Jayme Neves

Long duration of septicaemic salmonellosis: 35 cases with 12 implicated species of salmonella☆

35 cases of prolonged septicaemic salmonellosis have been described in the State of Minas Gerais, Brazil, in recent years. The following points are emphasized: 1. 1. This salmonellosis does not represent a prolonged course of classical typhoid fever, but exhibits a clinical picture of a reticulo-endotheliosis closely related to that of kala-azar. 2. 2. Prolonged septicaemia is one of the most constant characteristics of the disease, and differs from those severe and lethal, as well as from the benign ambulatory, types observed in typhoid fever. 3. 3. Through serological typing of blood cultures, the following salmonellae were implicated in the infections: S. typhi, S. newport, S. panama, S. dublin, S. anatum, S. paratyphi A, S. paratyphi C, S. cholerae-suis, S. cholerae-suis var. kunzendorf, S. derby and S. montevideo. 4. 4. There is some evidence that biochemical identification of salmonellae and routine Widal agglutination tests were not suitable laboratory procedures for definite identification. 5. 5. The patients showed dramatic and convincing clinical response to chloromycetin, without relapses. 6. 6. Schistosoma mansoni infection was constant in these cases, but there is no convincing proof to evaluate the role it plays in the pathogenesis of septicaemic salmonellosis of protracted course.

Prolonged septicaemic salmonellosis: Treatment of intercurrent schistosomiasis with niridazole

Abstract With the appearance of cases of septicaemic salmonellosis resistant to chloramphenicol and various antibiotic and chemotherapeutic drugs (tetracyclines, streptomycin, nalidixic acid, sulphonamides) we decided to treat the intercurrent schistosomiasis from which these patients suffered. The response to treatment with niridazole was excellent. Two resistant cases showed dramatic and convincing clinical and laboratory response, the cure not being followed by relapses; both the salmonellosis and the schistosomiasis were cured by daily doses of 25-20 mg. per kg. for 7–10 consecutive days. The results so far obtained from this preliminary study led us to treat 8 other patients with niridazole before any antibiotics. This was successful and all the patients were cured of both infections; the rapid sterilization of cultures was outstanding, particularly the blood cultures (Table I). Although it is too soon to draw any definite conclusion on the pathogenetic importance of schistosomiasis in the salmonellosis of long duration, the results of the present trial are discussed on the basis of a probable anti-salmonella action of niridazole, which was also demonstrated in vitro.

Gastro-intestinal manifestations of the initial phase of schistosomiasis mansoni.

Clinical gastro-intestinal manifestations were studied in 34 patients in the initial phase of schistosomiasis mansoni. The patients, all men, were of similar age and in similar nutritional condition and had been infected simultaneously at the same transmission site. Most (85%) showed some gastro-intestinal sign or symptom, generally of light or moderate intensity; 56% had liquid or pasty diarrhoea, 41% abdominal pain, 29% hepatomegaly, 21% dysentery, 15% anorexia, 12% pain on colon palpation and 9% nausea and/or vomiting. High worm burden was associated with blood in faeces but apparently not with any other clinical manifestation. There was no apparent association between any clinical manifestation and peripheral-blood eosinophil counts or titres of IgE specific for Schistosoma mansoni (evaluated by the area of immediate intradermal reaction to injected adult worm antigen). The absence of association between worm burden and nearly all the clinical gastro-intestinal manifestations strengthens the concept that factors other than worm burden, such as host reactivity, constitute important pathogenetic elements in the initial phase of schistosomiasis mansoni.

Pathogenetic factors of acute schistosomiasis mansoni: correlation of worm burden, IgE, blood eosinophilia and intensity of clinical manifestations

A clinical study of 34 previously healthy young patients simultaneously infected in an endemic area of schistosomiasis mansoni is presented, emphasizing the initial phase of the infection. Its intensity was established according to the occurrence, intensity, and duration of the signs and symptoms in order to investigate the possible correlations between the worm burden (estimated by the number of eggs in faeces), the blood eosinophilia and specific levels of IgE (estimated by the area of immediate intradermal reaction), with the clinical manifestations. A significant but low‐level association was found between the worm burden and morbidity, suggesting that multiple factors, besides worm burden itself, may contribute to the pathogenesis of the disease.

Pulmonary manifestations in the initial phase of schistosomiasis mansoni

The clinical and radiological pulmonary manifestations in the initial phase of schistosomiasis mansoni were studied in thirty previously healthy individuals who were simultaneously infected. The findings were compared with those concerning a control group and related to possible pathogenetic factors. The respiratory manifestations were of light or of moderate intensity, the dry cough being the most common symptom. The significant radiological alterations were: thickening of bronchial walls and beaded micronodulation, predominantly localized in the lower pulmonary fields. It was observed significant association between wheezing and IgE levels, estimated by the area of immediate intradermal reaction, as well as between the number of blood eosinophils and the occurrence of radiological changes. Moreover, there was correlation between the worm burden and the presence of wheezing, thoracic pain and beaded micronodulation. Thus, the clinical and radiological pulmonary manifestations described are significant part of the initial phase of schistosomiasis mansoni and present the worm burden, eosinophilia and levels of IgE as probable pathogenetic factors.

Ischaemic colitis (necrotizing colitis, pseudomembranous colitis) in acute schistosomiasis mansoni: report of two cases

Two cases of ischaemic necrosis of the sigmoid colon (necrotizing colitis) are reported in 2 brothers aged 7 and 4 years, diagnosed within a 10 d interval. The children had bathed in streams suspected to be contaminated by Schistosoma mansoni about 50-60 d before the onset of acute disease. Both patients had been previously exposed to schistosome-infected streams without showing signs or symptoms of infection. Before admission, S. mansoni eggs had not been found in the stool. Both patients presented with an apparently identical, relatively symptomatic clinical course with rapid evolution to an acute abdomen. Laparotomy disclosed, in both patients, extensive necrosis (ischaemic necrotizing colitis of schistosomal aetiology) of about 20 cm in the first child and 8 cm in the second, extending from part of the descending colon to the sigmoid. The patients were successfully operated upon (hemicolectomy plus colostomy). The histopathological findings were similar in both patients. Ischaemic necrosis with complete destruction of the mucosa and part of the submucosa was detected in the first case; in the necrotic areas a few eggs of S. mansoni were seen, with no granulomatous reaction, but surrounded by cell shadows, pycnotic nuclei and amorphous material. Necrosis extended to the muscular layer and serosa, in which schistosome granulomas in the necrotic-exudative phase were seen, as well as diffuse granulocytic exudate and fibrin. Sections of tissue from both patients contained numerous eggs and granulomas all in the same exudative phase in regional lymph nodes and near the thrombotic vessels. After surgery, the 2 patients progressed similarly. About 10 d after hospital discharge, the patients received anti-schistosomal treatment with oxamniquine. No further sign of infection was detected at subsequent recall visits.

Intradermal vaccination of adults with three low doses (2 µg) of recombinant hepatitis B vaccine. I. Seroconversion rate and adverse effects

A total of 250 dentists (53.6% men and 46.4% women), with a mean age of 35.1 ± 9.8 years, were submitted toserological tests for the diagnosis of hepatitis B (HB) – HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe – using aradioimmunoassay. One or more of these markers were detected in 78 individuals (31.2%) who were excluded fromthe group to be vaccinated. Of the 172 HB-susceptible individuals, 135 (78.5%) responded to the call and wereintradermally injected with three 2 µg doses of the Belgian HB recombinant vaccine, applied at an interval of onemonth between the 1st and 2nd dose and of five months between the 2nd and 3rd dose. A new determination of HBmarkers carried out 50 days after the 3rd dose showed that 110 (81.5%) individuals had become anti-HBs positive(65.5% good responders and 34.5% poor responders). Mean serum anti-HBs titer of these 110 dentists was 42.4 US/N, similar in both sexes. The adverse effects analyzed in 106 dentists were: (a) local: pain (12.3%), burningsensation (14.1%), pruritus (25.5%), erythema (28.3%), local heat (18.9%), and a hypochromic spot (32.1%); (b)systemic (4.7%): discomfort in two patients, and fever, anorexia, and asthenia in one patient each. Intradermaladministration of a fourth 2 µg vaccine dose to 39 dentists (poor or non-responders) increased the total number ofanti-HBs-positive individuals from 110 (81.5%) to 114 (84.4%), with the number of good responders increasingfrom 72 (65.5%) to 85 (74.6%). We conclude that the Belgian recombinant vaccine applied in the scheme used hereinduces a high rate of seroconversion and causes only mild and transitory adverse effects.

Characterization of the non-apparent clinical form in the initial phase of schistosomiasis mansoni

In this paper the history of 115 recruits that had bathed simultaneously in streams contaminated with Schistosoma mansoni, during military maneuvers, is reported. Thirty four of the infected patients presented the initial phase of the infection diagnosed through epidemiologic, clinical and laboratory parameters. Three out of the 34 patients did not reveal the clinical picture of the infection, thus being considered representatives of the non-apparent form of the disease. Differences between the intensity of blood eosinophilia, the area of immediate cutaneous reaction and the number of Schistosoma eggs eliminated in the stools proved not to be statistically significant (p > 0.05) when the non-apparent and acute cases of schistosomiasis were compared. These cases actually may be considered evidences of the non-apparent form hitherto merely taken for granted in the literature.

As dimensões do granuloma causado pelos ovos do Schistosoma mansoni no fígado humano

The authors have determinated the medium-size diameter of the Schistosomas granuloma during its many forms of evolution (necrotic - exsudative, produtive and recovery by scarring) in 332 cases of human hepatic schistosomiasis. Within those studied cases three were 167 in the acute, toxemic form and 167 the cronic form (hepato-splenic and disseminated). The 286 measured granulomas were studied from needle-biopsy material in the acute form and 165 from surgi cal and needle-biopsy in the latter.

Intradermal vaccination of adults with three low doses (2 µg) of recombinant hepatitis B vaccine. II. Persistence of immunity and induction of immunologic memory

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> or = 10 mIU/ml) in 42 dentists (82.4%), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6%) (good responders), between 10 and 100 mIU/ml in 6 (11.8%) (poor responders), and lower than 10 mIU/ml in 9 (17.6%) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 micrograms booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB--with intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine at 0, 1, and 6 months--carried out eight years before in 51 dentists.