ABSTRACT Leptospirosis is an acute infection caused by pathogenic species of the genus Leptospira, which affects humans and animals in all world. In severe forms of the disease, kidneys, liver and lungs are the main affected organs, resulting in acute kidney injury, jaundice and pulmonary hemorrhage. Previous post-mortem studies have shown that lesions are not limited to these organs. Cardiac and striated muscle injuries have already been reported, but the pathophysiology of cardiac and skeletal lesions in leptospirosis is not fully understood. It has been suggested that the tissue damage observed in leptospirosis could be directly mediated by leptospires or by their toxic cellular components. LipL32 and Lp25 are leptospira membrane proteins with unknown functions, that are present only in pathogenic strains of Leptospira spp. Both proteins induce skeletal muscle lesions similar to those observed when normal guinea pigs are inoculated with leptospires. Through immunohistochemistry, this study showed the presence of LipL32 and Lp25 proteins on muscle cell membranes and in the underlying cytoplasm of skeletal muscles, as well as focal lesions in cardiac tissues of fatal cases of leptospirosis. Altogether, these results reinforce that both proteins can be important factors in the pathogenesis of leptospirosis.

OBJECTIVE: Celiac disease is a permanent enteropathy caused by the ingestion of gluten, which leads to an immunemediated inflammation of the small intestine mucosa. The prevalence of celiac disease varies among different nations and ethnic backgrounds, and its diversity is determined by genetic and environmental factors. São Paulo city is one of the largest cities in the world, with a vast population and an important history of internal migratory flow from other Brazilian regions, as well as immigration from other, primarily European, countries, resulting in significant miscegenation. The aim of the present study was to estimate the prevalence of adults with undiagnosed celiac disease among blood donors of São Paulo by collecting information on the ancestry of the population studied. METHODS: The prevalence of celiac disease was assessed by screening for positive IgA transglutaminase and IgA endomysium antibodies in 4,000 donors (volunteers) in the Fundação Pró-Sangue Blood Center of São Paulo, São Paulo, Brazil. The antibody-positive subjects were asked to undergo a small bowel biopsy. RESULTS: Of the 4,000 subjects, twenty-four had positive tests, although both antibody tests were not always concordant. For example, ten subjects were positive for IgA tissue transglutaminase only. In twenty-one positive patients, duodenal biopsies were performed, and the diagnosis of celiac disease was confirmed in fourteen patients (Marsh criteria modified by Oberhuber). In this group, 67% claimed to have European ancestry, mainly from Italy, Portugal and Spain. CONCLUSION: The prevalence of celiac disease is at least 1:286 among supposedly healthy blood bank volunteers in São Paulo, Brazil.

A Feohifomicose cerebral ("cromoblastomicose") é uma lesão rara. Apresentamos o primeiro caso desta entidade com cultura do abscesso cerebral, devido a Fonsecaea pedrosoi. O paciente, um homem de 28 anos de idade, imunocompetente, apresentou manifestações oculares e síndrome de hipertensão intracraniana. Imagens de ressonância magnética (MRI) cerebral mostraram massa tumoral envolvendo a área temporo-occipital direita e outra lesão menor, possivelmente cicatricial, no lobo occipital esquerdo. Biopsia cerebral mostrou cromoblastomicose cerebral. A lesão principal foi enucleada cirurgicamente e Fonsecaea pedrosoi foi cultivado da massa necrótica e supurada. O paciente tinha tido um ferimento por faca 16 anos antes de ser visto no nosso hospital e, mais recentemente, uma lesão pulmonar granulomatosa no pulmão direito onde foi identificada uma forma isolada, não pigmentada, de fungo. A possibilidade de que o fungo tenha penetrado no organismo do paciente através da lesão de pele foi considerada, mas não se pode excluir uma eventual lesão primária pulmonar. O paciente teve alta hospitalar e foi seguido durante oito meses sem recorrência da doença. Meses depois, entretanto, desenvolveu complicações relacionadas à neurocirurgia, vindo a óbito. Uma autopsia completa foi feita, não demonstrando doença fúngica remanescente.

Cerebral phaeohyphomycosis ("chromoblastomycosis") is a rare intracranial lesion. We report the first human culture-proven case of brain abscesses due to Fonsecaea pedrosoi in Brazil. The patient, a 28 year-old immunocompetent white male, had ocular manifestations and a hypertensive intracranial syndrome. Magnetic resonance imaging (MRI) of the brain revealed a main tumoral mass involving the right temporo-occipital area and another smaller apparently healed lesion at the left occipital lobe. A cerebral biopsy was performed and the pathological report was cerebral chromoblastomycosis. The main lesion was enucleated surgically and culture of the necrotic and suppurative mass grew a fungus identified as Fonsecaea pedrosoi. The patient had received a knife wound sixteen years prior to his hospitalization and, more recently, manifested a pulmonary granulomatous lesion in the right lung with a single non-pigmented form of a fungus present. It was speculated that the fungus might have gained entrance to the host through the skin lesion, although a primary respiratory lesion was not excluded. The patient was discharged from the hospital still with ocular manifestations and on antimycotic therapy and was followed for eight months without disease recurrence. Few months after he had complications of the previous neuro-surgery and died. A complete autopsy was performed and no residual fungal disease was found.

Dois antissoros produzidos em carneiros, um dos quais contra a fração polissacarídica (Po) e outro contra componentes protéicos (Pt) de vermes adultos de Schistosoma mansoni, foram avaliados quanto ao seu desempenho na detecção de antígenos parasitários circulantes em pacientes com diferentes formas clínicas da esquistossomose mansônica crônica, através de um ensaio imunoenzimático, (ELISA). O primeiro antissoro revelava antígenos parasitários no granuloma hepático e o segundo, nos glomérulos renais de pacientes com esquistossomose mansônica, bem como em camundongos experimentalmente infectados pelo S. mansoni. Em geral, os níveis bem como a positividade, de antígenos circulantes e anticorpos IgG específicos foram significativamente mais elevados nos pacientes com formas hepatointestinais (HI) e hepatosplênicas (HS) do que em pacientes com formas amenas intestinais (I). Foi observada uma associação entre os antígenos Po e as características clínicas da doença, em vista do nível destes antígenos se encontrar abaixo (137 ng/ml), assim como sua positividade (7.9%) em pacientes com formas I, intermediários (593 ng/ml e 33.3%) naqueles com formas HI e altos (1.563 ng/ml e 50.0%) nas formas HS. Os níveis de antígenos Pt não diferiram estatisticamente nas três formas clínicas estudadas, mas a positividade foi significantemente maior nas formas HS em comparação com as formas I. Os antissoros estudados revelaram perfis distintos de antígenos circulantes e o valor prognóstico dos antígenos Po e Pt foi aventado.

Two sheep antisera, one of which raised against polysaccharide (Po) and other against protein (Pt) components of Schistosoma mansoni adult worms, were assessed by ELISA for their ability to detect circulating parasite antigens in patients with different clinical forms of chronic schistosomiasis mansoni. The former antiserum detected parasite antigens in liver granulomata and the latter in renal glomeruli from schistosomiasis patients and mice experimentally infected with S. mansoni. In general, the levels and/or positivity rate of circulating antigens and specific IgG antibodies were significantly higher in patients with hepatointestinal (HI) and hepatosplenic (HS) forms than in mild intestinal (I) forms. An association between Po antigens and clinical features of the disease was observed, as the level of these antigens was low (137 ng/ml) as well as the positivity rate (7.9%) in patients with I forms; values that were intermediate (593 ng/ml and 33.3%) in those with HI forms, and high (1.563 ng/ml and 50.0%) in more severe HS forms. The Pt antigens were detected in the studied clinical forms not differing statistically but, the positivity rate was significantly higher in HS forms comparatively to I forms. The antisera studied revealed distinct circulating antigen profiles, and the prognostic value of Po and Pt antigens was suggested.