Multifunctional interleukin 10 (IL10) + Th1 cells have been implicated in favorable evolution of many infectious diseases, promoting an efficacious immune response while limiting immunopathology. Here, we investigated the presence of multifunctional CD4 + and CD8 + T-cells that expressed interferon gamma (IFNc), IL10 and tumor necrosis factor (TNF), or its combinations during dengue infection. Peripheral blood mononuclear cells (PBMCs) from outpatients with dengue (mild dengue forms) and hospitalized patients (or patients with dengue with warning signs and severe dengue) were cultured in the presence of envelope (ENV) or NS3 peptide libraries of DENV during critical (hospitalization period) and convalescence phases. The production of IFNc, IL10 and TNF by CD4 + and CD8 + T-cells was assessed by flow cytometry. Our data show that patients with mild dengue, when compared with patients with dengue with warning signs and severe dengue, presented higher frequencies of multifunctional T-cells like NS3-specific IFNc/IL10-producing CD4 + Tcells in critical phase and NS3-and ENV-specific CD8 + T-cells producing IFNc/IL10. In addition, NS3-specific CD8 + T-cells producing high levels of IFNc/TNF and IFNc/TNF/IL10 were also observed in the mild dengue group. We observed that multifunctional T-cells produced higher levels of cytokines as measured by intracellular content when compared with single producer T-cells. Importantly, multifunctional CD4 + and CD8 + T-cells producing IFNc, TNF and IL10 simultaneously displayed positive correlation with platelet levels, suggesting a protective role of this population. The presence of IL10 + Th1 and IL10 + Tc1 multifunctional cells was associated with mild dengue presentation, suggesting that these cells play a role in clinical evolution of dengue infection.
Visceral leishmaniasis is a severe and potentially fatal vector-borne disease. The most typical symptoms are fever, hepatosplenomegaly, weight loss, bleeding and bacterial infections. Neurological changes are rarely reported. This paper describes a child who presented with neurological signs as the first symptoms of leishmaniasis; tone was diminished and tremors in the extremities were observed. A diagnosis of visceral leishmaniasis was confirmed by parasite detection in the bone marrow. Symptoms were reversed by specific treatment. The nature of a possible mechanism of neurological involvement in visceral leishmaniasis remains unexplained.
Objectives: Kawasaki disease is an acute self-limiting systemic vasculitis that affects medium and small caliber vessels, preferably the coronary arteries. Patients who do not present all the necessary criteria for diagnosis are classified as bearers of the incomplete form. This study describes a child with the incomplete form of Kawasaki disease emphasizing the clinical and laboratory aspects that may be of aid in the disease diagnosis. Case description: male patient, six years old, with fever, myalgia, and meningeal signs admitted to the hospital with a diagnosis of meningitis. He presented bilateral conjunctival hyperemia and conjunctival hemorrhage. The spinal tap showed pleocytosis and elevated proteinorachy. Started treatment for meningoencephalitis, with the disappearance of fever and meningeal signs. On the third day of hospitalization expressed heart failure, and the fever reemerged four days after persisting for seven days. The research of infection was negative. After fever defervescence, the echocardiogram revealed dilated coronary. The incomplete Kawasaki syndrome was diagnosed. On the same day, laminar desquamation was observed at fingertips. Discussion: the incomplete Kawasaki syndrome should be considered in every child with prolonged fever for more than five days without apparent focus, associated with some of the main typical manifestations. The late diagnosis represents higher risk for coronary artery disease.
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