Prevalence and antibiotic resistance in bacterial isolates of dogs with ulcerative keratitis in São Paulo State, Brazil

OBJECTIVE

Identify microorganisms present in canine eyes affected by ulcerative keratitis and assess its resistance profile to available antimicrobial drugs.

METHODS

Samples were collected from 88 canine eyes that exhibited ulcerative keratitis. They were identified using MALDI-TOF and subjected to antimicrobial susceptibility testing by disk diffusion.

RESULTS

Among the assessed subjects, brachycephalic dogs accounted for 74.48% (50/83) of the evaluated canines. Among the 88 evaluated eyes, 90.9% (80/88) showed positive cultures, with 11.33% (10/88) of the samples isolating more than one species of bacteria. Of all bacterial isolates identified (90), Gram-positive bacteria accounted for 63.33% (57/90), while Gram-negative bacteria constituted 36.66% (33/90), with predominance of Staphylococcus spp. at 35.55% (32/90) being, Staphylococcus pseudintermedius at 68.75% (22/32), and Pseudomonas aeruginosa at 15.55% (14/90), respectively. Staphylococcus spp. exhibited resistance to penicillin (89.29%), sulfadiazine and trimethoprim (60.71%), and tetracycline (67.86%), while doxycycline (88.89%), cefotaxime (85.71%), chloramphenicol (82.14%), gentamicin, and moxifloxacin (78.57%) showed the highest sensitivity rates. Pseudomonas aeruginosa displayed sensitivity (100%) to gentamicin and imipenem, and resistance (8.33%) to norfloxacin, ciprofloxacin, and cefepime. Similarly, the Enterobacteriaceae family showed higher sensitivity to amikacin and gentamicin (88.89%), imipenem (88.24%), and levofloxacin (87.5%), with pronounced resistance to amoxicillin-clavulanate (50%) and cefazolin (47.06%). This highlights multiresistance in 23.33% (21/90) of the isolates.

CONCLUSIONS

The most isolated species in canine ulcerative keratitis are S. pseudintermedius and P. aeruginosa. However, other species were also isolated, demonstrating diversity in ocular microbiota infection. There is a high-rate multidrug resistance associated with canine ulcerative keratitis. Nevertheless, these strains exhibited sensitivity to antimicrobials commonly used in veterinary ophthalmology.

Fetal hemivertebra: a rare form of 18q deletion prenatal presentation

The 18q deletion is a rare condition with several described features. A common phenotype includes short stature, microcephaly, facial defects, small feet, intellectual disability and hypotonia.We present a rare case of a fetus with del18q22.1q23 whose diagnosis was obtained by amniocentesis after a routine ultrasound at 20 weeks, where a hemivertebra was detected.Congenital hemivertebra is infrequent and is rarely associated with chromosomal anomalies. Expectant management can be advocated in isolated hemivertebra. This report shows that a hemivertebra can be an isolated prenatal finding in del18 so it is important to screen for, and exclude, chromosomal anomalies.

Rabies in Bats (Chiroptera, Mammalia) in Brazil: Prevalence and Potential Risk Factors Based on Twenty Years of Research in the Northwestern Region of São Paulo, Brazil

The number of rabies cases in bats has increased recently in Brazil and in the state of São Paulo, representing a new epidemiological scenario for this zoonosis. This study aimed to analyze the prevalence of rabies in bats according to food habits, taxonomic classification, sex and season of the year to identify possible risk factors for rabies occurrence in bats. A retrospective analysis of 6389 records of bat samples, from different municipalities of São Paulo, submitted to rabies diagnosis and taxonomic identification was carried out at the Rabies Diagnostic and Chiroptera Laboratories of Unesp Araçatuba, São Paulo, Brazil, from 1998 to 2017. Seventy-six (1.1%) positive rabies cases were detected in bats from ten species and seven genera of three families. The number of rabies-positive cases was higher in the dry season, with a significant association. The prevalence was higher in the Vespertilionidae family (37), especially Myotis nigricans (19) and Eptesicus furinalis (14). Frugivorous bats had a greater association with positivity for rabies, whereas the variable "sex" had no association. We recommend that the surveillance and control of rabies should be undertaken primarily during the dry season, especially in the Vespertilionidae family species and other species with a frugivorous food habit.

Profile of human anti-rabies care and post-exposure prophylaxis in the state of São Paulo

Background:

Rabies is an anthropozoonosis that greatly impacts public health and is transmitted by infected mammals. Aggression by animals is notifiable and may result in anti-rabies post-exposure prophylaxis (PEP). This study aimed to characterize anti-rabies PEP notifications in São Paulo state, Brazil.

Methods:

A descriptive study was conducted using data provided by the SINAN between 2013 and 2017.

Results:

A total of 572,889 aggressions were recorded during the study period, characterized mostly by dogs (83.5%), single wounds (56.9%), superficial wounds (58.6%), and hands/feet (34.6%).

Conclusions:

Animal observation was the most frequent recommendation, even in cases of attacks from non-domestic animals.

Can intramammary infections change immunoglobulins and acute phase proteins of colostrum and transition milk in dairy goats?

ABSTRACT Proteiongram analysis is useful for the early diagnosis of intramammary infections during the period of colostrogenesis. This study aimed to evaluate the profile of total proteins, immunoglobulins, lactoferrin, and gamma-glutamyl transferase (GGT) in the colostrum of dairy goats with intramammary infections. Animals were divided in groups: GI (n=12) of goats without mammary gland infections, and GII (n=8) of goats with mammary gland infections. Intramammary infections were diagnosed using microbiological isolations and somatic cell counts (SCCs). Total protein was evaluated in the samples using SDS-PAGE shortly after parturition, and 24 and 48 hours after that event. Non-aureus Staphylococcus (NAS) were detected in all isolates. At 48 h, GII had high IgG levels and a SCC of 1660.25 × 10³/mL. Levels of total protein were high in this group at 24 and 48 h. Albumin levels were high in goats with mastitis at 24 h. Overall, the IgG, lactoferrin, and albumin levels differed between animals with and without intramammary infections at M0. GGT activity was not influenced by the intramammary infection. The results of this study reinforce the importance of the proteinogram as an auxiliary tool in the diagnosis of mastitis in dairy goats.

Aripiprazol and Hypersexuality: when partial is to much

Introduction

A growing number of published cases has showed that hypersexual behavior may arise with treatment with second-generation antipsychotics, including aripiprazole and olanzapine. Aripiprazole is a second-generation antipsychotic commonly used to treat schizophrenia and bipolar disorder. It has a unique pharmacologic profile acting as a partial agonist of the dopamine D2 receptor, as a partial agonist at the 5-HT1A receptor, and as an antagonist at the 5-HT2A receptor. Literature shows that medication with partial dopaminergic agonistic activity can cause compulsive behaviors, such as pathological gambling, compulsive eating, compulsive shopping, and hypersexuality. Although it is difficult to predict who would develop these behaviors, the literature suggests that patients at a higher risk of developing impulsive behaviors include those with a personal or family history of obsessive-compulsive disorder, impulse control disorder, bipolar disorder, impulsive personality, alcoholism, drug abuse, or other addictive behaviors.

Objectives

Here, we present a case of a 32-year-old male who developed hypersexuality symptoms after receiving aripiprazole as treatment for bipolar disorder.

Methods

We have done a literature review using the MeSH terms Aripiprazole and hypersexuality in the “PubMed”.

Results

After switching Aripiprazole to Risperidone the hypersexuality symptoms started to decrease and got almost complete relief after 2 weeks.

Conclusions

This case highlights the rare hypersexuality side effect that can arise in patients receiving aripiprazole for bipolar disorder treatment. Clinicians should be aware of the increased risk of hypersexuality and other impulsive behaviors as they can significantly impair a patient’s daily functioning.

Disclosure

No significant relationships.

Placental spectrum features between mesenchymal dysplasia and partial hydatidiform mole coexisting with a live fetus

We report a case of a singleton hydrops pregnancy with placental gross and microscopic features between partial hydatidiform mole (PHM) and placental mesenchymal dysplasia (PMD) in a diploid live fetus. Pregnancy was complicated by early onset of growth restriction and pre-eclampsia. A female newborn was born at 29 weeks with no congenital malformations. Histology of the placenta revealed mixed phenotype of PMD and PHM, and genetic test results were normal.

Prenatal diagnosis of fibular aplasia-tibial campomelia-oligosyndactyly syndrome: Two case reports and review of the literature

Fibular aplasia-tibial campomelia-oligosyndactyly also known as FATCO syndrome is a rare condition characterized by fibular aplasia, shortening and anterior bowing of the lower limb at the tibia with overlying soft tissue dimpling and oligosyndactyly. Its etiology is currently unknown, but there is a male predominance. There are less than 30 cases reported in the literature but only three with prenatal diagnosis. We report two cases of FATCO syndrome with prenatal lower limb malformation diagnosis. Identification of the ultrasound findings of this condition in the prenatal stages allows an adequate parental counselling regarding the clinical features, prognosis, and potential treatments.

Neuropsychiatric symptoms of multiple sclerosis: A case report

Introduction

Multiple Sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of the central nervous system. Concomitant psychiatric diseases are frequent in MS, with depression and anxiety disorders constituting the majority. The presence of psychotic disorders with MS is rare. Several studies have reported that psychotic symptoms usually develop after the neurological signs of MS and they are mostly linked to the side effects of treatment with interferon or with corticosteroids.

Objectives

The authors report here the case of patient with MS without psychiatric history that developed psychotic symptoms.

Methods

Beside the medical record of the patient a non-systematic search of the literature was carried out in the databases Pubmed and Google Scholar with the terms “Multiple Sclerosis”, “Multiple Sclerosis treatment ”and“ Neuropsychiatric symptoms ”.

Results

A 38 years old woman with MS, with no psychiatry history developed paranoid and reference delusions, several months after starting interferon beta-1a therapy. The inferferon therapy was stopped and the patient was started Risperidone 3 mg id with a rapid but only partial remission of the psychotic symptoms. The patient presented high blood levels of prolactine and the MRI showed a pituitary microadenome. The Risperidone was switched to Aripiprazol 15 mg also with partial remission of the psychtic symptons.

Conclusions

It is not possible to attribute our patient’s psychotic symptoms entirely to his Interferon therapy or to MS lesion load, but the occurrence during treatment, no psychiatric history and the rapid but parcial resolution with discontinuing suggest that Interferon therapy was at least contributory to the clinical picture.

Prenatal diagnosis of isolated frontonasal dysplasia: A case report

We report a case of mild frontonasal dysplasia, a complex and rare malformation affecting the central portion of the face, especially the eyes, nose, and forehead, which was diagnosed at 20 weeks of gestation. The diagnosis was made by two- and four-dimensional ultrasound and confirmed at autopsy after pregnancy termination. A review of the literature is presented.

Prenatal diagnosis of frontal encephalocele

Encephalocele is a rare congenital form of neural tube defect characterized by a protrusion of the meninges and cerebral tissue through a skull defect. These defects are classified according to their location: frontal, parietal and occipital, the last one being the most common form of presentation. The prognosis is related to the anatomical site, the volume of the neural contents and the presence of coexisting abnormalities. Most pregnancies are terminated, since the prognosis is poor. We report a case of an isolated fetal frontal encephalocele diagnosed at 21 weeks of gestation.

Percepção e práticas da população atendida nos serviços primários de saúde sobre a Raiva

A raiva é uma encefalite viral aguda, transmitida por mamíferos com letalidade próxima de 100%, acarretando graves problemas econômicos e na saúde pública, principalmente em países em desenvolvimento e subdesenvolvidos. Enfermidade causada por vírus do gênero Lyssavirus, pertencente à família Rhabdoviridae, que se espalha pelo sistema nervoso central e encontra-se em sobressalentes concentrações nas glândulas salivares de seu reservatório. O objetivo do trabalho foi avaliar o conhecimento da população usuária das Unidades Básicas de Saúde em relação à Raiva no município de Birigui, estado de São Paulo. Para tanto utilizou-se um questionário com questões fechadas a fim de identificar e categorizar o conhecimento e atitudes da população frente à Raiva. Foram entrevistados 400 pacientes de ambos os sexos, escolhidos de forma randômica. Nossos resultados revelaram que 74,25% (297/400) dos entrevistados eram do sexo feminino, sendo 44% (176/400) alocados na faixa-etária entre 31 a 50 anos, 45,25% (181/400) possuíam o ensino médio completo, 97,25% (389/400) já tinham, ouvido falar sobre a Raiva, 67% (268/400) sabiam quais eram os transmissores da enfermidade e 85,05% (256/400) adotavam esquema imunoprofilático contra a Raiva em seus animais. Pelo exposto concluímos que a população demonstrou conhecimento elevado sobre a Raiva, visto que em sua maior parte os entrevistados souberam quais eram os fatores causadores da doença como a transmissão, letalidade, terapêutica e medidas de prevenção, além de já terem ouvido falar sobre a zoonose em sua maior parte por meios digitais ou trocas de informações entre os indivíduos.

Gene expression is associated with virulence in murine macrophages infected with Leptospira spp

Leptospira genus contains species that affect human health with varying degrees of pathogenicity. In this context, we aimed to evaluate the differences in the modulation of host gene expression by strains of Leptospira varying in virulence. Our data showed a high number of differentially expressed transcripts in murine macrophages following 6h of infection. Leptospira infection modulated a set of genes independently of their degree of virulence. However, pathway analysis indicated that Apoptosis, ATM Signaling, and Cell Cycle: G2/M DNA Damage Checkpoint Regulation were exclusively regulated following infection with the virulent strain. Taken together, results demonstrated that species and virulence play a role during host response to Leptospira spp in murine macrophages, which could contribute to understanding the pathogenesis of leptospirosis.

microRNA profile datasets of murine macrophages infected with different strains of Leptospira spp

MicroRNAs play an important role in the regulation of immune responses. The influence of epigenetic mechanisms, particularly RNA-mediated post-transcriptional regulation of host immune responses has been proven vital following infections by different pathogens, and bacteria can modulated host miRNAs. Global miRNA expression analysis from macrophages infected in vitro with different strains of Leptospira spp was performed using miRNA 4.1 microarray strips. Leptospirosis is a bacterial zoonosis of global importance, responsible for significant morbidity and mortality worldwide. Despite considerable advances, much is yet to be discovered about disease pathogenicity, particularly in regards to host-pathogen interactions. We present here a high-quality dataset examining the microtranscriptome of murine macrophages J774A.1 following 8h of infection with virulent, attenuated and saprophyte strains of Leptospira. Metadata files were submitted to the Gene Expression Omnibus (GEO) repository.

Effect of atenolol pre-treatment in heart damage in a model of intestinal ischemia-reperfusion

PURPOSE

To investigate the effects of atenolol in inflammatory mediator and oxidative stress in a myocardial injury by intestinal ischemia/reperfusion in rat model.

METHODS

Adult Wistar male rats were randomly (n=8), anesthetized and divided in: Sham: submitted to operation only; group SS+IR: intravenous saline infusion following superior mesenteric artery occlusion during 60 minutes (ischemia) and open for 120 minutes (reperfusion); group AT+IR: intravenous atenolol infusion (2 mg/kg) following superior mesenteric artery occlusion during 60 minutes (ischemia) and open for 120 minutes (reperfusion); and group AT+I+AT+R: intravenous atenolol infusion following superior mesenteric artery occlusion during 60 minutes (ischemia) and in the time 45 minutes other atenolol doses were administrated and the artery was open for 120 minutes (reperfusion), all animals were submitted to muscular relaxation for mechanical ventilation. In the end of experiment the animals were euthanized and the hearts tissue were morphology analyzed by histology and malondialdehyde by ELISA, and the plasma were analyzed for tumor necrosis factor-alpha by ELISA.

RESULTS

The group SS+IR demonstrated the higher malondialdehyde levels when compared with the atenolol treated-groups (p=0.001) in the heart tissue. The tumor necrosis factor-alpha level in plasma decrease in the treated groups when compared with SS+IR group (p=0.001). Histology analyses demonstrate pyknosis, edema, cellular vacuolization, presence of inflammatory infiltrate and band contraction in the heart tissue of the rats.

CONCLUSION

Atenolol significantly reduce the degree of cardiac damage after intestinal ischemia-reperfusion.

HIV/AIDS “worried well”–When the “virus” leads to a significant illness, even in its absence

Introduction

Management of HIV/AIDS “worried well” people is among the most complex and challenging psychiatric problems in HIV care.

Objectives

To provide an overview of HIV/AIDS “worried well”.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “worried well”.

Results

The HIV/AIDS “worried well” are those individuals who are intensely worried about being infected with HIV, despite overwhelming evidence to the contrary. Indeed, they will rapidly return with the renewed conviction that the physician has “got it wrong” or “missed something”. So, they tend to over-utilize health care services. Seven HIV/AIDS “worried well” sub-groups have been identified: those with past sex or drug use history; those with relationship problems; the partners/spouse of those at risk; couples in individual or family life transitions; past history of psychological problems; misunderstanding of health education material; and pseudo and factitious AIDS. These patients have several striking consistencies in their presenting phenomenology and background features and usually have psychiatric problems associated. The authors will analyze all these aspects. Currently there are no guidelines to deal with this clinical condition, however cognitive-behavioral therapy along with selective serotonin reuptake inhibitors has been an effective approach. It is also important to ensure follow-up discussion to these patients, especially where unresolved life issues may cause future vulnerability in absence of intervention.

Conclusions

Patients may express their concerns about HIV infection by several ways, directly or indirectly, and psychiatrists need to be aware of this reality, which causes much suffering as well as severe monetary loss.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychosis Induced by Interferon-α–A Limitation of Treatment

Introduction

Psychosis is an uncommon but serious complication of treatment with interferon-α, a cytokine frequently used to treat several infectious and malignant diseases.

Objectives

To provide an overview of interferon-α-induced psychosis.

Methods

Literature review based on PubMed/MEDLINE, using the keywords “interferon-α” and “psychosis”.

Results

Psychotic symptoms usually emerge between 6 to 46 weeks and on average 3 months after the start of interferon-α treatment, occurring most frequently in the form of persecutory, guilt or grandeur delusions and auditory hallucinations. Often they are accompanied by mood symptoms, anxiety, attention disturbances and insomnia. Many factors are known to increase the risk of psychiatric effects as a whole associated with interferon-α. Pathogenesis of interferon-induced psychosis remains unclear, however several theories have been discussed, namely the overlap influence of biological vulnerability and the cytokine's action on the brain. Dopaminergic, opioid, serotoninergic and glutaminergic pathways as well as hypothalamic-pituitary-adrenal axis hypersensitivity are some of the hypotheses raised about the underlying cause of that susceptibility. Psychosis management usually includes stopping interferon-α and introducing antipsychotics with minimal antidopaminergic effects and at the lowest possible dose, due to the increased risk of extrapyramidal reactions in these patients.

Conclusion

The decision to use interferon-based treatments in psychiatric patients should be highly individualized. Early recognition and adequate treatment of interferon-induced psychosis might prevent subsequent emergence of serious debilitating symptoms. Thus, it is very important that medical and psychiatric treatment teams work closely together and are familiar with this important subject.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Postictal psychosis – A complex challenge

Introduction

Patients with epilepsy have 6–12 times higher risk of suffering from psychosis, with a prevalence of about 7–8%, and the coexistence of these two conditions is associated with increased morbidity and mortality. The psychosis of epilepsy is generally split into two groups: interictal psychoses and postictal psychosis (PIP), and the latter has been estimated to represent 25% of all types. However, many of these episodes remain under-recognized and/or are often misdiagnosed.

Objectives

To provide an overview of PIP.

Methods

Literature review based on PubMed/Medline, using the keywords “epilepsy” and “psychosis”.

Results

PIP has been recognized since the 19th century, when Esquirol described postictal “fury”. Although its etiology and pathogenesis remain poorly understood, several risk factors and etiopathogenic mechanisms have been suggested and analysed. An essential step in PIP management is its accurate and early diagnosis. Generally, before the onset of PIP there is a lucid period of one to six days after the seizure(s). PIP frequently has a polymorphic presentation, tends to be affect-laden and symptoms often fluctuate. It is of limited duration and frequently responds very rapidly to low doses of benzodiazepines and antipsychotics. However, the propensity of the antipsychotics to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptics are important considerations. Recurrence rates range 25% to 50%.

Conclusions

Given the negative impact of PIP in morbidity and mortality among these patients, it is crucial that neurologists and psychiatrists are able to adequately recognize and treat this clinical condition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Antidepressant withdrawal mania: Two case reports

Introduction

Although rarely reported, antidepressant discontinuation may induce hypomania or mania even in the absence of bipolar disorder [1,2].

Objectives

We report two cases of antidepressant withdrawal induced mania.

Methods

Clinical process consultation and PubMed search were performed in November 2016 using the search keywords antidepressant, mania and discontinuation.

Results

Case report 1: a dysthymic 60 years old woman with 20 years of psychiatric following had been treated with venlafaxine 150 mg/daily the past year. She abruptly stopped taking this drug, developing heightened mood, irritability and racing thoughts five days later. She was admitted at our hospital, initiating then valproate and antipsychotics. Two weeks later, the hypomania clinical state remitted completely.

Case report 2: a 64 years old woman, with a 12-year-old diagnosis of unipolar depression was brought to our emergency service with complaints of disorganized behavior, paranoid delusional ideas, excessive speech, irritable mood and reduced need for sleep, 1 week after abrupt trazodone 150 mg/daily discontinuation. Valproic acid 1000 mg/daily and olanzapine 20 mg/daily were introduced, with gradual improvement of symptoms. Two weeks later she was completely asymptomatic.

Conclusion

Psychiatrists should be aware of the risk of antidepressant withdrawal induced mania. More studies should be conducted about this subject, aiming for the clarification of risk factors and the establishment of clinical criteria for this phenomenon.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Depression Among Cancer Patients–A Reality Where Therapeutic Nihilism Cannot be Accepted

Introduction

Cancer is a life-threatening disease, characterized by a great deal of uncertainty and unpredictability. Thus, several stressors and emotional upheavals pervade the everyday life of cancer patients and can lead to the development of depression.

Objectives

To review the recent research related to depression in cancer patients.

Methods

Literature review based on PubMed/MEDLINE, using the keywords “cancer” and “depression”.

Results

It is estimated that 20–25% of cancer patients meet the criteria for major depressive syndrome at some point in their illness. Depression is associated with a negative impact on treatment adhesion, cancer progression and quality of life, besides increasing suicide risk. However, it is often unrecognized and untreated. Importantly, the mistaken belief that depressive symptoms are expected in this group, the overlap between the neurovegetative symptoms of depression, the somatic symptoms of cancer and its treatment, as well as the effects of comorbid diseases make the diagnosis of major depression so complex in these patients. Some of the most helpful diagnostic indicators are feelings of hopelessness, worthlessness, excessive guilt, loss of self-esteem, and wishes to die. The several risk factors for the development of depression in cancer patients can be divided into four broad categories, namely cancer-related factors, cancer treatment-related factors, psychiatric history, and social factors. Effective management of depression consists in a combination of psychotherapy and psychopharmacology.

Conclusion

Depression in cancer patients has serious consequences, however appropriate psychiatric intervention can do it over. Thus, its early recognition and appropriate management is imperative.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Efavirenz and Neuropsychiatric Effects–When the Treatment Complicates Matter Further

Introduction

Efavirenz, a non-nucleoside analogue inhibitor of the reverse transcriptase, has become commonly used in the treatment of HIV infection. Although highly effective, efavirenz is associated with causing neuropsychiatric side effects in approximately 50% of patients.

Objectives

To provide an overview of efavirenz-induced neuropsychiatric effects.

Methods

Literature review based on PubMed/Medline.

Results

The neuropsychiatric side effects of efavirenz usually begin quickly, commonly peak in the first two weeks after the start of therapy, and can include depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, paranoia, psychosis. Generally, these events are mild to moderate in severity and time limited, however, in a small number of cases, are late, persistent or intolerable. They are often associated with a negative impact on treatment adhesion. Some factors are known to increase the risk of neuropsychiatric effects in HIV-positive patients. The behavioral effects of efavirenz appear to be dose-dependent and mediated predominately by the 5-HT2A receptor, a primary site of action of lysergic acid diethylamine (LSD). Importantly, the efavirenz-induced neuropsychiatric effects may be difficult to distinguish from HIV-related neuropsychiatric symptoms, preexisting mental disorder or substance use. The neuropsychiatric effects should be treated with non-pharmacologic or pharmacologic interventions, according to severity. The psychiatric status of patients should be closely monitored for at least the first 6 to 12 months of treatment.

Conclusion

Taking into account the high rates of neuropsychiatric side effects, it is crucial that the physicians are familiar with this important subject, and the decision to initiate efavirenz in psychiatric patients is individualized.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

“The Old Lady and the Dead Bird”–A Case of Very-late-onset Schizophrenia-like Psychosis

Introduction

In 1943, Bleuler defined “late-onset schizophrenia” as a form of schizophrenia with onset after the age of 40. Half a century had passed with no consensus on the late psychosis’ terminology, when in 1998 the international late- onset schizophrenia group Consensus proposed a nosology for these disorders: late-onset schizophrenia and very-late-onset schizophrenia-like psychosis.

Objectives

Presentation of a case and diagnostic discussion.

Methods

Interviews with the patient during his hospitalisation.

Results

We present a case of a 73-year-old single woman, with no psychiatric history, who was driven to the emergency department by her relatives when they noticed her bizarre behaviour: she had drowned and strangled her pet bird. At examination she was agitated, had persecutory delusions, thought broadcasting, cenesthetic and auditory hallucinations in the form of a masculine voice, who sang and dialogued with her. Symptoms had evolved during the past six months with no apparent functional impairment. During hospitalisation she was treated with risperidone (up to 5 mg/day) with improvement in a few days. There were no significant abnormalities on cerebral tomography and analytical exams. Neuropsychological evaluation ruled out cognitive deficits. At the time of discharge although the patient kept referring auditory hallucinatory activity, she had an appropriate behaviour, and no evidence of negative symptoms.

Conclusions

The small group of patients who meet schizophrenia's criteria for the first time at a later age present some particular clinical characteristics to be taken into account. This case highlights some of them, drawing attention to this uncommon diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Isolation, characterization and immunomodulatory-associated gene transcription of Wharton's jelly-derived multipotent mesenchymal stromal cells at different trimesters of cow pregnancy

The possibility of isolating bovine mesenchymal multipotent stromal cells (MSCs) from fetal adnexa is an interesting prospect due to the potential use of these cells in biotechnological applications. However, little is known about the properties of these progenitor cells in bovine species. Wharton's jelly (WJ) MSC cells were obtained from the umbilical cord of bovine fetuses at three different stages of pregnancy and divided into groups 1, 2 and 3 according to gestational trimester. Cell morphology, from the three stages of pregnancy, typically appeared fibroblast-like spindle-shaped, presenting the same viability and number. Moreover, the proliferative ability of T-cells in response to a mitogenic stimulus was suppressed when WJMSC cells were added to the culture. Multilineage properties were confirmed by their ability to undergo adipogenic, osteogenic/chondrogenic and neurogenic differentiation. Mesenchymal phenotyping, CD105+, CD29+, CD73+ and CD90+ cell markers were detected in all three cell groups, yet these markers were considered more expressed in MSCs of group 2 (p < 0.005). Expression of cytokines IL2, IL6RR, INFAC, INFB1, IFNG, TNF and LTBR were downregulated, whereas IL1F10 expression was upregulated in all tested WJMSCs. The present study demonstrated that WJMSCs harvested from the bovine umbilical cord at different gestational stages showed proliferative capacity, immune privilege and stemness potential.

Aquisição de imunidade passiva em cabritos alimentados com colostro de cabras com e sem mastite

O objetivo deste trabalho foi avaliar a transferência de imunidade passiva de cabras, que pariram com mastite, para seus respectivos cabritos. Os animais foram distribuídos em dois grupos, a saber: grupo 1 (GI), constituído por cabritos, filhos de cabras sem isolamento microbiológico em ambas as glândulas mamárias, e grupo 2 (GII), composto por cabritos, filhos de cabras com resultado positivo à lactocultura, em pelo menos uma das glândulas mamárias. Foram coletadas amostras de colostro e sangue à parição, bem como às 24 e às 48 horas após o parto/nascimento. O diagnóstico e o monitoramento da mastite nos animais foram realizados por meio do California Mastitis Test (CMT), contagem de células somáticas e isolamento microbiológico. A proteína total foi mensurada pelo método do biureto, e as concentrações de imunoglobulina A (IgA), imunoglobulina G (IgG), transferrina, albumina e haptoglobina por meio da eletrofoerese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE). Os agentes mais isolados na cultura microbiológica foram os Staphylococcus coagulase negativa. Não houve diferença significativa (P<0,05) entre os valores médios de imunoglobulina G (IgG) nos cabritos provenientes de cabras com mastite quando comparados aos recém-nascidos oriundos de cabras livres de infecções intramamárias. Da mesma forma, a atividade de gamaglutamiltransferase (GGT) não mostrou diferença entre os grupos em todos os momentos avaliados. A ingestão de colostro decorrente de cabras com mastite não causou falha na transferência de imunidade passiva nos respectivos conceptos.

Anxiety Among Hiv-Infected Patients – When Anxiety Is A Disorder and not Simply A Natural Reaction to a Life-Threatening IIIness

Introduction

HIV infection is a chronic disease characterized by a great deal of uncertainty and unpredictability, being anxiety disorders a frequent psychiatric problem.

Objective

To provide an overview of anxiety in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “anxiety disorders”.

Results

HIV-infected individuals can experience symptoms of anxiety across the spectrum of anxiety disorders. Adjustment disorder with anxious mood is the most common diagnosis, followed by generalized anxiety disorder and panic disorder. Some patients present with these disorders prior to notification, others develop them during the course of their illness, mainly at key moments. In HIV-infected patients, anxiety can be a manifestation of side effects of medication; a symptom of an illness associated with HIV disease; or, most commonly, the psychological response to the stressors of the illness. In fact, many issues are responsible for the anxiety experienced by people living with HIV. The authors will analyze them. Besides the distress of anxiety disorders, these lead to a decrease in adherence to antiretroviral treatments, resulting in adverse progression of HIV disease and increased risk of mortality. Importantly, however, appropriate psychiatric intervention can do it over.

Conclusions

Careful diagnosis and treatment of anxiety disorders in the context of HIV disease is even important, given the serious effects if untreated. Thus, anxiety should never be seen simply as a natural reaction to a life-threatening illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Aids Mania – Is It A Potential Indicator to Initiate HAART?

Introduction

Mania occurs in higher rates among individuals with HIV/AIDS, especially with the progression of HIV infection, and constitutes an additional risk factor for facilitate the HIV spread.

Objective

To provide an overview of secondary mania in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV”, “AIDS” and “mania”.

Results

Secondary mania or AIDS mania may be due to illicit or prescribed drugs, CNS infection with HIV, medical illness, including opportunistic infections. Of these, HIV neurotoxicity has been proposed to be the most important factor in its pathogenesis. Mania AIDS differs from primary mania with regard to clinical presentation, course, management and prognosis. The authors will analyze them. Besides decrease to treatment adherence, maniac symptoms also predispose to HIV risk behaviors, which may lead to further HIV transmission. Importantly, the occurrence of HIV mania may announce the transition from HIV infection to AIDS perhaps before other clinical signs are evident. Early recognition and treatment of manic symptoms with mood stabilisers, antipsychotics and HAART improve quality of life, protect from further cognitive deterioration and decrease mortality. In these patients, medication side-effects toxicity, drug interactions, and adherence require special attention.

Conclusions

Mania has been associated with HIV/AIDS and in many instances acts as a barrier to achieving best treatment outcomes. Thus, psychiatrists need to be aware of the complexities involved in the emergence of manic episodes in HIV-infected patients in order to deal with them in the most appropriate and effective manner.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Depression Among HIV-Infected Patients–A Reality that Must Not be Forgotten

Introduction

HIV-infection is a very stigmatized, chronic disease with increased rates of psychiatric disorders, being major depression the most common.

Objective

To review the recent research related to depression in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “depression”.

Results

HIV-infected patients have a chance 2-7 times higher of developing major depression, around the time of diagnosis or during the course of their illness. However, only fewer than 50% of the cases are recognized clinically. Several factors contribute to its under-recognition and under-treatment, such as the overlap between the neurovegetative symptoms of depression, the somatic symptoms of HIV disease, and the effects of comorbid diseases; the mistaken belief that depressive symptoms are expected in this group; the neuropsychiatric side effects associated with some antiretrovirals. Besides, major depression presents important diagnostic challenges due to biological, psychological, and social components associated with the infection. The authors will analyze the clinical presentation.

Depression has been associated with a negative impact on quality of life, poorer HAART adherence, faster HIV disease progression and increased mortality risk. Importantly, however, appropriate psychiatric intervention can do it over. In fact, studies suggest that patients receiving SSRI treatments for depression have rates of adherence and CD4+ T-cell counts similar to non-depressed patients receiving HAART.

Conclusions

The high prevalence of major depression in HIV-positive individuals and its serious consequences if untreated, increase even further the importance of its effective identification and subsequent treatment in this group of patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The role of augmentation treatment with second-generation antipsychotics in major depression disorder–current evidence in the literature

Introduction

Major depressive disorder (MDD) is a chronic mental illness with a considerable lifetime prevalence in adult men and women. Only a third of MDD patients remit following adequate antidepressant treatment, while most suffer from significant core depressive or residual symptoms during their clinical course. Augmentation treatment with second-generation antipsychotics (SGAs) has been one of the suggested approaches to overcome this shortage of efficacy of antidepressant therapy.

Objectives

To review the role of SGAs as an augmentation strategy to antidepressant therapy in MDD.

Methods

A search of the MEDLINE/Pubmed database was conducted for articles from 2010 to 2015, using the MeSH terms “antypsichotics”, “depression” and “treatment”.

Results

There is a general consensus in the literature that antidepressant augmentation treatment with SGAs is more effective than placebo in the management of patients with MDD who failed to respond adequately to antidepressant therapy alone. The majority of studies found no significant differences between the different studied drugs (namely, aripiprazole, quetiapine, olanzapine and risperidone). On the other hand, discontinuation rates due to adverse effects are also higher with SGAs versus placebo. However, it remains unclear if augmentation with SGAs is more effective than other therapeutic strategies, such as combination or switching to other antidepressant or augmentation with other psychotropics.

Conclusions

There is strong evidence that SGAs augmentation is an effective and generally safe therapeutic approach to patients with MDD who respond poorly to antidepressants. Nevertheless, more studies are needed to understand the efficacy of this treatment comparing other therapeutic approaches.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Living with Parkinson disease – the central role of primary care physicians and a multidisciplinary approach

Introduction

Parkinson disease is a frequent neurodegenerative disorder. Presence of psychopathology is well described in this illness, nevertheless the etiology is still unknown.

Methods and aims

The authors present a clinical case of a patient with idiopathic Parkinson disease with depressive symptoms after the decline of his functioning. We aim to emphasize the importance of a multidisciplinary approach and the central role of general physicians in screening these situations.

Results

The patient is a male with 64 years old, reformed with a personal history of hypertension. With 62 years old he started with mild motor complaints that got worse over time, culminating after a year and half on him being almost dependant for most of his daily activities. He also started to express feelings of sadness, despair, and recurrent thoughts of death. He refused to seek out medical help, but was convinced by his wife to consult his general physician that observed the patient and referenced him to Neurology and Psychiatry consultations. He also started sertraline 50 mg/day. He was diagnosed with Parkinson disease and started medication with ropinirole, levodopa and carbidopa with a good response. In Psychiatry consultation the dose of sertraline was increased to 100 mg/day with improvement, and it was provided information on the disease to the patient and family and also supportive psychotherapy.

Conclusions

General physicians have a privileged position on screening patients with psychopathology when other physical conditions or illnesses are present. The fast and correct referencing of these patients can improve the prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The influence of espresso coffee on neurocognitive function in HIV-infected patients

The aim of our study was to evaluate the impact of coffee intake on cognitive function in persons living with HIV (PLWH). 130 PLWH with CD4 > 200 cells/mm(3), undetectable viral load, treated with HAART were included. A structured interview was applied and relevant clinical and laboratory data were assessed, including coffee intake. For neuropsychological assessment, the HIV Neurobehavioral Research Center Battery was chosen. Univariate nonparametric statistics and multivariate regression model were used. A significant association between espresso coffee use and a better cognitive function was verified in five of the eight psychometric measurements. In the multivariate analysis, after variable adjustment, linear regression analysis showed that coffee intake was a positive predictor for attention/working memory, executive functions and Global Deficit Score. Although the mechanisms behind the influence of caffeine on cognitive functioning are controversial, regular espresso coffee intake may have favourable effects on cognitive deterioration caused by HIV.

Caracterização bioquímica e molecular de Cryptococcus spp. isolados de excretas ambientais de pombos (Columba livia domestica)

Os pombos possuem uma rica diversidade de microrganismo, entre eles fungos sapróbios, como do gênero Cryptococcus, que podem atuar como agentes patogênicos para o homem e animais. Objetivou-se o isolamento, a caracterização bioquímica e a molecular de amostras de Cryptococcus spp. de excretas ambientas de pombos. Foram colhidas 100 amostras ambientais de pontos equidistantes e representativos da área da cidade de Araçatuba, São Paulo. As amostras foram rasteladas do solo de vias públicas, armazenadas em frasco coletor e encaminhadas para o Laboratório de Bacteriologia e Micologia da FMVA, onde foram processadas e cultivadas em duplicata, em placas de Petri contendo ágar Sabouraud dextrose a 4% e Niger. Em seguida, foram incubadas à temperatura ambiente e a 30ºC, respectivamente, por um período não inferior a 15 dias. Após a observação diária, as colônias sugestivas para levedura foram reisoladas em ágar Niger e submetidas a testes bioquímicos para posterior caracterização molecular pela técnica da PCR. Como resultado, a caracterização bioquímica e a molecular isolaram 32 colônias leveduriformes, sendo 8% dos cultivos positivos para Cryptococcus neoformans var. neoformans, 17% para Rhodotorula rubidae e 7% Candida albicans. Pelo exposto, concluiu-se que excretas ambientais de pombos constituem um microfoco para Cryptococcus neoformans var. neoformans e outras leveduras com potencial patogênico, representando um risco à saúde pública, sendo necessárias medidas preventivas, como a higienização com a correta remoção das excretas, a fim de minimizar os riscos de exposição ambiental.

Presence of enterobacteria in free-living and captive Amazon turtle Podocnemis expansa (Podocnemididae: Testudines)

<p class="Textodecomentrio1">La tortuga amazónica <em>Podocnemis expansa</em> Schweigger, 1812 es un recurso muy importante para las poblaciones ribereñas de fauna de la región amazónica, además de ser una de las principales especies enumeradas para la producción en cautiverio. El consumo de esta especie como alimento en la región ha generado una demanda de estudios sobre salud animal y sus posibles impactos en la salud pública. El objetivo principal de este estudio fue evaluar la microbiota gastrointestinal de las tortugas amazónicas en cautiverio y vida libre, y la influencia del hábitat en la composición de la flora. Un total de 116 tortugas adultas, de ambos sexos fueron elegidas, y 51 fueron capturados en la isla de São Miguel, Santarém (PA), 50 animales en cautiverio para comercio y 15 provenían de un criadero de reproducción para la conservación, que se encuentra en la región metropolitana de Belém. De cada animal se recogió material biológico de la cloaca y se envió al laboratorio de la Universidad Federal de Pará, Brazil. De 116 muestras se obtuvieron 245 aislamientos bacterianos en el que 83 (33.87 %) eran de animales de vida libre, y 162 (65.72 %) de cautiverio. Especies de <em>Klebsiella pneumoniae</em> fueron los aislamientos más frecuentes de las 52 muestras, 21.22 % del crecimiento total de bacterias, seguido de <em>Enterobacter cloacae</em> 29 %, (35/14), <em>Serratia marcescens </em>84 % (11/29) y <em>Salmonella </em>spp. 80 % (24/9). En las tortugas de vida libre, los microorganismos aislados corresponden a los géneros: <em>Enterobacter, Klebsiella, Citrobacter </em>y<em> Aeromonas. Klebsiella pneumoniae, S. marcescens, E. cloacae </em>y <em>Salmonella </em>spp. presentaron frecuencias altas en animales de cautiverio. Este resultado muestra una mayor diversidad de microorganismos en animales de vida libre y muestras con alta contaminación en animales de cautiverio<strong>.</strong> Las especies de <em>Salmonella </em>spp., <em>E. coli </em>y<em> Acinetobacter </em>spp., pueden ser sugeridas como indicadores de la calidad sanitaria de las poblaciones de la tortuga amazónica. Sin embargo el estudio reveló que el hábitat influyó en la composición de la flora gastrointestinal de las tortugas. El conocimiento de la flora gastrointestinal de los animales es de suma importancia en la identificación de los agentes patógenos presentes en la fauna nativa de la región amazónica.</p>

Cryptococcus: isolamento ambiental e caracterização bioquímica

O gênero Cryptococcus caracteriza-se por ser uma levedura responsável por infecção sistêmica, causada pelas espécies Cryptococcus neoformans e Cryptococcus gattii. O fungo é encontrado em substratos de origem animal e vegetal, e a infecção ocorre com a inalação de basidiósporos ou leveduras desidratadas infectantes presentes no ambiente. O presente trabalho teve por objetivo pesquisar a existência de microfocos de Cryptococcussp.em amostras ambientais da cidade de Araçatuba, São Paulo, com a finalidade de minimizar os riscos de contaminação do homem e dos animais, buscando o conhecimento da ecoepidemiologia do Cryptococcus. Foram colhidas 50 amostras oriundas de ocos e troncos de árvores (Cassiasp., Ficussp., Caesalpinea peltophorides) de 10 locais representativos do perímetro urbano, as quais foram encaminhadas ao Laboratório de Bacteriologia e Micologia da Faculdade de Medicina Veterinária de Araçatuba-Unesp, onde foram processadas e semeadas em placas de Petri contendo ágar semente de Níger e Sabouraud dextrose com clorafenicol e incubadas à temperatura de 30ºC, por um período não inferior a cinco dias. Posteriormente, foram submetidas às provas bioquímicas: produção de urease, termotolerância a 37ºC e quimiotipagem em ágar CGB (L-canavanina-glicina-azul de bromotimol). A análise dos resultados revelaram que 17 (34%) dos cultivos foram positivos para o gênero Cryptococcus, sendo nove (18%) para Cryptococcus gattiie oito (16%) para Cryptococcus neoformans. Outras leveduras correlacionadas, como Rhodotorula sp. e Candida sp., também foram isoladas. Conclui-se que os basidiósporos de Cryptococcusencontram-se dispersos na natureza, constituindo microfocos ambientais, não vinculados necessariamente a um único hospedeiro.

Tissue apoptosis in mice infected with Leptospira interrogans serovar Icterohaemorrhagiae

BACKGROUND

This investigation aimed to evaluate the occurrence of some apoptotic features induced by Leptospira interrogans serovar Icterohaemorrhagiae infection in young BALB/c mice during 2, 4, 7, 10, 14 and 21 days post-infection (dpi).

METHODS

The animals were euthanized and lung, liver and kidneys were harvested to histopathology analysis and immunohistochemistry to caspase-3 antigen detection was performed.

RESULTS

Chromatin condensation in kidney and liver tissues, but not in lung tissue, was observed. Caspase-3 reactive cells, mainly characterized as renal epithelial cells, were detected in the days 14 and 21 at high levels when compared to days 2, 4 and 7 (p = 0.025; p < 0.05). Lung sections revealed caspase-3 labeled alveolar cells in 10 and 14 days post-infection was higher than observed at 7 days (p = 0.0497; p < 0.05). Liver sections demonstrated reactive cells at a highest level at 14 and 21 days post-infection when comparison to 2, 4, 7 and 10 days (p = 0.0069; p < 0.05).

CONCLUSIONS

Our results suggest that infection of L. interrogans induce in kidney, liver and lung an activation of apoptosis mediated by caspase-3 dependent pathway in later phases of infectious process.

Short courses of mechanical ventilation with high-O2 levels in elderly rat lungs

PURPOSE

To evaluate the effects of mechanical ventilation (MV) of high-oxygen concentration in pulmonary dysfunction in adult and elderly rats.

METHODS

Twenty-eight adult (A) and elderly (E), male rats were ventilated for 1 hour (G-AV1 and G-EV1) or for 3 hours (G-AV3 and G-EV3). A and E groups received a tidal volume of 7 mL/kg, a positive end-expiratory pressure of 5 cm H2O, respiratory rate of 70 cycles per minute, and an inspiratory fraction of oxygen of 1. We evaluated total protein content and malondialdehyde in bronchoalveolar lavages (BAL) and performed lung histomorphometrical analyses.

RESULTS

In G-EV1 animals, total protein in BAL was higher (33.0±1.9 µg/mL) compared with G-AV1 (23.0±2.0 µg/mL). Upon 180 minutes of MV, malondialdehyde levels increased in elderly (G-EV3) compared with adult (G-AV3) groups. Malondialdehyde and total proteins in BAL after 3 hours of MV were higher in elderly group than in adults. In G-EV3 group we observed alveolar septa dilatation and significative increase in neutrofiles number in relation to adult group at 60 and 180 minutes on MV.

CONCLUSION

A higher fraction of inspired oxygen in short courses of mechanical ventilation ameliorates the parameters studied in elderly lungs.

Pulmonary disease in hamsters infected with Leptospira interrogans: histopathologic findings and cytokine mRNA expressions

Our aim was to evaluate the pulmonary changes induced by Leptospira interrogans infection in hamsters, and the gene expression of endogenous mediators in lung fragments during 28 days of observation. The animals were euthanized on days 4, 7, 14, 21, and 28 post-inoculation. Histopathologic lung analysis showed hemorrhage, pneumonia, alveolar congestion, and infiltrated cellular areas, with increasing severity until day 21 post-inoculation. Tumor necrosis factor (TNF)-alpha mRNA expression enhanced in first days with peak on day 4 and slightly decreased in the final phase. The interleukin (IL)-10 remained relatively constant throughout the period, with the exceptions of days 4 and 14. The endothelial nitric-oxide synthesis (eNOS) showed an increased expression on day 4, followed by an augment on days 7 and 14, and remaining constant up to day 28 post-infection. Our results demonstrate that inoculation of L. interrogans sorovar Icterohaemorrhagiae induced pulmonary lesions, including pulmonary hemorrhage, supporting that the lung is a target organ.

Resposta humoral, recuperação bacteriana e lesões histológicas em camundongos geneticamente selecionados para bons e maus produtores de anticorpos e Balb/c, frente à infecção por Leptospira interrogans sorovar icterohaemorrhagiae

O presente trabalho teve por finalidade associar a cinética da resposta humoral à recuperação de leptospiras viáveis e à intensidade das lesões teciduais em camundongos geneticamente selecionados para bons (High) e maus (Low) produtores de anticorpos (seleção IV-A), além de camundongos outbreed, Balb/c, inoculados com amostra patogênica de Leptospira interrogans sorovar icterohaemorrhagiae. As linhagens High e Low (seleção IV-A) apresentam modificações em alguns compartimentos da resposta imune, principalmente em relação à atividade macrofágica, representando fenótipos extremos encontrados em populações naturais heterogêneas. Os camundongos foram sacrificados em oito momentos após a infecção. A análise dos resultados revelou que a partir do 7º dia após a infecção, os camundongos da linhagem High apresentaram elevação nos títulos de anticorpos estatisticamente significantes quando comparados aos camundongos da linhagem Low, mantendo assim o efeito multiespecífico. Os camundongos Balb/c apresentaram resultados intermediários entre as duas linhagens. A produção de anticorpos colaborou como fator limitante à infecção, pois quando obteve-se maior recuperação de leptospiras, na fase inicial da infecção, os títulos de anticorpos encontravam-se em elevação. As lesões observadas nos órgãos de camundongos infectados consistiram basicamente nos mesmos processos inflamatórios e degenerativos, que não se alteraram, variando apenas o grau de comprometimento tecidual, de acordo com a linhagem. A linhagem high apresentou lesões mais extensas que as apresentadas pelas linhagens low e Balb/c, sendo que nesta última as lesões foram moderadas. De forma geral a linhagem High e Balb/c apresentaram um perfil de resposta Th2, com o maior índice de produção de anticorpos e gravidade das lesões, enquanto a linhagem Low apresentou um perfil de resposta Th1.