A patient with tremors and breathlessness

We describe a patient with Parkinson's disease who developed bilateral pleural effusions and pleural fibrosis associated with pergolide therapy. Pergolide is an ergot-derived dopamine agonist used in the treatment of Parkinson's disease. This case report illustrates that physicians should have a high index of suspicion and consider drug-induced adverse effects in any differential diagnosis.

Differentiation of Pasteurella multocida isolates from cases of atrophic rhinitis in pigs from Zimbabwe by RAPD and ribotyping

Atrophic rhinitis in pigs is rarely reported in Southern Africa. To determine the relationship between Pasteurella multocida clones from clinical cases of atrophic rhinitis, twenty-one strains were characterised by selected phenotypic and genotypic methods. Biochemical analysis classified 18 strains as P. multocida subspecies multocida, whilst the remainder were grouped into separate unassigned biotypes. Capsular groups A (16/21) and D (l/21) were found among the isolates by PCR. Four ribotype patterns were obtained following HpaII ribotyping, whilst random amplification of polymorphic DNA (RAPD) revealed three main clusters. However, subclusters were also noted for each RAPD cluster. Our results indicate that RAPD offers a better discrimination of strains than ribotyping and that none of the phenotypic characters were directly related to the genotypic clusters.

Unidentified coryneform bacterial strain from cases of polyarthritis in chickens: phenotype and fatty acid profile

We report isolation of a strain of fermentative coryneform bacteria from an outbreak of polyarthritis in chickens. This strain could not be assigned to any recognized bacterial taxon because its peculiar phenotype is not yet reported. The strain possessed phenotypic characteristics and fatty acid profile similar to Erysipelothrix but, on the other hand, exhibited temperature-dependent motility like Listeria. We found no evidence of either Mycoplasma synoviae or Chlamydia infection. Details of the phenotype and fatty acid profile of the isolate and measures undertaken to contain the outbreak have been described.

Imaging spectrum of bronchial carcinoid--a case of central bronchial obstructing lesion

Here one case of bronchial carcinoid is reported, which presented as intrabronchial obstructing lesion with sequelae. Carcinoid syndrome is quite uncommon with bronchial carcinoids and x-ray or CT usually gives non-specific appearances. Still, the relatively younger age group of patients and presence of obstructing lesions in major bronchi with features like extraluminal extension and mucoid impactions are helpful signs. However, a few instances of carcinoid mimics do occur during imaging studies, like other types of intrabronchial tumours and long standing foreign bodies.

Random amplification of polymorphic DNA and phenotypic typing of Zimbabwean isolates of Pasteurella multocida

Eighty-one isolates presumptively identified as Pasteurella multocida from a variety of diseases in animals in Zimbabwe were subjected to biochemical characterization, capsular typing and RAPD analysis. The majority of isolates (over 80%) were assigned into named taxa and were predominantly P. multocida subsp. multocida and P. multocida subsp. septica, whilst the remainder were unassigned. Serogroup A was predominant among the three capsular types (A, B and D) of P. multocida detected. Three main RAPD clusters and three subclusters were observed among the majority of isolates (93.8%), whilst the remainder was found to be weakly related. Nine different groups of strains with similar RAPD profiles (100% similarity) were also observed. The reference strain of capsular serogroup F clustered with the reference strain of P. multocida subsp. septica, whilst all other serogroups clustered with reference strains of subsp. multocida and gallicida. Notably, serogroups A and D were observed to be closely related to the reference strain of subsp. multocida. The relationship between biotype, capsular type, host origin and disease manifestation was not clear-cut. However, most pig isolates of subsp. multocida clustered together as did most cattle isolates of subsp. multocida. RAPD tended to separate subsp. multocida from septica.

Vaccination to control an outbreak of Mycoplasma crocodyli infection

Details of a severe outbreak of M. crocodyli infection in farmed crocodiles are reported. The outbreak was suspected to have been precipitated by translocation-related stress on the animals brought from a farm with a known history of M. crocodyli infection. Resorting to the use of an autogenous vaccine proved more effective in alleviating the disease manifestations than antibiotic therapy. Prospects of vaccination in the face of an outbreak are discussed.

Visual acuities after levodopa administration in amblyopia

PURPOSE

To investigate the effect of the augmentation of levodopa with part-time and full-time occlusion on visual acuity and to determine its late results in amblyopia.

METHODS

Seventy-two patients with amblyopia were prospectively studied and randomly distributed into groups A, B, and C consisting of 24 patients each. Group A patients received levodopa alone, group B received levodopa and part-time (3 hours/day) occlusion, and group C received levodopa and full-time (during all waking hours) occlusion of the dominant eye. Levodopa 0.50 mg/kg body weight, with a 25% fixed dose combination of carbidopa, was administered orally three times a day for 7 weeks. Snellen visual acuity and its logMAR equivalent were recorded before treatment, at weeks 1, 3, 5, and 7 after starting treatment, and every 6 weeks for 1 year after the completion of treatment.

RESULTS

Fifty-three (74%) of the 72 patients had an improvement in visual acuity after treatment. Forty-four of the 53 patients with improved visual acuities completed 1-year post-treatment follow-up. Twenty-three (52%) of the 44 patients had a regression in visual acuity.

CONCLUSION

The augmentation of levodopa with part-time or full-time occlusion does not enhance the recovery of vision in amblyopia. Improved visual acuity after levodopa administration persists at least 1 year in almost half of patients after cessation of treatment. Addition of full-time occlusion to levodopa helps maintain improved visual acuity for a longer duration compared to levodopa alone or combined with part-time occlusion.

Modulation of host responses to blood-stage malaria by interleukin-12: from therapy to adjuvant activity

This review focuses on the role of interleukin (IL)-12, a proinflammatory cytokine with pleiotropic effects as a potent immunoregulatory molecule and hematopoietic growth factor, in infection with Plasmodium parasites, the causative agents of malaria. IL-12 has been demonstrated to have profound effects on the immune response to blood-stage malaria, to induce protection, and to alleviate malarial anemia. In combination with an anti-malarial drug, IL-12 is effective in an established malaria infection. This cytokine also has potent immune effects as a malaria vaccine adjuvant. However, IL-12 can also mediate pathology during blood-stage malaria.

Granulocyte-macrophage colony-stimulating factor-deficient mice have impaired resistance to blood-stage malaria

The contribution of granulocyte-macrophage colony-stimulating factor (GM-CSF), a hematopoietic and immunoregulatory cytokine, to resistance to blood-stage malaria was investigated by infecting GM-CSF-deficient (knockout [KO]) mice with Plasmodium chabaudi AS. KO mice were more susceptible to infection than wild-type (WT) mice, as evidenced by higher peak parasitemia, recurrent recrudescent parasitemia, and high mortality. P. chabaudi AS-infected KO mice had impaired splenomegaly and lower leukocytosis but equivalent levels of anemia compared to infected WT mice. Both bone marrow and splenic erythropoiesis were normal in infected KO mice. However, granulocyte-macrophage colony formation was significantly decreased in these tissues of uninfected and infected KO mice, and the numbers of macrophages in the spleen and peritoneal cavity were significantly lower than in infected WT mice. Serum levels of gamma interferon (IFN-gamma) were found to be significantly higher in uninfected KO mice, and the level of this cytokine was not increased during infection. In contrast, IFN-gamma levels were significantly above normal levels in infected WT mice. During infection, tumor necrosis factor alpha (TNF-alpha) levels were significantly increased in KO mice and were significantly higher than TNF-alpha levels in infected WT mice. Our results indicate that GM-CSF contributes to resistance to P. chabaudi AS infection and that it is involved in the development of splenomegaly, leukocytosis, and granulocyte-macrophage hematopoiesis. GM-CSF may also regulate IFN-gamma and TNF-alpha production and activity in response to infection. The abnormal responses seen in infected KO mice may be due to the lack of GM-CSF during development, to the lack of GM-CSF in the infected mature mice, or to both.

Capsular serogroups of Pasteurella multocida isolated from animals in Zimbabwe

Pasteurella multocida is isolated from a variety of disease conditions from different animal species in our diagnostic laboratory. In order to determine serogroup distribution among the isolates, an indirect haemagglutination test using glutaraldehyde-fixed sheep red blood cells was employed. A serological examination of 79 isolates revealed that 47/79 were of capsular serogroup A, 11/79 capsular serogroup D, 4/79 capsular serogroup B and 17/79 were untypable strains. None of the isolates belonged to either serogroup E or F. All those from cases of classical pasteurellosis could be grouped, but a significantly high proportion of those which originated from companion animals were untypable. The significance of these results is discussed. This report appears to be the first detailed information on the prevalence of various serogroups of P. multocida in animals in southern Africa.

Pasteurella gallinarum: Zimbabwean experience of a versatile pathogen

Pasteurella gallinarum-related outbreaks in chickens and African guinea fowls are described. Four outbreaks were recorded in chickens and one in guinea fowls. Periorbital swelling and keratoconjunctivitis were the consistently present clinical signs in all the diseased birds. In several, swollen hocks and wattles were also discerened. Birds which succumbed to the infection showed petechiation in the internal organs and evidence of airsacculitis. Pasteurella gallinarum was isolated from the lesions and also from conjunctival swabs of the apparently healthy in-contact birds. There was no evidence of concurrent infection with Haemophilus, Mycoplasma or Chlamydia. Quinolone therapy when resorted to on one of the farms resolved the clinical signs. Phenotypes of 28 isolates were studied. The results compared well with the Pasteurella gallinarum isolates reported earlier from elsewhere. It was also found that results of xylose fermentation and ONPG test appear to be a variable character. There is no earlier report of P. gallinarum infection in guinea fowls.

Viremia in neonatal herpes simplex virus infections

BACKGROUND

Polymerase chain reaction assays of the peripheral blood mononuclear cells (PBMC) and plasma may facilitate the diagnosis of neonatal herpes simplex virus (HSV).

METHODS

Assays for HSV DNA were submitted from at least 1 specimen site (PBMC, plasma or cerebrospinal fluid) in 11 consecutive cases of neonatal HSV infection.

RESULTS

HSV DNA was detected by PCR in the PBMC of 6 of 10 infants tested (60%), the plasma of 4 of 6 tested (67%) and the cerebrospinal fluid of 4 of 11 tested (36%).

CONCLUSIONS

HSV viremia is more frequent than previously appreciated, and detection of HSV DNA in PBMC and plasma is a useful diagnostic tool, particularly in infants without skin lesions.

Cyanoacrylate tissue adhesive augmented tenoplasty: a new surgical procedure for bilateral severe chemical eye burns

PURPOSE

To report on cyanoacrylate tissue adhesive augmented tenoplasty, a new surgical procedure for bilateral severe chemical eye injuries.

METHODS

A 26-year-old man presented with bilateral severe (grade IV) chemical burns involving the eye, periorbital tissues, face, and neck. Despite adequate medical therapy, corneal, limbal, and scleral ulceration progressed in both eyes. Secondary Pseudomonas keratitis necessitated therapeutic penetrating keratoplasty in the right eye. Tenoplasty and glued-on rigid gas permeable contact lens were unsuccessful to arrest progression of corneolimboscleral ulceration in the left eye. We applied n-butyl cyanoacrylate tissue adhesive directly on the ulcerating corneal, limbal, and scleral surface to augment tenoplasty.

RESULTS

The left ocular surface healed with resultant massive fibrous tissue proliferation and symblepharon on the nasal side. Ocular surface rehabilitation resulted in a vascularized leukomatous corneal opacity with upper temporal clear cornea. The patient achieved visual acuity of 6/36 in the left eye.

CONCLUSION

We suggest that cyanoacrylate tissue adhesive-augmented tenoplasty can be undertaken to preserve ocular integrity and retain visual potential in a severe chemical eye injury.

Mycobacterium avium-related epizootic in free-ranging lesser flamingos in Kenya

An epizootic in free-ranging lesser flamingos (Phoeniconaias minor) in Kenya resulted in more than 18,500 deaths from August through mid-November 1993. Disease was concentrated along the shores of Rift Valley Lakes Bogoria and Nakuru (Kenya) and did not involve any of the other avian or mammalian species frequenting the lakes. Coincidental to the outbreak was a bloom of algae on Lake Bogoria, toxins from which were first suspected to be causative. Discrete necrotic and granulomatous lesions were often noted in spleen and liver, and Mycobacterium avium serovar I was isolated from both organs. Escherichia coli and Pseudomonas aeruginosa also were often recovered in pure culture from liver. Gross and histopathological evaluation of the cases disclosed signs of acute sepsis and also chronic, potentially life-threatening lesions of mycobacteriosis, primarily involving the spleen and liver. Lesions typical for algae toxicosis were not seen in any birds. Deaths were attributed to septicemia complicated in those affected, by mycobacteriosis.

Mycotic keratitis in non-steroid exposed vernal keratoconjunctivitis

PURPOSE

To report a patient with vernal keratoconjunctivitis who developed mycotic keratitis in absence of known risk factors.

METHODS

A 17-year-old male suffering from vernal keratoconjunctivitis presented with infective keratitis. The patient had been treated in the past with topical antihistaminics and vasoconstrictors. The patient had not been exposed to topical steroids in 2 years of follow-up. He did not have dry eye or corneal micro or macroerosions prior to the development of infective keratitis. Corneal scrapings were obtained and subjected to KOH wet mount smear, calcofluor and Grams stain as well as bacterial culture sensitivity and fungal culture.

RESULTS

Clinical diagnosis of mycotic keratitis in association with vernal conjunctivitis was supported by microbiological investigations. KOH wet mount and calcofluor staining showed presence of filamentous septate hyphae while fungal culture showed growth of aspergillus fumigatus. Antifungal therapy was initiated in the form of topical natamycin 5% suspension to which the patient responded and recovered 6/6 final visual acuity.

CONCLUSION

The authors wish to conclude that patients suffering from vernal keratoconjunctivitis, even in the absence of corneal involvement, steroid exposure and trauma, may be at increased risk of developing keratomycosis.

Therapy with a combination of low doses of interleukin 12 and chloroquine completely cures blood-stage malaria, prevents severe anemia, and induces immunity to reinfection

The immunoregulatory cytokine interleukin 12 (IL-12) induces host resistance against experimental malaria. In this study, we tested the feasibility of using IL-12 in combination with chloroquine (CQ) to rescue susceptible A/J mice from lethal blood-stage Plasmodium chabaudi AS infection. Combined treatment with low doses of CQ and IL-12 resulted in a >15-fold reduction in the parasite load and 100% survival of A/J mice with established infections. Compared to control mice, which succumbed to severe anemia, CQ-plus-IL-12-treated mice had significantly higher early- and late-stage erythroid-cell progenitors in the bone marrow and spleen, resulting in significantly higher hematocrits, erythrocyte counts, and percentages of reticulocytes. Production of parasite-specific gamma interferon (IFN-gamma) by splenocytes from these mice was upregulated >20-fold relative to controls in parallel with enhanced IFN-gamma mRNA expression. Further, enhanced responsiveness to IL-12 and increased downstream IFN-gamma production in CQ-plus-IL-12-treated mice was evident from increased mRNA expression for the beta1 and beta2 subunits of IL-12 receptor in the splenocytes. Moreover, this combined therapy induced higher levels of anti-malaria antibodies than did CQ alone as well as sterile immunity against reinfection. Because IL-12 can be used at low doses and is effective even in established infections, it may be feasible to use this immunochemotherapeutic approach in human malaria.

Dyserythropoiesis and severe anaemia associated with malaria correlate with deficient interleukin-12 production

Complex cytokine interactions occur during blood-stage malaria which offer a unique opportunity to study their influence on the pathogenesis of malarial anaemia. Plasmodium chabaudi AS susceptible A/J mice experience severe and fatal anaemia whereas resistant C57BL/6 (B6) mice survive following moderate anaemia. In this study we analysed the role of IL-12 in erythropoiesis and tested whether the levels of IL-12 produced in these mice correlated with the extent of anaemia. In vitro, IL-12 significantly enhanced the numbers of erythroid burst (BFU-E) and colony forming units (CFU-E) in bone marrow and spleen cells from normal and day 7 infected A/J and B6 mice. Despite the presence of IL-12 in vitro, the level of splenic erythropoiesis in infected A/J mice was significantly lower than in B6 mice. Moreover, sera from infected B6 mice, but not A/J mice, significantly up-regulated erythropoiesis in vitro and this enhancement correlated with several fold higher levels of IL-12 in the sera of B6 compared to A/J mice. Furthermore, the erythropoietic potentiating effect of sera from infected B6 mice was abrogated following depletion of IL-12. Taken together, these findings suggest that defective IL-12 production in A/J mice during the early course of infection may result in fatal anaemia.