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Análise do dano neural em pacientes hansenianos e na coinfecção HIV/ Hanseníase através de duas coortes clínicas
(Universidade Federal do Pará, 2013) BATISTA, Keila de Nazaré Madureira; XAVIER, Marília Brasil; http://lattes.cnpq.br/0548879430701901
In Brazil where leprosy is endemic and where HIV infection continues to expand and internalizing, if expected to find an increased prevalence of individuals living with both leprosy and HIV / AIDS, but there are few reports on the neurological damage that can cause overlapping. The aim of this study was to investigate nerve damage in leprosy leprosy patients coinfected with human immunodeficiency virus, compared with leprosy coinfected not at the beginning of treatment and at discharge, through two clinical cohorts. The sample consisted of 99 patients of whom 46 had coinfection MH / HIV and only 53 leprosy, these patients were seen at the outpatient clinic of the Center for Tropical Medicine and evaluated by the Simplified Technique. As a result there was a predominance of males, aged between 15 and 45 and the origin of the Metropolitan Region of Belém In group coinfection MH / HIV were prevalent in these paucibacillary patients and the presence of neuritis , abnormal sensitivity , motor abnormalities, presence of disability and neural damage was higher in this group than in the MH. In group predominated MH multibacillary patients and the presence of these neuritis, abnormal sensitivity, motor abnormalities, presence of disability and nerve damage was higher in this group than in coinfected MH / HIV. Monitoring of patients coinfected MH / HIV there was a small reduction in the presence of failure and nerve damage while in the MH group monitoring the presence of disability remained increased and nerve damage. In the Kaplan-Meier survival analysis was found that in patients MH was maintaining the chance of the patient remains without nerve damage, while in the coinfected patients group, was observed a reduction in the chance of the patient to keep without nerve damage the end of treatment. Thus it is concluded that the neural damage behaves differently in the two groups manner, predominantly in the paucibacillary group coinfected patients coinfected and not in multibacillary patients, but with the same gravity, which is troubling since diagnosing this damage at the beginning of the appearance of leprosy is still a problem for public health.
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Análise morfológica das células de Langerhans purificadas da epiderme de camundongo Balb/c, após interação in vitro com Leishania (Viannia) brasiliensis e Leishamania (Leishmania) amazonensis
(Universidade Federal do Pará, 2003) QUARESMA, Mariana do Socorro Maciel; SALGADO, Claudio Guedes; http://lattes.cnpq.br/2310734509396125
Langerhans Cells (LC) are MHC class II positive antigen-presenting cells that constitute 2-3% of all epidermal cells, which have been demonstrated to stimulate a vigorous T-cell response to Leishmania major. New World cutaneous leishmaniasis is caused by different species, presenting diverse clinical pictures, varying from cutaneous localized to mucous or anergic disease. Using a "panning" technique, murine (Balb/c) epidermal LC were purified to around 95% purity (pLC). The freshly prepared LC (fLC) presented small, delicate dendrites and the classic Birbeck granules. Parasites of the subgenera Viannia and Leishmania, which are genetically very distinct, have been suggested to have a possible species-specific response in cell mediated immunity. In this study, pLC and L. (V.) braziliensis or L. (L.) amazonensis were cultured and their morfology were analyzed after 12h or 36h culture. Using Giemsa stain and scanning electron microscopy, different morphologic changes were detected on LC afier 12h culture on both cultures, LC and L. (V.) braziliensis or LC and L. (L.) amazonensis. After interaction with L. (V.) braziliensis, LC became more dendritic, that were smaller in lenght when compared to LC cultivated alone. In contrast, after interaction with L. (L.) amazonensis, LC became round shaped with a few cells showing some dendrites. Moreover, there was a dose contact between the promastigotes flagelli and LC, but without phagocytosis in 12h or 36h culture, what is different of the observations found in the literature on the interaction between LC and L. major. These results suggest that LC primary response against different species of Leishmania could be distinct upon the species involved in the interaction process.
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Associação do polimorfismo do gene humano NRAMP1 na susceptibilidade/resistência para hanseníase em áreas endêmicas do estado do Pará
(Universidade Federal do Pará, 2011) SILVESTRE, Maria Perpétuo Socorro Amador; QUARESMA, Juarez Antônio Simões; http://lattes.cnpq.br/3350166863853054
Leprosy is a public health problem in the Pará state and a challeng for the Control Programs that aim strategies improvement to elimination of this disease between us. The agreement of the genetic and immunology mechanism to explain maintenc endemic disease can be one of the alternatives for problem resolution. The human gene for natural resistance associated macrophage protein – NRAMP1 is expressed in macrophages and seems to be involved with influence cellular immune responses to mycobacterium leprae infection. We evaluated the polymorphism association of this gene as reported by Buu et al (1995) with leprosy “per se” and clinical forms according to the anti-PGL-1 levels in the population studied. A total of 122 leprosy patients and 110 individual healthy coming from endemic municipalities in Para were genotyped for the polymorphism of NRAMP1. Association was found with leprosy “per se” (p=0.0087) and 3’ untranslated region with insertion/deletion of four base pairs was significantly associated with multibacillary (p=0.025) compared to contacts not cosanguineos. Heterozygotes and haplotypes with four base pairs deletion were more frequent among multibacillary than paucibacillary. The NRAMP1 gene haplotypes seem to have important influence on leprosy clinical presentation also revealed by Mycobacterium leprae anti-PGL-1 positively.
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Avaliação da presença de parvovírus B19 na pele psoriática e sua correlação com as alterações imunológicas in situ
(Universidade Federal do Pará, 2010) SIMÕES, Adriana Christie Lacerda; QUARESMA, Juarez Antônio Simões; http://lattes.cnpq.br/3350166863853054
Psoriasis is a disease already considered multisystemic, whose most known feature is the joint and skin involvement, with unclear etiology. The affected skin usually presents with erythema and desquamation. At the cellular level, the process involves primarily the activated T cells, macrophages and polymorphonuclear cells. Keratinocytes action and immune-dependent expression of adhesion molecules reveal a complex network of mediators with high biological activity. The presence of these inflammatory cytokines determines changes in Immunoregulatory functions translated by clinical symptoms of the disease. After verification of B hemolytic Streptococcus as a causative agent of guttate psoriasis, several studies has been attempted to relate other etiopathogenic factors capable of exerting a clonal expansion of T cells, as observed in the disease. Among some viruses studied, parvovírus B19 was listed as precipitating agent for arthritis and other autoimmune diseases, and due to be a common virus to produce infection often asymptomatic, spend time in the host, inducing local inflammatory response and mainly reside in the skin have also been researched as an "agent trigger" in the development of psoriasis. In this study, we used the viral DNA by PCR in the skin of psoriatic patients in the skin of eczema patients as controls and did not observe any significant positive results that would differentiate it in the two groups, therefore, no causal relationship or triggering the disease in question. In search of cytokines was observed that expected in psoriatic skin as TNF-a, but also of TH2 cytokines. Eczema in the group, the presence of TH2 cytokines was not altered by the presence of the virus in tissue. Despite the genetic predisposition to disease development, further studies are needed in order to study antigenic stimuli capable of altering immune function and create a profile and a clinical phenotype that can be recognized as psoriasis.
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Avaliação da susceptibilidade de camundongos BALB/c e Swiss, hamster e Proechimys roberti à infecção por Leishmania (Viannia) Naiffi e Leishmania (Viannia) Lindenbergi
(Universidade Federal do Pará, 2005) SODRÉ, Roberta Nice Salgado; ISHIKAWA, Edna Aoba Yassui; http://lattes.cnpq.br/3074963539505872
Leishmania (Viannia) naiffi and Leishmania (Viannia) lindenbergi are species that cause cutaneous leishmaniasis in Amazonia and present great similarity in its isoenzymatic profile, monoclonals antibodies and production of unapparent infection in hamsters. The fact of not having a highly susceptible experimental model to the infection for L. (V.) naiffi and L. (V.) lindenbergi, the objective of this study was evaluate the susceptibility of BALB/c and Swiss mice, hamsters and Proechimys roberti to the infection for those two species. It was prepared inoculums with salivary glands and without glands for each group of animals, associated to the promastigotes. The experimental animals, of both sexes, were inoculated intradermally in the dorsal surface of back feet and they were observed for 90 days. In the period of 30, 60 and 90 days after inoculation, the animals were sacrificed and different fragments of skin of the inoculation place were used in the culture, microscopic exam and polymerase chain reaction (PCR). It was not possible to observe lesions in the animals inoculated with L. (V.) naiffi and L. (V.) lindenbergi even at the presence or absence of salivary glands. As well as, forms amastigotes during 30, 60 and 90 days after the inoculation. In the culture, all the animals inoculated with L. (V.) lindenbergi haven’t developed promastigotes. For the other hand, BALB/c mice inoculated with L. (V.) naiffi presented positively when sacrificed 30 days after inoculation. PCR presented low sensibility compared to the culture. This way, we concluded that L. (V.) naiffi and L. (V.) lindenbergi is species that present low infectivity and none of the animals used in the study experimental model can be considered highly susceptible to the infection for those two species.
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Avaliação sorológica dos antígenos micobacterianos ND-O-BSA, LID-1 E NDO-LID em pacientes com hanseníase, contatos intradomiciliares e estudantes de um município hiperendêmico da Amazônia brasileira
(Universidade Federal do Pará, 2014-04-05) MORAES, Tânia Mara Pires; SALGADO, Claudio Guedes; http://lattes.cnpq.br/2310734509396125
Despite efforts for its elimination as a public health problem, leprosy remains highly prevalence in some countries, including Brazil, specially in the state of Pará, which accounts for approximately 10% of the 400,000 new cases in Brazil during the last 10 years. To date, there is no diagnostic test to detect leprosy in its early stages, thus contributing to the maintenance of high rates of disease incidence. In this sense, the Discovery of new specific antigens of M. leprae to enable the development of new diagnostic methods may facilitate early detection of disease prior to the onset of disfigurement and nerve damage and contribute to achieving the goals of leprosy control. In this study, dermatological clinical evaluation of the participants was performed to detect new cases and blood samples were collected for antibody screening at two different timpoints, T1 (2011) and T2 (2013), two years apart. IgM anti-ND-O-BSA and IgG anti-LID-1 titers were detected by ELISA, and anti-IgM and anti-IgG were combined for detection of both in plasma samples by ELISA or also the whole blood by OrangeLife® (OL) rapid test in 79 leprosy patients, 131 household contacts and 331 students from the municipality of Breves, Pará State. Samples collected at T1 showed a high number of new cases detected, with 18.6% of household contacts and 6.1% of students diagnosed, while two years later at T2, there were 19.8% of household contacts and 9.4% of students diagnosed. At T2, 44.3% of contacts were positive for anti-ND-O-BSA, 7.8% for anti-LID-1 and 37.4% for anti-NDO-LID. Mong the students 49.5% were positive for anti-ND-O-BSA, 5.1% for anti-LID-1 and 37% for anti-NDO-LID. The association between antigens showed a strong correlation to ND-O-BSA and NDO-LID. Positivity of the OL rapide test was 44.3% for newly diagnosed MB cases (BT majority), in students was 47.4% and 36.3% in household contacts, with poor agreement with ELISA anti-NDO-LID. At follow-up (T2), the percentage of new cases was 35% and the largest number was identified among individuals positive for anti-ND-O-BSA. The data show a high incidence in contacts and students through active search and serologic follow-up, and we concluded that the antigen ND-O-BSA was more sensitive in the ELISA assay for identifying new cases in populations endemic.
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Ciclosporina A no eritema nodoso hansênico com manifestações sistêmicas: avaliação clínica, laboratorial e histopatológica
(Universidade Federal do Pará, 2003-01-28) AZEVEDO, Maria do Socorro Marques; BRITO, Arival Cardoso de; http://lattes.cnpq.br/0563291980190339
The ENL is a severe and acute interference that attacks patients of lepromatous and borderline lepromatous leprosy forms from Ridley and Jopling classification. In this study, the immunomodulator drug cyclosporine A was used to evaluate its effectiveness in ENL reaction, whose treatment is based on the use of drugs as thalidomide that has several restrictions and that induce dependence among other damages. Ten ENL patients with systemic manifestations and more than two reactions episodes were chosen. These patients had taken high doses of corticosteroids during years and eight of they, took thalidomide more than three times too. All patients were followed clinically for 90 days and took 3-5 mg/kg/daily, besides they accomplish laboratory exams in the zero day, 15 th and 60 th of use cyclosporine A and made also hystopathologic exams (before and 60 days after cyclosporine A). It was requesting the next laboratory exams: blood-count; leuko-count; TGO; TGP; urea and creatinine. Among laboratory exams changes, there was leucocytosis in 70% of patients that was reduced until the end of follow up in the same percentage. Biochemical exams didn't show significance disturb, except for the increase of TGO in one patient and of TGP in another, besides two cases who showed increase of urea and creatinine, but later on, they were better without any additional assistance. In 40 % of patients, the first's hystopathologic exams, alterations were represented for granulomatosis dermatitis and in 30% of sick ones, for nodular dermatitis. In second exams, there was change to superficial and deep infiltration in the blood vessel walls, in 50 % of cases; septal panniculitis in 20 %. It denotes histological improvement verified in the first fifteen days of therapy. The cyclosporine A action was specially useful in systemic symptoms, except in the cases who had neuritis. Then, cyclosporine A can be an alternative for clinical improvement to leprosy reaction type II.
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Doença de Jorge Lobo: estudo histopatológico retrospectivo de casos registrados no serviço de dermatologia da Universidade Federal do Pará no período de 1967 a 2009
(Universidade Federal do Pará, 2010) BITTENCOURT, Maraya de Jesus Semblano; BRITO, Arival Cardoso de; http://lattes.cnpq.br/0563291980190339
Jorge Lobo‟s disease (JLD) or lacaziosis is a chronic, granulomatous skin and subcutaneous tissue infection caused by the fungus Lacazia loboi. Clinical lesions are generally polymorphous, often presenting with a keloid-like aspect, and most often involving ears or limbs. Histopathology remains the “gold standard” exam to reach diagnosis. Few clinical-pathological correlation studies on this disease are available to date. Our goal was to systematically review cases of JLD diagnosed at the dermatopathology laboratory of the Dermatology Service of the Federal University of Pará, Brazil, from 1967 to 2009. After a thorough chart review, we could retrieve demographic and clinical data, as well as histopathological features from each case studied. 59 biopsies from 45 patients were evaluated. The sample consisted of 37 men and eight women, with a mean age of 50 years. Most patients were agricultural workers (55%), of which 93% were males. Fifty-nine percent of the lesions showed a keloid-like appearance. Verrucous (8%), plaque (3%), gummatous (1%), and hyperchromatic macular (1%) lesions were less frequently observed. Most skin lesions occurred on the lower limbs (56%). Histopathologically, the stratum corneum showed hyperkeratosis in 71% of the biopsies, associated with parakeratosis in 37% and with orthokeratosis in 50%. Transepidermal elimination of parasites (TEP) was present in 36% of the cases in association with hyperkeratosis in 95% (p=0.0121) and with parakeratosis in 90% (p<0.0001). The epidermis showed a hyperplastic appearance in 58% of the specimens, was atrophic in 29%, normal in 12%, and ulcerated in 8% of them. There was a hyperplastic epidermis (86%, p=0.0054) in sites where TEP took place. We could also observe the presence of parasites in the epidermis in 30% of the biopsies, in which an association with TEP occurred in 89% (p<0.0001). There was no statistically significant relationship between the occurrence of TEP and the clinical aspect of the lesion (p=0.4231). Lymphocytes, macrophages and giant cells of the foreign-body type were predominant in the infiltrate, being observed in 100% of the cases. Plasma cells were seen in 35%, neutrophils in 15%, and eosinophils in 11% of the cases. There was a statistically significant relationship between the occurrence of TEP and the presence of neutrophil infiltration (p=0.0016). An exudative reaction pattern was present in 10% of the biopsies, and 11% exhibited focal areas of necrosis. Langhans giant cells were observed in 59% of the biopsies, and asteroid bodies in 5%. Pseudo-Gaucher cells were present in 69% of the cases, and fibrosis in 96%. The infiltrate showed extension to the reticular dermis in all cases, and to the deep dermis in 88%. A subcutaneous spread of the infiltrate occurred in 10% of the cases, with identification of parasites within the fat tissue in one of them. As for age distribution, sex and profession of the patients, the data overlapped those of the literature. The results allowed us to evaluate epidemiological, clinical and histopathological profiles of the disease, which in certain respects differed from the classically described ones of the literature, especially concerning characteristics of the epidermis, inflammatory cell infiltrate, and location of lesions.
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Donovanose no Pará
(Universidade Federal do Pará, 1991-12) SALGADO, Ubirajara Imbiriba; NEVES, Cláudio Domingues das; SILVA, Domingos; MACÊDO, Célia
From 1954 to 1990 granuloma inguinale was diagnosed in 259 patients al the dermatology service of the Universidade Federal do Pará in Belém, Brazil. Among them, 56 cases had ocurred in the twenty-year period 1954-1974 and as many as 133 cases were seen during the last five years only. Greater sexual liberty, poor social and economic conditions, and especially increasing homosexual behavior were implicated by the authors as chief determinants for this augmented incidence of the disease.
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Epidemiologia espacial e sorológica da hanseníase no estado do Pará
(Universidade Federal do Pará, 2013) BARRETO, Josafá Gonçalves; KITRON, Uriel; http://lattes.cnpq.br/4693583802608442; SALGADO, Claudio Guedes; http://lattes.cnpq.br/2310734509396125
Leprosy remains a severe public health problem in the State of Pará, Brazil. Over 80,000 cases were detected during the last 20 years in Pará, and currently, the annual case detection rate (50/100,000 inhabitants) is three-fold higher than the Brazilian average. The main objective of this study was to develop a method combining anti-PGL-I serology and spatial epidemiology as a tool for reducing the leprosy disease burden in Pará. An initial cross-sectional survey was conducted in eight municipalities of Pará at the residences of people reported to be affected by leprosy during the last five to six years. A group of researchers with experience treating leprosy patients, including dermatologists, nurses, physical therapists and lab technicians, performed a dermatoneurologic clinical examination and collected blood samples to test for anti-PGL-I IgM in 1,945 household contacts (HHC) of the 531 reported cases. Additionally, 1,592 school children (SC), aged 6-20 years, from 37 randomly selected elementary and secondary public schools underwent the same clinical and serologic evaluation. The residential addresses of reported leprosy cases and the residences of the examined SC were georeferenced to determine the spatial distribution pattern of leprosy. Two years later, based on the previous serological data, we returned to two cities to re-examine the same subjects. To evaluate the significance of geographic information in detecting new cases, we also selected two new public schools located in high-risk areas for leprosy. High-risk areas were determined by the spatial analysis of the distribution of cases in one municipality. During the initial survey, 156 (8%) HHC and 63 (4%) SC were diagnosed as new leprosy cases; 806 (41.4%) HHC and 777 (48.8%) SC tested positive for anti-PGL-I. Spatial analysis of one selected municipality demonstrated heterogeneity in the distribution of leprosy cases, with spatial clusters of high and low detection rates in specific regions of the city (p<0.01). Additionally, 94.7% of the initially examined SC lived within less than 200 meters of a leprosy case registered during the six years prior to this study. During follow-up, the incidence of leprosy was significantly higher among seropositive individuals (22.3%) when compared to seronegative individuals (9.4%) (OR = 2.7; 95%CI = 1.29 – 5.87; p = 0.01); leprosy rates were also significantly higher among dwellers of residences with at least one seropositive subject (17.4%), compared with dwellers of residences with no seropositive subjects (7.4%) (OR = 2.6; 95%CI = 1.18 – 5.91; p = 0.02). Selecting schools located in areas of the city at high-risk of leprosy increased the efficiency of detecting new cases among SC (8.2%) when compared to randomly selected schools (4%) (p = 0.04). The data indicate a high rate of undiagnosed leprosy cases and of subclinical infection with M. leprae in the State of Pará. Anti-PGL-I serology and spatial epidemiology are effective tools to increase the early detection of new cases, and these methods should be used by the municipalities of Pará to help reach leprosy control targets.
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Estudo in vitro da infectividade de espécies de Leishmania do subgênero Viannia em macrófagos peritoneais de camundongo BALB/c
(Universidade Federal do Pará, 2003) CAMPOS, Marliane Batista; GOMES, Claudia Maria de Castro; http://lattes.cnpq.br/8660496919187291; SILVEIRA, Fernando Tobias; http://lattes.cnpq.br/8106158306299969
Parasites ofthe genus Leishmania show both intra- and inter-specific variations of infectivity. There is little available information, however, regarding the infective behavior of New World species particularly those of the Amazon Region of Brazil, where there occur at six species of the subgenus Viannia causing human cutaneous leishmaniasis (ACL). The aim of the present study was to investigate the infectivity of 5 of these species for the peritoneal macrophages of BALB/c mice, and their role in the host-cell's production of nitric oxide (NO). Thirty strains of Leishmania were divided into 6 groups of the fol1owing species: I-L. (V.) braziliensis (from cases of localized skin lesions-LCL); II- L. (V.) braziliensis (from cases of mucocutaneous lesions- LeM); III- L. (V.) guyanensis; IV- L. (V.) shawi; V- L. (V.) naiffi and VI- L. (V.) lainsoni. They were cultivated in RPMI 1640 medium supplemented with 10% fetal bovine serum and 1% penicillin/gentamicin, until reaching the stationary phase of development. These promastigotes were used to infect the macrophage cell cultures, in the proportion of 4 flagellates/macrophage. The cultures were then incubated at 35°C with 5% CO2 and, after 24 hours following inoculation, the corvelips were stained by Giemsa's method to determine the infection index. The nitric oxide (nitrite) concentration was measured in the culture supernatant by Griess' s method to determine the infection index. The nitric oxide (nitrite) concentration was measured in the culture supernatant by Griess' s method. It was found that LCM strains of L. (V.) braziliensis showed the highest infection index (385), significance p<0.05,compared with L. (V.) braziliensis LCL strains (264). L. (V). naiffi and L. (V.) lansoni had the lowest infection indices of (215) and (272), respectively, but, were not significally different from index of L. (V.) guyanensis (300). Rrgarding the NO levels, the highest was that for L. (V.) naiffi (4,1µM), and the lowest for L. (V.) braziliensis-LCM strains (2, 15µM). The other readings were (3,14µM) for L. (V.) lainsoni, 2,96µM for L. (V.) shawi, 2,76µM for L. (V.) guyanensis and 3,1µM for L. (V.) braziliensis-LCL strains. It is conc1uded that L. (V.) natffi. In this way it may be noted the NO levels for infected macrophage were inversely proportional to the degree of infectivity of the species studied.
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Implicações do perfil citocínico TH22 nas formas polares da hanseníase
(Universidade Federal do Pará, 2016-08-29) SILVEIRA, Edvaldo Lima; QUARESMA, Juarez Antônio Simões; http://lattes.cnpq.br/3350166863853054
BACKGROUND: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Among the immunopathological aspects of leprosy is known that the defense is done by the cellular immune response, able to phagocyte and destroy the bacilli, mediated by cytokines and mediators from oxidation. The long-standing concept of a Th1-Th2 dichotomy in leprosy, with predominant Th1 in tuberculoid lesions and Th2 predominant in virchowian pacients, has recently been challenged. Furthermore, the Th22 response was identified as modulating Th1-Th2 in inflammatory skin diseases, but their roles in leprosy have not yet been elucidated. OBJECTIVE: Evaluate the tissue expression of cytokines involved in Th22 response in the polar forms of leprosy. METHOD: Patients with dermato-immunological diagnosis of leprosy were included and selected 31 patients, 16 with the tuberculoid (TT) form and 15 with lepromatous (LL). Immunohistochemistry for tissue immunostaining with antibodies against IL-13, IL-22, TNF-α and FGF-b was based on the method involving the formation of biotin-streptavidin peroxidase complex. Quantitation of the immunostaining was taken randomly from 05 fields viewed at 400x magnification microscope. In univariate analysis, frequencies, measures of central tendency and dispersion were obtained and for investigation of the hypothesis were applied the Mann-Whitney test and the Pearson correlation, considering a significance level of 5% (p ≤ 0.05). RESULTS: Regarding the immunostaining for IL-22 can be observed statistical difference among the groups and in the LL pole the average was 241.3 ± 44.63 cells/mm2, while in the TT form the mean was 90.39 ± 30.18 cells/mm2 (p <0.0001). Engaging the presence of IL-13, LL pole average occurrence was 85.76 ± 19.99 cells/mm2. In the TT pole the mean was 57.20 ± 14.73 cells/mm2 (p = 0.0002). Regarding the immunostaining for FGF-b, in the LL lesions, the mean incidence was 228.9 ± 45.13 cells/mm2, while in the TT form the mean was 47.80 ± 14.29 cells/mm2 (p <0,0001). For TNF-α, quantitative analysis was statistically significant in TT form where the average of the cells expressing the cytokine was 99.74 ± 30.14 cells/mm2 when compared to the LL form where the results were 62.08 ± 13.67 cells/ mm2 (p = 0.0008). CONCLUSION: The Th-22 response, mediated by IL-22, has fundamental importance in the pathogenesis of leprosy, relating directly to the clinical form of the disease and other cytokines.
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Imunoexpressão para CD1a em lesões cutâneas na doença de Jorge Lobo
(Universidade Federal do Pará, 2009) UNGER, Deborah Aben-Athar; BRITO, Arival Cardoso de; http://lattes.cnpq.br/0563291980190339
Jorge Lobo’s disease (DJL) is a chronic infection caused by the fungus Lacazia loboi, endemic in South America, especially in the Brazilian Amazon region. The most common clinical presentation is parakeloidal lesion located mainly in the lower limbs in men who practice agricultural activity. The fungus can be identified by both mycological and anatomopathological examination. The main objective of this study was to investigate the possible role of Langerhans' cells (LC) in the pathogenesis of the disease in tissue samples from skin lesions, using immunohistochemical technique. Thirty-three medical records were selected with their respective paraffin blocks of skin biopsies from patients with DJL (group 1) registered in the dermatology service at the Federal University of Para in the period from 1955 to 2005. The control group consisted of 10 paraffin blocks from normal skin (group 2) and 42 blocks from patients with paracoccidioidomycosis (PCM) (Group 3). In the analysis of patient medical records data were collected regarding age, sex, origin, profession, location and clinical type of the lesions. Langerhans cells were identified by immunohistochemistry using anti-CD1a antibody (Serotec). Patients were mostly men (84, 8%), farmers (72. 7%) aged between 46-65 years, with predominance of parakeloidal lesions (81. 8%) in the lower limbs (45. 5%). The number of positive cells was statistically analyzed. The LC were visualized along the epidermis in all biopsies from Jorge Lobo's disease. The morphology and the number of cells, did not differ from normal skin (p> 0. 05), and was increased when compared to the PCM lesions (p <0. 05). Langerhans cells were present in Jorge Lobo’s disease skin lesions similarly to the way they are in normal skin, not suffering any numerical or morphological alterations, unlike what occurred in PCM. These results suggest that in DJL fungi probably present some escape mechanism of the local immune system to evade the antigen presentation by Langerhans’ cells.
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Imunomarcação tecidual para o fator XIIIa+ em dendrócitos dérmicos de lesões cutâneas com doença de Jorge Lobo
(Universidade Federal do Pará, 2010) CARNEIRO, Clivia Maria Moraes de Oliveira; BRITO, Arival Cardoso de; http://lattes.cnpq.br/0563291980190339
Jorge Lobo's disease (DJL) is a deep fungal infection caused by Lacazia loboi which mainly affects males farmers, with the clinical form keloid and location of the lower limbs. The highest incidence is found in the Brazilian Amazonia. There are few reports on immune tissue lesions of patients. This study aims to evaluate a possible role in the pathogenesis of the disease by factor XIIIa dermal dendrocytes (FXIIIa DD) in skin lesions, using the technique of immunohistochemistry. 33 skin biopsies were analyzed from patients with DJL. The control group consisted of 10 normal skin biopsies originating from patients without dermatological diseases and 61 biopsies from patients with paracoccidioidomycosis (PCM). The results obtained by records analyzing patients' revealed that DJL affects mainly men (84.8%), farmers (72.7%) with 46-65 years old (51.5%), coming from the northeastern Pará state (51.5%) with clinical form keloid (81.8%) and predominant location of lesions in the lower limbs (45.5). The values of the count of FXIIIa DD in skin lesions of DJL were not affected by variations in gender, age, occupation, origin, clinical manifestation and localization of lesions. The amount of FXIIIa DD in patients with DJL was higher than that found in the control group of patients with healthy skin and in the group of patients with PCM to both the histopathology of loose granuloma (GF) and organized granuloma (GBO). Because of FXIIIa DD be considered precursors of Langerhans cells (LCs) can be suggested that their increase in DJL reflects a reservoir for the LCs and transform them time and again, don’t allowing their decrease. It has been demonstrated the increase in the levels of Th2 cytokines (TGF-β) in the DJL, and the increase of FXIIIa DD that is able to secrete the factor TNF-α, observed in this study, shows a dominance of Th1. Whereas there is a co expression of cytokine profiles of both, the study suggests the existence of mixed patterns. So, the results obtained in this work suggest that DJL is a spectral disease, with a tendency of resistance or susceptibility. What might explain the existence of focal cases even with long duration of disease and disseminated cases like early manifestation of DJL.
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Perfil de anticorpos anti-pgl-1 em indivíduos sadios de áreas endêmicas em hanseníase do estado do Pará, método de Elisa
(Universidade Federal do Pará, 2012) CUNHA, Maria Heliana Chaves Monteiro da; XAVIER, Marília Brasil; http://lattes.cnpq.br/0548879430701901
Acesso aberto (Open Access)
Prevalência das dermatoses infecciosas e correlação com o estado imunológico de pacientes com HIV atendidos em Centro de Referência em Belém – Pará, Brasil
(Universidade Federal do Pará, 2012) SANTOS, Josie Eiras Bisi dos; BRITO, Arival Cardoso de; http://lattes.cnpq.br/0563291980190339
Skin disorders affect about 90% of patients infected with human immunodeficiency virus (HIV) in some stage of their disease. The skin manifestations are broad and include viral, bacterial and fungal infections and noninfectious inflammatory diseases. Some of these skin conditions are considered markers of HIV infection and acquired immunodeficiency syndrome (AIDS), they reflect the current state of the patient's immune, due to the occurrence more prevalent in patients with low CD4 cell count serum. Even with the technological evolution of laboratory methods, dermatological signs are still a basic index of the presence and the clinical course of HIV infection. The present study aims to assess the prevalence of skin diseases of infectious etiology in patients with HIV assisted in the Specialized Reference Unit in Special Infectious and Parasitic Diseases in Belém-Pará, Brazil, from March 2011 to October 2011. We conducted a cross-sectional study by clinical and laboratory evaluation of 210 patients with HIV. Serology, cytologic, mycological and skin biopsy with histopathologic examination were performed according to need. The overall prevalence of skin diseases was 49% Dermatological diseases identified were superficial mycoses, onychomycosis, scabies, viral warts, bacterial infections, genital warts, candidiasis, herpes simplex, herpes zoster, leprosy, syphilis, Kaposi's sarcoma and disseminated histoplasmosis skin. The median CD4 cell count in patients with infectious dermatoses was 298 cells/mm3, significantly lower (p=0.0158 *) compared to the median of the patients without infectious dermatoses (384 cells/mm3). The median CD4/CD8 ratio in patients with infectious skin disease was 0.30, significantly lower (p=0.0138 *) compared to the median of the patients without infectious skin disease (0.41). The median viral load in patients with infectious dermatoses was 173 cópias/mm3 and those without infectious skin disease was 25 cópias/mm3, there is no real difference between the groups (p=0.0741). The occurrence of infectious skin diseases according to CD4 cell count showed that there is significant association between viral warts and herpes simplex virus with the CD4 cell count below 350 cells/mm3 (p= 0.0182* and p=0.0428*, respectively). The variation in the prevalence of infectious dermatoses as time of use of antiretroviral therapy (HAART) showed that only superficial mycoses showed a significant increase in the prevalence when compared to patients who did not perform HAART. In the literature, studies of prevalence vary widely between services due to the type and location of the selected sample. The results found in this study characterize patients from the State of Pará, Brazil, sometimes agreeing with the information contained in other prevalence studies in the literature.
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Prevenção de incapacidades físicas causadas pela hanseníase na 1ª região de saúde, Ji-Paraná, Rondônia
(Universidade Federal do Pará, 2002-09-30) LACERDA, Dailton Alencar Lucas de; PÓVOA, Marinete Marins; http://lattes.cnpq.br/2256328599939923
The Leprosy, endemic illness in Brazil, infectum-contagious, of chronic character that mainly affects the skin and the peripheral nerves, can cause irreversible incapacity damages to the to attack individuais. This work objectified to carry through study on the Prevention of Disabilities (PD) in leprosy, in the First Region of Health of Rondônia, in the Program for Rub-out and Control of the leprosy with headquarters in the city of Ji-Paraná, that involves the systematic attendance to the carriers of leprosy of 16 surrounding cities. It was used as collection instrument a data-collecting in the control maps and reports of 1a Region of Health of ali the individuais taken care of in the program in the period of 2000 and 2001, considering age band, sex, c1inical form and degree of incapacity. 331 individuais had been studied, in the age band of 10 the 84 years of both the sexo ln a later stage, the crossing of the data mentioned above with other studies made regarding the subject was analyzed. Based in the joined and argued results, he was evidenced the importance of the diagnosis precocious, of the immediate handling for the use of the multidrug theraphy and the prevention of disabilities as half to park or to retrograde happened injuries of the to attack of the peripheral nerves and skin, found in some forms of leprosy mainly, the Tuberculoid and Borderline, that are of bigger frequency in the studied area.
Acesso aberto (Open Access)
Reações hansênicas em pacientes coinfectados com HIV/Hanseníase: Clínica e ibmunopatologia
(Universidade Federal do Pará, 2013) PIRES, Carla Andréa Avelar; XAVIER, Marília Brasil; http://lattes.cnpq.br/0548879430701901
Brazil is one of the few countries remaining endemic for infection for human immunodeficiency virus (HIV) and leprosy, and these diseases have a major impact on social costs and on quality of life. Although it is recognized the importance of this co-infection, various aspects are not fully understood yet. This study aims to describe the clinical, histopathological and immunopathological aspects of reactional states of patients coinfected HIV/leprosy, comparing them to leprosy patients without HIV. Were followed two groups: (1) 40 patients coinfected with HIV/leprosy, (2) consists of 107 leprosy patients. Prevailed male subjects in both groups. In Group 1, the majority were paucibacillary (70%), as borderline tuberculoid (45%) and with less risk of having lepra reaction in relation to non-coinfected. All of coinfected who had lepra reaction (n = 15) were taking antiretroviral therapy (ART), and most in the aids status (n = 14), being Immune Reconstitution Syndrome (IRS) a clinical condition markedly important in many of these patients (n=7). In the group of non-coinfected, the pattern of infection was the majority multibacillary (80.4%), type borderline-borderline (40.2%), and higher relative risk of presenting lepra reactions (p = 0.0026). The reversal reaction was the most common in both groups. In the coinfected group were observed skin lesions with aspect according to expected for each clinical form, in general, erythematous infiltrated with similar evolution to non-coinfected. The dermal edema was the most common histopathological findings in both groups. In group 1, giant cells were found in all histopathological and in greater quantity (2 +) and large size. The morphology of erythema nodosum leprosum no presented significant differences between groups, as well as the expression of IL-1􀈕 and IL-6. This study confirms the hypothesis that clinical and immunopathological aspects of reactions in these patients is an inflammatory active status, not of anergy, similar to that found in non-coinfected.
Acesso aberto (Open Access)
Tinea Capitis: aspectos clínico-epidemiológicos e tratamento com terbinafina em crianças atendidas na localidade de Marituba-Pará-Brasil
(Universidade Federal do Pará, 2003) TUMA, Kiânia Nazaré de Souza; SALGADO, Claudio Guedes; http://lattes.cnpq.br/2310734509396125
Tinea capitis is an infectious disease that affects specially children and has as the main clinical features pruritus, scaling, breaking hairs and alopecia. Conventional treatment is based on the use of griseofulvine, a drug that needs to be used for a mean period of 45 days and have important adverse effects. In this prospective work, clinical and epidemiological aspects of tinea capitis in children living in Marituba, Pará, were analyzed. Furthermore, the efficacy of a 2-week regimen of terbinafine was analyzed. Among the main findings are: 1) the identification of the genera Trichophyton as the most prevalent in the cases of tinea capitis in this region, represented by the species Trichophyton tonsurans and Trichophyton rubrum; 2) the characterization of the clinical picture with pruritus, scalling, breaking hairs and alopecia, what is consistent with the literature; 3) the absence of a specific relation between the clinical picture and the etiologic agent found, what does not permit the diagnosis of the species only by the clinical picture; 4) the identification of antropophilic fungi as the etiologic agents, what indicates the possibility of interhumans transmission instead of animal-human transmission, besides the high levels of contact found between children and animais; and 5) the efficacy and safety of terbinafine, that is well tolerated and had a high healing rate of 94.11%, specially considering the fact that the predominant genera in the region of Marituba, Pará, is the Trichophyton. Therefore, the use of terbinafine in the patients diagnosed with tinea capitis in this region is an alternative to the use of griseofulvine.