Three patients with atopic dermatitis, one boy and two girls, aged between 6 and 17 years, presented eczematous skin, pruritus, scarifications, lichenification and a family history of atopy. During exacerbations, the patients sought emergency care and were prescribed oral corticosteroids for a period of approximately 15 days. Initially, the patients improved but after cessation of therapy or dose reduction, marked worsening occurred with the development of lesions with extreme pruritus, several confluent lesions, scarification and intense exudates, as well as fever and dehydration. The patients' condition was so severe that two were admitted to the allergy unit. The medication was withdrawn and intravenous hydration was administered, together with hydrating skin creams and antihistamine therapy. In addition, weak topical corticosteroids were applied on the most severely affected areas. All three patients progressively improved. We conclude that the patients with atopic dermatitis described herein presented a rebound phenomenon after the use of corticosteroids. We believe that systemic corticosteroids may exacerbate the acute phase of atopic dermatitis, mediated by IgE, accentuating the Th2 pattern in these patients.

Patients with atopic dermatitis frequently present recurrent infections by pyogenic bacteria or by intracellular microorganisms, suggesting an immune disorder. Laboratorial investigation of phagocyte activity and chemotactic response by neutrophilic polymorphonuclear and mononuclear phagocytes in the peripheral blood of patients with atopic dermatitis from moderate to severe. Through a transversal study, patients with atopic dermatitis from moderate to severe were selected. The neutrophilic and mononuclear phagocytes were separated and the phagocytic ingestion of zymosan particles was analysed, in addition to migration distance to the bacterial lipopolysaccharide chemotactic factor, comparing the results to the values obtained from healthy individuals within the same age group. Nineteen patients were selected, 11 female and 8 male. The mean age was 6.47 years (+/-4.65). Among the 19 patients studied, 14 (73.68%) presented a reduction in the neutrophilic and mononuclear phagocyte activity, with two (1.53%) patients presenting a reduction in the activity of both phagocytes. Our results demonstrated a reduction in chemotactic response and phagocytic activity by neutrophilic and/or mononuclear phagocytes in the majority of patients with atopic dermatitis from moderate to severe. Our results were coherent with the clinical data concerning the higher incidence of infections by pyogenic bacteria and fungi in patients with atopic dermatitis, which are microorganisms that require defence by the phagocytes researched in the present study.

To analyze serum C3 and C4 complement system components with a view to their possible utility as biomarkers of intermittent atopic asthma. Serum levels of the C3 and C4 complement components were assayed in 70 children aged from 3 to 14 years and with a history of "wheezy chest." After 2 years' outpatients follow-up and after application of inclusion and exclusion criteria, the children were divided into two groups: 40 children with intermittent atopic asthma and 30 children without asthma. None of the children in either group were treated with inhaled or systemic corticosteroids or long-acting bronchodilators. The two groups had similar ages according to Student's t test. The C3 and C4 component test results followed a normal distribution and were therefore compared using Student's t test with significance set at p < 0.05. The results for the group with intermittent atopic asthma were significantly elevated for C3 in 85.0% of the children, for C4 in 87.5% of the children, for both C3 and C4 in 72.5% of the children, and for either C3 or C4 in 97.5% of the children, when compared with the results for the children without asthma from the same age group. We observed an increase in the serum levels of the C3 and/or C4 components of the complement system in the majority of the patients with intermittent atopic asthma studied here, when compared with the results for children in the same age group without asthma. We conclude that the presence of elevated C3 and/or C4 complement components could represent a biomarker for diagnosis of intermittent atopic asthma.

Background/objective: Studies suggest that the neutrophil/lymphocyte ratio (NLR) may be a prognostic marker for different diseases with inflammatory components. This study aimed to quantify the NLR in individuals affected by different subtypes and severities of ischemic stroke and associated it with risk factors and treatment, and compared the results with data from healthy individuals. Methods: Clinical and laboratory data from medical records of patients over 18 years of age, victims of ischemic stroke, were collected. Data included leukocyte count and subtype, topography, risk factors, treatment and severity of stroke. For comparison, the number of leukocytes in healthy individuals was also quantified. NLR was determined by dividing the number of neutrophils by the number of lymphocytes. Results: A total of 218 patients were included, 194 stroke patients and 24 healthy individuals. Among all stroke patients, 45% had NLR values > 4 and 35% had values between 2 and 4; otherwise, 71% of healthy individuals had NRL < 2. The data also showed that the greater the severity of the stroke, measured by the NIHSS scale, the higher the NLR, at 24 and 72 h after the stroke. Among the stroke subtypes evaluated, the one with the lowest NLR values was small vessel stroke. Finally, the risk factors for stroke, its topography and treatment were not associated with NLR values. Conclusions: NLR is associated with stroke severity but does not correlate with stroke risk factors, topography, and treatment. The NLR may serve as a marker of stroke severity.

Se presentan cuatro pacientes portadores del síndrome de ataxia telangiectasia que tuvieron diferente evolución neurológica y inmunológica. Tres pacientes empezaron el cuadro clínico con alteraciones neurológicas de progresión lenta y compromiso inmunológico tardío. La cuarta paciente desde el inicio presentó alteraciones inmunológicas y neurológicas graves y de rápida progresión. La secuencia cronológica de las alteraciones inmunológicos más observadas fue la siguiente: 1.° deficiencia de IgA; 2.° deficiencia de IgG2 y de la etapa de acción fagocítica de los neutrófilos; 3.° inmunodeficiencia común variable. Los dos primeros casos son dos hermanas en las que el diagnóstico fue hecho a los tres y seis años de edad, observándose apraxia ocular, ataxia cerebelar y telangiectasias. Hubo progresión lenta del cuadro neurológico, sin infecciones paralelas. Las pacientes empezaron a presentar alteración inmunológica acentuada a los 17 y 14 años, falleciendo a los 20 y 16 años respectivamente, por infecciones graves y resistentes al tratamiento. El diagnóstico del tercer caso fue establecido a los dos años de edad con la presencia de ataxia y telangectasias. La progresión del síndrome fue lenta, presentando trastornos neurológicos más acentuados y deficiencia de IgA a los ocho años de edad. La cuarta paciente presentó un importante compromiso neurológico a los cinco años de edad, simultáneamente a la deficiencia de IgA e IgG2, sinusitis y neumonías de repetición. En esa ocasión fue iniciada reposición de gammaglobulina endovenosa. Los trastornos neurológicos e inmunológicos progresaron rápidamente, observándose incapacidad de marcha e inversión de la relación CD4/CD8 a los ocho años de edad.

Cryoglobulinemia is frequent in renal transplant patients. The mononuclear and polymorphonuclear neutrophil (PMN) phagocytic systems are important for the clearance of cryoglobulin immune complexes. There might be a reduced phagocytic activity in transplant patients with cryoglobulinemia (CRYO+). We studied the phagocytic activity by PMNs, in the presence of immune complexes in renal transplant patients, with or without hepatitis C virus (HCV) infection. Thirty-seven patients subjected to kidney transplant were evaluated, and for the control group, healthy blood donors were chosen. The presence of cryoprecipitate was evaluated, as well as HCV infection, phagocytic activity by neutrophils during the ingestion and digestion phase. The presence of cryoprecipitate was detected in 75.7% of the patients, 39.28% of which had HCV infection. IgG, IgM, IgA, and C3 and C4 complement components were identified in the cryoprecipitate. There was a reduction in the ingestion phase of phagocytosis by PMNs in renal transplant CRYO+ though the digestion phase was preserved. We concluded that there was a decreased PMN activity in transplanted patients presenting cryoglobulinemia.