In vivo anergized CD4+ T cells express perturbed AP-1 and NF-kappa B transcription factors.

Anergy is a major mechanism to ensure antigen-specific tolerance in T lymphocytes in the adult. In vivo, anergy has mainly been studied at the cellular level. In this study, we used the T-cell-activating superantigen staphylococcal enterotoxin A (SEA) to investigate molecular mechanisms of T-lymphocyte anergy in vivo. Injection of SEA to adult mice activates CD4+ T cells expressing certain T-cell receptor (TCR) variable region beta-chain families and induces strong and rapid production of interleukin 2 (IL-2). In contrast, repeated injections of SEA cause CD4+ T-cell deletion and anergy in the remaining CD4+ T cells, characterized by reduced expression of IL-2 at mRNA and protein levels. We analyzed expression of AP-1, NF-kappa B, NF-AT, and octamer binding transcription factors, which are known to be involved in the regulation of IL-2 gene promoter activity. Large amounts of AP-1 and NF-kappa B and significant quantities of NF-AT were induced in SEA-activated CD4+ spleen T cells, whereas Oct-1 and Oct-2 DNA binding activity was similar in both resting and activated T cells. In contrast, anergic CD4+ T cells contained severely reduced levels of AP-1 and Fos/Jun-containing NF-AT complexes but expressed significant amounts of NF-kappa B and Oct binding proteins after SEA stimulation. Resolution of the NF-kappa B complex demonstrated predominant expression of p50-p65 heterodimers in activated CD4+ T cells, while anergic cells mainly expressed the transcriptionally inactive p50 homodimer. These alterations of transcription factors are likely to be responsible for repression of IL-2 in anergic T cells.

Antibody-targeted superantigens are potent inducers of tumor-infiltrating T lymphocytes in vivo.

Recruitment of antigen-specific tumor-infiltrating lymphocytes (TILs) is a major goal for immunotherapy of malignant tumours. We now describe that T-cell-activating superantigens targeted to a tumor by monoclonal antibodies induced large numbers of pseudospecific TILs and eradication of micrometastases. As a model for tumor micrometastases, syngeneic B16 melanoma cells transfected with the human colon carcinoma antigen C215 were injected intravenously into C57BL/6 mice and therapy with an anti-C215 Fab fragment-staphylococcal enterotoxin A (C215Fab-SEA) fusion protein reacting with the C215 antigen was initiated when visible lung metastases were established. More than 90% reduction of the number of lung metastases was observed when mice carrying 5-day-old established lung metastases were treated with C215Fab-SEA. The antitumor effect of C215Fab-SEA was shown to be T-cell-dependent since no therapeutic effect was seen in T-cell-deficient nude mice. Depletion of T-cell subsets by injection of monoclonal antibody demonstrated that CD8+ cells were the most prominent effector cells although some contribution from CD4+ cells was also noted. C215Fab-SEA treatment induced massive tumor infiltration of CD4+ and CD8+ T cells, while only scattered T cells were observed in untreated tumors. SEA treatment alone induced a slight general inflammatory response in the lung parenchyme, but no specific accumulation of T cells was seen in the tumor. TILs induced by C215Fab-SEA were mainly CD8+ but a substantial number of CD4+ cells were also present. Immunohistochemical analysis showed strong production of the tumoricidal cytokines tumor necrosis factor alpha and interferon gamma in the tumor. Thus, the C215Fab-SEA fusion protein targets effector T lymphocytes to established tumors in vivo and provokes a strong local antitumor immune response.

Accelerated induction of experimental allergic encephalomyelitis in PL/J mice by a non-V beta 8-specific superantigen.

Superantigens such as the staphylococcal enterotoxins can play an important role in exacerbation of autoimmune disorders such as experimental allergic encephalomyelitis (EAE) in mice. In fact, superantigens can reactivate EAE in PL/J mice that have been sensitized to rat myelin basic protein (MBP). The T-cell subset predominantly responsible for disease in PL/J mice bears the V beta 8+ T-cell antigen receptor (TCR). The question arises as to whether T cells bearing other V beta specificities are involved in induction or reactivation of EAE with superantigen. Thus, we have investigated the ability of a non-V beta 8-specific superantigen, staphylococcal enterotoxin A (SEA) (V beta specificities 1, 3, 10, 11, and 17), to induce EAE in PL/J mice that have been previously protected from disease by anergy and deletion of V beta 8+ T cells. PL/J mice were first pretreated with the V beta 8-specific superantigen staphylococcal enterotoxin B (SEB) and then immunized with MBP. These mice exhibited V beta 8-specific anergy and depletion and did not develop EAE, even when further treated with SEB. However, administration of SEA to these same mice induced an initial episode of EAE which was characterized by severe hindleg paralysis and accelerated onset of disease. In contrast to SEB pretreatment, PL/J mice pretreated with SEA did develop EAE when immunized with MBP, and after resolution of clinical signs of disease these mice were susceptible to relapse of EAE induced by SEB but not by SEA. Thus, superantigens can activate encephalitogenic MBP-specific non-V beta 8+ T cells to cause EAE in PL/J mice. These data suggest that superantigens can play a central role in autoimmune disorders and that they introduce a profound complexity to autoimmune diseases such as EAE, akin to the complexity seen in multiple sclerosis.

Differential modulation of Th1- and Th2-related cytokine mRNA expression by a synthetic peptide homologous to a conserved domain within retroviral envelope protein.

The influence of a synthetic retroviral peptide, CKS-17, on T helper type 1 (Th1)- or Th2-related cytokines was investigated in human blood mononuclear cells. Cells were stimulated with staphylococcal enterotoxin A, anti-CD3 plus anti-CD28 monoclonal antibodies, or lipopolysaccharide to induce cytokine mRNA. mRNA was detected by a reverse transcription-polymerase chain reaction or Northern blot analysis. CKS-17 down-regulated stimulant-induced mRNA accumulation for interferon gamma (IFN-gamma), interleukin (IL)-2, and p40 heavy and p35 light chains of IL-12, a cytokine that mediates development of Th1 response. CKS-17 up-regulated stimulant-induced mRNA accumulation of IL-10 and did not suppress Th2-related cytokine (IL-4, IL-5, IL-6, or IL-13) mRNA expression. A reverse sequence of CKS-17 peptide, used as a control, showed no such action. Anti-human IL-10 monoclonal antibody blocked ability of CKS-17 to inhibit mRNA accumulation for IFN-gamma but not the CKS-17 suppressive activity of IL-12 p40 heavy chain mRNA. Thus, CKS-17-mediated suppression of IFN-gamma mRNA expression is dependent upon augmentation of IL-10 production by CKS-17. This conserved component of several retroviral envelope proteins, CKS-17, may act as an immunomodulatory epitope responsible for cytokine dysregulation that leads to suppression of cellular immunity.

Estudo descritivo de série histórica da coqueluche no Brasil no período de 2006 a 2013

A coqueluche vem reemergindo enquanto importante problema de saúde pública em vários países do mundo, apesar das altas coberturas vacinais na infância. O objetivo geral deste estudo foi avaliar a morbimortalidade da coqueluche no Brasil e os objetivos específicos foram: estimar as taxas de mortalidade, incidência e letalidade anuais, geral e por faixa etária, por unidade da federação e regiões do país; caracterizar a sazonalidade da doença; estimar as taxas de hospitalização anuais por faixa etária e verificar as características clínicas, histórico de contato e vacinação prévia dos casos notificados da doença. Métodos: estudo descritivo, baseado nos casos de coqueluche notificados ao Sistema de Informação de Agravos de Notificação (SINAN), de 2006 a 2013. Os resultados mostraram aumento nas taxas de incidência de coqueluche no Brasil, a partir de 2011. Em 2013, foram confirmados 6.523 casos de coqueluche no país, três vezes o número de casos confirmados em 2011, com incidência geral de 3,24 /100.000 habitantes e incidência em menores de um ano de 125,82/100.000 habitantes, as maiores durante o período estudado. As crianças menores de um ano foram as mais acometidas pela doença em todas as macrorregiões. Em 2013, todas as regiões, exceto a região sul, apresentaram suas maiores taxas de incidência geral, com destaque para as regiões sudeste e centro-oeste com 4,0 e 3,1 por 100.000 habitantes, respectivamente. As maiores taxas de letalidade foram observadas na faixa etária menor de dois meses de idade, variando de 4,0% (2008) a 9,5% (2010). As taxas de letalidade foram maiores em crianças menores de seis meses em todas as regiões, sendo as regiões nordeste e sudeste as que apresentaram maiores taxas ao longo dos anos, exceto em 2013, quando o centro-oeste superou o nordeste. Houve predomínio dos casos nos meses mais quentes, entre novembro e março. A maioria das hospitalizações ocorreu na faixa etária de menores de um ano, principalmente em menores de quatro meses, cuja frequência de hospitalização ficou em torno de 75%. A tosse e o paroxismo foram os sintomas mais frequentes, independente da faixa etária, e a cianose foi importante sintoma nos menores de dois meses, com uma frequência de 80% nos casos confirmados desta faixa etária. A complicação mais comum foi pneumonia (13,93%), principalmente na faixa etária menor de dois meses, com frequência de 27,5%. O critério mais utilizado para diagnóstico de coqueluche foi o clínico, seguido pelo laboratorial que aumentou a partir de 2011, ano em que foi responsável por 49,9% dos diagnósticos. A maioria dos casos confirmados (51%) não relatou contato prévio com casos suspeitos ou confirmados de coqueluche, no entanto quando presente, a maioria dos contatos ocorreu no domicílio (70,6%). Os resultados mostraram aumento dos casos de coqueluche no Brasil, a partir de 2011, com as maiores taxas de incidência, hospitalizações, complicações e letalidade na faixa etária de menores de um ano

Hemoculturas positivas num serviço de pediatria: 2003-2012

Introdução: Em situações clínicas selecionadas é aconselhada investigação complementar da criança com febre, nomeadamente realização de hemocultura. Objetivos: Analisar as hemoculturas positivas por bactérias patogénicas num serviço de pediatria, nomeadamente agentes mais frequentes, sua evolução, respetivos antibiogramas e correlação com dados clínicos. Material e Métodos: Estudo retrospetivo de dados micro- biológicos das bactérias patogénicas isoladas em hemoculturas e dados clínicos de crianças com idade entre um mês e 17 anos, admitidas num serviço de pediatria, entre 2003 e 2012. Resultados: No período estudado, a percentagem anual de hemoculturas positivas por bactérias potencialmente patogénicas variou entre 0,8% e 2,9%. No total isolaram-se 158 bactérias patogénicas, sendo mais frequentes: Staphylococcus aureus (29,1%), Streptococcus pneumoniae (27,8%), Escherichia coli (10,1%), Enterococcus faecalis (8,2%), Neisseria meningitidis (5,7%) e Streptococcus pyogenes (5,7%). Nenhuma Neisseria meningitidis foi resistente à resistente à ampicilina, 9% dos Streptococcus pneumoniae tiveram resistência intermédia à penicilina, 8,7% dos Staphylococcus aureus tiveram resistência à meticilina e 6,3% das Escherichia coli tinham resistência à amoxicilina/ácido clavulânico. Sessenta e sete porcento das hemoculturas positivas por bactérias patogénicas correspondiam a crianças com idade inferior a 36 meses. Os diagnósticos mais relevantes foram: bacteriémia oculta, pneumonia, sépsis, meningite e pielonefrite. Ocorreu um óbito devido a choque sético (Streptococcus pneumoniae). Conclusão: Nos 10 anos analisados, as bactérias mais frequentes foram: Staphylococcus aureus, Streptococcus pneumoniae e Escherichia coli. Verificou-se diminuição da incidência da Neisseria meningitidis após 2005 e do Streptococcus pneumoniae após 2007. As suscetibilidades das diferentes bactérias patogénicas aos antimicrobianos mantiveram-se estáveis. Enfatiza-se a importância epidemiológica e clínica da monitorização de dados microbiológicos.

Toxocara canis, o passageiro clandestino de um voo…

A toxocarose humana é uma helmintozoonose, frequente em idade pediátrica, transmitida por ingestão de ovos presentes no solo. Crianças residentes em zonas com condições de saneamento precárias, que coabitem com animais de estimação não desparasitados e que apresentem geofagia, incorrem em eleva- do risco de desenvolvimento de toxocarose. Apresenta-se o caso de um rapaz de 5 anos, residente até há um mês em Cabo Verde, que recorreu ao serviço de urgência por febre, tosse e síndrome de dificuldade respiratória. Analiticamente destacava-se leucocitose e eosinofilia. A tomografia computorizada torácica revelava hiperdensidade irregular na base pulmonar direita. Perante serologia do Toxocara canis sugestiva de infeção aguda admitiu-se o diagnóstico de larva migrans visceral, atuando-se em conformidade terapêutica. A síndrome de larva migrans visceral atinge diversos órgãos, sendo o envolvimento pulmonar grave raro. Apesar de maioritariamente assintomática e autolimitada, quando sintomática a apresentação inespecífica e as limitações da interpretação serológica dificultam o diagnóstico e a abordagem terapêutica adequada.

Decúbito ventral em doentes com ARDS

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Regulatory T Cells Accumulate in the Lung Allergic Inflammation and Efficiently Suppress T-Cell Proliferation but Not Th2 Cytokine Production

Foxp3(+)CD25(+)CD4(+) regulatory T cells are vital for peripheral tolerance and control of tissue inflammation. In this study, we characterized the phenotype and monitored the migration and activity of regulatory T cells present in the airways of allergic or tolerant mice after allergen challenge. To induce lung allergic inflammation, mice were sensitized twice with ovalbumin/aluminum hydroxide gel and challenged twice with intranasal ovalbumin. Tolerance was induced by oral administration of ovalbumin for 5 consecutive days prior to OVA sensitization and challenge. We detected regulatory T cells (Foxp3(+)CD25(+)CD4(+) T cells) in the airways of allergic and tolerant mice; however, the number of regulatory T cells was more than 40-fold higher in allergic mice than in tolerant mice. Lung regulatory T cells expressed an effector/memory phenotype (CCR4(high)CD62L(low)CD44(high)CD54(high)CD69(+)) that distinguished them from naive regulatory T cells (CCR4(int)CD62L(high)CD44(int)CD54(int)CD69(-)). These regulatory T cells efficiently suppressed pulmonary T-cell proliferation but not Th2 cytokine production.

Cuidados de saúde oral em doentes hospitalizados

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

A new predilection site of Mycoplasma bovis: Postsurgical seromas in beef cattle

Mycoplasma bovis is a highly contagious bacterium, which predominantly causes chronic pneumonia, otitis and arthritis in calves and mastitis in adult cattle. In humans, Mycoplasma species have been associated with post-surgical infections. The present study aimed to identify the bacteria associated with three outbreaks of infected seromas after caesarian section in Belgian Blue beef cattle. A total of 10 cases occurred in three herds which were in close proximity of each other and shared the same veterinary practice. M. bovis could be cultured from seroma fluid in five of the six referred animals, mostly in pure culture and was isolated from multiple chronic sites of infection (arthritis and mastitis) as well. DNA fingerprinting of the isolates targeting two insertion sequence elements suggested spread of M. bovis from chronic sites of infection (udder and joints) to the postsurgical seromas. Identical genetic profiles were demonstrated in two animals from two separate farms, suggesting spread between farms. Mortality rate in the referred animals positive for M. bovis in a seroma was 80% (4/5), despite intensive treatment. A massive increase in antimicrobial use was observed in every affected farm. These observations demonstrate involvement of mycoplasmas in outbreaks of postsurgical seromas in cattle.

Clinical Streptococcus pneumoniae isolates induce differing CXCL8 responses from human nasopharyngeal epithelial cells which are reduced by liposomes.

BACKGROUND: Streptococcus pneumoniae causes several human diseases, including pneumonia and meningitis, in which pathology is associated with an excessive inflammatory response. A major inducer of this response is the cholesterol dependent pneumococcal toxin, pneumolysin. Here, we measured the amount of inflammatory cytokine CXCL8 (interleukin (IL)-8) by ELISA released by human nasopharyngeal epithelial (Detroit 562) cells as inflammatory response to a 24 h exposure to different pneumococcal strains. RESULTS: We found pneumolysin to be the major factor influencing the CXCL8 response. Cholesterol and sphingomyelin-containing liposomes designed to sequester pneumolysin were highly effective at reducing CXCL8 levels from epithelial cells exposed to different clinical pneumococcal isolates. These liposomes also reduced CXCL8 response from epithelial cells exposed to pneumolysin knock-out mutants of S. pneumoniae indicating that they also reduce the CXCL8-inducing effect of an unidentified pneumococcal virulence factor, in addition to pneumolysin. CONCLUSION: The results indicate the potential of liposomes in attenuating excessive inflammation as a future adjunctive treatment of pneumococcal diseases.

De pulmonum inflammatione.

Mode of access: Internet.

Über einen Fall von embolischer, eitriger Nephritis und Pneumonie bei einem Saugfohlen, hervorgerufen durch das Bacterium lactis aerogenes.

Inaug.-diss.--Hannover, 1912.

Untersuchungen über das Verhalten der Blutkörperchen bei Gesunden und mit croupöser Pneumonie behafteten Pferden...

"Sonderabdruck aus dem Archiv für wissensch. u. prakt. Tierheilkunde. Bd. 32, 1906."