José Carlos Bina

Enhanced helminthotoxic capacity of eosinophils from patients with eosinophilia.

To determine whether eosinophils from patients with eosinophilia have an enhanced capacity to kill parasites, we compared purified eosinophils (mean purity, 89 per cent) from 30 patients with various degrees of eosinophilia and with or without infection with Schistosoma mansoni for the capacity to kill schistosomula, the larval stage of S. mansoni, in vitro. There was a significant correlation between peripheral eosinophil count and antibody-dependent, eosinophil-mediated death of parasites after 40 hours of culture (P < 0.0001). Antibody-dependent adherence of eosinophils, measured after two hours of incubation, also correlated with the capacity of the eosinophils to kill the parasites. The correlation between the killing capacity of eosinophils and their peripheral-blood count was observed in patients both with and without S. mansoni infection. We suggest that eosinophilia involves not only a quantitative change in eosinophil numbers but also a qualitative change in functional capacity that renders circulating eosinophils more effective in resisting parasitic infections.

The changing pattern of pathology due to Schistosoma mansoni infection

A survey of the autopsy data on hepatosplenic schistosomiasis during periods, before and after the advent of new chemotherapeutic drugs, revealed that: a) the pathological presentation was the same for the two periods; b) the number of cases in the last five years is progressively decreasing; c) hepatosplenic disease due to schistosomiasis is becoming rare in young people. These data represent a change in the pattern of pathology in schistosomiasis, probably related to new chemotherapy.

The pathology of the hepatosplenic form of schistosomiasis mansoni in its advanced form (study of 232 complete necropsies)

This study includes an evaluation of pathological findings on 232 complete necropsies performed on subjects with advanced hepatic schistosomiasis in Salvador, Bahia, Brazil. The constant and characteristic feature was peri-portal hepatic fibrosis with destructive and obstructive vascular lesions of the intrahepatic branches of the portal vein. Usually the lesions were accomapained by signs of portal hypertension (splenomegaly and esophageal varices) representing hepatosplenic schistosomiasis, but in 12 cases such signs were absent (advanced hepatic schistosomiasis). Some individuals progressed from a compensated to a decompensated form of hepatic schistosomiasis by showing progressive evidences of hepatic cell failure. In such cases the liver usually presented more intense septal fibrosis and changes of chronic active hepatitis, but not a transformation toward a diffuse cirrhosis. Spelonomegaly resulted from chronic passive congestion and cellular proliferation, specially of the phagocytic mononuclear system. Occasionally the enlarged spleen developed a peculiar nodular type of lymphoma. Intestinal involvement was less than expected. Only rarely some more prominent changes, such as peri-colonic and retroperitoneal fibrosis due to massive deposition of eggs, pseudo-neoplastic formations and polyps appeard. A frequent complication was cor pulmonale due to schistosomal pulmonary arteritis, which appeard in 44 cases (18,9%). Associated renal disease was found in 15% of the cases, usually represented by chronic diffuse glomerulonephritis, wich is presumed to represent a immune-complex manifestation of schistosomiasis. Concommitant infections were frequently observed, and some of them, such as salmonellosis and viral hepatitits, tended to run a rather prolonged course. Thus, advanced schistosomiasis appeard as a pathological process that damages mainly the liver, but that reaches various organs through a varied and complex pathogenesis, the mechanisms of which are...

A field study of proteinuria in individuals infected with Schistosoma mansoni

Proteinuria was detected in 24.7% of 89 individuals with hepatosplenic schistosomiasis and in only 4.6% of 86 subjects with mild hepato-intestinal schistosomiasis, all of them living in comparable conditions in two endemic areas in Bahia, Brazil. From nine individuals who hadproteinuria over30 mg/100ml, eight had hepatosplenic schistosomiasis. These findings maybe related to the presence of schistosomal nephropathy and reveal the significance of this condition in thefield in endemic areas of schistosomiasis.

Sintomatologia intestinal na fase crônica da esquistossomose mansoni

A total of 102 autochthonous patients from the districts of Lagoa Redonda and Menezes (Sapeacu, Bahia), with ages rangingfrom nine to 19years, were evaluated for intestinal symptoms related to the chronic phase of Schistosomiasis mansoni, with emphasis on the following complaints: abdominal pain, diarrhea, mucus and blood in the stools. One half of the sample (case group) was treated with mebendazole followed by oxamniquine; the otherhalf (control group) received only mebendazole. The results showed that schistosomiasis is probably responsible for the appearance of mucus and/or blood in the stools, since a statistically significant reduction of such manifestations was achieved with specific treatment.

Multiple drug regimen for severe diarrhea associated with Cryptosporidium in aids patients

Cryptosporidium is one of the most common identified causes of chronic diarrhea and malabsorption in AIDS patients. The severity of human cryptosporidiosis in AIDS patients may be correlated with the degree of immune dysfunction that they present. No effective treatment however exists against this disease. An alternative association therapy is therefore suggested to control severe diarrhea in AIDS patients with cryptosporidiosis. A patient with Cryptosporidium-induced diarrhea was first treated with spiramycin without success. Co-trimoxazole and doxycycline were then introduced for prophylaxis of Pneumocystis carinii pneumonia while the subjects chlamydial urethritis was also treated. This regimen brought about a complete recovery of symptoms. Based upon these results the authors went on to treat 5 consecutive patients with Cryptosporidium-induced diarrhea with a combination of 50 mg/kg/day of spiramycin 4 mg/kg/day of doxycycline and co-trimoxazole (25/5 mg/kg/day TMP-SMX). All 5 had a history of 30-45 days of diarrhea with 10-15 episodes daily and weight loss of more than 10%. Further only Cryptosporidia had been identified in their stool prior to treatment. After completing treatment over a period of approximately 1 week all subjects presented with stool samples negative for Cryptosporidium and remained asymptomatic after 3 months of follow-up. The medication was well-tolerated and no significant side-effects were observed. this therapy may therefore be useful in treating cryptosporidiosis in AIDS patients but it requires further evaluation.