HTLV-I-specific antibody in AIDS patients and others at risk

Serum samples from 440 acquired immunodeficiency syndrome (AIDS) patients or individuals at risk for AIDS were examined by the enzyme-linked immunosorbent assay technique for antibodies to HTLV-I core proteins. Specific antibodies were detected in 7% of AIDS patients, 7% of patients with lymphadenopathy, 0% of healthy homosexual men, and 12% of healthy Haitians. When findings in homosexual men were analysed separately, the prevalence for homosexual men with lymphadenopathy was 7% and for homosexuals with AIDS, 6%. Antibody titres ranged from 77 to 74 000. The antibody-positive cases included intravenous drug users, a Haitian AIDS patient, a recipient of multiple blood transfusions, and homosexual men. Haemophiliacs were not examined. Although HTLV-I-specific antibodies are more prevalent in AIDS patients than in healthy US donors, the difference is not sufficient to suggest an association of HTLV-I with the disease. The low rate may indicate an opportunisitic infection of AIDS patients by HTLV-I, or a crossreaction with the recently described HTLV variant, HTLV-III, believed to be the aetiological agent of AIDS. Whether HTLV-I normally exerts immune suppressive effects in vivo with biological consequences remains to be determined.

The kallikrein-kinin system as mediator in vasogenic brain edema

✓ Vasogenic edema was induced in mongrel cats by cold injury to study uptake and activation of the plasma-kallikrein-kinin system in central nervous system (CNS) tissue. A method was developed for quantitative assessment of kinin formation in affected brain tissue areas. Gross disruption of the blood-brain barrier by focal trauma causes marked penetration of plasma kininogens into necrotic and edematous brain tissue. Moreover, the kallikrein-kinin (KK) system was activated in both necrotic and perifocal edematous areas, and was markedly enhanced by additional cerebral ischemia. Formation of kinins in necrotic brain tissue led to consumption of approximately 60% to 80% of the amount of kininogens being taken up. In perifocal edematous tissue, formation of kinins was less pronounced, or even absent. However, if cerebral ischemia evolved after severe intracranial hypertension, kinins were also formed in the perifocal edematous brain. The intravascular origin of kininogens found in pathological tissue areas secondary to injury was deduced from the observation that cerebral tissue of the contralateral hemisphere with an intact blood-brain barrier had no measurable quantities of kininogens. Consumption of plasma kininogens or formation of kinins were assessed as the difference of the total amount of plasma kininogens taken up into the tissue minus the amount of kininogens found in the brain at postmortem examination.

The data indicate that uptake and activation of the plasma-KK system might occur under all pathological conditions in which blood-brain barrier damage permits cerebral penetration of plasma proteins, such as with cerebral contusion, focal ischemia, and tumors. The potent pathophysiological mechanisms induced by kinins in CNS tissue, such as formation of brain edema, microcirculatory dysfunction, and enhancement of blood-brain barrier permeability, together with their formation in focal and perifocal pathological brain tissue, provide further support for a mediator function of the KK system. Methods that specifically interfere with the formation of kinins in damaged brain should therefore be expected to attenuate vasogenic edema.

Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host

The usefulness of bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in the immunosuppressed patient was studied in 97 patients. In immunosuppressed patients, the available diagnostic procedures are often invasive and have variable yield and a potential for serious complications. Bronchoalveolar lavage had an overall diagnostic yield of 66% (61 of 92 diseases). It was most effective in the diagnosis of opportunistic infections, including infection with Pneumocystis carinii (18 of 22 cases), cytomegalovirus pneumonia (10 of 12 cases), fungal pneumonia (5 of 6 cases), and mycobacterial disease (4 of 5 cases). The technique was also helpful in suspected pulmonary hemorrhage (7 of 9 cases) but was less useful for diagnosing malignancy (10 of 22 cases) and drug-induced toxicity (6 of 15 cases). Findings of bronchoalveolar lavage could be combined with those of transbronchial biopsies, brushings, and washings in the diagnosis of most of the diseases. The procedure was safe, even in thrombocytopenic patients and those requiring mechanical ventilatory support. Bronchoalveolar lavage is a valuable procedure for evaluation of pulmonary disease in the immunosuppressed host.

Neisseria subflava endocarditis. Case report and review of the literature

Neisseria subflava is a rare cause of bacterial endocarditis. Only seven cases have been identified in the world literature if strict criteria as to organism classification and of endocarditis are applied to individual case reports. The first reported case in an intravenous drug user is described. In addition, findings on serial two-dimensional and M-mode echocardiography performed during and after the treatment period are presented. This patient's recovery with anti-microbial therapy alone despite evidence of aortic and significant mitral valve involvement is in accord with results of other antibiotic-treated cases.

Central-nervous-system toxoplasmosis in homosexual men and parenteral drug abusers

Central-nervous-system toxoplasmosis developed in 7 of 269 patients with the acquired immunodeficiency syndrome reported to the New York City Health Department through July 1982. Focal neurologic abnormalities, mass lesions on computed-tomographic brain scans, lymphocytic cerebrospinal fluid pleocytosis, and detectable IgG antibody to Toxoplasma gondii were common; but IgG titers of 1:1024 or more, IgM antibody to T. gondii, and positive open brain biopsies were uncommon. Serologic findings suggested that the disease resulted from recrudescent rather than primary infection. Four of five patients improved when treated with sulfonamides and pyrimethamine, but 2 had relapses. An aggressive diagnostic approach and sometimes even empiric therapy are warranted when central-nervous-system toxoplasmosis is suspected in a seropositive patient with the acquired immunodeficiency syndrome.

Covalent coupling of antigens to chemically activated lipopolysaccharide: a tool for in vivo and in vitro specific B cell stimulation

A simple chemical method is described which creates cyanate groups on the saccharide core of bacterial lipopolysaccharide (LPS). The activated LPS molecule is stable at pH 3.5 and can be kept for months at -20 degrees C without loss of properties. The strong reactivity of the cyanate groups permits efficient covalent coupling of various molecules to LPS. This is done under non-denaturing conditions. This paper also describes the coupling of microquantities of antigen (5-10 micrograms) to LPS. The 'LPS-antigen' conjugates are easily purified upon centrifugation at 15,000 X g. These compounds are mitogenic for B cells and trigger in vivo or in vitro production of antibodies directed against the coupled antigen. In vitro, a concentration of conjugate as low as 10(-2) micrograms/ml triggers specific antibody synthesis. Injection of 5 micrograms of conjugate in mice induces a humoral response detectable 7 days after immunization. B cells cultured for 5 days with an adequate dose of the LPS-beta-galactosidase conjugate were fused with the Sp2-0-Ag cell line to give anti-beta-galactosidase hybridomas.

IgM detection by ELISA in the diagnosis of cytomegalovirus infections in homosexual and heterosexual immunosuppressed patients

A new commercially developed cytomegalovirus (CMV)-IgM ELISA was found to be sensitive and specific when compared with sucrose gradient fractionation of Ig classes in CMV antibody-positive and negative sera. The presence of CMV IgM in patients' sera correlated with positive virus isolation from circulating mononuclear blood cells and urine. Serial examinations of patients with primary or recent CMV infection revealed a typical sequence of IgM and IgG development. The frequency of CMV isolation declined as the concentration of IgM decreased and the IgG levels increased. Since the isolation of CMV from clinical specimens is a cumbersome procedure, we suggest that the IgM ELISA could provide rapid and valuable information on the presence of an active or reactivated CMV infection.

[Production of anti-L-histidine decarboxylase monoclonal antibodies]

Hybridomas secreting monoclonal antibodies directed against Rat gastric L-histidine decarboxylase (H.D.) have been obtained from a partially purified preparation and screened by immunoprecipitation of the enzyme activity. They cross react with Rat brain H.D., indicating at least that these two enzymes share common antigenic determinants.

Treatment of metastatic breast cancer in estrogen receptor positive patients. A randomized trial comparing tamoxifen alone versus tamoxifen plus CMF

In a controlled clinical trial, 52 patients with ER positive metastatic breast cancer were randomly assigned to receive initial treatment with either tamoxifen alone followed by sequential cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) after tumour progression of concurrent tamoxifen plus CMF, All 52 patients entered are eligible and 50 patients were currently assessable. Response rates (CR + PR) were similar for the two treatment groups (15/24 tamoxifen alone, 17/26 tamoxifen + CMF). The median durations of survival for the two treatment groups 17.7 months and 17.1 months were also not significantly different. Significant correlations were found between level of ER and response rate and also between level of ER and response duration. From the result of this investigation it would appear that there is no advantage to the addition of chemotherapy prior to an adequate trial of hormone therapy in patients with metastatic ER positive breast cancer.

Demonstration of the percutaneous resorption of a lipophilic pesticide and its possible storage in the human body

The kinetics of lindane concentration in the serum and the time-dependent urinary excretion of two groups, one with healthy subjects and one with scabies-infested subjects, were comparatively analyzed by gas chromatography. Both groups showed similar cumulative excretion curves at completely different lindane concentrations in the serum. Comparison of serum concentration in healthy females (high lindane concentration in serum) and healthy males (low serum concentration) to the urinary excretion showed similar results. There appears to be a serum 'threshold concentration', above which it is possible that lindane is no longer primarily excreted by the kidney. Based on these results recommendations are presented, for the practical use of such data in the treatment of scabies.

An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction

Eleven cases of community-acquired Pneumocystis carinii pneumonia occurred between 1979 and 1981 and prompted clinical and immunologic evaluation of the patients. Young men who were drug abusers (seven patients), homosexuals (six), or both (two) presented with pneumonia. Immunologic testing revealed that absolute lymphocyte counts, T-cell counts, and lymphocyte proliferation were depressed, and that humoral immunity was intact. Of the 11 patients, one was found to have Kaposi's sarcoma, and another had angioimmunoblastic lymphadenopathy. Eight patients died. In the remaining three, no diagnosis of an immunosuppressive disease was established, despite persistence of immune defects. These cases of pneumocystosis suggest the importance of cell-mediated immune function in the defense against P. carinii. The occurrence of this infection among drug abusers and homosexuals indicates that these groups may be at high risk for this infection.