[Non-bacterial meningitis].
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Biomedical subjects
Publications and source records attributed to L H Moncada.
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Serum electrophoresis patterns and various measures of specific and non-specific immune competence were determined in 16 patients with paracoccidioidomycosis, at time of diagnosis and 6 months after therapy. The results were compared with those furnished by the study of 16 control subjects, matched by age and sex. Once treated, the patients approached normality in some parameters. Untreated patients had significantly diminished albumin levels with increased alpha 1, alpha 2 and gamma fractions. Immune gamma globulin G (IgG) was elevated and remained so during therapy. Both before and after treatment patients had diminished total numbers and decreased percentages of E rosettes; they also had depressed lymphocyte transformation with phytohemagglutinin (PHA) and paracoccidioidin (P). Also, untreated patients exhibited the lowest skin test responses to PHA, purified protein derivative (PPD), P and candidin (C); significant differences, however, were limited to the former 2 antigens. All untreated patients had detectable antibody titers against P. brasiliensis; these titers had a tendency to drop during treatment. No direct correlation was found between elevated serum fractions, presence of antibodies and depressed cellular immunity.
In order to characterize the precipitin bands detected in the immunodiffusion test for paracoccidioidomycosis, a study was undertaken in 54 patients with the disease. On the basis of the pattern of known control sera, the three commonly observed lines of precipitate were designated as 1, 2, and 3 according to their location in the immunodiffusion plate. At time of diagnosis, 28 of the patients exhibited all three bands, 16 gave two bands, and 10 showed only one precipitin line. Over 50 of the sera with three bands had high complement fixation titers (above 1:512), whereas those with one band exhibited lower titers. A similar picture was obtained with the quantitative agar-gel techniques, where titers of 1:64 and above were more commonly observed in sera with three precipitin lines. Follow-up studies carried out in 18 patients revealed that band 3 disappeared first, followed by band 2, and, finally, by band 1. At the end of 2 to 3 years, 85.7% of the patients had lost band 3, 75% band 2, and only 27.7% band 1. Cross-reactions with histoplasmin were found in eight patients who gave the M precipitin line with this antigen. It was found that the latter band and our paracoccidioidin band 3 fused, producing lines of identity. Bands 1 and 2 were specific. The implications of these findings are discussed.
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The value of various serological tests in the diagnosis of paracoccidioidomycosis was studied. Quantitative agar-gel immunodiffusion and indirect immunofluorescent tests were performed, and the results were compared with those of complement fixation and qualitative agar-gel procedures. The quantitative immunodiffusion procedure was found to serve as the simplest and safest quantitative test that could be performed for evaluation purposes, whereas the indirect fluorescent-antibody test gave nonspecific reactions and, as such, proved unsuitable.
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