Clinical results of a multicenter study with sulbactam/ampicillin for the treatment of patients with lower respiratory and urinary tract infections

A total of 124 patients with lower respiratory tract (44) or urinary tract infections (80) were enrolled in an open, multicenter study to evaluate the efficacy and tolerability of sulbactam/ampicillin, administered at the dosage of 3 g/die by intramuscular route. Pretreatment pathogens from patients with lower respiratory tract infections included: Streptococcus alpha-haemolyticus in 8 cases, Streptococcus beta-haemolyticus in 2 cases, Staphylococcus albus in 7 cases, Haemophilus influenzae in 7 cases, Staphylococcus aureus in 6 cases, Klebsiella oxytoca in 5 cases, Staphylococcus epidermidis in 3 cases, Streptococcus pneumoniae in 3 cases, Escherichia coli in 2 cases; in one subject (2.75%), no microorganisms were isolated. In vitro, 36 isolates (84%) were sensitive to SA and 7 (16%) were resistant. At the end of therapy, all the causative pathogens sensitive to sulbactam/ampicillin were eliminated. In patients with urinary tract infections, pretreatment pathogens were: E. coli in 40 cases, S. albus in 16 cases, Proteus mirabilis in 8 cases, Enterobacter agglomerans in 6 cases, Proteus vulgaris in 3 cases, Streptococcus faecalis in 3 cases, Streptococcus liquefaciens in 2 cases, Pseudomonas aeruginosa in 2 cases. In vitro, 64 isolates (80%) were sensitive to sulbactam/ampicillin and 16 (20%) were resistant. At the end of therapy, 63 out of the 64 pathogens sensitive to sulbactam/ampicillin were eliminated; in one case the therapy was interrupted due to adverse effect. Clinical efficacy: in subjects with lower respiratory tract infections, sulbactam/ampicillin cured 32 patients (72.72%) and ameliorated the clinical status of 8 patients (18.18%); efficacy rate: 90.9%).(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of cerebrospinal fluid antibodies against myelin basic protein in patients with AIDS dementia complex

We evaluated cerebrospinal fluid (CSF) antibody levels against a lipid-free, denatured form of myelin basic protein (LF-MBP) in 11 patients with AIDS dementia complex (ADC) by using an enzyme-linked immunosorbent assay (ELISA). In 9 out of 11 patients, anti-LF-MBP antibody levels were significantly higher than those observed both in 15 human immunodeficiency virus (HIV)-infected patients without neurological disorders and in 9 anti-HIV-negative subjects affected by other neurological diseases. Furthermore, we followed up anti-MBP levels in 5 out of the 11 ADC patients and detected a strict relationship with the encephalopathy progression. At the same time, with the aim to detect early demyelinating events we investigated CSF antibody levels against a lipid-bound, native-like form of MBP (LB-MBP). Results did not show any significant difference between LF-MBP and LB-MBP in terms of antibody reactivity. The detection of anti-MBP antibodies in CSF may provide the opportunity to assess a diagnostic tool for discovering demyelinating lesions in ADC patients.

Clinical and immunologic effects of combination therapy with intravenous immunoglobulins and AZT in HIV-infected patients

30 patients with HIV infection were enrolled to evaluate the clinical efficacy and toxicity of zidovudine (AZT), 0.5 g/day p.o. (Group A) vs. AZT 0.5 g/day p.o. plus intravenous immunoglobulins (IVIG), 0.4 g/kg of body weight for three consecutive days, followed by one treatment of 0.6 g/kg of body weight every fourth week (Group B), over a period of one year. The study was open and randomized. The treatment groups were compared using the following study variables: 1) type of infections, recurrences and severity; 2) change in CD4+ T and CD8+ T cell count; 3) change in platelet count; 4) change in TNF alpha serum levels; 5) the probability of not developing an opportunistic infection over a period of 12 months. Patients from Group B developed less pathological events in comparison to Group A. No significative differences were evident with regard to values of T cell subsets obtained before and after treatment in each group and between the two groups. On the contrary, in 12 out of 15 patients from Group B there was a significant increase in platelet count. In both groups there was a significant decrease of mean serum levels of TNF alpha when a comparison was made between time 12 vs. time 6. However, when data were expressed as single values, in three subjects from Group B TNF alpha was still detectable by time 12 vs. 9 individuals in Group A. The cumulative probabilities of developing an opportunistic infection over the 12 months of treatment in the Group A subjects were significantly higher than in the Group B subjects (p less than 0.01). Adverse effects--nausea and gastric pain--were reported for 3 individuals (20%) from Group A and 4 patients (26%) from Group B. In conclusion, patients treated with AZT are especially likely to benefit from IVIG prophylaxis.

Report of the symposium on the use of intravenous gammaglobulin in adults infected with the human immunodeficiency virus

On July 27, 1989, the International Conference on Molecular Aspects of Immune Response and Infectious Diseases devoted a symposium to the subject of the use of intravenous gamma globulin (IVIG) in acquired immunodeficiency syndrome (AIDS). The information presented confirmed that IVIG benefits human immunodeficiency virus (HIV)-infected children with recurrent infections and that much remains to be learned about the influence of IVIG in adult AIDS. The symposium participants recognized the urgent need to develop randomized clinical trials using a control group to assess the efficacy of a treatment with IVIG in PGL (persistent generalized lymphadenopathy), ARC (AIDS-related complex), and AIDS. To prepare this report, a committee was established, including individuals with expertise in immunology, immunopharmacology, microbiology, virology, infectious diseases, general medicine, and pediatrics and representing research experience in academia and hospitals. After an introduction to the report with a summary of immunotherapeutic agents under evaluation to treat HIV infection, section 1 lays out the present understanding of the disease pathogenesis. Section 2 then outlines the treatment of HIV-seropositive individuals, discussing the uncertainties that any treatment entails. Section 3 discusses the rationale for treating HIV-infected individuals with IVIG, and Section 4 examines the major differences between IVIG and hyperimmunoglobulins for the treatment of HIV infection. Section 5 looks at IVIG as a mean to delay the emergence of opportunistic infections and restore immunocompetence in AIDS and related illnesses, and Sections 6 and 7 suggest a pilot protocol on the use of IVIG in association with low-dose or standard-dose zidovudine (AZT).(ABSTRACT TRUNCATED AT 250 WORDS)

[Yersinia enterocolitica in fresh and packaged meats]

In these last years it was observed an increased frequency of human infections by Y. enterocolitica supported mostly in Europe by serotype 0:3 and 0:9, and by serotype 0:8 in U.S.A. As far as it is concerned the transmission form to man, in addition to the possible infection between men, the one from animal to man and the one consequent on water use, most important suspicions are about foods derived from infected animals or however contaminated by man (fresh or preserved or processed meat, milk and its products; the produce of sea). Y. enterocolitica was isolated from all the animals for slaughter (especially from the swine's pharynx and excrement, where pathogenic serotypes for man were isolated), this ascertainment has led the Authors to research the microorganism in foods of animal kind. It is a facultative anaerobe and this characteristic allows it to survive and multiply also in packed products kept in the refrigerator. For this reason the A.A. carry out a research of Y. enterocolitica on 484 samples of fresh meats and sausages as follows: beef (150 samples), superficial scratching of ox's skeleton (150 samples), minced meat (20 samples), sausages (164 samples). Sausages and beef were bought in some butcher's shops, the other samples were drawn from slaughter-houses of Messina province. The results have pointed out that none of the analysed samples is found contaminated by these microorganisms.

Clinical and immunological assessment in HIV+ subjects receiving inosine-pranobex. A randomised, multicentric study

Inosine-pranobex (methisoprinol, isoprinosine; INPX) is the p-acetamidobenzoic salt of N,N-dimethylamino-2-propanol and inosine in a 3:1 molar ratio. In early studies, INPX was found to partially inhibit human immunodeficiency virus (HIV) and to increase the immunocompetence of HIV-infected subjects in vitro. We report the results of a randomised, multicentric clinical trial carried out on 553 HIV+ patients. 261 individuals were treated with INPX (two 500 mg tablets every 6 h for 3 months) and the remaining 292 constituted the untreated control group. INPX treatment was associated with a slightly improved clinical condition or with a trend in that direction, as compared to the untreated group. A preservation of the CD4/CD8 cell ratio values, a decrease in the CD8+ cells and an increase in the Leu 2-7+ cell number better than in the untreated individuals was also observed in the patients taking INPX. No serious or adverse effects of INPX have been observed.

Humoral and cellular immune responses to Salmonella typhi in patients with typhoid fever

Humoral and cellular immune responses to Salmonella typhi have been studied in nine children with typhoid fever. By using dot immunobinding assay, anti-O-polysaccharide chain and antilipid A antibody titers have been evaluated during the course of the disease. Anti-O-polysaccharide chain antibody titers are lower at the first week and increase up to the third week of the infection. On the other hand, antilipid A antibody levels, which are already higher at the beginning of the disease, progressively augment during the following weeks. Concerning cellular immunity to S. typhi, antibacterial activity mediated by typhoid peripheral mononuclear cells has been determined. Results show this function to be depressed in the initial phase of typhoid, increasing with the time. Together, these data bring new insight on immunity in typhoid patients.

Pharmacokinetics of zidovudine and concomitant inosine-pranobex in AIDS patients

3'-azido-3'-deoxythymidine (AZT) was administered orally to 8 AIDS patients at a dose of 100 mg every 6 hours for 14 days. On days 8 - 14 the patients were also given 1 g inosine-pranobex (INPX) every 6 hours. On day 7, while the subjects were taking AZT alone and on day 14 while they were receiving AZT + INPX, blood samples were obtained over a 6-hour dosing interval for measurement of AZT by a specific AZT radioimmunoassay. AZT levels on day 14 were significantly higher than the corresponding levels on day 7, resulting in a 2-fold increase of the area under the serum concentration-time curve (AUC) and a prolongation of the mean half-life of AZT (44 to 70 min) during the INPX treatment. INPX is an immunomodulatory drug with an inhibitory effect on HIV. The potential advantages of a combined treatment AZT + INPX are: 1) need for lower dose of AZT for maintaining a therapeutic anti-retroviral level; 2) a longer interval period between AZT treatments; 3) a potential to enhance immunological response resulting from INPX treatment; 4) reduced costs of care for patients.

Ofloxacin: clinical evaluation in urinary and respiratory infections

40 patients with urinary tract (30 cases) or pulmonary infections (ten cases) caused by different agents were treated with ofloxacin in order to evaluate the efficacy and safety of this new quinolone derivative. Treatment was performed with a dose of 300 mg three times a day for nine to 26 days. Out of the 30 urinary tract infections, 22 were clinically and bacteriologically cured, six had a clinical improvement but the causative organism persisted, one suffered a reinfection with a different pathogen and one failed to respond. Clinical and bacteriological cure was achieved in eight of the ten pulmonary infections. The overall clinical response for the two groups of patients was 97% (cure and improvement): bacteriological cure was achieved in 75% of the patients treated. No serious side effects of ofloxacin therapy were observed in any of our patients.

Influence of ofloxacin on murine Peyer's patch lymphocytes

Several factors must be considered before the clinical impact of antimicrobials on the immune function can be determined. No data are available as yet on the influence of ofloxacin, a new fluoro-quinolone, on the lymphocytes of Peyer's patches. The present study offers evidence that murine Peyer's patches are influenced by ofloxacin administered by the oral route for seven days (15 mg/kg). No modifications of the percentage of the Thy 1,2 and SIg positive splenocytes and of the PHA and LPS-induced proliferative responses were observed studying cell suspensions from the spleen of the same animals. An immunotoxic effect of the compound on the cells of Peyer's patches or an impairment of their homing tendency has been postulated.

Human amoebiasis: the interaction of lymphocyte surface-bound immune complexes and PMNs impairs T cell proliferative responses to E. histolytica mitogen

In some of the sera from patients with amoebiasis circulating immune complexes are present which are thought to interact with lymphoid cells, enabling them to elicit a burst of oxygen consumption in PMNs. The intensity of chemiluminescence is related to the presence of C3+ and Fc IgG+ cells in the lymphoid cell suspensions employed. The generation and release of highly reactive oxygen derivatives from PMNs impair T lymphocyte proliferative responses to the E. histolytica mitogen. The Authors suggest that one of the mechanisms by which circulating immune complexes present in the sera of patients with amoebiasis may interfere with T cell-mediated immune responses, is through their binding to the surface of the C3+, Fc IgG+ cells with subsequent stimulation of the PMN oxidative metabolism.

New trends in the rapid serodiagnosis of leptospirosis

TR/Patoc slide test, ELISA and TIA (Thin-Layer Immunoassay) were evaluated for their use in a rapid serodiagnosis of human leptospirosis. The results obtained indicated that the TR/Patoc slide test is very sensitive and able to detect within a few minutes early antibodies against whichever serovar of leptospires, like the antigens of the Galton test. The value of the ELISA test in detecting antibodies at a low level is confirmed. The TIA assay, employed here for the first time for the diagnosis of leptospirosis, though sensitive seemed too long to perform and consequently it is not a test of choice for a rapid screening of sera.

[Radial counter-immunoelectrophoresis in the determination of specific anti-hydatidosis antibodies. Preliminary observations]

Radial counter-immunoelectrophoresis was evaluated with sera from surgically-confirmed hydatidosis cases, patients with other parasitic diseases and healthy controls. Radial counter-immunoelectrophoresis was a sensitive as classic counter-immunoelectrophoresis based on the same positivity criterion and was equally specific for the immunodiagnosis of human hydatidosis. The procedure appears to be simple and rapid (the immunoprecipitation step requires just 5 minutes) and merits consideration.

Fractionation and characterization of hydatid fluid antigens with identification of an antigen similar to human serum albumin

Human and sheep hydatid fluids were separated by ultrafiltration, gel chromatography and immunoabsorption into several immunogenic fractions in which both parasite antigens and host substances were present. The immunological characterization of proteic antigens was carried out by immunodiffusion and immunoelectrophoresis with rabbit and ram antisera. A line of identity was observed between a human fraction (labelled as III) and a sheep fraction (labelled as 2B). Further evidence of the presence of a parasitic antigen in fraction III was given by its reaction against an antiserum from ram directed against sheep fraction 2B. The immunological characterization of fraction III indicated a close similarity between human serum albumin and parasitic antigens.

Anti-Ia reactivity in sera from subjects with Entamoeba histolytica infection

Sera from 15 patients with Entamoeba histolytica infection were tested for anti T-cell antibodies by assessing cross-reacting specificities with the antigens defined by an anti-Ia hybridoma antibody. T cells prepared by sheep erythrocyte rosetting were preincubated with the test sera and then with the anti-Ia antibody. Binding of the specific monoclonal antibody was assessed by rosetting with ox erythrocytes conjugated with goat anti-mouse IgG. Eight sera from amoebic patients were found to block the binding of monoclonal mouse hybridoma anti Ia-antibody to T cells. Blocking of anti-Ia binding was not due to Fc IgG receptor binding by immune complexes nor was it HLA-DR restricted. T cells pre-treatment with the amoebic sera positive for anti-Ia activity showed reduced activity when tested in the autologous mixed lymphocyte reaction (AMLR). The results of our study seem to suggest the existence of specific anomalies of immunoregulation during E. histolytica infection which may play a role in inducing immune disregulation in vivo.