Immunitat und Infektion最新文献

CD4+ T cells play a central role in the development of the immediate-type allergic response. It was shown that T cells from allergic patients exhibit an imbalance on the level of cytokine production which is characterized by increased IL-4- and decreased IFN-gamma production. Different strategies were developed to therapeutically interfere on various levels of the immunological dysregulation. In this article, the use of the immunomodulatory and immunosuppressive drugs methotrexate, cyclosporine, and intravenous immunoglobulin (IVIG) will be discussed. Furthermore, new experimental therapeutic approaches will be presented which are aimed to selectively interfere on the level of cytokine production and regulation. A different approach targets the functional activity of allergen-specific T cells whose functions could be modulated in an animal model system by subcutaneous treatment with peptides.

Allergenic source material consists of a great number of single components of which only a small number is IgE-reactive. Since allergenic source material is the basis of diagnostics and immunotherapy, there is a strong interest in identification, characterization and quantification of allergens. A further reason of interest is to explain the pathomechanism of the type I allergy. The structure of allergens is of central importance, because only a small number of antigens are allergens and the structure of these components is essential in giving rise to symptoms. The process and further prospects of molecular characterization of allergens are described and grass pollen allergens are used as paradigm. Allergies are an excellent model to study the meaning of specificity in immunologic disorders.

In all patients with fever after returning from tropical countries malaria must be excluded. Amebic liver abscess is an important differential diagnosis, especially in patients with pain in the right epigastrium. In all patients with diarrhea after returning from tropical countries amebic colitis is an important differential diagnosis. The diagnosis of malaria is based on microscopical demonstration of the parasite in blood slides. In patients with Plasmodium falciparum malaria the extent of organ complications has to be checked. The diagnosis of intestinal amebiasis rests on parasitological stool examination. Amebic liver abscess is diagnosed by demonstration of the liver abscess in imaging techniques and verification by finding specific antibodies.

In a study it was investigated to what extent the early pregnancy factor, the placental proteins 12 and 14 and tumor necrosis factor alpha are suited to control and select patients with habitual abortions for immunotherapy. Immunotherapy shows good clinical results. Placental protein 12 ist not suited for selecting patients. Placental protein 14 shows typical changes after the application of polyvalent immunoglobulin and could be an important prognostic factor. Tumor necrosis factor alpha seems to be useful for selecting patients for immunotherapy, because in cases of habitual abortions this factor can be a sign for immunological causes. In the late phase of pregnancy, early pregnancy factor is also an indicator for disturbances of pregnancy.

New findings on the molecular biology of plasmodia have led to new approaches for the development of chemotherapeutics. Trials to circumvent the relative toxicity of individual substances by a combination of active agents have been successful in several cases, and there will be more of those combinations in the future. An additional advantage of combinations can be the improvement of activity. In some cases, antiparasitic side effects of long known drugs with low toxicity such as imipramine can be used to decrease or overcome resistance. And, last but not least, ideas or in some cases new drugs will come from the traditional medicine.

Stimulation of the immune response could be obtained in outpatients with inoperable locally advanced or metastasizing gastrointestinal tumors (n = 56), who were palliatively treated with cyclophosphamide (cy), 350 mg/m2 i.v., thymostimulin, echinacin i.m. and in part additionally with epirubicin, 15 mg/m2 i.v. At present, outpatients with pancreatic (n = 7) or colon carcinomas (n = 1) receive interleukin 2 (IL-2) intralesionally, 2 x 10(5) Cetus units (CU), days 3, 5 and 7 after cy, and by portable continuous infusion systems i.v., 3 x 10(5) CU/day, days 3-8 after cy. Subsets of lymphocytes slightly decreased in the patients' peripheral blood, recall antigen reactivity slightly increased. Patients' mean survival time was 5.7 +/- 1.7 months.

Treatment of malaria depends on the infecting Plasmodium species. In Plasmodium falciparum malaria the treatment also depends on whether chloroquine resistances occur and whether the course is uncomplicated or complicated. Uncomplicated cases are cared for with chloroquine and with mefloquine or halofantrine when the patient comes from areas with chloroquine resistances. Patients with complicated Plasmodium falciparum malaria must get chinine and doxycycline. A careful fluid balance is extremely important in order to prevent noncardiac pulmonary edemas. Luminal infections with pathogenic Entamoeba histolytica are treated with diloxanide furoate, luminal infections with non-pathogenic Entamoeba histolytica (= E. dispar) do not have to be treated. If differentiation is not possible, all asymptomatic cyst passers must get treatment. Patients with invasive amebiasis (amebic colitis and amebic liver abscess) have to be treated with metronidazole, followed by diloxanide furoate.