Lack of effect of peroral acyclovir for the treatment of acute infectious mononucleosis.

Perorally administered acyclovir was evaluated in the therapy of acute infectious mononucleosis in a multicentered, randomized, double-blind, placebo-controlled trial. A total of 120 patients received 600 mg of acyclovir or placebo five times daily for 10 days. All patients were entered into the study within 7 days of symptom onset and had a positive Monospot test. Analysis of mean values and time to resolution of fever, lymphadenopathy, weight change, hepatomegaly, splenomegaly, liver function tests, atypical lymphocytes, hours of bed rest, sense of well-being, and return to normal activities revealed no significant differences. There was a trend toward suppression of Epstein-Barr virus excretion in the oropharynx in acyclovir recipients. No toxicity was detected in patients treated with acyclovir. Under the conditions of the study, there was no evidence that treatment with perorally administered acyclovir affected the course of infectious mononucleosis.     

Treatment of severe infectious mononucleosis with famciclovir

We report a patient with severe acute infectious mononucleosis who was successfully treated with famciclovir. A 15-year-old male was admitted with a 6-week history of fever, malaise, generalized lymphadenopathy, and hepatosplenomegaly, the patient was acutely ill with a temperature of 39.0 degrees C. Oropharingeal examination revealed enlarged tonsils partially obstructing the airways. EBV serology obtained during admission showed a positive Monospot test, virus capsid antigen IgM, 1:320, Epstein-Barr nuclear and early antigen, negative. After 72 hours of treatment with famciclovir (500 mg t.i.d.), the patient was afebrile with important regression of the lymphadenopathy, enlarged tonsils and hepatosplenomegaly. Because acute infectious mononucleosis may be associated with extensive and prolonged disease, the potential therapeutic role of famciclovir in the treatment of severe forms of the disease deserves further studies.     

Comparative evaluation of seven commercial tests for detection of heterophile antibody in infectious mononucleosis

Detection of heterophile antibodies in infectious mononucleosis is the most rapid and cost-effective method for confirming the clinical diagnosis of the disease. This study compared seven commercial test kits (the Oxoid Infectious Mononucleosis Kit [Oxoid Ltd], Immunoscan Im-Latex [Baxter Travenol], Mono-Latex [Wampole Laboratories], Monospot and Im Screen Test [Ortho Diagnostics], Immunoscan Im-RBC Test [Baxter Travenol], and Infectious Mononucleosis Test [NCS Diagnostics]) to the Davidsohn differential test. All of the kits were shown to be acceptable for use, with specificities and sensitivities greater than 96.5% and 95.5%, respectively.     

Hemolytic anemia associated with multiple autoantibodies and low serum complement

A 37 year old woman with extravascular hemolytic anemia had a positive Monospot test associated with positive antiglobulin and anticomplement Coombs' tests, cold agglutinins and warm autoantibodies. IgG-kappa (κ) antibodies, which reacted with all panel red cells at 37 °C, were eluted from her circulating red cells. However, neither immunoglobulins nor C3 was detected after her serum was adsorbed with heterologous red cell stroma at 37 °C and eluted at the same temperature in glycine buffer. In contrast, IgM-κ and IgM-Iambda (λ), IgG3-κ, IgG4-λ, IgA-λ and C3 were eluted at 37 °C from heterologous red cell stroma after adsorption with her serum at 0 °C. Thus, antibodies of several types, which were present in the patient's serum, reacted optimally with red cell antigens at low temperature. Cold-reactive IgG3-κ antibodies, which were also capable of interacting with red cells at 37 °C, probably accounted for the IgG-κ antibodies eluted from the patient's circulating red cells.The patient's serum C4 titers were decreased, with low normal to moderately depressed C3 and low normal C5, indicating that the anti-red cell IgM and/or IgG3-κ antibodies probably fixed complement.A localized cold stress test resulted in a transient increase in plasma hemoglobin and a decrease in serum C3 titer. These findings, and the beneficial clinical response obtained with small doses of prednisone, suggest that both the cold-reactive antibodies and the IgG-κ on circulating red cells were pathophysiologically significant.This is the first report of a patient with multiple red cell autoantibodies in whom serum complement component titers were determined in conjunction with characterization of the anti-red cell immunoglobulins. Subclinical infectious mononucleosis may have preceded the prolonged hemolytic episode. Clinical evidence of systemic lupus erythematosus has not appeared.     

Hepatitis in fatal infectious mononucleosis

A detailed clinicopathologic analysis of 30 patients with sporadic fatal infectious mononucleosis and 31 males with fatal infectious mononucleosis and the X-linked lymphoproliferative syndrome was performed to determine the extent of hepatic dysfunction in these cases. At death, the median age of patients with sporadic infectious mononucleosis was 10.7 yr vs. 2.4 yr for X-linked lymphoproliferative syndrome. The median survival time was 8 wk for sporadic infectious mononucleosis and only 4 wk for X-linked lymphoproliferative syndrome. The male to female ratio was 3:2 in sporadic infectious mononucleosis; all patients with X-linked lymphoproliferative syndrome were males. Fever, sore throat, lymphadenopathy, hepatomegaly, and splenomegaly were prominent findings. Hepatic dysfunction was uniformly present and caused death in 13 of 30 sporadic infectious mononucleosis cases and 18 of 31 X-linked lymphoproliferative syndrome cases. Diagnosis of infectious mononucleosis was confirmed by heterophile antibody titers or Monospot, Epstein-Barr virus antibody studies, viral culture, molecular hybridization studies, clinical and histologic findings, and pedigree analysis.     

不同部位淋球菌感染实验室诊断方法的比较

目的 评价三种不同淋球菌检测方法在不同部位淋球菌感染诊断的临床意义。方法 采用培养、涂片和血清抗体三种试验,对429例临床上疑似淋病病人进行诊断。结果 泌尿生殖道急性淋菌感染阳性检出率从高到低依次为染色涂片79.3％,培养法71.5％和抗体试验2.9％;泌尿生殖道慢性淋病感染阳性检出率从高到低依次为抗体试验53.3％、染色涂片8.3％和培养5.0％;口腔及肛门直肠淋球菌感染阳性检出率从高到低依次为培养64.3％、染色涂片50.4％和抗体试验9.6％;表皮淋球菌感染阳性检出率从高到低依次为培养70.4％、染色涂片61.3％和抗体试验4.5％。结论 实验室在淋病诊断时,应根据淋球菌感染部位和病人患病时间选择合适的方法,否则,将影响诊断的准确性。     

A clinical evaluation of the new laboratory method that diagnoses bacterial infection, using silkworm larvae plasma

Based upon the phenomenon that the peptidoglycan, a common component of Gram positive and negative bacteria, reacts specifically with silkworm larvae plasma (SLP), a new laboratory method named "SLP test" was developed to measure the reaction products in plasma quantitatively as SLP. This SLP test seems to be able to diagnose both Gram positive and negative bacterial infection. So we evaluated its usefulness in diagnosing clinical infectious diseases. This study included 14 patients with result to positive bacterial blood culture, 22 patients with bacterial local infection, 7 patients without any evidence of bacterial infection, and 19 healthy volunteers. It seemed that the cut-off value of this SLP test should be set at 0.6 ng/ml. The sensitivity and specificity of this SLP test were 57.1%, 100%, respectively. A significant difference was not detected statistically between SLP values of patients with Gram positive and Gram negative bacterial infectious diseases. So the SLP test did not appeared specific to either Gram positive or Gram negative bacteria. This test may become a new method diagnosing bacterial infectious disease.     

Infectious mononucleosis and fatal myocarditis.

Mycocarditis is an uncommon manifestation and, very rarely, a lethal complication of infectious mononucleosis. A 14-year-old girl initially had exudative pharyngitis and splenomegaly and developed refractory ventricular fibrillation. The diagnosis of infectious mononucleosis was confirmed by both a strongly positive heterophil antibody test and a high titer of Epstein-Barr virus. Pathologic studies demonstrated extensive histiocytic and lypmhocytic infiltration of the myocardium.     

A complement fixation test for visceral leishmaniasis using homologous parasite antigen I

The complement fixation test using homologous parasite antigen was evaluated in 60 individuals with confirmed visceral leishmaniasis and compared with the results obtained in individuals with other parasitic and infectious diseases; 88% of the confirmed cases of visceral leishmaniasis were positive whilst no positive reactions were observed in individuals with other infectious and parasitic diseases. The specificity was partially compromised by anticomplementary activity in 5%, limited to individuals with visceral leishmaniasis, and doubtful (2%) or sero-negative (7%) results.     

The relationship between atypical lymphocytosis and serological tests in infectious mononucleosis

The relationship between serological tests for infectious mononucleosis was compared with atypical lymphocytosis in one hundred cases with clinical features of the disease. All blood samples showed atypical lymphocytosis greater than 20 per cent of the total leucocyte count. Positive serological tests were obtained in 69 of these patients, whereas in patients with more than 40 per cent atypical lymphocytosis all had positive serology. Of the 31 patients with negative serological tests for infectious mononucleosis, significant antibody titres to Toxoplasma gondii were obtained in five and to cytomegalovirus in two. Twenty-four patients remained undiagnosed. The Paul-Bunnell-Davidsohn positive patients had a significantly higher white cell count, lymphocyte count and atypical lymphocyte count than the toxoplasmosis group or the undiagnosed group.     

A rapid slide test for heterophile antibody in infectious mononucleosis

The sera of 473 individuals were examined for sheep cell agglutinins both by theslide test and the Paul-Bunnell method. In this group there were 46 patients withpositive slide tests and 35 of these individuals also had a diagnostic serum dilutiontest for heterophile antibody. In 11 cases the slide test was positive but the Paul-Bunnell test gave very low serum dilution values. However, when the slide testwas carried out at 37 C, it was negative in 9 of the 11 cases. In the remaining 2instances, one patient had a Forssman type of antibody which gave a 1:64 titer insaline and the slide test was positive at 37 C. In the other case no studies were madeon the effect of temperature and the nature of the agglutination reaction wasunfortunately not determined.

Using human and bovine albumen, sheep serum and human AB serum absorbedwith sheep cells as a diluent no evidence for blocking or hyperimmune antibodywas discovered in the cases of infectious mononucleosis studied in this series.Moreover, of the 6 patients with negative serology but with strong clinical andhematological evidence for the disease, no blocking or hyperimmune antibodywas disclosed by the slide test or by the use of absorbed human AB serum. Theconclusion seems justified that blocking, incomplete or hyperimmune heterophileantibody must be rather uncommon in infectious mononucleosis.

In the use of the rapid slide test it has been pointed out that cold agglutinins,(which may be abolished by warming to 37 C) and Forssman antibodies (whichmay be absorbed by guinea pig kidney) can give positive results. However, diseases in which cold agglutinins are strong enough to give a positive slide testare relatively rare and the occurrence of Forssman antibodies of a strength likely togive a positive slide test would be decidedly uncommon. In any event unless furtherexperience reveals more serious discrepancies, the rapid slide test as described inthis paper seems to offer a practical screening test to detect clinically significantamounts of heterophile antibody in cases of infectious mononucleosis.

     

Fever of unknown origin (FUO) caused by multiple myeloma: the diagnostic value of the Naprosyn test

Fever of unknown origin (FUO) remains a difficult diagnostic problem. The causes of FUO have changed over the years. Neoplastic disorders have now displaced infectious diseases as the most common cause of FUOs. Most neoplasms are associated with no or low-grade temperatures, with some important exceptions. Hypernephromas and lymphomas are neoplasms typically associated with high spiking fevers or may present as FUOs. Hematologic malignancies, that is, the acute and chronic leukemias, myeloproliferative disorders, and multiple myeloma, do not usually present with acute fevers or as FUOs. We present an elderly male patient who presented with an FUO, whose history is significant for multiple myeloma in remission. Differential diagnostic possibilities in this patient included plasma cell leukemia, relapse of multiple myeloma, secondary/superimposed malignancy, or opportunistic infection. The main differential diagnosis for his FUO was between neoplastic and infectious disorders. As part of the diagnostic workup, a Naprosyn test (naproxen 375 mg [by mouth] every 12 hours for 3 days) was used to differentiate neoplastic from infectious causes of FUO in this patient. The Naprosyn test was positive, which indicated a neoplastic explanation for the patient's FUO and eliminated, along with the infectious disease workup, an infectious explanation for his FUO. The patient's FUO was finally determined to be the result of a relapse of multiple myeloma and not of a secondary malignancy or malignant transformation of myeloma into plasma cell leukemia. We conclude the Naprosyn test remains a valuable diagnostic test to use to narrow differential diagnostic possibilities in patients with FUOs when a malignancy is a diagnostic consideration.     

Diagnostic significance of pleural fluid lactate concentration in pleural and pulmonary diseases

Pleural fluid samples from 198 patients were analysed in order to evaluate the usefulness of lactate concentration as a diagnostic test for separating infectious from non-infectious processes in the pleural cavity. Pleural fluid lactate was quantified by means of a gas chromatographic method. The highest lactate levels were found in patients with septic pleuritis. Significantly lower values were observed in cases with malignancies. With a cut off value of 10 mmol/l, the predictive value of a positive test was 0.94 and of a negative test 1.0. Because of the high predictive values of the test, measurement of lactate concentration in pleural fluid offers a rapid and useful information in the differentiation between infectious and non-infectious pleural disease.     

Significant sex differences in the correlation of electrocardiographic exercise testing and coronary arteriograms.

Two hundred fifty-one patients (195 male and 56 females) referred for evaluation of chest pain were studied by multistage submaximal stress testing and selective coronary arteriography. In men with positive exercise tests the incidence rate of true positive exercise test results--that is, positive tests associated with 75 percent of greater coronary stenosis--was 89 percent in contrast to a 33 percent incidence rate of true positive exercise test results in women. The incidence rate of false positive excercise test results--that is, positive tests associated with no coronary stenosis or less than 50 percent stenosis--was 8 percent in men in contrast to 67 percent in women. Conversely, the incidence rate of false negative exercise test results (that is, negative exercise tests associated with 75 percent or greater coronary stenosis) was higher in men (37 percent) than in women (12 percent). It is concluded that in men a positive multistage stress test is useful in predicting the presence of significant coronary artery disease although a negative stress test cannot be relied upon to rule out the presence of significant disease. In women, a positive exercise test is of little value in predicting the presence of significant coronary artery disease, whereas a negative test is quite useful in ruling out the presence of significant disease. New criteria should be developed for stress testing of women.     

细菌感染性腹泻2380例临床及病原学分析

目的 了解细菌感染性腹泻的临床及病原学特点.方法 回顾性分析1998年至2007年复大学附属金山医院感染性腹泻患者2380例的临床及细菌学特点.计数资料行X~2检验.结果 10年间因腹泻就诊的20 169例患者中,2380例粪细菌培养阳性,包括副溶血弧菌感染2247例,占94.4%,志贺菌属感染99例,占4.2%,沙门菌属感染29例,占1.2%,溶藻弧菌感染3例,致病性大肠埃希菌感染2例.因腹泻就诊者在每年6至10月多见,副溶血弧菌感染主要表现为腹痛、腹泻、恶心、呕吐,可伴有脱水,志贺菌属感染主要表现为发热、腹痛、腹泻.结论 上海市金山区细菌感染性腹泻患者粪细菌培养阳性率不高,仍以副溶血弧菌、志贺菌属为主要致病菌.     

Effectiveness of BCG vaccination in children in relation to genetic and social factors]

The social status, genetic parameters, somatic and infectious diseases have been studied in BCG--vaccinated children who presented a postvaccinal cicatrix and in those in whom it did not form. Children having a postvaccinal cicatrix were found to belong mainly to the muscular type of constitution, while those without it--to the thoracic type. It was shown that a one--time positive tuberculin reaction to the Mantoux test with 2 TU (infiltrate of 6-7 mm) is associated with somatic and infectious pathology. This reaction can be considered to be para--allergy within 4 months after the disease.     

Discrepancy between Clq deviation and Raji cell tests in detection of circulating immune complexes in patients with leprosy.

Samples of serum from 45 patients with different clinical forms of leprosy and from 17 patients with systemic lupus erythematosus were studied in parallel for circulating immune complexes with use of two different in vitro tests adjusted to the same degree of sensitivity. The Clq deviation test relied upon the reaction of the complement component Clq with immune complexes. The Raji cell test detected complement-fixed immune complexes that bound to the complement receptors on cultured, bone marrow-derived lymphocyte-like Raji cells. Thirty (67%) of 45 patients with leprosy showed immune complexes according to the Clq deviation test; however, only two (7%) of the 30 samples of sera with positive Clq test results were positive by the Raji cell test. In contrast, 54% of 13 samples of sera from patients with systemic lupus erythematosus positive by the Clq test were positive according to the Raji cell test. Since Clq is known to react with DNA as well as with bacterial antigens, the Clq reaction may in fact be detecting antigenemia in many instances. Considerable caution is warranted in application of sensitive screening tests for assay of circulating immune complexes in various states of infectious diseases.     

4825例外科患者输血和手术前传染病检测结果分析

目的 探讨外科患者输血和手术前传染病感染情况。方法 选择本院2004年2月至2005年2月4825例外科输血和手术患者，输血和手术前进行乙肝五项、抗-HCV、艾滋病抗体（抗-HIV）和梅毒抗体检测分析。结果 乙肝五项皆阴性者2475份，占51．30％；1项或多项阳性者2350份，阳性率为48．70％。结论 外科患者输血和手术前，传染病有一定的感染率，尤其是乙肝感染率。因此，外科患者输血和手术前进行传染病检测很有必要，可减少或避免医院感染和医疗纠纷的发生。     

Value of transesophageal echocardiography as an adjunct to transthoracic echocardiography in evaluation of native and prosthetic valve endocarditis

To determine if transesophageal echocardiography provides better visualization of valvular vegetations than transthoracic echocardiography, we used both methods to evaluate 24 consecutive patients (mean age, 54 years; 15 female patients and nine male patients) referred for symptoms suggestive of infectious endocarditis. Ten of the 24 patients had one or more valvular prostheses. Echocardiograms were classified as positive or negative based on visualization of valvular vegetations or abscesses. Of ten patients with a final diagnosis of infectious endocarditis on extended follow-up, transthoracic echocardiography was positive in five patients. Transesophageal echocardiography not only yielded abnormal findings in all ten of these patients, but also revealed additional information in four of the five patients with abnormal transthoracic echocardiographic examinations. Among the 14 patients who, on subsequent follow-up, were found not to have infectious endocarditis, transthoracic echocardiography was normal in 13 and falsely abnormal in one. Transesophageal echocardiography revealed no evidence of infectious endocarditis in any of these patients. The ten patients who were determined to have infectious endocarditis all had positive blood cultures and no alternative cause for their clinical presentation; in seven patients in this group who underwent operative or postmortem evaluation, infectious endocarditis was confirmed. All patients without infectious endocarditis were demonstrated to have other causes for their clinical presentation. We conclude that transesophageal echocardiography is a highly valuable test in the work-up of patients with suspected infectious endocarditis, especially those patients with inconclusive or normal transthoracic echocardiograms. In addition, transesophageal echocardiography may be of benefit to patients with previously documented infectious endocarditis and a complicated clinical course in whom additional cardiac lesions are suspected but not demonstrated by transthoracic echocardiography.     

Value and limitations of the thymol turbidity test as an index of liver disease

In a group of seventy-six patients with infectious hepatitis who were followed throughout their illness the thymol turbidity test in every case showed a maximal value that was higher than the highest value obtained in a control group of forty-six patients. The results would appear to demonstrate the value of this reaction for the diagnosis of acute liver damage.No correlation between severity of symptoms and degree of aberration in the thymol turbidity test could be found. The test proved to be of particular use in evaluating persistent symptoms following infectious hepatitis.Patients with cirrhosis of the liver associated with chronic alcoholism showed considerably lower values for the thymol turbidity test than did patients in a non-alcoholic group. The test was of little value in estimating the degree of involvement of the liver in patients with cirrhosis.Markedly positive reactions were associated with hyperglobulinemia in various parasitic diseases and other conditions in which an inflammatory process in the liver was present.