Nutritional status and immunocompetence in eating disorders. A comparative study

Nutritional status and immunocompetence were evaluated in 26 patients suffering from anorexia nervosa (AN) (n = 16) or bulimia nervosa (BN) (n = 10) in comparison with a control group (n = 22). Body mass index (BMI) was lower in all patients than in controls, AN patients having the lowest values. Slight leukopenia together with relative lymphocytosis was shown in both AN and BN. The CD4/CD8 ratio was low in all patients, but more so for BN patients, although cell-mediated immune function was impaired to the same extent for both eating disorders. The complement system appeared to be damaged in all the patients in comparison with controls. These results may mean that the nutritional status of both syndromes was different. Although anthropometric measurements in the BN group may suggest a more acceptable nutritional status, immunological parameters were shown to be depleted at the same level as the AN group and even more impaired when judged by the lower CD4/CD8 values.

[Splenic abscess, a diagnostic and therapeutic problem]

Splenic abscess remains a rare entity, reserved for patients with predisposing factors or immunosuppressive conditions. In our 13 patients in which a splenic abscess was diagnosed pre- or intra-operatively, an average of 14 days past before the diagnosis was made. Main symptoms were fever, upper left abdominal pain, auscultatory left basal anomalies and splenomegaly. Culture from the spleen material included E. coli, Staphylococcus, Proteus, Salmonella and Streptococcus v. Although splenectomy has been considered the standard procedure for this pathology, we treated our last three patients by means of Computed Tomography Percutaneous Drainage (C.T.G.P.D.). There was no need for splenectomy after this procedure and there were no complications associated with the C. T. G. P. D.

[Psoas abscess. The diagnostic and therapeutic considerations in 5 patients]

Five cases of psoas abscesses are discussed, four pyogenes and one tuberculous, the current etiology of this process, together with its pathogenesis and clinical manifestations are discussed. In all of them the guided punction through Computerized Axial Tomography (CAT) has been the way to diagnose and treat the process. Utility of this technique considering both aspects is discussed because it allows to determine the etiology and avoids the surgical drainage; even tough this therapy should be individualized in each case, probably is in primary staphylococci abscesses where this therapeutic option is best indicated.

In vitro antimicrobial production of beta-lactamases, aminoglycoside-modifying enzymes, and chloramphenicol acetyltransferase by and susceptibility of clinical isolates of Acinetobacter baumannii

Antimicrobial susceptibility testing was performed on 54 epidemiologically unrelated clinical isolates of Acinetobacter baumannii by using a standard agar dilution technique. On the basis of the in vitro activities, imipenem and doxycycline were the most active agents, whereas amikacin, isepamicin, and the new fluorquinolones ciprofloxacin and ofloxacin presented moderate activity. Cephalosporinase activity was found in 98% of the strains, whereas lactamases of TEM type 1 and one with a pI of 7 to 7.5 were present in 16 and 11% of the strains, respectively. Resistance to aminoglycosides was explained by the production of the three classes of aminoglycoside-modifying enzymes, with predominance of aminoglycoside-3'-phosphotransferase VI in 28% of the strains.

Evaluation of immunocompetence and nutritional status in patients with bulimia nervosa

Nutritional status of patients suffering from bulimia nervosa was evaluated by anthropometric, hematological, and immunological parameters in comparison with a healthy control group. Anthropometry showed no signs of malnutrition in either group. Bulimic patients showed a significant decrease in most of the routine clinical indexes related to red blood cells. Lymphocyte subsets CD2 and CD4 in bulimic patients were lower than in controls, whereas CD8 remained unmodified, leading to a lower CD4:CD8 in bulimic patients. The decreases in CD2 and CD4 numbers might be linked to an impaired cell-mediated immune function, as evaluated by the response to skin tests. The B lymphocyte subset was increased in the bulimic group. Innate immunity was impaired in the bulimic patients. Although anthropometric and most of the routine clinical parameters were within the normal range, these results might suggest that the depleted immune function accounts for a subclinical malnutrition status in bulimic patients.

Zinc status in anorexia nervosa

Some aspects of zinc nutritive status in patients suffering from anorexia nervosa were evaluated. Basic anthropometric measurements, Zn levels in serum, urine and hair as well as serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH; Zn-dependent enzymes) and delayed dermal hypersensitivity were tested both in patients and in control subjects. The patients showed higher Zn levels in serum (123%), hair (85%) and urine (215%) than controls, whereas ALP and LDH values were 38 and 21%, respectively, lower than those from the control group. Half of the patients showed hypoergy, and less than 50% of them were able to show a normal immune response. These results suggest that Zn-dependent functions may be impaired in anorexia nervosa as a consequence of Zn unavailability.

Serum lipids and apolipoprotein B values, blood pressure and pulse rate in anorexia nervosa

Some risk factors associated with coronary heart disease (CHD) were evaluated in patients with different types of anorexia nervosa (AN). Anthropometric parameters, serum cholesterol, triglycerides and apoprotein (apo) B values, blood pressure and pulse rate were tested in 29 young female patients and 16 controls. Cholesterol, triglycerides and apo B were higher at the acute period of the illness (AN1), whereas at the chronic period the values of these parameters tended to normalize. Triglycerides were higher in patients who binge ate (bulimarexia). Systolic blood pressure decreased in all types of AN, while diastolic blood pressure decreased only in AN1; pulse rate was not altered. According to cholesterol and apo B values, AN patients may be at risk of CHD if they remain at low body weight.

Nutritional status assessment of HIV-positive drug addicts

Since human immunodeficiency virus (HIV) is known to lead to modifications of immune function and interrelationships among malnutrition, anergy and drug addiction have been shown, the aim of this work was to assess the nutritional status of 36 male heroin addicts under a period of detoxication (3 months). They were divided into two groups: (1) HIV negative (n = 20) and (2) HIV positive (n = 16); heights, weights and serum albumin concentration were measured and immune function was tested, using delayed hypersensitivity skin tests containing 7 antigens. No significant differences in anthropometric measurements were found between both groups, but anthropometric improvement was shown in every patient after the detoxication period. Serum albumin, often used as a classical index of malnutrition, remained within the normal values in both groups. The whole response to skin tests was depressed in both groups and no significant differences were shown between them. Therefore, these results might suggest that in spite of the apparent anthropometric recovery and the normal values of albumin, a subclinical malnutrition was indicated by the depressed immune function, which was more noticeable in the HIV-positive group.

[Influence of dietary protein levels on the electrophoretic pattern and plasma IgG and IgM levels in pregnant rats and their offspring]

In view of the influence that nutritional and physiological status exert on the immunological capacity of the subject, a study was carried out for the purpose of studying the changes induced by three protein levels in the diet: (4%, 10% (control), and 20%) on total plasma proteins (TPP) and their fractions, as well as Ig G and Ig M levels in non-pregnant (NP) and pregnant (P) rats and their offspring. Effect of the diet on adult rats--In non-pregnant rats submitted to the high protein diet, Ig G levels increased while TPP decreased in P rats fed on 4% and 20% protein diets. The higher the protein level in the diet, the higher were the TPP values. Effect of pregnancy--Ig G and Ig M levels suffered an increase in rats fed the 4% and 10% protein diets, while a decrease was observed in rats submitted to the 20% protein level diet. The TPP rate diminished in rats fed on the low protein diets, and increased when the highest protein diet was administered. Effect of the diet on offspring--Ig M levels were only detected in neonates from rats fed with the low and high protein diets. Moreover, the TPP rate increased as a direct function of the dietary protein intake.