Detection of antibodies to Candida albicans germ tubes for diagnosis and therapeutic monitoring of invasive candidiasis in patients with hematologic malignancies.

We prospectively investigated the ability of detection of antibodies to Candida albicans germ tubes (CAGT) to diagnose invasive candidiasis in 95 consecutive admissions of 73 patients with hematologic disorders undergoing intensive chemotherapy. The episodes were divided into three groups according to clinical and microbiological diagnosis. Group 1 comprised eight admissions of eight patients with invasive candidiasis. Group 2 comprised 42 admissions of 34 patients without evidence of invasive candidiasis. Group 3 comprised the remaining 45 admissions of 37 patients with febrile episodes which were not diagnosed by microbiological culture. Antibodies to CAGT were detected in 87.5% of group 1 patients. Detection of antibodies to CAGT in patients with Candida fungemia was delayed somewhat relative to the time the blood culture was positive, but antibodies to CAGT were detected earlier than a diagnosis was made in patients with deep-tissue candidiasis. Sera from 2 admissions in group 2 and 12 admissions in group 3 revealed antibodies to CAGT. At a titer of > or = 1:20, detection of antibodies to CAGT had a sensitivity of 87.5%, specificity of 95.2%, positive predictive value of 77.8%, and negative predictive value of 97.6%. Antibodies to CAGT were usually detected before beginning of empiric antifungal therapy. Titers of antibodies to CAGT were maintained in most patients who died but declined and eventually disappeared in the patients who survived. Since antibodies to CAGT were detected in all patients with tissue-proven invasive candidiasis but negative by blood culture, detection of antibodies to CAGT complemented blood cultures for diagnosis and therapeutic monitoring of patients with hematologic malignancies and invasive candidiasis.     

Clinical and genetic characteristics of diabetic patients with high-titer (>10,000 U/ml) of antibodies to glutamic acid decarboxylase

We investigated the clinical aspects and genetic background of 13 diabetic patients with high-titers (>10,000 U/ml) of anti-glutamic acid decarboxylase antibody (Group A) and compared these 28 middle-aged (35-51 years, Group B) and 13 elderly (66-79 years, Group C) patients with anti-GAD(+) (<1100 U/ml) who were diagnosed initially as having type 2 diabetes. The mean age and mean age at onset of Group A were 70.8 +/- 3.9 years (range, 64-78) and 50.4 +/- 5.4 years (range, 43-61), respectively. In Group A, the prevalence of insulin-deficient patients was significantly lower (30.8%, 4 of 13) than in Group C (96.3%, 27 of 28, P < 0.001). Patients in Group A had a significantly longer interval between the clinical onset of diabetes to initiation insulin therapy (21.8 +/- 2.3 years) compared to patients in both Group B (1.8+/-1.1 years, P < 0.001) and Group C (14.8 +/- 7.1 years, P = 0.049). The frequency of DRB1*0405-DQB1*0401/DRB1*1502-DQB1*0601 or DRB*1501-DQB*0602 heterozygous genotypes in Group A (53.8%, 7 of 13) was significantly higher than in both Group B (3.6%, 1 of 28, P < 0.01) and Group C (7.7%, 1 of 13, P < 0.05). Compared with Group B, Group A had an increased frequency of the TNFA-U01 haplotype and the IL-10 -592 C allele (TNFA-U01; 53.8% versus 30.4%, P = 0.05 and IL-10 -592 C; 57.7% versus 33.9 %, P = 0.042). All sera from Group A reacted with GAD(65) protein on Western blots. We conclude that adult-onset diabetic patients with a high-titer of anti-GDAab differ from patients with latent autoimmune diabetes mellitus in adult (LADA) with respect to beta-cell function, cellular autoimmunity and genetic background. Our study also showed that high-titers of antibodies to glutamic acid decarboxylase (anti-GADab) were not predictive of later development of insulin deficiency in adult and/or elderly patients with type 2 diabetes. Furthermore, our results suggest that HLA-DRB1*1502-DQB1*0601 or DRB1*1501-DQB1*0602/DRB1*0405-DQB1*0401 heterozygous genotypes may be associated with high production of anti-GADab that recognizes the linear epitope(s) on the GAD(65) protein.     

复发性外阴阴道假丝酵母菌病局部病因调查及治疗

目的 调查复发性外阴阴道假丝酵母菌病(RVVC)的局部病因及探讨其合理有效的治疗方案.方法 选择158例确诊为RVVC的患者,常规行肛周分泌物及性伴侣龟头分泌物真菌培养,另50例非阴道病患者同时行肛周分泌物真菌培养作为对照.158例研究病例随机分3组,A组:口服易启康(依曲康唑)0.1 g,每天2次,连服7 d为一疗程.B组:口服易启康+克霉唑栓0.15 g阴道上药每天1次,共10d为一疗程.C组:在B组基础上再进行维持治疗,克霉唑栓0.15 g阴道上药,每隔3d1次,共3次.3组均每次月经干净后3 d开始重复治疗,连续6个疗程.性伴侣龟头分泌物真菌培养阳性者同时口服抗真菌药物治疗.治疗完成后第4、8、12、24周分别进行临床及真菌观察评定疗效.结果 158例患者肛周分泌物真菌培养阳性率100%(158/158);50例非阴道病患者肛周分泌物真菌培养阳性率8%(4/50),两者差异有统计学意义(P＜0.05).158例性伴侣中有18例有包皮过长或龟头炎,这18例性伴侣其龟头分泌物真菌培养阳性率100%(18/18),另140例性伴侣无龟头炎或包皮过长者,其龟头分泌物真菌培养阳性率为1.43%(2/140),两者差异有统计学意义(P＜0.05).3组治疗4周后有效率差异无统计学意义(P＞0.05);治疗8周后A组有效率显著低于B、C组,差异有统计学意义(P＜0.01);24周后A组复发率显著高于B、C组,差异有统计学意义(P＜0.01).结论 消化道真菌感染可能是RVVC反复发作的病因之一;性伴侣有包皮过长或龟头炎时需同时治疗;小剂量、长时间口服易启康及口服加阴道用药治疗RVVC近期4周内均有较好疗效,但联合用药远期疗效优于单纯口服用药.     

Comparison of outer membrane protein subtypes of Haemophilus influenzae type b isolates from healthy children in the general population and from diseased patients.

Over a 12-month period we obtained throat cultures from 1,448 children less than 5 years of age attending well-child clinics and identified 24 carriers of Haemophilus influenzae type b (1.7%). The outer membrane protein subtypes of the strains from the carriers were compared to the subtypes of isolates from 50 patients with Haemophilus type b disease hospitalized in St. Louis, Mo., during the same period (1981 to 1982), and the latter were compared to the subtypes of isolates from 51 patients hospitalized between 1977 and 1980. There were no significant differences in the frequencies of the five most common subtypes (1L, 1H, 2L, 2H, and 3L), comparing isolates from the carriers to those from the patients. However, 5 of the 24 throat isolates had the unusual 13L subtype compared with only 1 of the 50 invasive isolates (P = 0.02). The lower frequency of 13L strains among the invasive isolates suggests that type b isolates with this subtype may be less pathogenic than type b isolates with other subtypes. Subtype 2L strains accounted for only 2% of recent cerebrospinal fluid or blood isolates, compared with 22% of those from 1977 to 1980 (P = 0.02). Subtype 1H and 3L strains together accounted for 73%, compared with 47% of the earlier ones (P = 0.02). Thus, temporal shifts may also occur in the subtype distribution of Haemophilus type b strains causing invasive disease in a community.     

Risk factors of hepatitis C virus-related liver cirrhosis in young adults: positive family history of liver disease and transporter associated with antigen processing 2(TAP2)*0201 Allele

The aim of this study was to clinically characterize young patients with hepatitis-C-related cirrhosis. We compared 27 patients with liver cirrhosis (Group LC) who were anti-HCV positive, aged 40 years or less at the time of diagnosis, with 323 consecutive patients with HCV-related chronic hepatitis (Group CH) matched for age and gender. Furthermore, Group LC was divided into two arbitrary groups (29-35 years, n = 8 /36-40 years, n = 19), based on the age of patients at the time of diagnosis of liver cirrhosis. Patients' characteristics and family history were investigated, and the frequency of transporter associated with antigen processing 2 (TAP2) was determined. A family history of liver disease was present in 40.7% of Group LC but in 18.0% of Group CH (P < 0.05). The younger the age of diagnosis of cirrhosis in Group LC, the higher the frequency of a positive family history (29-35 years, 87.5%; 36-40 years, 21.1%, P < 0.05). The frequency of TAP2*0201 was significantly higher in young adult patients with HCV-related liver cirrhosis than in HCV carriers with normal ALT (P < 0.05), and tended to be higher than in uninfected normal subjects (P = 0.05). The cumulative survival rate of cirrhosis patients with family history of liver diseases was significantly lower than that of cirrhosis patients without such history (P < 0.05). Our findings suggest that a positive family history of liver disease and TAP2*0201 polymorphism may be risk factors for HCV-related liver cirrhosis in young adults.     

Characterization of the binucleated giant cells generated in the autologous mixed leucocyte reaction from patients with rheumatoid arthritis.

Binucleated giant cells several times larger than lymphocytes or monocytes were generated in an autologous mixed leucocyte reaction (AMLR) independent of DNA synthesis in patients with rheumatoid arthritis (RA). The AMLR giant cells with multiple cytoplasmic granules were non-specific esterase-staining positive, phagocytic, non-adherent, HLA-DR+, CD11b+, CD14+, 4F2+, CDW29+, and anti-transferrin receptor positive, but negative for T, B, or NK markers. RA patients aged less than 60 years from more giant cells: 12.6 +/- 13.5% (n = 33) as compared with 0.4 +/- 1.5% in age- and sex-matched normals (n = 38, (P less than 0.001). More giant cells were seen over age 60 in both groups: RA 20.1 +/- 15.5% (n = 5) and healthy controls 3.0 +/- 3.2% (n = 8) (P less than 0.01). Neither disease activity nor treatment appear to influence the result in RA. The giant cells that are probably derived from monocytes in AMLR may explain the formation of the giant cells in rheumatoid granulation tissues.     

External quality assessment of patient HLA‐B*57:01 testing prior to abacavir prescription

Hypersensitivity reactions to the drug abacavir are strongly associated with possession of HLA‐B*57:01. Hence, patients with HIV/AIDS who may be prescribed abacavir should be tested for this HLA allele and the drug withheld from those that possess B*57:01. The UK National External Quality Assessment Service for Histocompatibility and Immunogenetics has operated a scheme for B*57:01 testing since 2008 which, in 2013, involved 47 participants from 12 countries. A total of 24 B*57:01‐positive, 2 B*57:03‐positive and 22 B*57‐negative blood samples (including 2 B*58 samples) were distributed to between 28 and 47 laboratories each year over 6 years. Participants, who were unaware of the samples' HLA types, tested and reported on their B*57/B*57:01 status. A total of 1868 reports were assessed over the 6 years. Of the 880 reports on B*57:01 samples, 93.4% were correctly assigned as B*57:01, 2.8% were assigned as groups of B*57 alleles including B*57:01, and 3.3% were reported as B*57 positive only. Over the 6 years, there were four (0.46%) false B*57:01 negative reports. All the B*57:03‐positive and B*57‐negative samples, involving 72 and 916 assignments, respectively, were essentially reported as B*57:01 negative. Thus, there were no false B57:01 positive assignments. The reporting of B*57:01 status over the last 3 years of the scheme was 99.8% sensitive and 100% specific. Over the last year, it was 100% sensitive and 100% specific.     

比较α-干扰素不同联合治疗方案对儿童HBeAg阳性慢性乙型肝炎的疗效

目的评估两种不同的α-干扰素联合治疗对儿童HBeAg阳性慢性乙型肝炎的临床疗效。方法选择HBeAg阳性慢性乙型肝炎儿童120例,随机分为3组,每组各40例:第1组(A组)为α-干扰素(IFN-α)组;第2组(B组)为IFN-α 拉米夫定(LAM)组。第3组(C组)为α-干扰素(IFN-α) 乙肝疫苗组。其中干扰素疗程6个月,拉米夫定疗程6个月,所有病例均观察至12个月。结果治疗结束时丙氨酸转氨酶(ALT)复常率3组无差异。治疗6个月和12个月时B组HBeAg阴转率和HBV DNA的阴转率明显高于A组和B组,差异有统计学意义(P<0.05)。结论α-干扰素与拉米夫定联合治疗对HBeAg阳性慢性乙型肝炎儿童的病毒学应答(VR)疗效明显优于单用α-干扰素组和α-干扰素 乙肝疫苗组。     

Diagnosis of invasive pneumococcal infection by serotype-specific urinary antigen detection

Widespread use of conjugate pneumococcal polysaccharide-protein vaccines may alter the spectrum of pneumococci producing invasive disease. Novel sensitive diagnostic methods would be valuable for monitoring the epidemiology of pneumococcal disease within populations and vaccine recipients. Ideally, these methods should allow determination of the serotype of the infecting clone. Serotype-specific enzyme-linked immunosorbent assays (ELISA) for 13 capsular polysaccharides (types 1, 3, 4, 5, 6A, 6B, 7A, 9 V, 14, 18C, 19 A, 19F, and 23 F) were developed. Experiments with pure capsular polysaccharide demonstrated that the assays were sensitive (0.01 to 1.0 ng/ml) and specific. These assays were used to detect capsular polysaccharide in urine from 263 adult patients with proven (blood culture-positive) invasive pneumococcal disease and pneumonia of unknown etiology and from patients with positive blood cultures yielding bacteria other than pneumococci (control group). Among 76 patients with invasive pneumococcal disease from whom blood culture isolates had been serotyped, 62 (82%) had infections with pneumococci of serotypes represented in the ELISA panel. Capsular antigen matching the serotype of the blood culture isolate was detected in the urine of 52 of these patients, giving a sensitivity of 83.9% for the target serotypes. The tests were significantly more sensitive for urine from patients with pneumococcal pneumonia (89.8%) than for urine from patients with non-pneumonic invasive infection (61.5%; P<0.05). Data from the control group indicated a specificity of 98.8%. These assays should prove valuable in epidemiological investigation of invasive pneumococcal infection in adults, particularly if combined with a sensitive C-polysaccharide detection assay to screen for positive samples.     

~(131)I治疗Graves’病后发生甲低与TGA,TMA及TRAb的关系

目的 :从甲状腺自身免疫方面探讨1 3 1 I治疗甲亢的效果及甲低发生的因素。方法 :选择1 3 1 I治疗的88例Graves’病甲亢患者随访 3年 ,分为第 1组 (TGA、TMA、TRAb均阳性 )和第二组 (TGA、TMA阴性 ,TRAb阳性 )。采用x2 分析自身抗体水平与甲低发生的关系。结果 :1组甲低发生率为 31 4 % ,2组为 3 8% ,1组明显高于 2组 ,差异有显著性。结论 :TGA、TMA和TRAb水平与确定1 3 1 I剂量及甲低的发生关系密切。认为TGA、TMA水平高的患者应酌情减少1 3 1 I用量     

131I治疗Graves'病后发生甲低与TGA,TMA及TRAb的关系

目的：从甲状腺自身免疫方面探讨^131Ⅰ治疗甲亢的效果及甲低发生的因素。方法：选择^131Ⅰ治疗的88例Graves’病甲亢患者随访3年，分为第1组(TGA、TMA、TRAb均阳性)和第二组(TGA、TMA阴性，TRAb阳性)。采用x^2分析自身抗体水平与甲低发生的关系。结果：1组甲低发生率为31．4％，2组为3．8％，1组明显高于2组，差异有显著性。结论：TGA、TMA和TRAb水平与确定^131Ⅰ剂量及甲低的发生关系密切。认为TGA、TMA水平高的患者应酌情减少^131Ⅰ用量。     

复发性外阴阴道假丝酵母菌病局部病因调查及治疗

目的调查复发性外阴阴道假丝酵母菌病(RVVC)的局部病因及探讨其合理有效的治疗方案。方法选择158例确诊为RVVC的患者,常规行肛周分泌物及性伴侣龟头分泌物真菌培养,另50例非阴道病患者同时行肛周分泌物真菌培养作为对照。158例研究病例随机分3组,A组:口服易启康(依曲康唑)0.1g,每天2次,连服7d为一疗程。B组:口服易启康 克霉唑栓0.15g阴道上药每天1次,共10d为一疗程。C组:在B组基础上再进行维持治疗,克霉唑栓0.15g阴道上药,每隔3d 1次,共3次。3组均每次月经干净后3d开始重复治疗,连续6个疗程。性伴侣龟头分泌物真菌培养阳性者同时口服抗真菌药物治疗。治疗完成后第4、8、12、24周分别进行临床及真菌观察评定疗效。结果158例患者肛周分泌物真菌培养阳性率100%(158/158);50例非阴道病患者肛周分泌物真菌培养阳性率8%(4/50),两者差异有统计学意义(P<0.05)。158例性伴侣中有18例有包皮过长或龟头炎,这18例性伴侣其龟头分泌物真菌培养阳性率100%(18/18),另140例性伴侣无龟头炎或包皮过长者,其龟头分泌物真菌培养阳性率为1.43%(2/140),两者差异有统计学意义(P<0.05)。3组治疗4周后有效率差异无统计学意义(P>0.05);治疗8周后A组有效率显著低于B、C组,差异有统计学意义(P<0.01);24周后A组复发率显著高于B、C组,差异有统计学意义(P<0.01)。结论消化道真菌感染可能是RVVC反复发作的病因之一;性伴侣有包皮过长或龟头炎时需同时治疗;小剂量、长时间口服易启康及口服加阴道用药治疗RVVC近期4周内均有较好疗效,但联合用药远期疗效优于单纯口服用药。     

Impact of screening donor blood for alanine aminotransferase and antibody to hepatitis B core antigen on the risk of hepatitis C virus transmission

The transfusion-related risk of transmission of hepatitis C virus (HCV) was evaluated in France for the periods before and after exclusion of donor blood units with the surrogate markers elevated alanine aminotransferase (ALT) levels and antibody to hepatitis B core antigen (anti-HBc). A total of 1,412 blood recipients undergoing surgery were followed up prospectively in the period from 1986 to 1989. The stored serum samples were tested for antibodies to HCV by an enzyme immunoassay (EIA) and the result in reactive sera confirmed by a recombinant immunoblot assay (RIBA). The risk of HCV transmission was estimated by the maximum likelihood method for a subpopulation of 892 recipients divided into three groups. Of 55 (3.9 %) EIA positive patients, 56.4 % were found to be positive prior to transfusion. HCV seroconversion (positive RIBA) occurred in 22 patients (1.6 %). The risk of HCV transmission per 1,000 transfused blood units decreased significantly from 4.11 in Group 1 (receiving non-screened blood) to 3.43 in Group II (receiving ALT screened blood) and to 1.40 in Group III (receiving ALT and anti-HBc screened blood). These results demonstrate that screening of donors for surrogate markers had reduced the risk of HCV transmission before the introduction of a systematic anti-HCV screening policy in France in March 1990.     

Decreased levels of CD54 (ICAM-1)-positive lymphocytes in the peripheral blood in untreated patients with active juvenile dermatomyositis

Significant abnormalities are observed in the peripheral blood of juvenile dermatomyositis (JDM) patients with active disease. In this study, we confirm that there is a significant increase in the relative percentage of B lymphocytes in the peripheral blood of a group of untreated children with newly diagnosed active JDM compared to healthy children (P < 0.0001). In order to investigate if properties intrinsic to B cells contributed to their relative increase in JDM, the percentage of B cells expressing activation markers (CD23, CD25, CD54, and CD69) was measured and compared to pediatric controls. Compared to healthy children less than 10 years of age (not significantly different from the JDM group), the JDM patients had an increase in the proportion of lymphocytes expressing CD19 (B cells; P = 0.0017) and decreases in the percentage of lymphocytes that were CD3(-) CD16(+) and/or CD56(+) (NK cells; P = 0. 01) and CD3(+) CD8(+) (T suppressor/cytotoxic cells; P = 0.02). There were no significant differences in any of the B-cell activation markers assessed. Of note, the percentage of CD54(+) non-B lymphocytes (i.e., T cells and NK cells expressing CD54) was significantly lower in the JDM patients (25% +/- 5%) than in the "age-related" healthy control group (43% +/- 4%; P = 0.013). These results suggest the following for untreated children with active JDM: (i) the increase in the percentage of peripheral blood B cells is not due to intrinsic B-cell activation, and (ii) CD54/ICAM-1(+) non-B cells, CD8(+) T cells, and NK cells are being removed from circulation and may be participating in the pathophysiology of the disease.     

High IFN-gamma production by CD8+ T cells and early sensitization among infants at high risk of atopy

BACKGROUND: High genetic risk (HR) of atopy among unstratified populations of infants is associated with attenuated IFN-gamma responses. However, the role of IFN-gamma in progression from HR status to active disease is less clear. OBJECTIVE: To identify immune function markers in neonates with HR that are associated with positive atopic outcomes at 2 years. METHODS: Cord blood mononuclear cells (CBMCs) were collected from 175 children with HR and cryopreserved. The children were assessed for atopy by skin prick at 0.5 and 2 years. CBMCs were thawed and stimulated with allergens and mitogens PHA and staphylococcal enterotoxin B (SEB), and cytokine responses were determined. RESULTS: No correlations were observed between allergen-specific CBMC responses and atopic outcomes. In contrast, sensitization was strongly associated with polyclonal IFN-gamma responses to both PHA (P=.002) and SEB (P=.005), and also with SEB-induced IL-5 (P =.05), IL-10 (P =.02), and IL-13 (P =.01). Logistic regression analysis identified elevated PHA-induced IFN-gamma and SEB-induced IL-13 responses as the strongest independent predictors of atopy development. Cell separation studies confirmed CD8+ T cells as the source of approximately 90% of IFN-gamma production. CONCLUSIONS: IFN-gamma produced by CD8+ T cells may synergize with T(H)2 cytokines in driving atopy development in children with HR.     

Culture of Bartonella quintana and Bartonella henselae from Human Samples: a 5-Year Experience (1993 to 1998)

Bartonella quintana and Bartonella henselae are fastidious gram-negative bacteria responsible for bacillary angiomatosis, trench fever, cat scratch disease, and endocarditis. During a 5-year period, we received 2,043 samples for culture of Bartonella sp. We found Bartonella sp. to be the etiologic agent in 38 cases of endocarditis, 78 cases of cat scratch disease, 16 cases of bacteremia in homeless people, and 7 cases of bacillary angiomatosis. We correlated the results of positive cultures with the clinical form of the disease, type of sample, culture procedure, PCR-based genomic detection, and antibody determination. Seventy-two isolates of B. quintana and nine isolates of B. henselae from 43 patients were obtained. Sixty-three of the B. quintana isolates and two of the B. henselae isolates, obtained from patients with no prior antibiotic therapy, were stably subcultured. The sensitivity of culture was low when compared with that of PCR-based detection methods in valves of patients with endocarditis (44 and 81%, respectively), skin biopsy samples of patients with bacillary angiomatosis (43 and 100%, respectively), and lymph nodes of cat scratch disease (13 and 30%, respectively). Serological diagnosis was also more sensitive in cases of endocarditis (97%) and cat scratch disease (90%). Among endocarditis patients, the sensitivity of the shell vial culture assay was 28% when inoculated with blood samples and 44% when inoculated with valvular biopsy samples, and the sensitivity of both was significantly higher than that of culture on agar (5% for blood [P = 0.045] and 4% for valve biopsy samples [P < 0.0005]). The most efficient culture procedure was the subculture of blood culture broth into shell vials (sensitivity, 71%). For patients with endocarditis, previous antibiotic therapy significantly affected results of blood culture; no patient who had been administered antibiotics yielded a positive blood culture, whereas 80% of patients with no previous antibiotic therapy yielded positive blood cultures (P = 0.0006). Previous antibiotic therapy did not, however, prevent isolation of Bartonella sp. from cardiac valves but did prevent the establishment of strains, as none of the 15 isolates from treated patients could be successfully subcultured. For the diagnosis of B. quintana bacteremia in homeless people, the efficiency of systematic subculture of blood culture broth onto agar was higher than that of direct blood plating (respective sensitivities, 98 and 10% [P < 10(-7)]). Nevertheless, both procedures are complementary, since when used together their sensitivity reached 100%. All homeless people with positive blood cultures had negative serology. The isolation rate of B. henselae from PCR-positive lymph nodes, in patients with cat scratch disease, was significantly lower than that from valves of endocarditis patients and skin biopsy samples from bacillary angiomatosis patients (13 and 33%, respectively [P = 0.084]). In cases of bacillary angiomatosis for which an agent was identified to species level, the isolation rate of B. henselae was lower than the isolation rate of B. quintana (28 and 64%, respectively [P = 0.003]). If culture is to be considered an efficient tool for the diagnosis of several Bartonella-related diseases, methodologies need to be improved, notably for the recovery of B. henselae from lymph nodes of patients with cat scratch disease.     

Human neutrophil elastase in RSV bronchiolitis

Acute bronchiolitis is the most common lower respiratory tract infection in young children and may be life-threatening in those with underlying cardiac or respiratory conditions. We evaluated the nasal and serum levels of human neutrophil elastase (HNE) in patients with acute respiratory syncytial virus (RSV) bronchiolitis and investigated the correlation of these levels with illness severity. Fifty-one patients (28 boys, 23 girls) with acute bronchiolitis positive for RSV by direct immunoenzyme assay in nasal secretions (Group A) were studied. Thirty healthy children (17 boys, 13 girls) constituted the control group (Group B). Subjects in both groups were matched for age and gender. The ages (mean+/-SE) in Groups A and B were 4.5+/-0.41 and 5.0+/-0.65 mo, respectively. Venous blood and nasal secretions were taken from patients in group A on 1, 5, and 15 days after admission and once from controls (Group B) for determinations of HNE in nasal lavage and serum, as well as white blood counts (WBC). The peripheral blood eosinophil and neutrophil counts were elevated in 22/51 patients (43.1%) and 15/51 patients (29.4%), respectively. In nasal lavage specimens, neutrophils represented>or=75% and eosinophils>2% of all cells in 42/51 (82.0%) patients and 11/51 (21.5%) patients, respectively. There was strong correlation between the level of HNE and the percentage of neutrophils in nasal lavage (r=0.92). The mean nasal HNE concentrations of the patients on 1, 5, and 15 days after admission were higher than those of Group B (p<0.0001, p<0.001, p<0.001, respectively). Mean serum HNE concentrations on 1, 5, and 15 days after admission were higher in Group A than in Group B (p<0.0001, p<0.0001, p<0.0001, respectively). Nasal and serum HNE concentrations showed no correlations with the clinical score of disease severity (r=0.28 and r=0.29, respectively). This study shows that (a) serum and nasal HNE concentrations were significantly higher in RSV bronchiolitis patients than in controls, (b) they did not return to normal after the respiratory symptoms had improved, and (c) they showed no significant correlations with clinical score of severity. The results indicate that neutrophils contribute significantly to airway inflammation in these subjects and HNE levels in serum and nasal lavage may be useful markers of inflammation in acute RSV bronchiolitis.     

Comparison of two rapid latex agglutination methods for detection of group A streptococcal pharyngitis

Throat swabs from 404 patients with suspected pharyngitis were collected using duplicate swabs. Both swabs were used to inoculate 5% sheep blood agar plates, which were incubated in an anaerobic atmosphere for the isolation of Group A streptococci. The throat swabs were tested for the presence of Group A antigen using the Culturette Brand 10-Minute Group A Strep ID kit (Marion Scientific, Kansas City, MO), and the Direct Antigen Identification D.A.I. Strep A Test (Difco Laboratories, Inc., Detroit, MI). We found that 77 of the 404 specimens were culture positive for Group A streptococci. The Strep ID kit had a sensitivity of 83.7% and a specificity of 91.6%. The positive and negative predictive values were 72% and 95.6%, respectively. The D.A.I. test had a sensitivity of 80.2% and a specificity of 100%. The positive and negative predictive values were 100% and 94.5%, respectively. There was not a significant difference in the sensitivity of the two kits (P less than 0.1), but there was a significant difference in the specificity (P less than 0.01).     

Lower sperm aneuploidy frequency is associated with high pregnancy rates in ICSI programmes

BACKGROUND: A large proportion of patients undergoing ICSI have been shown to have an increased sperm aneuploidy rate. This study was undertaken to evaluate the impact of sperm aneuploidy on ICSI outcome. METHODS: To accomplish this, 48 consecutive unselected male patients (median age 34 years) had their sperm aneuploidy rate evaluated in the same swim-up preparation used for ICSI. Chromosomes 8, 12, 18, X and Y were evaluated by fluorescence in-situ hybridization. Patients were divided into two groups (A and B) based on the sperm aneuploidy frequency in their sperm. Group A had values below and group B above the upper limit of normal [1.55%, determined in 14 healthy men (median age 25 years) with normal semen parameters by WHO 1999 criteria (control group)]. RESULTS: Group A consisted of 12 patients (25%) whose sperm aneuploidy rates fell below the cut-off value of the control group (median 1.25%; range 0.85-1.52). Group B consisted of the remaining 36 patients (75%), who had an elevated sperm aneuploidy rate (median 3.25%; range 1.64-23.60). Fertilization (93 versus 85%) and cleavage (100 versus 98%) rates were similar for both groups. Group A had significantly higher clinical pregnancy (75 versus 34%; P < 0.001) and implantation (34 versus 13%; P < 0.001) rates compared with group B. In addition, group A had a lower overall miscarriage rate (11.1 versus 38.9%). Other factors that affect pregnancy and implantation, such as patient age and conventional semen parameters, were similar for both groups. CONCLUSION: This study showed that chromosomally abnormal sperm have a negative impact on ICSI outcome.     

Detection of hepatitis B virus DNA in the serum of Canadian hepatitis B surface antigen negative,anti-HBc positive individuals,using the polymerase chain reaction

Continuing hepatitis B virus (HBV) infection is normally associated with the presence of hepatitis B surface antigen (HBsAg) in the serum. In spite of sensitive screening assays for HBsAg, rare cases of post-transfusion HBV infection are still observed. Antibody to hepatitis B core antigen (anti-HBc) often indicates remote HBV infection but DNA hybridisation and more sensitive polymerase chain reaction (PCR) assays have demonstrated that some HBsAg negative individuals, positive for anti-HBc, have continuing HBV replication. To determine the incidence of ongoing HBV infection in a Canadian HBsAg negative, anti-HBc positive population we studied three groups with this combination of HBV markers: Group A, 36 patients referred for investigation of raised serum aminotransferases; Group B, 21 Canadian Red Cross blood donors; Group C, seven vaccinees in an Ottawa Health Care Student hepatitis B vaccination programme. The PCR was carried out using a nested PCR reaction with primers specific for the pre-core region of HBV. Seven of 36 (19%) patients in Group A had detectable HBV DNA whereas none of Group B or C were positive. This data indicates that in some HBsAg negative patients with ongoing hepatic inflammation, continuing HBV replication may persist. This was not observed in any healthy blood donors or health care students investigated. Larger studies are required, but this data would suggest that, in Canada, the addition of anti-HBc testing for all blood donors for detection of low level HBV replication would not be indicated. © 1994 Wiley-Liss, Inc.