[Immunohormonal homeostasis in meningococcal meningitis]

The examination of 18 patients with meningococcal infection has revealed the presence of reciprocal relationships between changes in the content of cortisol and triiodothyronine in their blood, especially at the beginning of the disease. The dynamics of changes in the concentration of rosette-forming cells has proved to be similar to that of changes in the concentration of triiodothyronine. A decrease in the level of thyroid hormones in the blood has been observed in experimental infections and oncological processes in mice, rats or guinea pigs, as well as after the injection of adjuvants into these animals. The centroid factor analysis with the use of the criteria of symmetry and asymmetry has revealed 3 main factors in the process under study, interpreted as follows: the homeostasis destabilization factor of infectious nature (F1), the homeostasis maintenance and restoration factor of endogenous nature (F2) and the factor of the integral relationship catabolism/anabolism between energy streams in the body (F3).

Effect of exchange transfusion with an oxygen-carrying resuscitation fluid on the efficacy of penicillin therapy of pneumococcal infection in rats

The effects of exchange transfusion with Fluosol DA (FDA) or stroma-free hemoglobin on the outcome of pneumococcal infection in rats were determined. Rats were sham transfused or exchange transfused with 25 ml of FDA or stroma-free hemoglobin. They were then challenged intraperitoneally with Streptococcus pneumoniae type 3 and treated with penicillin for 120 h. Only 2 of 15 (13.3%) FDA-transfused rats were alive at 312 h compared with 11 of 15 (73.3%) concurrently studied sham-transfused control rats (P = 0.0016). Of 10 stroma-free hemoglobin-transfused rats and 10 concurrently studied sham-transfused control rats (P = 0.98), 8 from each group (80%) were alive at 312 h. Penicillin therapy only suppressed pneumococcal infection in FDA-transfused rats, and relapse occurred after therapy was stopped. This effect could not be attributed to interference with the bactericidal activity of penicillin against pneumococci, to an alteration in the pneumococcal burden before penicillin therapy or to an alteration of the leukocyte and polymorphonuclear leukocyte response by FDA. In contrast, pneumococcal infection in stroma-free hemoglobin-transfused rats was cured with penicillin therapy. These data showed that FDA altered the ability of rats to respond to pneumococcal infection.

Pneumococcal sonicate-induced biphasic granulocytopenia and its dissociation from pulmonary leukostasis. The contribution of pneumococcal products and complement to early and late granulocytopenic phases

The pathogenesis of pneumococcus (PNC)-induced granulocytopenia is unclear. We studied its relationship to pulmonary leukostasis and the possible roles of PNC constituents and complement. Nonviable PNC was infused into normal and 99% C3-depleted rabbits. PNC challenge induced both granulocytopenia and pulmonary leukostasis in normal animals; complement-depleted animals displayed granulocytopenia without pulmonary leukostasis. Therefore an intact complement system was not essential to the granulocytopenia, whereas pulmonary leukostasis was complement-dependent. Rabbits infused with serum, plasma, or nonpyrogenic normal saline, each after in vitro incubation with PNC, developed significant granulocytopenia (p less than 0.001, p less than 0.01, and p less than 0.001, respectively) with maximal mean percent decreases of -98%, -97%, and -91%, respectively. When the animals were sacrificed at 3 hr, no pulmonary leukostasis was found. The granulocytopenia persisted for 3 hr after infusion of either PNC-exposed serum or plasma, whereas the granulocytopenia induced by PNC-exposed saline was of less than or equal to 1 hr duration. If serum or plasma complement was inactivated prior to PNC incubation, subsequent infusion also induced significant granulocytopenia of less than 1 hr duration (p less than 0.05 and p less than 0.01). PNC-exposed saline that was subsequently heat-treated induced this same early (less than or equal to 1 hr) granulocytopenia (p less than 0.05). Control animals infused with serum, plasma, or saline unexposed to PNC displayed neither granulocytopenia nor pulmonary leukostasis. Therefore neither prior in vitro complement inactivation nor heat treatment after PNC incubation prevented the early granulocytopenic phase; in vitro complement inactivation totally aborted the late phase. The complement-independent, heat-stable early granulocytopenic phase was further investigated. Its granulocytopenia-inducing activity did not require the presence of PNC capsular polysaccharide and was resistant to trypsin treatment. With ultrafiltration, its molecular weight was 100,000 to 300,000. Thus PNC-induced granulocytopenia is a multifactorial phenomenon involving both complement-dependent and complement-independent mechanisms as well as contribution by PNC constituents or by-products.

Restoration of phagocytosis and oxidative metabolism by Piracetam in failing human neutrophils: a qualitative assessment

By the use of immunobeads, a convenient clinical laboratory test is available which detects, in metabolically stressed leukocytes, failing or absent phagocytosis and/or impaired to absent oxidative metabolic activity. Furthermore, it has been demonstrated that Piracetam, 2-oxo-pyrrolidine acetamide, will restore such compromised neutrophils to normal functional status. In 4 of 19 patients, all with a variety of serious diseases, a range from impaired to total failure of neutrophilic phagocytic and metabolic oxidative activities was detected by the test. Piracetam, as shown by qualitative methods, restored to optimal activity the two impaired neutrophil functions in these 4 patients. Quantitative techniques are available currently to establish the beneficial effect of Piracetam on such defective neutrophils. Piracetam merits additional study to determine its efficacy in enhancement of restorative effects on compromised neutrophils which have been observed. The clinical promise of this investigation offers benefit to some patients now jeopardized by certain stressful diseases in part due to agonal failure of neutrophils.

Changes in the serum of mice infected with Streptococcus pneumoniae that stimulate in-vitro multiplication of virulent but not avirulent strains

During pneumococcal infection of mice, nucleic-acid products, including deoxynucleotides, may be released into the serum from cellular disintegration in at least three organs, the lungs, spleen and liver. The serum, after sterilisation to remove contaminating pneumococci, stimulated multiplication of virulent but not avirulent pneumococci in vitro. It also stimulated growth of virulent pneumococci in serum from uninfected animals and could be replaced, at least in part, by certain nucleic-acid degradation products at concentrations found in infected serum. The effects of the serum were lost after dialysis or dilution.

Complement in pneumococcal infections with varying degrees of severity

Complement component levels (Clq, Cls, C4, C3, factor B and properdin) and C1 subcomponent complexes (C1r-C1s, C1-r-C1-, C1-r-C1-s-C1 inactivator, 1A) were studied in 16 adults with pneumococcal infections varying severity. Patients with fulminant disease and signs of septic shock showed pronounced hypocomplementemia. In patients with pneumococcal pneumonia or meningitis elevated levels of C1-r-C1-s-C1- IA complexes indicated activation of C1, despite normal levels of C1q, C1s, C4 and C3. Moderately decreased properdin values suggested involvement of the alternative pathway. In adults with pneumococcal otitis no changes in the complement profile was found. In contrast, pronounced aberrations of the C1 subcomponents were earlier demonstrated in children with otitis.

The role of the spleen in experimental pneumococcal bacteremia

The importance of the spleen in host defense against pneumococcal bacteremia has been suggested by a number of experimental models as well as the occurrence of the syndrome of overwhelming pneumococcal sepsis in asplenic individuals. We studied the mechanism of splenic protection against pneumococcal bacteremia using a guinea pig model. Rates of removal of pneumococci from the blood stream in normal and splenectomized guinea pigs were compared with the extent of hepatic and splenic sequestration of radiolabeled organisms for three different types of pneumococci. A relationship was found between the virulence of a pneumococcus for normal guinea pigs, the extent to which it is cleared by the spleen, and the magnitude of the defect in blood stream sterilization induced by splenectomy. The spleen plays an increasingly important role in the clearance of progressively more virulent organisms, for which hepatic clearance cannot compensate. Thus, the division between hepatic and splenic clearance of bacteremia is a key determinant of the outcome of experimental pneumococcal infection.

A probable endocrine basis for the depression of ketone bodies during infectious or inflammatory state in rats

The effects of infection with Streptococcus pneumoniae, Francisella tularensis, and Venezuelan equine encephalitis virus as well as inflammatory stress induced by the administration of turpentine and endotoxin on plasma ketone bodies and insulin were studied in white rats. All of the infectious/inflammatory stresses caused a significant decrease in the ketonemia of fasting and an elevation of plasma insulin. When a pneumococcal infection was initiated in a diabetic rat, inhibition of fasting ketonemia did not occur. Similarly, pneumococcal infection in the hypophysectomized rat did not result in a noticeable depression of either fasting ketonemia or plasma FFA. The increase in circulating insulin appears to be closely correlated with the inhibition of fasting ketonemia noted in the infectious/inflammatory stress.

Polymorphonuclear leukocyte function during otitis media

Polymorphonuclear leukocyte (PMN) function was evaluated in children with serous (SOM) and mucoid otitis media (MOM) and in an experimental model of acute purulent otitis media due to Streptococcus pneumoniae using chinchillas. Twenty-three of 100 children with SOM or MOM had depressed peripheral blood PMN chemotactic, bactericidal or chemiluminescence activity. Depressed PMN chemotactic activity was observed in 17(18%) of 97 children. Children whose middle ear effusions cultured Hemophilus influenzae were more than twice as likely to have depressed PMN chemotactic activity as children whose effusions were sterile. Depressed PMN bactericidal activity was observed in seven (23%) of 30 children, and depressed PMN chemiluminescence activity was found in three (16%) of 19 children. Combined chemotactic and bactericidal dysfunction was observed in four (13%) of 30 children. All seven of the chinchillas with pneumococcal otitis media showed significantly depressed PMN chemotactic activity during the first week after inoculation, while only two of ten uninfected control chinchillas showed the same degree of chemotactic depression (P = .002). The association of H. influenzae and S. pneumoniae with depressed PMN function suggested that bacterial components of these microbes might have functional similarities. Both bacteria are surrounded by capsular polysaccharides which are known to persist in mammalian tissues for an extended period. It is possible that these or other components of H. influenzae and S. pneumoniae, or even host factors generated during middle ear infection and inflammation, impair the PMN response to middle ear infection resulting in delayed bacterial killing and persistent middle ear effusion.

Disseminated intravascular coagulopathy during experimental pneumococcal sepsis: studies in normal and asplenic rhesus monkeys

Disseminated intravascular coagulation (DIC) was induced in both normal and asplenic rhesus monkeys by intravenous challenge with Streptococcus pneumoniae. Our observations in the infected monkeys have led us to conclude that (1) pneumococcal capsular polysaccharide (PCP), immune complexes and complement may not have primary roles in the initiation of DIC; (2) intact pneumococci may be catalysts for the development of DIC; (3) the initial event in DIC may be activation of Hageman factor; and (4) evidence of activation of Hageman factor-dependent systems is present regardless of severity of infection.

The significance and mechanism of an increased serum phenylalanine-tyrosine ratio during infection

Infections or inflammatory states often cause significant increases in serum phenylalanine and the phenylalanine-tyrosine ratio. More than 95% of samples obtained during inflammatory diseases in man showed phenylalanine-tyrosine ratio increases greater than the maximum normal values. An increase in this ratio also occurred in monkeys with induced Rocky Mountain spotted fever, viral encephalitis, yellow fever, or pneumococcal and Salmonella infections, as well as in rats with pneumococcal and Salmonella infections, as well as in rats with pneumococcal, Salmonella or tularemia infections. A similar ratio increase occurred in rats inoculated with unpurified mediator substances (released by activated leukocytes) that appear to initiate many of the secondary metabolic phenomena associated with infection and/or inflammation. To identify responsible mechanisms, rats were given lethal doses of Streptococcus pneumoniae; serum phenylalanine and phenylalanine-tyrosine ratios increased significantly. Hepatic phenylalanine hydroxylase activities were slightly decreased when compared to noninfected controls. Infected and noninfected rats showed comparable oxidation rates for 14C-phenylalanine given with an oral phenylalanine load, as a pulse-oral dose, or as an intraperitoneal injection. After 8 hr, both infected and control rats had similar amounts of radioactivity in total body protein, but tissue distributions were markedly altered during pneumococcal sepsis. Serum proteins of infected rats contained almost twice as much total radioactivity as that found in controls, while the amount of labeled phenylalanine in skeletal muscle protein was significantly reduced in the infected group. Isolated muscles from infected rats released more phenylalanine and less tyrosine than control muscles. Infection-related increases in serum phenlalanine could not be explained by decreased hydroxylation or oxidation. Rather, the data were consistent with an increased flux of phenylalanine into serum, most likely as the result of increased skeletal muscle catabolism. Elevations in the serum phenylalanine-tyrosine ratio have potential value for estimating the presence of an inflammatory fisease and the catabolic state of a patient.

Behavior of eosinophil leukocytes in acute inflammation. II. Eosinophil dynamics during acute inflammation

The marked diminution in the number of circulating eosinophils, which has been shown to occur during acute bacterial infections, is a distinctive aspect of eosinophil physiology and of the host response to acute infection. The mouse rendered eosinophilic by infection with trichinosis provides a suitable model for study of the eosinopenic response induced by acute inflammation. The alterations in eosinophil dynamics associated with acute inflammatory reactions in trichinous mice were studied with pneumococcal abscesses, with Escherichia coli pyelonephritis, with Coxsackie viral pancreatitis, and with acute subcutaneous inflammation due to turpentine. Each of these stimuli of acute inflammation markedly suppressed the eosinophilia of trichinosis. This suggests that the eosinopenia is a response to the acute inflammatory process rather than the response to a specific type of pathogen. These studies apply quantitative techniques to ascertain the effects of acute inflammation on eosinophil production in bone marrow and on distribution of eosinophils in the peripheral tissues. From these observations, it is apparent that the initial response to acute inflammation includes a rapid drop in numbers of circulating eosinophils, a rapid accumulation of eosinophils at the periphery of the inflammatory site, and an inhibition of egress of eosinophils from the bone marrow. With prolongation of the inflammatory process, inhibition of eosinopoiesis occurs.

Effect of pneumococci on blood clotting, platelets, and polymorphonuclear leukocytes

Infections due to Streptococcus pneumoniae and products from the organism have been associated with alterations in blood clotting and function of platelets. Pneumococci and pneumococcal polysaccharide shortened the clotting times of whole blood, platelet-rich plasma (PRP), and platelet-poor plasma (PPP) in vitro. Clotting times of PPP and PRP from C6-deficient animals were likewise decreased. The bacteria had no effect on the one-stage prothrombin time or the partial thromboplastin time when the organisms were used as activating agents. Platelets aggregated in the presence of pneumococci, but aggregation was prevented by the addition of cyclic adenosine 3', 5'-monophosphate (cAMP). Furthermore, cAMP corrected the shortened clotting time of PRP in the presence of pneumococci. The clumping and release of polymorphonuclear coagulant that was induced by pneumococci was not prevented by cAMP. Thus, pneumococci exert several dose-dependent thromboplastic effects: (i) release of platelet thromboplastic substances; (ii) a direct thromboplastic effect; and (iii) release of polymorphonuclear coagulant.

Cell-mediated immunity after bacterial infection of the lower respiratory tract

Lower respiratory tract and systemic cell-mediated immunity have been studied in rabbits after infection with Listeria monocytogenes or Diplococcus pneumoniae. Respiratory tract cell-mediated immunity was evaluated by direct and indirect assays of migration inhibitory factor (MIF) production. Systemic delayed hypersensitivity was determined by means of intradermal testing with appropriate antigens. Aerosol exposure to listeria was followed by markedly increased numbers of free lower respiratory tract cells. These cells manifested antigen-stimulated inhibition of migration (mean inhibition of migration = 30.4%). Pneumococcal pneumonia was associated with similar but less dramatic changes. Intravenous administration of organisms was uncommonly followed by inhibition of lower respiratory tract cells in direct migration assays. Fractionated MIF, as well as crude supernates of antigen-stimulated lower respiratory tract and lymph node lymphocytes from animals exposed to listeria aerosols, caused inhibition of normal alveolar macrophage migration. MIF, produced by lymph node lymphocytes, has a molecular weight of approximately 65,000 and is inactivated by chymotrypsin or neuraminidase. Delayed dermal hypersensitivity to listeria antigen was observed in 54 of 55 animals exposed to listeria aerosols and in all 9 animals infected by the intravenous route. Delayed dermal reactions to pneumococcal sonicate antigen (but not capsular polysaccharide) followed D. pneumoniae respiratory tract infection in 19 of 28 animals, and was elicited in 5 of 6 animals after intravenous infection. Both local (macrophage migration inhibition) and systemic delayed hypersensitivity followed bacterial infection of the lower respiratory tract. MIF activity was shown to be one mechanism for inhibition of alveolar macrophage migration.

Altered glucoregulatory hormones during acute pneumococcal sepsis in the rhesus monkey

To determine the effects of a Diplococcus pneumoniae infection upon the dynamics of glucose metabolism and the hormones responsible for its control, intravenous glucose tolerance tests (IVGTT's) were performed in monkeys during baseline control conditions and twenty-four hours after initiating infection when the monkeys were febrile. Along with plasma glucose, immunoreactive insulin and glucagon concentrations were measured sequentially through each IVGTT. Furthermore, fasting concentrations of plasma amino acids, immunoreactive growth hormone and cortisol were determined.

These data reveal no differences in the fasting plasma concentrations of growth hormone and glucose, or in the disappearance rates of glucose during the two IVGTT's. There was, however, a mild relative hyperinsulinemia (p < 0.05) (following glucose) along with fasting hyperglucagonemia (p < 0.01) during infection. Of the twenty-one amino acids measured, twenty were depressed during infection; only cysteine was elevated (p < 0.05) in the infected monkeys. Although plasma cortisol levels were significantly (p < 0.05) increased above preinfection values by the stress of infection, they remained within the control range.

The hyperglucagonemia and depression of the mean insulin: glucagon molaf ratio are compatible with the catabolic events occurring during a mild bacterial infection in the monkey.

Periodicity of susceptibility to pneumococcal infection: influence of light and adrenocortical secretions

Circadian periodicity of susceptibility to pneumococcal infection was altered but not abolished in blind or adrenalectomized mice. Serum corticosterone concentrations 24 hours after pneumococcal challenge were greatest in animals challenged at 0400 hours, a time when circulatory corticosterone is lowest; the smallest absolute increase in serum corticosterone followed challenge at 1600 hours.

Altered immune function in hypercholesterolemic monkeys

Humoral and cellular immune responses to several antigens were compared in control and hypercholesterolemic groups of monkeys. Chronic hypercholesterolemia, with concomitant hyperphospholipidemia and hypotriglyceridemia, was produced experimentally by feeding monkeys a high-fat, high-cholesterol diet. When studied prior to infection, hypercholesterolemic monkeys exhibited impaired development of precipitating antibodies against ovalbumin, enhanced sensitivity to tuberculin antigen (stimulated apparently by mycobacterial components in complete Freund adjuvant), and an increased rate of clearance of colloidal carbon from blood. During pneumococcal infection the ability of neutrophiles from hypercholesterolemic monkeys to reduce nitroblue tetrazolium dye showed an increase greater than that of control monkeys; both groups exhibited increased but comparable final clearance rates of colloidal carbon, although the increment of increase was smaller in hypercholesterolemic monkeys.

Effect of pneumococcal neuraminidase on canine cerebral cortex in experimental meningitis

We examined the effect of experimental meningeal infection with a neuraminidase-producing strain of Diplococcus pneumoniae on the N-acetylneuraminic acid (NANA) content of canine cerebral cortical gray matter. The Warren thiobarbituric acid assay for NANA was used. There was no significant difference between the free and bound NANA levels of the tissue from control animals and from those with meningitis. This finding suggests that the neurological impairment so frequent in clinical pneumococcal meningitis is not a result of the activity of this bacterial enzyme upon cortical glycolipids.

Correlation of circulating capsular polysaccharide with bacteremia in pneumococcal pneumonia

Immunoelectroosmophoresis with rabbit anticapsular antibody was used to detect type-specific pneumococcal polysaccharide in serum from bacteremic patients with pneumococcal pneumonia. The test could detect as little as 0.1 to 1.0 mug per ml or 0.2 to 2 ng per test of polysaccharide from types 1, 2, 3, 4, 5, 8, 12, and 18, and its sensitivity was 10 times that of double immunodiffusion. Although antigen could be detected by double immunodiffusion with types 7 and 14, no antigen could be detected by immunoelectroosmophoresis. Types 7 and 14 polysaccharides were found to be positively charged, whereas the other polysaccharides were negatively charged. Forty-six patients with pneumonia were selected for study because pneumococci corresponding to those types where the test was known to work had been isolated from blood or the respiratory tract. Antigenemia correlated strongly with bacteremia: 12 of 20 bacteremic patients with pneumonia showed antigenemia, whereas 26 patients negative for bacteremia did not show circulating antigen detectable with antisera against the pneumococcal type isolated from the respiratory tract. The apparent concentration of circulating polysaccharide ranged from 0.1 to 100 mug per ml of serum, and the concentration did not appear to diminish appreciably in 10 to 15 days. Three of 12 patients with antigenemia died, and two of these had the highest levels of circulating antigen observed.

Tissue amino acid flux after exposure of rats to Diplococcus pneumoniae

The concentration of 21 individual free amino acids in serum, liver, and skeletal muscle was determined in rats during the incubation, acute illness, and terminal stages of experimental infection with Diplococcus pneumoniae. By 4 hr after subcutaneous inoculation with bacteria, the concentration of total and many individual free amino acids in serum, liver, and muscle was significantly decreased in comparison to findings in noninfected, pair-fed control rats. By use of a nonmetabolizable amino acid analogue (cycloleucine), it was possible to detect a flux of amino acids from muscle to liver in the infected rat. The endogenous amino acids which moved to the liver were rapidly utilized for the synthesis of serum proteins.

Leukocyte lactate dehydrogenase changes as an indicator of infection prior to overt symptoms

Lactic acid dehydrogenase (LDH) concentration of rabbit serum and leukocytes was followed during the course of an acute infection with Diplococcus pneumoniae. Control values were obtained prior to infection, and again 4, 24, and 48 hr later. LDH isozymes were characterized by acrylamide gel electrophoresis and quantitated by densitometry. An increase in serum LDH was observed as early as 4 hr after infection. These levels returned to normal in 24 hr and rose again 48 hr after infection. The LDH level of leukocytes, from 10 of 12 infected rabbits, rose rapidly during the 24-hr period after exposure. The levels were two to three times the original preinoculation level for that animal. In six of these rabbits, this LDH elevation occurred 4 hr after inoculation and preceded the onset of fever. Change in the type of leukocyte did not account for the increase in cellular LDH. All infected rabbits showed approximately the same increase in polymorphonuclear leukocytes, but not all developed comparable increases in LDH. The isozyme patterns obtained, when defined amounts of enzyme were applied to the gel for electrophoresis, were characterized for the most part by a three-enzyme pattern. Increasing amounts of enzyme occasionally revealed a fourth, more cathodal, enzyme. The more cathodic enzymes appear to be the most responsive when sudden shifts in enzyme concentration occur within the cell.

Effects of three bacterial infections on serum lipids of rabbits

Alteration of the rabbit serum lipids as a result of three bacterial infections was studied by quantitative thin-layer and gas-liquid chromatography. Anthrax infection slightly changed the serum lipid. Cholesterol did not change, though free fatty acids, triglycerides, and cholesteryl esters doubled, and lecithin increased threefold. Tularemia infection produced drastic changes in the serum lipid content of rabbits, increasing levels of cholesterol over 4-fold, free fatty acids 17-fold, triglycerides 11-fold, cholesteryl esters 2.5-fold, and lecithin almost 3-fold. Pneumococcus infection increased cholesterol 2.5 times, free fatty acids were more than doubled, triglycerides were increased 9.5 times, and lecithin was increased almost 4 times. Gas-liquid chromatographic analysis of the methyl esters of free fatty acids showed only quantitative changes in these acids due to infection. Some possible mechanisms of alteration of serum lipid content are discussed.

Neutrophil kinetics in acute infection

Neutrophil kinetics of acute experimental infection were studied with diisopropylfluorophosphate-(32)P labeling in 31 dogs inoculated intrabronchially with pneumococci. In vitro neutrophil labeling indicated a rapid transit time through the blood in early infections, with an elevated marginal granulocyte pool sometimes preceding an elevation of the circulating granulocyte pool. 13 hr after infection, the circulating and total blood granulocyte pools were increased but the rate of neutrophil transit through the blood was normal. During the recovery from infection there was a marked prolongation of neutrophil blood transit time, suggesting virtually complete cessation of bone marrow release of neutrophils into the blood. Labeling of neutrophils in vivo indicated an increased rate of emptying of the bone marrow storage pool proportional to the severity of infection as measured by the fever index. The change in the blood ratio of nonsegmented to segmented neutrophils was a much more accurate index of the severity of infection than the blood granulocyte concentration, correlating significantly with the fever index.