Different Degrees Of Inflammation Research Articles

Trypanosoma cruzi persistence at oral inflammatory foci in chronic chagasic patients

The persistence of Trypanosoma cruzi in seropositive individuals, previously diagnosed as chronic chagasic patients (CCP), was detected for the first time in biopsies taken from gingival inflammatory foci processed by polymerase chain reaction (PCR). Seven out of 31 (22.5%) gum samples from selected unquestionably CCP showing different degrees of gingival inflammation revealed T. cruzi-DNA using 3 specific PCR assays. All the included CCP had been diagnosed in previous studies carried out over the last 19 years. Samples of inflamed gums were recently taken from the indicated patients at: an outpatient hospital cardiac unit; a village where Chagas disease is endemic; and a specialized diagnostic research center, showing molecular evidence of parasite persistence in 17.6%, 42.8% and 14.3% of them, respectively. The relatively frequent parasite persistence, demonstrated here in oral inflammatory processes of treated and/or untreated patients bearing long term T. cruzi-infection, suggests the establishment of secondary small foci for the maintenance of hidden or inapparent chagasic infection. The easy and low-risk, non-invasive method to get the sample may add the use of gingival biopsy as a potential alternative diagnostic tool to confirm T. cruzi-infection in CCP. The significance of T. cruzi persistence as a primary cause of chronic Chagas disease and the proposal of this mechanism to explain the pathogenesis in CCP are considered.

Outbreak of Streptococcus equi subsp. zooepidemicus infections in cats

Streptococcus equi subsp. zooepidemicus ( S. zooepidemicus) is a commensal of the mucous membranes and skin of animals, notably equine, and is associated with various infections in animals and humans. Here, we describe an outbreak of respiratory disease in a cattery, which, to the best of our knowledge, is the first report of S. zooepidemicus infection in cats. Clinical disease was characterized firstly by abundant purulent nasal discharges and cough, progressing to sinusitis, dyspnea, symptoms of pneumonia and death. Pathological examination revealed different degrees of inflammation of the lower respiratory tract. S. zooepidemicus was the main bacteria isolated. Sequencing of the V2 fragment of the 16S gene revealed that the isolates were distributed in two previously described genogroups.

MR findings in patients with disabling musculocutaneous chronic graft-versus-host disease

To describe musculocutaneous MR-findings responsible for disability in chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT). Between June 2005 and February 2008, we performed whole-body musculoskeletal magnetic resonance imaging (MRI; n = 12) or regional MRI (n = 4) in 16 consecutive patients presenting with disabling sclerodermatous cGVHD (e.g., skin edema, fixed deep dermal sclerosis, joint contractures, painful muscular contractures, or myalgia). In all patients, MRI showed musculocutaneous abnormalities reflecting different degrees of inflammation and collagen tissue involvement of the skin (n = 10), subcutaneous fat tissue (n = 13), muscle fasciae (n = 16), subfascial muscular septae (n = 6), or findings compatible with myositis (n = 3). The most frequently involved muscle fasciae comprised those of the vastus lateralis muscle (n = 12), biceps femoris muscle (n = 11), gastrocnemius medialis muscle (n = 8), serratus anterior muscle, and latissimus dorsi muscle (each, n = 5). Increased signal of involved tissues on STIR-images and fat-saturated postgadolinium T1-weighted images represented the most frequent MR-signal abnormalities. MR imaging of musculocutaneous cGVHD allows accurate evaluation including assessment of deep tissue infiltration and assists in the differential diagnosis.

Intraperitoneal Cytokine Productions and Their Relationship to Peritoneal Sepsis and Systemic Inflammatory Markers in Patients With Inflammatory Bowel Disease

This prospective, blinded study was designed to assess intraperitoneal cytokine productions and their relationship to clinical presentations and systemic inflammatory markers in patients with inflammatory bowel disease. Fifty patients who required abdominal surgery for active inflammatory bowel disease (ulcerative colitis, 27; and Crohn's disease, 23) were investigated. Interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha levels in intraperitoneal fluid (obtained by intraoperative lavage) and plasma were measured by enzyme-linked immunosorbent assay. To compare intraperitoneal cytokine productions between diseases with a different degree of inflammation, intraperitoneal cytokine measurement also was performed for patients who required surgery for colorectal cancer (n = 25) and acute appendicitis (n = 25). The median intraperitoneal cytokine (interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha) levels were significantly higher in patients with inflammatory bowel disease than in patients with colorectal cancer and acute appendicitis. In patients with inflammatory bowel disease, intraperitoneal cytokine levels were significantly higher in patients with intraperitoneal sepsis (abscess/fistula) than in patients without intraperitoneal sepsis at laparotomy. Intraperitoneal cytokine levels did not correlate with type of disease (ulcerative colitis/Crohn's disease), age, gender, duration of disease before surgery, preoperative medical treatment, and the extent or site of disease. There were no significant correlations between intraperitoneal cytokine levels and the following systemic inflammatory markers: plasma cytokine levels, white blood cell count, platelet count, erythrocyte sedimentation rate, and C-reactive protein levels. Postoperative intraperitoneal septic complications (anastomotic leak/abscess/enterocutaneous fistula) more frequently occurred in patients with higher intraperitoneal cytokine levels. Intraperitoneal cytokine productions were greatly elevated in patients with inflammatory bowel disease, and their levels correlated with the presence of intraperitoneal sepsis at laparotomy and development of postoperative intraperitoneal septic complications. Intraperitoneal cytokine levels showed no correlations with systemic inflammatory markers.

Prospective clinical study of the expression of the cox-2 gene in nasal polyposis

Problem: Nasosinusal polyposis (NP) is an inflammatory disease, with higher incidence in asthmatic patients than nonasthmatic, especially in aspirin-intolerant asthmatics. Corticoids are the first line of treatment of NP. The research objective was to demonstrate the existence of different degrees of inflammation in the NP associated or not with asthma, and its different response to corticoid treatment. Methods: Our sample consisted of 80 patients with NP, 19 of whom were assigned to the control group and 61 to the experimental group. Of the latter group, 22 did not have asthma (NPNA), 21 had tolerable asthma (NP+TA), and 18 had intolerant asthma to acetylsalicylic acid (PN+IA). We performed a clinical evaluation (subjective nasal obstruction, nasal endoscopy, rhinomanometry, and computerized tomography) and experimental evaluation (expression of the Cox-1 and Cox-2 gene) after 4 weeks without corticoid treatment (baseline), after 2 weeks of treatment with oral corticoids (OCC), and 12 weeks of intranasal corticoids (ICC). Results: At week 2 there are significant differences between the study and control groups ( P < 0.001). After treatment with OCC, patients with NP improve clinically and significantly increase the expression of the Cox-2 gene ( P < 0.01). The ICC maintain the clinical improvement ( P < 0.01) but not the increased expression of the Cox-2 gene. The expression of Cox-1 does not present variations, not even after treatment with OCC or ICC. The endoscopic evaluations are correlated with the tomographic grade before (r = 0.51; P < 0.01) and after the treatment (r = 0.6; P < 0.01). Conclusion: We conclude from these results that OCC and ICC are effective with all patients, but to a lesser extent when associated with tolerant or intolerant asthma to acetylsalicylic. Also, nasal endoscopy is at least as useful a technique as the computerized tomography for the follow-up of NP. Significance: The expression of Cox-2 gene changes in patients with NP under OCC treatment but not under ICC. Support: Grant from the Ministry of Health FIS 99–0133. 1999–2001. Project: Nasal poliposi and inflammation.

C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases

Inflammatory processes play a pivotal role in the pathogenesis of atherosclerosis and mediate many of the stages of atheroma development from initial leukocyte recruitment to eventual rupture of the unstable atherosclerotic plaque. C-reactive protein (CRP), an acute phase reactant that reflects different degree of inflammation, has been indicated an independent risk factor in a variety of cardiovascular disease (CVD), especially in unstable coronary syndrome. Our data have showed that increased level of CRP in patients with unstable angina was associated with short-term clinical outcomes, response for conventional therapy, and activation of nuclear factor-kappa B (NF-κB), but it is not correlated to coronary artery stenosis as well as lipid profile. Traditionally, CRP has been thought of as a bystander marker of vascular inflammation, without playing a direct role in the CVD. More recently, accumulating evidence suggest that CRP may have direct proinflammatory effects, which is associated with all stages of atherosclerosis. In our recent study, the results demonstrate that monocytes exhibit an enhanced production of interleukin-6 (IL-6) in response to CRP, and this response is significantly inhibited by simvastatin in a dose-dependent manner. This may be of important interest in the connection between CVD and CRP. Based on those evidence, we hypothesis that CRP is not only an inflammatory marker but also a direct cause of CVD, and treatments that reduce CRP should be benefit for primary and secondary prevention of CVD. Administration of several agents, especially statin has been showed to modify CRP concentrations with a concurrent fall in cardiovascular events. Our clinical investigation suggested that treatment with a single high-dose or a short-term common dose of simvastatin could rapidly reduce CRP level. Those data indicated that the benefit to the vascular endothelium might occur quickly in patients with CVD, which is critical issue for high-risk subgroup. Other interventions, such as lifestyle changes, weight loss, and stop smoking are also warrant attention.

Similar inflammatory response in human whole blood to live Streptococcus pneumoniae of different serotypes

Differences in inflammatory responses in human adult whole blood to live pneumococcal serotypes 3, 7F, 9V and 23F were investigated. Using flow cytometry and ELISA, oxidative burst, expression of activation markers CD11b/CD18, and in-vitro production of tumour necrosis factor-alpha, interleukin-6 (IL-6) and interleukin-8 were measured. There was no significant difference between the serotypes regarding any of the variables investigated, although there was a trend towards higher concentrations of IL-6 induced by serotypes 9V and 23F. In the present experimental model, the serotypes of Streptococcus pneumoniae shown previously to cause different degrees of inflammation were found to cause a similar inflammatory response in human whole blood.

Imaging of sacroiliitis.

Inflammation of one or both sacroiliac joints is a characteristic feature of patients with spondyloarthropathies (SpA). Sacroiliitis often leads to inflammatory back pain (IBP). IBP and asymmetric peripheral arthritis of the lower limbs are the main clinical symptoms and criteria for classification and diagnosis of SpA in which sacroiliac joints are uni- or bilaterally affected with an intensity ranging from mild to very severe inflammation resulting in partial or complete ankylosis Sacroiliitis is a very frequent feature of undifferntiated SpA. In ankylosing spondylitis (AS) inflammation in the axial skeleton occurs rarely in the absence of sacroiliitis. Objective evidence of sacroiliitis obtained by imaging procedures, especially x-rays, has always been part of diagnostic and classification criteria for AS. This is in contrast to spinal radiography which, however, has been recently included in a core set of outcome items to be assessed in clinical studies. In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs -- which are known to have considerable intra- and interobserver variability -- may be normal. Since IBP is not a specific indicator of sacroiliitis there is need for valuable imaging techniques. Scintigraphy lacks specificity. Computed tomography (CT) is a very good method to demonstrate already established bony changes and magnetic resonance imaging (MRI) has the advantage of combining a good visualisation of the complicated anatomy of the sacroiliac joint with the ability to localise different degrees of inflammation and oedema and prove a possible spread to muscles as it occurs in septic sacroiliitis, an important differential diagnosis.

Inflammation of the abdominal aortic aneurysm wall

Inflammation and fibrosis do not only appear in an "inflammatory" aneurysm, but also in "ordinary" abdominal aortic aneurysms. In this study inflammatory changes in 130 abdominal aortic aneurysms were studied and related to patients' clinical records. According to histopathological criteria five different degrees of inflammation (Histological Inflammation Scale of Aneurysms) were found and patients were classified according to these criteria: grade A or mixed acute/chronic inflammation (4.5%); grade 0 or no inflammation (16.2%); grade 1 or mild chronic (57.7%); grade 2 or moderate chronic (16.2%); and grade 3 or severe chronic inflammation (5.4%) corresponding to an "inflammatory" aneurysm. Patients with grade 3 or an "inflammatory" aneurysm were younger (p = 0.013), were all symptomatic (p = 0.02), showed no associated iliac or femoral aneurysms (p = 0.03), were only recognised peroperatively and had elevated erythrocyte sedimentation rates (p = 0.0002). No other differences could be demonstrated between sex, risk factors, cardiovascular diseases, previous abdominal operations, bacterial culture, aneurysm diameter, white blood count, cholesterol level in-hospital mortality when compared to the degree of inflammation.

A Proposito di Tre Casi di Pielonefrite Multifocale Ascessualizzata: Diagnosi ed Evoluzione

Renal bacterial infection spans a continuum of severity from uncomplicated acute pyelonephritis to frank abscess formation. It can be a multi-focal process, with different portions of the kidney exhibiting different degrees of inflammation. The radiologic diagnosis of acute renal infections is based upon IVU, US and CT. In this investigation, the contribution of IVU, US and CT is evaluated in 3 patients with acute multifocal pyelonephritis and renal abscesses. The lack of specificity of IVU and the high false negative rate of US make them unsatisfactory diagnostic tools for patients clinically suspected of having multifocal pyelonephritis or renal abscess. CT is more sensitive for the detection of acute renal inflammatory diseases and for defining the extent of disease, thereby helping programme early and accurate therapy.

Experimental colonic inflammation and ulceration. Permeation of a water-soluble contrast medium as a measure of 'disease' activity.

The aim of this study was to investigate the permeation of an isosmolar water-soluble X-ray contrast medium (CM) from the unperforated colon after experimental induction of inflammation and ulceration. One hundred and sixty-five male rats were included. In 110 rats 0.25 ml of 40% ethanol + 15 mg or 30 mg trinitrobenzene (TNB) was instilled into the colon, 7-9 cm proximal to the anus, inducing different degrees of inflammation. Fifty-five rats served as controls and had 0.25 ml saline instilled with the same procedure. At 7, 14, 21, and 28 days 3 ml of the non-ionic CM iodixanol was applied as an enema, and subsequently all urine was collected for the next 4 h. High-performance liquid chromatography analyses of the urine showed a positive relation between the severity of inflammation/ulceration in the colonic wall as assessed by a macroscopic damage score and the amount of CM excreted in the urine. Water-soluble contrast media may have prospects of combining functional tests of intestinal membrane dysfunction with segmental exposure control.

Bronchiolitis obliterans organizing pneumonia: CT features in 14 patients.

Bronchiolitis obliterans organizing pneumonia is a disease characterized by the presence of granulation tissue within small airways and the presence of areas of organizing pneumonia. We retrospectively reviewed the chest radiographs, CT scans, and biopsy specimens in 14 consecutive patients with proved bronchiolitis obliterans organizing pneumonia. Six patients were immunocompromised because of leukemia or bone-marrow transplantation. In all patients, 10-mm collimation CT scans were available. In 11 of the 14 patients, select 1.5-mm scans were obtained. The CT findings included patchy unilateral (n = 1) or bilateral air-space consolidation (n = 9), small nodular opacities (n = 7), irregular linear opacities (n = 2), bronchial wall thickening and dilatation (n = 6), and small pleural effusions (n = 4). All patients had areas of air-space consolidation, small nodules, or both. A predominantly subpleural distribution of the air-space consolidation was apparent on the radiographs of two patients and on CT scans of six. Pathologically, the nodules and the consolidation represented different degrees of inflammation in bronchioles, alveolar ducts, and alveoli. Although most of the findings were apparent on the radiographs, the CT scans depicted the anatomic distribution and extent of bronchiolitis obliterans organizing pneumonia more accurately than did the plain chest radiographs.