suMMARYAntigenic preparations from Sporothrix schenckii usually involve materials from mixed cultures of yeast and mycelia presenting cross-reactions with other deep mycoses. We have standardized pure yeast phase with high viability of the cells suitable to obtain specific excretion-secretion products without somatic contaminations. These excretion-secretion products were highly immunogenic and did not produce noticeable cross-reactions in either double immunodiffusion or Western blot. The antigenic preparation consists mainly of proteins with molecular weights between 40 and 70 kDa, some of them with proteolytic activity in mild acidic conditions. We also observed cathepsin-like activity at two days of culture and chymotrypsin-like activity at four days of culture consistent with the change in concentration of different secreted proteins. The proteases were able to cleave different subclasses of human IgG suggesting a sequential production of antigens and molecules that could interact and interfere with the immune response of the host.
ResumenLa hidatidosis o equinococosis quística es una enfermedad zoonótica que tiene presentaciones clínicas muy heterogé-neas. Los quistes sintomáticos y complicados habitualmente son resueltos mediante cirugía siguiendo las reglas de la WHO-IWGE. Sin embargo, en las formas transicionales (CE3) los criterios terapéuticos continúan en discusión. Asimismo, en quistes asintomáticos y en pacientes con alto riesgo quirúrgico, la opción del tratamiento médico con benzoimidazólicos y su combinación con la estrategia de vigilar y esperar puede ser una alternativa terapéutica segura. Se presenta un caso de hidatidosis hepática CE3b con características clínico-evolutivas excepcionales y alto riesgo quirúr-gico en que se adoptó un manejo de vigilancia clínica y tratamiento con albendazol. Se analizan los beneficios y riesgos de esta terapéutica.
IntroducciónLa equinococosis quística o hidatidosis es una enfermedad zoonótica causada por el parasitismo de la larva de Echinococcus granulosus, que continúa siendo un grave problema sanitario en el mundo, en la región y en Uruguay (1) . El hígado es la localización más frecuente; según nuestra casuística representa el 59% de los casos, con una gran variabilidad en su presentación clínica y sintomatología (2) . El diagnóstico se basa en la presentación clínica, factores de riesgo epidemiológicos, imagenología y serología, teniendo esta última un rol complementario (3) . Actualmente los criterios generales de tratamiento se ajustan a los criterios establecidos a partir de la clasificación WHO-CE (4) y la clásica de Gharbi (5) , los que dependen de la localización, tamaño, presencia de complicaciones, quistes y riesgos de diseminación. Sin embargo, existe una población de casos asintomáticos y no complicados en los cuales se discuten los resultados de la cirugía (abierta o laparoscópica) frente a otras alternativas de tratamiento médico, percutánea o una estrategia de vigilancia y espera, o ambas (6,7) . En algunos casos la combinación de terapéutica mé-dica con albendazol (ABZ) en series (3 a 6) de 30 días con descanso de 15 días entre ellos es recomendada, continuando con un seguimiento regular por imagenología anual (6)(7)(8) . El propósito de este trabajo es presentar un caso de equinococosis quística hepática CE3b, con alto riesgo quirúrgico, tratado mediante vigilancia/esperar y alben-269
Cystic echinococcosis is endemic and hyperendemic in Uruguay. The objective of this study was to determine the species and genotype of Echinococcus granulosus sensu lato in symptomatic patients with cystic echinococcosis who underwent surgery, together with the location and stage of the cysts. The study included 13 patients aged between 6 and 57 years old. Samples of cysts from these cases were analyzed using DNA extraction, polymerase chain reaction amplification and sequencing. The results revealed the presence of E. granulosus sensu stricto in all cases, with 12 samples belonging to the G1 genotype and 1 to the G3 genotype, suggesting that disease persistence might be related to the dog–sheep cycle. However, other intermediate hosts, such as cattle, could also be involved. Cysts were most frequently found in the liver, followed by muscle and other sites (e.g. pulmonary, vertebral, pelvic and cardiac); and stage CE1 was most frequently found, followed by CE2 and CE3b. Three cases occurred in children or adolescents, suggesting an active parasite cycle in at least some areas of the country. Since there is considerable diversity of E. granulosus sensu lato species and genotypes in South America, it is important to continue the present study in order to draw stronger epidemiological conclusions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.