Investigation of tick-borne viruses as pathogens of humans in South Africa and evidence of Dugbe virus infection in a patient with prolonged thrombocytopenia

In the course of investigating suspected cases of viral haemorrhagic fever in South Africa patients were encountered who had been bitten by ticks, but who lacked evidence of infection with Crimean-Congo haemorrhagic fever (CCHF) virus or non-viral tick-borne agents. Cattle sera were tested by enzyme-linked immunoassay to determine whether tick-borne viruses other than CCHF occur in the country. The prevalence of antibody in cattle sera was 905/2116 (42.8%) for CCHF virus, 70/1358 (5.2%) for Dugbe, 21/1358 (1.5%) for louping ill, 6/450 (1.3%) for West Nile, 7/1358 (0.5%) for Nairobi sheep disease, 3/625 (0.5%) for Kadam and 2/450 (0.4%) for Chenuda. No reactions were recorded with Hazara, Bahig, Bhanja, Thogoto and Dhori viruses. The CCHF findings confirmed previous observations that the virus is widely prevalent within the distribution range of ticks of the genus Hyalomma, while antibody activity to Dugbe antigen was detected only within the distribution range of the tick Amblyomma hebraeum. Cross-reactivity for the nairoviruses, Hazara, Nairobi sheep disease and Dugbe, was detected in serum samples from 3/72 human patients with confirmed CCHF infection, and serum from 1/162 other patients reacted monospecifically with Dugbe antigen. The latter patient suffered from febrile illness with prolonged thrombocytopenia.

Cold-sensitive mutations of Dictyostelium myosin heavy chain highlight functional domains of the myosin motor

Dictyostelium provides a powerful environment for characterization of myosin II function. It provides well-established biochemical methods for in vitro analysis of myosin's properties as well as an array of molecular genetic tools. The absence of myosin function results in an array of phenotypes that can be used to genetically manipulate myosin function. We have previously reported methods for the isolation and identification of rapid-effect cold-sensitive myosin II mutations in Dictyostelium. Here, we report the development and utilization of a rapid method for localizing these point mutations. We have also sequenced 19 mutants. The mutations show distinct clustering with respect to three-dimensional location and biochemically characterized functional domains of the protein. We conclude that these mutants represent powerful tools for understanding the mechanisms driving this protein motor.

Urinary retention in sexually abused women

Urinary retention is generally believed to be the result of neurogenic or non-neurogenic problems. In men, it is often caused by benign prostatic hypertrophy which can be treated by transurethral surgery.1 In women, however, studies have shown that urinary retention is usually caused by detrusor dysfunction rather than obstruction. Surgery on the urethra or bladder neck is, therefore, inappropriate and ineffective. Once the cause of retention has been determined (i.e whether neurogenic or non-neurogenic in origin), appropriate treatment can be decided upon. The most common neurogenic problems are diabetes mellitus, multiple sclerosis and spinal cord pathologies.(1) Patients with non-neurogenic etiology associated with urinary retention are often found to have psychosocial problems that inhibit detrusor activity causing psychogenic retention.1-4 Studies have found that woman with a history of psychosis, depression and stress/anxiety have a higher incidence of urinary retention than woman with no history of such conditions. Psychological problems involving the loss of loved one, recent marriage break-up, abortion, pelvic surgery, etc. have been found to contribute to the incidence of urinary retention. There is another group of women who may or may not exhibit psychological problems associated with psychogenic urinary retention, but who may develop the same physical manifestations. These women have been sexually abused and have not fully resolved or realized the trauma of the assault. This paper looks at four cases or urinary retention in sexually abused woman, the treatments used and the results and conclusions obtained.

Lack of detection of enteroviral RNA or bacterial DNA in magnetic resonance imaging-directed muscle biopsies from twenty children with active untreated juvenile dermatomyositis

OBJECTIVE

To investigate for the presence of increased titers of circulating antibody to putative infectious agents and for detectable viral RNA or bacterial DNA in children with active recent-onset juvenile dermatomyositis (DM).

METHODS

Magnetic resonance imaging-directed muscle biopsies were performed in 20 children with active, untreated, recent-onset juvenile DM and in age-matched children with neurologic disease. Sera were tested for complement-fixing antibody to Coxsackievirus B (CVB), influenza A and B, parainfluenza 1 and 3, Mycoplasma pneumoniae, mumps, respiratory syncytial virus, and Reovirus; and by immunofluorescence for IgG antibody to Toxoplasma gondii cytomegalovirus and IgM antibody to Epstein-Barr virus. Muscle from juvenile DM patients and control children, CD-1 Swiss mice with and without CVB1 infection, and viral stock positive for CVB1-6 were tested using reverse-transcriptase polymerase chain reaction with 5 primer sets, 4 probes (1 Coxsackievirus, 3 Enterovirus), and universal primers for DNA.

RESULTS

No increased antibody, viral RNA, or bacterial DNA was present in the juvenile DM patients or the control children.

CONCLUSION

Juvenile DM may be triggered by unidentified agent(s) in the genetically susceptible host.

Highly purified quiescent human peripheral blood CD4+ T cells are infectible by human immunodeficiency virus but do not release virus after activation

Previous studies have suggested that resting CD4+ lymphocytes can be infected by human immunodeficiency virus (HIV), but viral production is inhibited. If these cells are activated, progeny virions are released. The present data indicate that CD4+ lymphocytes in the G0/G1 stage of the cell cycle which have been highly purified to remove macrophages and activated HLA-DR+ cells can also be infected by HIV. However, our findings differ from those of earlier reports since in this study, infected quiescent CD4+ cells cannot be activated to produce virus after virus inoculation. PCR analyses indicate that reverse transcription in these CD4+ cells is arrested at a very early step in proviral DNA formation (U3-R region). They do not show any evidence of longer DNA transcripts (e.g., U3-gag). When these quiescent infected CD4+ lymphocytes are activated by exposure to mitogens and macrophages and then reinoculated with HIV, the replication of virus takes place. Resting CD4+ lymphocytes are also resistant to infection when they are cocultured with HIV-infected macrophages. Only activated CD4+ cells are susceptible to cell-to-cell transmission. These observations suggest that in vivo tissue macrophages, susceptible to HIV replication, are the major cells initially productively infected by the virus. Then these cells can transfer HIV to activated CD4+ lymphocytes with resultant virus production. The presence of arrested reverse transcription in quiescent cells raises questions about the cellular factors required to permit production of longer HIV proviral DNA copies. Because they can be reinfected once they have been activated, these infected quiescent cells could be a source of recombinant viruses in the host.

A novel positive selection for identifying cold-sensitive myosin II mutants in Dictyostelium

We developed a positive selection for myosin heavy chain mutants in Dictyostelium. This selection is based on the fact that brief exposure to azide causes wild-type cells to release from the substrate, whereas myosin null cells remain adherent. This procedure assays myosin function on a time scale of minutes and has therefore allowed us to select rapid-onset cold-sensitive mutants after random chemical mutagenesis of Dictyostelium cells. We developed a rapid technique for determining which mutations lie in sequences of the myosin gene that encode the head (motor) domain and localized 27 of 34 mutants to this domain. We recovered the appropriate sequences from five of the mutants and demonstrated that they retain their cold-sensitive properties when expressed from extrachromosomal plasmids.

Direct evidence using in situ polymerase chain reaction that the endothelial cell and T-lymphocyte harbor latent murine cytomegalovirus

The latent viral genome, harbored indefinitely, threatens reactivation from its remote location. Although polymerase chain reaction (PCR) has detected the organs responsible for latency, it is not known whether latent cytomegalovirus (CMV) infection is maintained within organ-specific cells or ubiquitous elements such as macrophages, endothelial cells, or perhaps others. PCR lacks correlation with tissue structure. However, PCR-based in situ hybridization maintains cellular architecture while allowing the identification of the latently infected cells. Murine CMV (MCMV) nucleic acid sequences in organs of latently infected Balb/C mice were amplified by PCR incorporating digoxigenin-11-dUTP, holding the product DNA in situ (appropriate controls analyzed in parallel). Product DNA was then hybridized in situ with a biotinylated oligonucleotide probe for detection via streptavidin-alkaline phosphatase and light microscopy. Immunohistochemistry verified the positive cell types. Using this technique, we have shown directly in multiple organs of latently infected Balb/C mice including kidney (5/5), liver (5/5), and spleen (5/5) that the endothelial cell and/or T-lymphocyte harbor latent MCMV, whereas in uninfected animals, MCMV DNA was not detected. PCR-based in situ hybridization allows detection of the specific cell(s) harboring latent MCMV DNA while allowing conservation of cellular architecture.

Stage-specific requirement for myosin II during Dictyostelium development

Dictyostelium cells that lack a functional myosin II heavy chain are motile and are capable of aggregation, but fail to undergo further multicellular development. We have used a Dictyostelium mutant expressing a cold-sensitive myosin heavy chain to examine the requirement for myosin throughout the course of development. The loss of myosin function upon cooling is rapid and reversible. Temperature-shift experiments reveal that myosin is essential during two different stages of development. During aggregation, myosin function appears to be necessary for cells to sort correctly in a way that allows further development to occur. During the final stage of development, it is required for the formation of a complete stalk and the raising of the spore head. Development between those stages, however, proceeds normally in the absence of myosin function. Aggregates at non-permissive temperature undergo an aberrant form of development resulting in a ball of cells. Calcofluor staining and reporter gene fusions reveal that these structures contain defective spores and a miniature stalk.

Pneumatosis intestinalis with free air mimicking intestinal perforation in a bone marrow transplant patient

A case of pneumatosis intestinalis with perforation is reported in a patient after bone marrow allograft for chronic myeloid leukemia. Risk factors included the transplant, prolonged immunosuppression and neutropenia, graft-versus-host disease, extended use of corticosteroids, infection and lower gastrointestinal endoscopic biopsy. The literature is reviewed and a management plan for patients presenting with this complication is discussed.

Renal epithelial cells rapidly bind and internalize calcium oxalate monohydrate crystals

Renal tubular fluid is supersaturated with calcium and oxalate ions, which can nucleate to form crystals of calcium oxalate monohydrate (COM), the most abundant constituent of kidney stones. However, the mechanisms by which nascent crystals are retained in the nephron and then grow into kidney stones are unclear. An interaction of COM crystals with the surface of renal epithelial cells could be a critical initiating event in nephrolithiasis. To investigate this possibility we used cultures of monkey kidney epithelial cells (BSC-1 line) as a model system and found that [14C]COM crystals bound to the cell surface within seconds. Scanning electron microscopy revealed that crystals bind first to apical microvilli, which subsequently migrate over the crystalline surface. When visualized by transmission electron microscopy, intracellular crystals were located within vesicles. Cytoskeletal responses to crystal uptake were sought by immunofluorescence microscopy, which revealed concentration of F-actin at sites of crystal contact as well as a generalized reorganization of the intermediate filament network containing cytokeratin 8. Uptake of COM crystals did not adversely affect renal epithelial cell growth, and internalized crystals were apparently distributed to daughter cells during division. Rapid adherence of COM crystals to the apical surface of tubular epithelial cells could promote crystal retention in the kidney. Elucidation of factors that regulate this process may provide insight into the pathogenesis of nephrolithiasis.

Acinic cell carcinoma of salivary glands. Prognostic relevance of DNA flow cytometry and nucleolar organizer regions

OBJECTIVE

To test the prognostic ability of flow cytometry and counts of silver-enhanced intranuclear nucleolar organizing regions (AgNORs) in acinic cell carcinoma.

DESIGN

Using statistical methods to establish if analysis of DNA content, percentage DNA synthetic (S)-phase, and the AgNOR counts on 45 cases of acinic cell carcinoma with clinical follow-up ranging from 10 to 379 months are predictors of time to recurrence or time to death due to acinic cell carcinomas.

MAIN OUTCOME MEASURES

Whether tumors with low AgNOR counts and diploid DNA are favorable acinic cell carcinomas and the converse, aneuploid DNA and elevated AgNOR count, predict unfavorable neoplasms.

RESULTS

Tumors with a diploid DNA content had as unfavorable a clinical course as aneuploid acinic cell carcinomas. Similarly, S-phase and AgNOR count results showed considerable overlap when separated into carcinomas with or without local recurrence, metastasis, or death due to tumor. Statistical evaluation also failed to provide predictors of clinical course based on ploidy, percentage S-phase, or AgNOR counts.

CONCLUSION

The results, although negative, are important in showing that data on DNA content, cell cycle, and nuclear limits useful in other neoplasms are of limited practical application in establishing predictors of time to recurrence or time to death in acinic cell carcinomas. Solving the enigmas, for clinicians and pathologists, associated with acinic cell carcinomas will require further information about the biology of this neoplasm.

Immature human cord blood progenitors engraft and proliferate to high levels in severe combined immunodeficient mice

Unseparated or Ficoll-Hypaque (Pharmacia, Piscataway, NJ)--fractionated human cord blood cells were transplanted into sublethally irradiated severe combined immunodeficient (SCID) mice. High levels of multilineage engraftment, including myeloid and lymphoid lineages, were obtained with 80% of the donor samples as assessed by DNA analysis, fluorescence-activated cell sorting (FACS), and morphology. In contrast to previous and concurrent studies with adult human bone marrow (BM), treatment with human cytokines was not required to establish high-level human cell engraftment, suggesting that neonatal cells either respond differently to the murine microenvironment or they provide their own cytokines in a paracrine fashion. Committed and multipotential myelo-erythroid progenitors were detected using in vitro colony assays and FACS analysis of the murine BM showed the presence of immature CD34+ cells. In addition, human hematopoiesis was maintained for at least 14 weeks providing further evidence that immature hematopoietic precursors had engrafted the murine BM. This in vivo model for human cord blood-derived hematopoiesis will be useful to gain new insights into the biology of neonatal hematopoietic cells and to evaluate their role in gene therapy. There is growing evidence that there are ontogeny-related changes in immature human hematopoietic cells, and therefore, the animal models we have developed for adult and neonatal human hematopoiesis provide useful tools to evaluate these changes in vivo.

A hematopoietic protein tyrosine phosphatase (HePTP) gene that is amplified and overexpressed in myeloid malignancies maps to chromosome 1q32.1

Tyrosine phosphorylation is an important regulator of cell growth and differentiation reflecting the interaction of protein tyrosine kinases (PTK) and protein tyrosine phosphatases (PTP). Although excessive PTK activity can result in hematopoietic cell transformation, perturbation of either of these two modulators may result in uncontrolled cell growth. Myeloid cells are responsive to growth factors and cytokines that induce tyrosine phosphorylation and can become ligand independent when endogenous PTKs become dysregulated. Specific PTPs, through mutation or altered expression, may enhance PTK activities and also cause myeloid ligand independence, though this has not yet been demonstrated. We have previously reported the isolation of a hematopoietic specific cytoplasmic PTP (HePTP). We now report that this gene maps to chromosome 1q32.1 utilizing fluorescent in situ chromosomal hybridization (FISH). This site is frequently amplified in preleukemic myeloproliferative diseases. FISH analysis of a patient with myelodysplastic syndrome characterized by myeloid hypoplasia and monocytosis reveals triplication of the HePTP gene on one allele with elevated protein expression in neoplastic myelomonocytic cells. Elevated expression is also identified in blasts from some patients with acute leukemia. These observations prompted us to examine the experimental effects on cell growth of HePTP overexpression. Though normal myeloid cells show minimal HePTP expression, all hematopoietic cell lines tested show high expression of HePTP. Gene transfer of HePTP into NIH 3T3 cells was therefore performed, which caused altered cell morphology, disorganized growth, anchorage independent colony formation and subtle differences in the pattern of tyrosine phosphoproteins compared to control cell lines. We conclude that amplification and overexpression of HePTP may be an important cofactor contributing to abnormal myeloid cell growth.

"Eat for Health": a supermarket intervention for nutrition and cancer risk reduction

OBJECTIVES

The results of an evaluation of "Eat for Health," a supermarket nutrition intervention, are presented. The study tested whether such a program could be successfully carried out and whether it could effect changes in knowledge, attitudes, and food purchasing behavior in line with nutrition and cancer risk reduction guidelines.

METHODS

The evaluation consisted of an in-store monitoring element, an in-store and telephone consumer survey, and an analysis of sales data on selected foods. A matched-pair design, using a total of 40 stores in the intervention and comparison groups, was used.

RESULTS

The intervention was successfully implemented and had limited success in changing some food purchasing behaviors. There appeared to be no effect on knowledge and attitudes except for increased awareness of a link between diet and cancer and of the program itself.

CONCLUSIONS

Despite the intervention's success, limitations of the consumer survey and sales data analyses and the continuing diffusion of nutrition messages throughout society make it difficult to specify the impact of this program on consumer nutrition knowledge and behaviors.

Risk taking and its influence on metabolic control: a study of adult clients with diabetes

Clients afflicted with diabetes are routinely faced with making decisions about insulin control, diet, exercise and skin care. The specific aims of this study were (a) to determine if clients with controlled blood sugar levels were more likely to have risk-averse information processing styles and, (b) to determine the extent to which the differences in blood sugar levels were attributed to information processing styles, after controlling for knowledge of diabetes, participation in home monitoring, and age. A comparative design utilizing 86 insulin-dependent male and female clients with diabetes was used. Findings indicated that there were no differences in risk scores between uncontrolled and controlled diabetics. Additionally, in this study there were no differences in control between clients who were knowledgeable and those who were not. This study has several implications for nursing practice. As taking risks may not be as dangerous to the diabetic client's wellbeing as many believe, there may be a need to consider this behaviour in developing the client's plan of care. Questions are also raised about the influence of knowledge on control.

Engraftment of human lymphoid cells into newborn SCID mice leads to graft-versus-host disease

Although there has been considerable progress in transplanting normal human hematopoietic cells into immune-deficient mice, the establishment of a functional human immune system has proved to be difficult. Current methods of introducing mature human lymphoid cells into adult SCID mice lead to oligoclonal engraftment with restricted dissemination to various organs. We have attempted to improve human lymphoid cell engraftment in mice, both qualitatively and quantitatively, by injecting human bone marrow cells and peripheral blood leukocytes intraperitoneally into newborn SCID mice. Newborn mice were used as recipients because certain immune functions such as natural killer cell activity do not develop until several weeks after birth and the numerous growth factors secreted in young mice may facilitate the engraftment and proliferation of transplanted human cells. At various times after transplantation, the presence of human cells in different organs was determined by Southern blot analysis using a human specific probe. Within 4 weeks, 70% of the mice were engrafted with human cells. Human cell engraftment of the bone marrow, spleen, lungs, kidneys, liver, and thymus exceeded 10% in at least 40% of the transplanted mice; most of these highly engrafted mice were sick. Flow cytometry and immunocytochemistry indicated these organs were heavily infiltrated with mature T and B lymphocytes. Histologic and molecular analysis showed massive human cell infiltrates within the liver, lung and spleen. The presence of human IgG and IgM antibodies against mouse red blood cells provided evidence that the engrafted human cells retained some immune function. Mice transplanted with peripheral blood leukocytes from donors that were allergic to mouse antigens engrafted to the same extent as normal cells but in addition developed the classical symptoms of acute allogeneic graft-versus-host disease (GVHD) including infiltrates of the skin, gut, and liver. The newborn SCID system provides a new in vivo model to study human xenoreactivity and GVHD.

Zygotic transcription and cell proliferation during Drosophila embryogenesis

The zygotic expression of only a few Drosophila genes is known to be required for completion of the normal embryonic mitoses. Molecular genetic analyses of these genes reveal that they fall into two classes, those whose mRNA levels are regulated in a stage and/or tissue-specific fashion to control cell cycle events during embryogenesis, and those in which, in the absence of functional zygotic expression, the maternal mRNA contribution does not provide sufficient product to complete the normal embryonic mitoses. Genes that comprise the first class are involved in the developmental control of the cell cycle, while those of the second class identify components of the cell cycle machinery.

A preliminary study of the relationship between central auditory processing disorder and attention deficit disorder

Fifteen boys aged six to ten who met the criteria for attention deficit disorder (ADD) were compared with ten boys who did not have ADD in a double-blind, placebo-controlled, single-crossover study of methylphenidate. To assess the degree of overlap between ADD and central auditory processing disorder (CAPD), all subjects were assessed on parent and teacher behavior rating scales, as well as a battery of CAPD tests at baseline and after three and six weeks of treatment. Twelve of the 15 subjects with ADD and none of the subjects without ADD met the criteria for CAPD. The subjects with ADD also responded to stimulant treatment on the measures of both ADD and CAPD. The overlap in the symptomatology of these disorders, the finding that the criteria for both disorders were met in 12 of 15 cases and the sensitivity of both ADD and CAPD measures to treatment with methylphenidate suggest that ADD and CAPD are closely related disorders. The implications of these results are three-fold. First, sustained attention is a critical feature of performance on CAPD tests and the current diagnostic criteria for CAPD make a clinical separation of the two disorders problematic. Second, stimulants appear to be a useful treatment for the symptoms of both ADD and CAPD. Third, CAPD tests may be a useful measure of ADD symptomatology and response to stimulants.

Neurologic prognosis of cytomegalovirus polyradiculomyelopathy in AIDS

Cytomegalovirus (CMV) polyradiculomyelopathy is an uncommon but distinctive clinical syndrome in HIV-infected patients in which ascending motor weakness, areflexia, loss of sphincter control, paresthesias, and varying sensory impairment develop subacutely in association with a polymorphonuclear pleocytosis, increased protein, and hypoglycorrhachia in CSF. Responses to treatment with ganciclovir have varied in reported cases. We report three additional cases: two of these patients responded to treatment and the third was demonstrated to have CMV resistant to ganciclovir. We review other reported cases and identify factors predictive of ganciclovir resistance, which include persistent polymorphonuclear pleocytosis and hypoglycorrhachia on serial CSF studies, and positive CMV cultures from CSF or blood after induction therapy. We conclude that ganciclovir may be an effective therapy for CMV polyradiculomyelopathy, but the presence of these factors, or the development of the syndrome in a patient already being treated with ganciclovir, should prompt consideration of alternative antiviral therapy.

High-level multilineage engraftment of human cord blood cells in SCID mice

Cord blood is increasingly used as an alternative to bone marrow transplantation in pediatric patients. Therefore, to study cord blood-derived hematopoiesis in vivo we are developing a xenogeneic transplantation model using immunodeficient SCID mice.

Synthetic lethal mutations suggest interactions between U5 small nuclear RNA and four proteins required for the second step of splicing

To investigate the function of the U5 small nuclear ribonucleoprotein (snRNP) in pre-mRNA splicing, we have screened for factors that genetically interact with Saccharomyces cerevisiae U5 snRNA. We isolated trans-acting mutations that exacerbate the phenotypes of conditional alleles of the U5 snRNA and named these genes SLU, for synergistically lethal with U5 snRNA. SLU1 and SLU2 are essential for the first catalytic step of splicing, while SLU7 and SLU4 (an allele of PRP17 [U. Vijayraghavan, M. Company, and J. Abelson, Genes Dev. 3:1206-1216, 1989]) are required only for the second step of splicing. Furthermore, slu4-1 and slu7-1 are lethal in combination with mutations in PRP16 and PRP18, which also function in the second step, but not with mutations in factors required for the first catalytic step, such as PRP8 and PRP4. We infer from these data that SLU4, SLU7, PRP18, PRP16, and the U5 snRNA interact functionally and that a major role of the U5 snRNP is to coordinate a set of factors that are required for the completion of the second catalytic step of splicing.