Raised serum neopterin levels and imbalances of T-lymphocyte subsets in viral diseases, acquired immune deficiency and related lymphadenopathy syndromes

D-erythro-neopterin, a biochemical marker of cell-mediated immune response, was found to be significantly (p less than 0.001) elevated in the serum of homosexual patients with acquired immunodeficiency syndrome and related lymphadenopathy syndrome. The most pronounced rise was observed in viral diseases causing a numerically measurable activation of the immune system such as EBV or CMV infections. In the latter patient groups, the increase in T8+, HLA-DR+ and monocytic antigen+ lymphocyte subsets correlated with the raised neopterin level. Thus, neopterin seems to be released under various conditions in viral diseases and may reflect a functional state of T-lymphocytes irrespective of the actual number expressing differentiation antigens on the cell surface.

Serological and immunological investigations in patients with gross splenomegaly from the Gabon

Serological investigations (immunoglobulin, haptoglobin, cryoglobulin, and antibody determination against Plasmodium falciparum and P. malariae antigens) were performed in 64 adults of the Albert-Schweitzer-Hospital, Lambarene, Gabon. The patients were referred consecutively for ultrasound examination of the upper abdominal tract. 31 patients had clinically and sonographically an enlarged spleen, whereas 34 had a normal-sized spleen. 18 patients were regarded as having a gross splenomegaly without an obvious underlying cause (tropical splenomegaly (TSS]. No significant differences were seen between the patient groups with regard to immunoglobulin M or antiplasmodial antibody concentration. Thus, a causal association of splenomegaly with chronic malaria infections could not be established. The haptoglobin levels were significantly (P less than 0.01) reduced in patients with splenomegaly. Peripheral T-lymphocyte subsets as defined by monoclonal antibodies showed in all 4 cases with gross splenomegaly examined distinct abnormalities. Tropical splenomegaly is thought to encompass a variety of diseases, most of them presenting an intermediate stage of reactive to autonome disorders of the lymphatic system.

Interaction of bovine epithelial lens (BEL) cells with extracellular matrix (ECM) and eye-derived growth factor (EDGF). II. Partial re-expression of the differentiated collagen distribution and phenotype

The differentiated phenotype of bovine epithelial lens (BEL) cells consists primarily of type IV collagen production with homogeneous cellular form and monolayer organization. We have previously described how, after several subcultures, BEL cells lost this phenotype, which was replaced by a complex collagen mixture consisting predominantly of type I and type III collagens and a minor proportion of type IV collagen. The cells became irregular and formed multilayers. These dedifferentiated cells can re-express their initial morphological properties when subcultured on an extracellular matrix (ECM) in presence of an eye-derived growth factor (EDGF), as described in the first paper of this series [30]. Furthermore, those cells passaged only one time on ECM + EDGF partially re-express the native differentiated collagen phenotype. The cells synthesize a majority of type IV collagen (up to 65%) with minor amounts of interstitial collagens. As in early subcultured cells, the major proportion of total collagen accumulated in the cell layer. Taken together, the morphological and biochemical data emphasize the relationship between cell shape and collagen phenotype expression. They also provide a reversible system for the study of normal gene expression and pathological alterations.

[Paragonimus uterobilateralis as the cause of 3 cases of human paragonimiasis in Gabon]

During 1981, three cases of pulmonary paragonimiasis were diagnosed and successfully treated at the Albert Schweitzer Hospital, Lambarene, Gabon. Circumstances prevented our receiving eggs for identification of the lung fluke species involved. The history revealed that all the patients originated from the same small village Mitoné, some 10 km north of Lambarene. Extensive testing in the region failed to reveal further cases. Our efforts, therefore, were concentrated on the study of the intermediate crustacean hosts responsible for the human infections. We examined 90 fresh-water crabs of the species Sudanonautes aubryi and S. africanus collected from small creeks located close to the village of the patients. 14 per cent of the former species and 8 per cent of the latter contained freely moving, non-encysted metacercariae resembling those of Paragonimus uterobilateralis. A domestic cat was subsequently infected with these metacercariae. During autopsy of the cat some 260 days later, 2 adult lung flukes were recovered and clearly identified as P. uterobilateralis, confirming the diagnosis on the larval metacercariae. These findings support the surmise that the human cases of paragonimiasis in the same area could be attributed to an infection with P. uterobilateralis.

Ineffective erythropoiesis in acute human P. falciparum malaria

An analysis of erythroblast cell kinetics utilizing quantitative 14C-autoradiography has been performed in five cases of acute Plasmodium falciparum malaria prior to and, in four patients, 3 or 6 days after the onset of antimalarial therapy. Associated with no or only moderate anemia were changes of erythroblast morphology, a considerable shift in the frequency of red and white blood cell precursors in the bone marrow, and a reduced rate of erythroblast proliferation. There was a marked loss of polychromatic erythroblasts, which was smaller but still detectable during the therapeutic phase. The results provide some quantitative data on the extent of "parenchymal damage" of bone marrow and stress the impact of ineffective erythropoiesis and reduced rate of erythropoietic proliferation on the emergence of anemia in Plasmodium falciparum malaria.

Observations on mebendazole vs. thiabendazole in the treatment of human trichinellosis

Six patients with acute trichinellosis were studied. Three patients were treated with mebendazole and the other three with thiabendazole. Both drugs were given at a daily dose of 50 mg per kg body weight for seven consecutive days. No substantial differences were evident in the efficacy of the two drugs when symptoms, clinical findings, and laboratory data were followed for three months. However, mebendazole was better tolerated than thiabendazole. The diagnosis was based on epidemiological data and positive antibody tests. In two cases, diagnosis was confirmed by isolation of trichinella larvae from 10 ml blood samples filtered through polycarbonate membranes.

Efficiency of serodiagnosis in amebiasis. Results obtained by four different tests in 13 458 persons with varying exposure

Results are reported of antibodies to E. histolytica antigen obtained by enzyme immunoassay, complement fixation, indirect hemagglutination and latex agglutination in sera of persons with varying exposure to infection by E. histolytica. The data are compared to findings in non-exposed persons and in patients with amebic liver abscess. From the results it is concluded that the value of serodiagnosis in amebiasis is higher in patients, who have traveled in tropical areas for a limited period, than in residents of the tropics.

[Amebic liver abscess: sonographic and clinical observations on 20 patients]

A retrospective analysis of 20 patients with amoebic liver abscesses was performed. Seven of 20 patients had more than one abscess. In all, 33 separate abscesses were observed. The diagnosis was based on clinical findings such as malaise, fever, abdominal discomfort, and pain in the right abdomen, haematological and serological anomalies, such as leukocytosis, elevated erythrocyte sedimentation rate, and slightly elevated liver enzymes. The serological investigation included complement fixation, indirect haemagglutination, and latex fixation test; this latter test produced strong reactions in all patients with acute symptoms. The typical ultrasonographic pattern resembled that of a minor echogenic lesion at the time of diagnosis and initiation of therapy. However, in a few acutely ill patients the lesions could not be identified by ultrasonography on first examination, but were clearly identifiable on second investigation on the following days. This finding has not been published previously. It may be observed in a very early stage of the disease only and is, therefore, dependent on rapid diagnosis of amoebiasis. During the follow-up investigations of three months to one year, the majority of abscesses could still be identified.

[Amebic liver abscess: ultrasound and clinical follow-up of 20 patients]

A retrospective analysis of 20 patients with amoebic liver abscesses was performed. Seven of 20 patients had more than one abscess. In all, 33 separate abscesses were observed. The diagnosis was based on clinical findings such as malaise, fever, abdominal discomfort, and pain in the right abdomen, haematological and serological anomalies, such as leukocytosis, elevated erythrocyte sedimentation rate, and slightly elevated liver enzymes. The serological investigation included complement fixation, indirect haemagglutination, and latex fixation test, this latter test produced strong reactions in all patients with acute symptoms. The typical ultrasonographic pattern resembled that of a minor echogenic lesion at the time of diagnosis and initiation of therapy. However, in a few acutely ill patients the lesions could not be identified by ultrasonography on first examination, but were clearly identifiable on second investigation on the following days. This finding has not been published previously. It may be observed in a very early stage of the disease only and is, therefore, dependent on rapid diagnosis of amoebiasis. During the follow-up investigations of three months to one year, the majority of abscesses could still be identified.

Modulation of in vitro lymphocyte proliferation in patients with Schistosomiasis haematobium, Schistosomiasis mansoni and mixed infections

Cell-mediated immunity to mitogens, nonparasitic and parasitic antigens was evaluated by means of in vitro lymphocyte proliferation in 37 African patients infected with S. haematobium, S. mansoni, or both parasites as well as in an uninfected control group. Lymphocytes of patients with schistosomiasis mansoni or schistosomiasis haematobium monoinfection could be similarly stimulated by a delipidized extract of S. mansoni adults. There was also no difference in lymphocyte responsiveness to stimulation by PHA, PWM, ConA, and PPD between these groups and as compared with uninfected controls. In the mixed infection patient group, stimulation by mansoni antigen - as well as by PPD, PHA, PWM - was significantly suppressed (p less than 0.01). Of particular interest, in cultures stimulated by the specific antigen the degree of in vitro suppression was inversely correlated to the intensity of infection (r = 0.54, p less than 0.025).

Human echinococcosis: diagnostic value of computed tomography

The diagnostic value of computed tomography was assessed in 44 patients with alveolar or cystic echinococcosis. The CT-examination was concentrated mainly on the liver, which was involved in all patients. It was extended to other organs, i.e. to lung, intra- or retroperitoneal space, bone and brain if necessary. The CT image of the liver in cystic echinococcosis was often characteristic. It showed sharply outlined masses with attenuation values similar to water. Internal structures were caused by daughter cysts. Furthermore, typical marginal calcium deposits indicated regressive changes in the host membrane. In all cases with alveolar echinococcosis in indistinct solid mass was found, often with central necrotic colliquation and plaque-like calcifications within the tumor.

Amoebic liver abscess: a retrospective clinical evaluation of twenty-seven cases

Twenty-seven patients with Amobebic Liver Abscess were observed during the last two years and were analysed retrospectively with respect to diagnostic procedures and therapeutic strategies. Seven of the 27 patients had surgery and were subsequently referred to our hospital. Those patients with surgery had a longer duration of illness and hospitalization (3.3 months) compared to the other 20 patients with chemotherapy alone (2 months). Most important diagnostic parameters for extraintestinal amoebiasis were: typical clinical findings, time spent in tropical or subtropical countries, strongly positive Latex agglutination against Entamoeba histolytica antigen, and isotope and/or ultrasound scanning to confirm abscess formation in the liver. The vast majority of abscesses were found in the right liver lobe. Response to treatment with complete cure was seen in all patients, regardless of whether Metronidazole alone or combinations of Metronidazole with Chloroquine and Metronidazole and Dehydroemetine or Chloroquine and Dehydroemetine were used. There is a need for prospective therapeutic studies to compare the different drug regimen concerning side-effects, toxicity, costs, application, and duration of hospitalization. From the retrospective data it seems that surgery is not beneficial for the patients.

Biosynthesis of skin collagens in normal and diabetic mice

Synthesis of collagens in vitro was studied on minced mouse skins incubated with [3H]-proline in organ-culture conditions. A comparative study was carried out on genetically diabetic mice (KK strain) and control mice (Swiss strain). After incubation, neutral-salt-soluble and acid-soluble collagens were extracted. The insoluble dermis was digested by pepsin and type I and type III collagens separated by differential precipitation in neutral salt solutions. Type I and Type III collagens were characterized by ion-exchange and molecular-sieve chromatography, amino acid analysis and by the characterization of CNBr peptides. In diabetic-mouse skin, the relative proportion of type III collagen was significantly higher than in control-mouse skin. The incorporation of radioactively labelled proline into hydroxyproline of type III collagen was significantly faster in diabetic-mouse skin than in control-mouse skin. No significant modifications in the total collagen content of the skin or of their rates of synthesis were observed between the two strains. Alteration in the ratio of type III to type I collagen in the diabetic-mouse skin can be interpreted as a sign of alteration of the regulation of collagen biosynthesis and may be related to the structural alterations observed in the diabetic intercellular matrix.

Chemotherapy of echinococcosis with mebendazole: clinical observations of 7 patients

The effect of high dosage therapy with Mebendazole was studied in 5 patients with cystic echinococcosis and 2 patients with alveolar echinococcosis involving several organs. Follow-up studies at regular intervals from 7 to 20 months indicated an improvement of the pathological findings initially observed. This could clearly be demonstrated by the radiographic findings in cases with pulmonary involvement. The desintegration or dissolution of pulmonary cysts was observed within a few months after treatment with Mebendazole had begun. However, consolidation of previously emptied cysts occurred during the follow-up later. Allergic reactions were observed after commencement of drug therapy in two cases. These were probably due to spillage of antigenic material. The following treatment periods were tolerated well. No serious toxic side effects were observed in the other cases described here.

Involvement of glycoconjugates in insulin-receptor interactions. Studies in liver plasma membranes of control and diabetic mice

The involvement of glycoconjugates in the insulin-receptor interactions in mouse liver is tested by digestions of membranes with various enzymes. Trypsin decreased the binding of [125I]insulin to liver membranes. After digestion with beta-galactosidase no ""high affinity'' receptor sites could be detected. The effects observed with plant lectins confirm the involvement of galactoconjugates in the insulin binding process. Sophora japonica and Ricinus communis lectins (with galactose specificity) and concanavalin A largely inhibit the binding process of insulin and those effects concern the ""high affinity'' receptor sites. Other lectins (wheat germ agglutinin, Dolichos) and enzymes (alpha-L-fucosidase, beta-N-acetyl-hexosaminidase and neuraminidase) are without effect on insulin binding. Comparative studies performed on diabetic mouse liver membrane (KK mice), previously characterized by decreased number of insulin receptors, are in good agreement with qualitatively similar receptor sites in both non-diabetic (control) and diabetic mice. Effects of enzymes and lectins yielded same results as compared to control membranes. Plasma membrane proteins and glycoproteins in both types of mouse are indistinguishable with respect to enzymic and chemical analysis. Sodium dodecyl sulphate acrylamide gel electrophoresis shows identical patterns. Moreover, the decrease in the number of insulin receptors is easily reversed with diet restriction. These data are consistent with the similarity of receptor sites in control and diabetic liver membrane.