Prova da esporotriquina. Contribuição para seu estudo

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Abstract
It is the author's purpose in this paper to help lead to a wider appreciation of the "immuno-allergy" SPOROTRICHIN test, by the study of two types of antigens in various concentrations. Following the preliminary investigation of LACAZ et a.l (1953), the author studied two antigens in greater detail: the first a suspension of the yeast-like elements of the Sporotrichum schencki; the second, an antigen rich in polysaccharides obtained from the same fungus, cultured at 37° with the FRANCIS and SABOURAUD media, extracted by autoc1aving a suspension of Sporotrichum schencki, yeast like type according to the technique of NORDÉN (1951) modified by FAVA NETTO (1955) for the extraction of the polysaccharides of Paracoccidioides brasiliensis. In the preface and introduction, reasons are given for the belief that the matter is an important one in both its theoretical and practical aspects. From the practical point of view it is necessary to know the exact validity of the Sporotrichin test as a diagnostic method, From the theoretical view point it is hoped to lead to a better understanding of the immuno-allergy of this mycosis, especially that aspect dealing with the possible existence of an "sporotrichosis infection" which, once proved, would put the Sporotrichin test in the same category as the other intradermal tests used for certain deep mycosis such as histoplasmosis and coccidioidomycosis. After reviewing the literature of the subject it was felt that further studies were required to lead to a better evaluation of this reaction. In the second chapter the antigen at present in use are investigated. That obtained from the suspension of Sporotrichum schencki in its yeast like phase was standardized by spectroscopy in 3 different concentrations; the polysaccharide antigen was extracted from the original substances with acetone and ether and later by autoclaving at 120°. The extract thus obtained was diluted to 1/100, 1/500 and 1/1000 and used as the antigen in the reaction, Tests were not made using filtered Sporotrichin because of the difficulty of standardizing such an antigen. The technique of the test is described, it is that normally used for skin tests, and also the criteria employed in reading the reaction. These were those proposed by the Department of Health, Education and Welfare of Public Health Service (1954) for histoplasmosis. Positive results were divided into groups one, two, three, or four to give the reader an idea of the degree of positivity obtained. The method used to study the histopathology of the reaction is described. Both types of antigen (N 2 and P 1) are injected into patients with sporotrichosis and biopsies performed, under local anesthesic with ethyl chloride at different lengths of time to give an idea of the sequence of events taking place in the histopathology. The skin biopsies were fixed in 10% formalin embedded in paraffin and sectioned 5 to 6 micra thick, using hematoxylin and eosin as stain. When it was thought advisable, sections were made and stained by other methods, periodic acid-Schiff and cresyl violet. Table IV shows the distribution of patients, in whom biopsies were made, of the reaction to antigen N 2 to the time between the injection of the antigen and the removal of the skin fragment; in Table V the same data are given for antigen P 1. Chapter III sets out the results obtained in various patients which were distributed in the following manner: (a) Paciente with sporotrichosis (both active and past cases). These consisted of five groups, i. e.:1st. group (18 cases) patients with active sporotrichosis who were tested with sporotrichin N 1, N 2 and N 3. A positive reaction was obtained with all of these (Table VI). A greater number of strongly positive reactions was obtained with antigens N 1 than N 2 and N 3, the result which would be expected. In a similar manner there were a greater number of strong positive with N 2 than N 3.2nd. group (21 cases) patients with active sporotrichosis who were tested with sporotrichin N 2 and N 3. As in the former group, the test was positive in every case receiving antigen N 2; one case receiving N 3 was negative.3rd. group (26 cases) patients with active sporotrichosis who were tested with sporotrichin N 2. A positive reaction was given by 25 of the 26 cases tested. Taking the three groups together it can be seen that of those individual with active sporotrichosis who were given the sporotrichin test, using antigen N 2, 64 out of 65 gave a positive result (98.46%).4th. group (23 cases) patients with active sporotrichosis who as well as being tested with sporotrichin N 2 were also tested with the polysaccharide antigen obtained from cultures of Sporotrichum schencki by the above mentioned method. This later antigen was diluted to 1/100 (P 1), 1/500 (P 2) and 1/1000 (P 3) and injected intradermally. With antigen P 1, 21 positive results were obtained (91. 30%) and 2 negative results: with P 2, 19 positives (82.6 %) and 4 negatives ; with P 3, 13 negatives and 10 positives (43.47%).5th. group (5 cases) patients in whom the sporotrichin test was made after a clinical cure of the disease. The time elapsed since the cure varied between 3 months and 7 years. The test was positive in all 5 cases with antigens N 2, P 1 and P. 2. With antigen P 3 a positive test was obtained in 3 cases and a negative in 2.(b) Patients with other mycosisTwenty five patients were studied, 23 with active disease and 2 cured cases. ln all of these the test was performed with antigens N 1 and N 2 and in 22 cases with P 1, P 2 and P 3 in addition. A positive result was obtained with the N antigens in one case of Tinea corporis (Nr. 23), in one of blastomycosis with N 1 (but negative with N 2); a positive with both N 1 and N 2 was given by 2 cases of blastomycosis and 2 of Tinea pedis with "id" (Nrs, 82, 87), (N 1 - 24% and N 2 - 16 positives in this group). With antigen P the following positive results were obtained: one case...

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