Juan A. Vargas

Decrease of regulatory T cells in patients with systemic lupus erythematosus

Current evidence indicates that regulatory T cells (Tregs) actively suppress autoreactive lymphocytes that escape central tolerance.1,2 Tregs are characterised by a high intensity CD25 constitutive expression3 on the surface of CD4 T lymphocytes, which distinguishes them from the non-regulatory CD4+CD25+ T lymphocytes.4 Because of their important role in the maintenance of tolerance, it has been suggested that Tregs are decreased in patients with systemic lupus erythematosus (SLE).5 We have quantified Tregs in patients with SLE and controls and evaluated their association with disease activity and treatment. Thirty three patients with SLE (26 women, 7 men) and 14 healthy volunteers matched for age and sex (11 women, 3 men) with a mean age of 39.9 and 36 years, respectively, were studied. All patients fulfilled at least four of the American College of Rheumatology 1982 revised criteria for the classification of SLE.6 Disease activity at the time of blood sampling was assessed using the SLE Disease Activity Index (SLEDAI).7 …

Disseminated-to-Skin Kala-azar and the Acquired Immunodeficiency Syndrome

Excerpt To the editor: The worldwide spread of infection with the human immunodeficiency virus (HIV) may modify the usual expression of regional endemic diseases. Conversely, those atypical forms m...

Validity of the Western Blot Immunoassay for Heat Shock Protein‐70 in Associated and Isolated Immunorelated Inner Ear Disease

Objective To assess the validity of the Western blot immunoassay for heat shock protein‐70 (hsp‐70) for diagnosis of autoimmune inner ear disease.

Monocytes and T Lymphocytes Contribute to a Predominance of Interleukin 6 and Interleukin 10 in Systemic Lupus Erythematosus

To investigate the contribution of T lymphocytes and monocytes to cytokine production in systemic lupus erythematosus (SLE).

Hepatic fibrin-ring granulomas: A clinicopathologic study of 23 patients

Twenty-three patients with characteristic hepatic fibrin-ring granulomas were studied. Q fever accounted for 10 cases (43%), visceral leishmaniasis for five cases (22%), boutonneuse fever for two cases (9%), and toxoplasmosis, Hodgkins disease, and allopurinol hypersensitivity for one case each (4%). The etiology remained undetermined in three cases (13%). This report broadens the range of etiologies of hepatic fibrin-ring granulomas to include boutonneuse fever and toxoplasmosis in the differential diagnosis of ring granulomas, and it could serve as a guideline to the clinician and pathologist for the most frequent categories of disease associated with this morphologic pattern.

Role of viral and Mycoplasma pneumoniae infection in idiopathic sudden sensorineural hearing loss.

Sudden deafness constitutes a challenge in terms of the etiopathogenic diagnosis. The causative origin of sudden deafness usually remains unknown. However, available evidence suggests that viral and Mycoplasma pneumoniae infection could be one factor involved. In order to analyze the incidence of these infectious agents, a microbiology study was carried out during the acute phase of the disease, and during convalescence, in 24 patients (17 men and 7 women; mean age 39.7 years; range 17-63 years) with idiopathic sudden hearing loss (SHL) according to previously published criteria. In the acute phase most of the patients presented IgG antibodies to Epstein-Barr virus (n=23), herpes simplex virus (n=24), parainfluenza virus (n=24), varicella-zoster virus (n=24) and cytomegalovirus (n=20). Results obtained from 3 patients suggested the existence of a recent infectious process caused by Mycoplasma pneumoniae (IgM+) in 1 patient, Mycoplasma (IgM+) and influenza A virus (complement fixation titer >1/64) in another and parainfluenza virus seroconversion (a fourfold higher titer between the acute phase and convalescence) in the third. In conclusion, the low incidence of documented positive serological tests in our series (12.5%) may be due to the presence of pathological situations other than acute infection and does not justify routine serological studies in patients with SHL.

Does the Serological Testing Really Play a Role in the Diagnosis Immune-mediated Inner Ear Disease?

In order to analyse the clinical presentation and laboratory tests used for the diagnosis of immune-mediated sensorineural hearing loss (IMSNHL) a prospective study was conducted involving 125 patients affected by diverse clinical forms of the disease. The following methods were used: analysis of clinical evolution, pure-tone audiometry, determination of the immunophenotype of peripheral blood lymphocytes, immunoglobulins, complement factors C3 and C4, erythrocyte sedimentation rate, antinuclear autoantibodies (ANA) and heat shock protein 70 and the response to therapy. Levels CD4 ( p = 0.03) and CD4CD45RA ( p = 0.002) T cells were significantly reduced in patients with sudden sensorineural hearing loss. ANA were found in 34.4% of patients and the incidence of antibodies to HSP-70 was similar in both patients and control subjects. Diagnosis of IMSNHL is still based on clinical impressions as laboratory testing is not sufficiently diagnostic. However, the long-term evolution of IMSNHL presented by the patients included in this study may explain the negative results obtained in the tests. The existence of a typical profile patient, including the clinical course, immunological changes (presence of ANA and detection of abnormalities in T-cell subpopulations) and the response to steroid therapy can facilitate diagnosis. Further investigation to help identify a specific marker characteristic of IMSNHL is required.

Candida Infection of Cerebrospinal Fluid Shunt Devices: Report of Two Cases and Review of the Literature

Summary¶ Use of CSF shunt devices is a common practice in neurosurgery, and infection of the shunt is the most frequent complication. In spite of the fact that bacteria are the most widely implicated pathogens, reports of fungal infections, especially due to Candida sp., have increased in recent years. Their reported frequency ranges between 6% and 17%. Many factors have been implicated in the pathogenesis of Candida meningitis, such as broad spectrum antibiotics used in the treatment of a bacterial meningitis, steroids and indwelling bladder and intravenous catheters. The treatment of Candida meningitis still consists of systemic antifungal agents and removal of the shunt.

Modulation of apoptosis by cytokines in B-cell chronic lymphocytic leukemia.

B-cell chronic lymphocytic leukemia (B-CLL) is characterized by the slow and progressive accumulation of monoclonal apparently mature, CD5(+) B lymphocytes. The majority of circulating cells appear to be nondividing, and it has been suggested that a prolonged life span is mainly responsible for the accumulation of the leukemic cells. However, spontaneous programmed cell death by apoptosis occurs when B chronic lymphocytic leukemia cells are cultured in vitro. This may be because of the lack of an unidentified essential cytokine present in vivo. Thus, we investigate interleukin-2 (IL-2), IL-4, IL-6 and IL-10 in vitro effects on apoptosis of B cells from 32 previously untreated patients with B-CLL in initial clinical stages. B cells were isolated from peripheral blood, and apoptosis was measured in these cells immediately after isolation and following incubation in vitro, without and with the different cytokines, for 24 and 48 h. Distribution of cellular DNA content and quantitative analysis of apoptosis were determined by standard propidium iodide staining and flow cytometry. Spontaneous apoptosis occurred in B-CLL cells incubated in vitro in the absence of cytokines. Our results indicate that both IL-2 and IL-4, but not IL-6, inhibit in vitro apoptosis in a large percentage of B-CLL patients. IL-10 increases in vitro apoptotic cell number in stage 0 patients, but not in stage I and II. These data support the hypothesis that IL-2 or IL-4, may be cell survival factors in vivo and that IL-10 might be a candidate for immune therapy of early B-CLL.

Prognostic value of neutrophils and NK cells in bronchoalveolar lavage of sarcoidosis

Not all the patients with sarcoidosis need pharmacological therapy, and the decision to start therapy is based mainly on clinical conditions. The aim of this study was to evaluate the prognostic value of the leukocyte and lymphocyte subpopulations in the bronchoalveolar lavage fluid from these patients.