggest that a pre‐existing infection by intestinal helminths may facilitate the establishment of M. leprae infection or its progression to more severe forms of leprosy.

Alcoholism and Strongyloides stercoralis: Daily Ethanol Ingestion Has a Positive Correlation with the Frequency of Strongyloides Larvae in the Stools

Background Significantly higher prevalence of Strongyloides stercoralis has been reported in chronic alcoholic patients. The aim of this investigation was to report the prevalence of Strongyloides larvae in stools of chronic alcoholic patients with known daily ethanol intake. Methods From January 2001 through December 2003 the results of fecal examinations and the daily ethanol intake were retrieved from the records of 263 chronic alcoholic and from 590 non-alcoholic male patients that sought health care at the outpatients unit of the University Hospital C A Moraes. Alcoholic patients were separated into four groups, with 150g intervals between the groups according to the daily ethanol intake. Results (a) The frequency of Strongyloides was significantly higher in alcoholic patients than in control group (overall prevalence in alcoholic 20.5% versus 4.4% in control group; p = 0.001). Even in the group with a daily intake of ethanol equal to or less than 150g the prevalence was higher than in control group, although non significant (9.5%, versus 4.4% in control group; p = 0,071); (b) the prevalence of Strongyloides in alcoholic patients rises with the increase of ethanol intake (Pearsons Correlation Coefficient = 0.956; p = 0.022), even in patients without liver cirrhosis (Pearsons Correlation Coefficient = 0.927; p = 0.037). Conclusion These results confirm and reinforce the hypothesis that chronic alcoholism is associated with Strongyloides infection, which is in direct relationship with the severity of alcoholism, independently of the presence of liver cirrhosis.

Anti-Toxocara antibodies detected in children attending elementary school in Vitoria, State of Espírito Santo, Brazil: prevalence and associated factors.

INTRODUCTION The aim of this study was to evaluate the frequency of anti-Toxocara antibodies in serum from 7-year-old children attending elementary school in Vitória-ES, Brazil and to correlate these antibodies with socio-demographic factors, the presence of intestinal helminths, blood eosinophil numbers, past history of allergy or asthma, and clinical manifestations of helminth infections. METHODS The detection of anti-Toxocara antibodies was performed using an ELISA (Cellabs Pty Ltd)on serum from 391 children who had already been examined by fecal examination and blood cell counts. Data from clinical and physical examinations were obtained for all children. RESULTS The prevalence of anti-Toxocara antibodies was 51.6%, with no gender differences. No significant differences were observed between positive serology and the presence or absence of intestinal worms (60.3 and 51.7%, respectively; p = 0.286). The only variables significantly related to positive serology were onycophagy and the use of unfiltered water. Although eosinophilia (blood eosinophil count higher than 600/mm³) was significantly related to the presence of a positive ELISA result, this significance disappeared when we considered only children without worms or without a past history of allergy or asthma. No clinical symptoms related to Toxocara infection were observed. CONCLUSIONS There is a high prevalence of anti-Toxocara antibodies in children attending elementary schools in Vitória, which may be partially related to cross-reactivity with intestinal helminths or to a high frequency of infection with a small number of Toxocara eggs.

Acute liver failure in children: observations in Vitória, Espírito Santo State, Brazil

In this communication we report 46 cases of acute liver failure in children diagnosed at the Hospital Infantil Nossa Senhora da Glória in Vitória, E Santo. Serology for IgM anti-HAV, IgM anti-HBc, HbsAg, anti-HCV and biochemical tests were performed in all cases in a routine laboratory. The M/F ratio was 1.1:1 and the mean age was 4.7 +/- 3.2 years, without gender difference. Anti-HAV IgM+ in 38 (82.6%) cases, anti-HbcIgM+ in two (4.3%) cases and 6 (13.1%) cases were negative for all viral markers investigated. Anti-HCV+ in one anti-HAV IgM+ case. HbsAg+ in two anti-HbcIgM+ and in two HAVIgM+ cases. Among the six A, B and C negative cases, four (8.6%) did not have the suspected exogenous intoxication. Mortality was 50%, without gender or age differences. These results demonstrate that HAV infection is the main etiology of acute liver failure in children in Brazil, confirming that, although it is a self limited, relatively mild illness, it can cause serious and even fatal disease. The observation of four cases without A, B and C viral markers and no history of exogenous intoxication, agree with the observation of non A-E acute sporadic hepatitis in Northeastern Brazil.

Miocardite chagásica crônica humana: estudo quantitativo dos linfócitos CD4+ e dos CD8+ no exsudato inflamatório

Em cortes histologicos de fragmentos transmurais congelados da parede livre do ventriculo esquerdo, obtidos em necropsias de 10 chagasicos cronicos cardiopatas, foram contados os linfocitos CD4+ e os CD8+ do infiltrado miocardico. As celulas foram marcadas com anticorpos monoclonais, usando-se a tecnica estreptavidina-biotina. Contou-se: l)os linfocitos em todo o exsudato (LTE) e, separadamente, 2) os linfocitos que estavam em contato ou muito proximos das miocelulas (LCMPM). Foram considerados muito proximos aqueles linfocitos cujos nucleos distavam, dasmiocelulas, menos que seus proprios menores diâmetros nucleares. Os linfocitos CD8+foram mais numerosos do que os CD4+, principalmente entre os LCMPM. A relacao CD4/CD8 foi de 0,37 ± 0,20 entre os LTE, mas foi menor quando considerados apenas os LCMPM (0,23 ± 0,11). Dentre os LTE, 34 ± 11% dos CD8+ (contra 24 ± 12% dos CD4+) eram LCMPM. Todas essas diferencas foram estatisticamente significantes. Linfocitos das duas subpopulacoes foram vistos em intima relacao com miocelulas integras ou rotas, e naoforam observados parasitas nos cortes examinados. Estes achados concordam com a ideia de que a lesao dos miocardiocitos na forma cardiaca da doenca de Chagas humana e mediada principalmente por linfocitos T citotoxicos.

Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espfrito Santo

OBJECTIVES: To report the etiology of liver cirrhosis cases diagnosed at the University Hospital in Vitoria, Espirito Santo, Brazil. METHODS: The medical charts of patients with liver cirrhosis who presented to the University Hospital in Vitoria were reviewed. Chronic alcoholism and the presence of hepatitis B or C infections (HBV and HCV, respectively) were pursued in all cases. RESULTS: The sample consisted of 1,516 cases (male:female ratio 3.5:1, aged 53.2±12.6 years). The following main etiological factors were observed: chronic alcoholism alone (39.7%), chronic alcoholism in association with HBV or HCV (16.1%), HCV alone (14.5%) and in association with alcoholism (8.6%) (total, 23.1%), and HBV alone (13.1%) and in association with alcoholism (7.5%, total 20.6%). The remaining etiologies included cryptogenic cases (9.8%) and other causes (6.0%). The mean patient age was lower and the male-to-female ratio was higher in the cirrhosis cases that were associated with alcoholism or HBV compared with other causes. Intravenous drug abuse and a history of surgery or blood transfusion were significantly associated with HCV infection. Hepatocellular carcinoma was present at the time of diagnosis in 15.4% of cases. Chronic alcoholism associated with HCV infection was significantly associated (p<0.001) with reduced age (at the time of cirrhosis diagnosis) and increased prevalence of hepatocellular carcinoma (p = 0.052). CONCLUSION: Alcoholism, HCV and HBV are the main factors associated with liver cirrhosis in the state of Espirito Santo. Chronic alcoholism associated with HCV infection reduced the age of patients at the time of liver cirrhosis diagnosis.

Viabilidade do baço de ratos após a ligadura simultânea da artéria e veia esplênicas

OBJETIVO: A ligadura simultânea da arteria e veia esplenicas, com preservacao do baco, e realizada em seres humanos, na pancreatectomia caudal, mas o efeito exato dessa ligadura sobre o baco nao e bem conhecido. O objetivo deste trabalho foi verificar o efeito da ligadura dos vasos esplenicos principais no baco de ratos. METODO: Foram operados 58 ratos Wistar, machos, variando entre 230 e 408 g de peso. Os animais foram divididos aleatoriamente em dois grupos: grupo 1, simulacao (N=23), submetido a laparotomia e manipulacao do baco; grupo 2 (N=35) submetido a ligadura simultânea da arteria e veia esplenica. Todos os animais foram mortos 12 dias apos a operacao. O baco era retirado, pesado, fixado em formol a 4%, incluido em parafina, e os cortes foram corados pela hematoxilina e eosina para exame microscopico. RESULTADOS: O baco era normal em todos os animais do grupo 1 e em tres dos 34 animais ( 8,82%) do grupo 2. Ocorreu infarto branco parcial do baco em 91,18% dos animais do grupo 2. O percentual medio de massa esplenica viavel nos bacos com infartos foi de 56,9 + 21,8 %. O aspecto histopatologico mostrou arquitetura preservada na porcao nao infartada, e neoformacao conjuntivo-vascular cicatricial substituindo as areas necrosadas. CONCLUSOES: A ligadura simultânea da arteria e veias esplenicas resultou em infarto branco parcial do baco em 91,2% dos animais, com preservacao minima de 35% e media de 56,9% de massa esplenica viavel. Na maioria dos animais que sofreram ligadura, o infarto se localizou na porcao inferior do baco.

Experimental models of longitudinal abdominal incisional hernia in rats

Hernias incisionais abdominais no rato tem sido produzidas pela resseccao de fragmento dos musculos de parede abdominal. Na tentativa de criar um modelo de hernia incisional abdominal no rato, sem resseccao de fragmentos de musculo de parede abdominal, os seguintes procedimentos cirurgicos foram realizados: (a) Ratos anestesiados com vapores de eter foram submetidos a uma incisao longitudinal mediana supra e infra umbilical, de 4 cm de comprimento, seguida do descolamento do tecido celular subcutaneo em uma extensao de 1,5 cm lateralmente a linha mediana; de cada lado; em seguida era feita uma incisao de linha alba e peritonio parietal com a mesma extensao de incisao cutânea; a incisao cutanea era suturada com pontos separados. (b) Ratos foram submetidos a uma incisao transversal, suprapubica, atraves da qual se introduzia a tesoura e se descolava o tecido celular sub-cutâneo ate 1,5 cm de cada lado da linha media em uma extensao de 4 a 5 cm em direcao ao apendice xifoide; em seguida era feita uma incisao na linha alba e peritonio parietal e suturada a incisao cutânea transversal. (c) Para controle, ratos foram submetidos a resseccao de um fragmento de 3 x 4 cm dos musculos da parede abdominal anterior, criando-se um grande defeito na parede abdominal. Todos os animais submetidos aos tres procedimentos desenvolveram hernias abdominais bem constituidas. Concluiu-se que hernias abdominais incisionais podem ser facilmente induzidas no rato apos incisao da parede abdominal, desde que o tecido subcutâneo seja deslocado lateralmente a incisao em extensao de pelo minimo 1,5 cm.