Comparative study of the enzyme activities of Borrelia burgdorferi and other non-intestinal and intestinal spirochaetes

Comparative analysis of the enzymatic profiles of 58 spirochaetal isolates clearly differentiated borrelias from leptospires, serpulinas and a treponeme. Strains of both Borrelia burgdorferi and Borrelia hermsii characteristically produced significant amounts of leucine arylamidase. This enzyme activity was not unique to borrelias but was also detected amongst pathogenic and non-pathogenic leptospira serovars. This fact, however, did not hamper a correct differentiation of borrelias from these spirochaetes, because leptospires possessed unique enzyme profiles. The API ZYM system could not differentiate the human strains of B. burgdorferi from those isolated from ticks, or from B. hermsii. Treponema phagedenis could be differentiated from all the other spirochaetes by the production of alpha-fucosidase. Our results confirm and extend previous studies indicating that human and animal intestinal spirochaetes have many common enzyme activities. All strains produced reactions of maximum intensity when tested for the presence of beta-galactosidase activity. However the avian strains lacked esterase (C4) which was present in human and swine intestinal spirochaetes. All strains of Serpulina hyodysenteriae, and Serpulina innocens as well as the human intestinal spirochaete strain HRM-14 showed alpha and beta glucosidase activity. Both enzyme activities were absent or insignificant in most other intestinal spirochaetes examined: 25 different human strains, non-pathogenic swine strain M1 and the avian strain 4742. However, swine strain LL3 and avian strain 1380 showed some beta-glucosidase activity.

Survey on the prevalence of leptospira infections in the Italian population

This investigation is the first nationwide survey on the circulation of leptospira infections in human beings in Italy. In nine out of twenty Italian regions, representative samples of the population were investigated for the presence of leptospira infections. Unexpectedly, leptospira infections were found to be widespread, the number of cases being much higher than the diagnosed clinical cases. There were found to be high, medium, and low risk areas. On the whole, the risk for the rural population was no higher than the risk for urban dwellers; leisure activities, contact with animals and residence on the plain versus residence in the hills were important risk factors. There was an unidentified risk factor in urbanites which was absent in the rural population. A changing pattern in infecting serovars was observed, with infections from serogroups Sejroe, Javanica and Australis prevailing over infections from the Icterohaemorrhagiae and Bataviae serogroups, which were the main agents of human leptospirosis during the 1950s. The mechanisms of these changes, the need for epidemiological surveys and improved diagnostic methods of screening are discussed.

[Treatment of early colorectal carcinoma: surgery or endoscopy?]

This retrospective study analyses the value of endoscopic polypectomy as the operation of choice in cases of early invasive colorectal carcinoma located on the adenomatous polyp. Under these conditions the authors outline their therapeutic strategy, based not only on the histological characteristics of lesions, but also on the evaluation of the risk/benefit ratio established in relation to the characteristics of each individual patient.

[Chronic pancreatitis: notes on diagnosis and surgical therapy]

The authors analyse their experience of 30 cases of which 25 underwent surgery. In addition to the onset of complications, indications for surgery were based on the presence of severe painful symptoms which did not respond to medical treatment. Over the past few years the latter have represented one of the main indications with a success rate of between 80-90% of cases. The type of surgery must be personalized to the characteristics of each individual patient on the basis of morphological alterations of the gland, which are easily defined during a preoperative study using CPRE, ultrasonography and CT. Of these, CPRE has been found to be the most reliable in diagnostic terms, since it can detect structural alterations at a relatively early phase and is of considerable value in differential diagnosis, which is at times extremely difficult, with pancreatic carcinoma.

[Cutaneous myiasis caused by Cordylobia anthropophaga(Blanchard, 1872): description of 5 cases froma coastal regions of Senegal]

Five cases of furuncular myiasis due to Cordylobia anthropophaga are reported in Italian tourists coming from Senegal. People who go to tropical and sub-tropical regions should be aware from now on to the possibility and the way to acquire myiasis.

Chronic bleeding caused by small bowel angiodysplasia: a problem of recognition and diagnosis

Angiodysplasia of the gastrointestinal tract is a disorder consisting of ectasia of submucosal and mucosal vessels, which causes acute and chronic bleeding. We describe the case of a 58-year-old man with a history of recurrent lower intestinal bleeding and severe anemia. Endoscopy and X-ray examination of the gastrointestinal tract failed to show the source of bleeding. Selective angiography of the superior and inferior mesenteric arteries revealed a vascular ectasia. The patient underwent ileo-cecal resection with remarkable improvement after surgery.

Oral condyloma lesions in patients with extensive genital human papillomavirus infection

OBJECTIVES

The incidence, location, and morphologic appearances of human papillomavirus oral lesions in patients with genital condylomatosis were investigated with clinical, colposcopic, and histologic examination as diagnostic procedures. The human papillomavirus types were also evaluated with filter in situ hybridization.

STUDY DESIGN

One hundred one patients, 66 female and 35 male, with genital condyloma underwent an oral cavity examination. Ninety-nine (99%) practiced orogenital sex, and all were asymptomatic for oral lesions.

RESULTS

Ninety-one underwent biopsy; histologic studies gave a diagnosis of condyloma in 48% of 101 specimens collected. In 8 of 91 (9%) oral lesions were suspected by naked-eye examination; they were confirmed histologically in all eight. Of 83 patients suspected of having oral condyloma on colposcopic examination, 38 (46%) were confirmed histologically. Thus 38 of 46 patients (83%) had oral condyloma not visible to the naked eye. Colposcopically, oral lesions appeared filiform (50%), moruloid (26%), and mixed (24%). Twenty cytologic oral samples were also collected for deoxyribonucleic filter in situ hybridization analysis. Human papillomavirus deoxyribonucleic genital types were observed in 45% (9/20) of all oral scrapings collected, and all were histologically confirmed.

CONCLUSION

Our data indicate that genital human papillomavirus types are capable of establishing a local infection in the oral cavity and demonstrate a high incidence of human papillomavirus oral lesions in patients with genital condyloma.

Molecular cloning and characterization of DNA from human intestinal spirochetes

HindIII cleaved human intestinal spirochete genomic DNA was cloned into the plasmid vector pBluescript. The inserts from three of these clones (pRB.C33, pRB.C47 and pRB.F11) successfully hybridized with DNA from the nine human intestinal spirochetes used in this study. The fourth insert (from clone pRB.A8) failed to hybridize with DNA from two of these isolates (HRM4 and HRM9), and, all four of the inserts hybridized with the M1 strain of swine intestinal spirochete Treponema innocens. Hybridization with DNA from the P18 strain of Treponema hyodysenteriae was observed only for the probe pRB.F11. No hybridization was detected with the human strain of Borrelia burgdorferi. With these probes we were thus able to demonstrate, in southern blot experiments, a restriction site polymorphism among the isolates of the human intestinal spirochetes we tested.

Serodiagnosis and follow up of patients with pulmonary tuberculosis by enzyme-linked immunosorbent assay

A new ELISA assay based on antigen A60 from M. bovis BCG was used to quantitate specific anti-mycobacterial antibodies in 250 sera from 133 subjects: 90 tuberculosis cases and 43 controls. Controls were all negative, suggesting the specificity of this assay. In subjects with secondary pulmonary tuberculosis, a correlation was observed between the anti-mycobacterial antibody titer and culture positivity. In fact, positive ELISA assays were found in 88.8% of patients with positive cultures for M. tuberculosis and in 45% of culture-negative tuberculosis patients under therapy. According to our results the A60 ELISA assay is useful in monitoring the efficacy of anti-mycobacterial drugs. In pulmonary tuberculosis cases with positive cultures for M. tuberculosis higher levels of specific anti-mycobacterial IgGs were found after therapy.

Increased prevalence of glucose-6-phosphate dehydrogenase deficiency in patients with cholelithiasis

The glucose-6-phosphate dehydrogenase (G6PD) enzyme activity was determined in 299 Northern Sardinian patients with cholelithiasis. Sixteen (12.80%) of the 125 male patients studied were G6PD deficient; 33 (18.96%) of the 174 females were heterozygous and 1 (0.57%) homozygous. Thus, the prevalence of G6PD deficiency in male subjects with cholelithiasis is about 35% higher (p less than 0.02) than that of a normal male control group (7.29%). As regards female patients, the incidence of the GdMed allele was also significantly different (p less than 0.05). Thus, G6PD-deficient subjects may have a predisposition to develop gallstones, even in the absence of clinical signs of chronic hemolysis.

In vitro susceptibility of 119 yeast isolates to fluconazole, 5-fluorocytosine, amphotericin B and ketoconazole

The in vitro activity of fluconazole was tested against 13 yeast species (119 strains) isolated from clinical specimens during a 3-month period. For comparative purposes, three other antifungal compounds (5-fluorocytosine, amphotericin B and ketoconazole) were also tested. The tests were carried out using a microautomated method previously developed in our laboratory. The method allowed us to determine the minimum inhibitory concentration (MIC) of the four antifungal drugs used. For each of the drugs we utilized different media. The MIC ranges (mg/l) of fluconazole were: 0.04-12.5 for Candida albicans, 0.19-6.25 for Candida parapsilosis, 12.5-50 for Candida krusei, 0.04-100 for Candida tropicalis, 0.04- greater than 100 for Candida glabrata, 0.09- greater than 25 for Cryptococcus neoformans, 0.09-0.78 for Saccharomyces cerevisiae, 6.25- greater than 100 for Trichosporon beigelii and 0.09-0.19 for Blastoschizomyces capitatus (Trichosporon capitatum). The MIC value (mg/l) was 0.39 for Candida guilliermondii and Candida lusitaniae, greater than 100 for Cryptococcus laurentii and 0.09 for the 3 isolates of Torulopsis candida. These results were obtained using the medium recommended for in vitro testing of fluconazole (high-resolution medium) by Pfizer UK.

Epidemiological and clinical aspects of mycoses in patients with AIDS-related pathologies

Mycological, cultural and/or serological studies were performed on 98 patients hospitalized in the Department of Infectious Diseases of the Catholic University in Rome with diagnoses of acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC) diseases. The incidence of mycoses was evaluated by retrospectively analyzing the results of mycological examinations and comparing them with clinical manifestations. The presence of concomitant bacterial, viral and parasitic infections was also examined. For epidemiological purposes, the study was extended to include the biotyping of all yeasts isolated from patients hospitalized between September 1988 and February 1989 in the same Department. Antimycotic susceptibility was also determined for the first yeast isolate obtained from each of these patients. Oral candidiasis (50 cases) caused by Candida albicans was the most frequent mycosis, followed by esophageal candidiasis (13 cases) and cryptococcosis (6 cases). Four out of the 6 cryptococcosis patients had meningeal involvement. Systemic candidiasis (2 cases) and aspergillosis (1 case) were less common. Biotyping of yeasts isolated between September 1988 and February 1989 with the killer system revealed type 377 to be the most common among the C. albicans isolates. It represented 70% of all the yeasts isolated.

[Trans-mesenteric hernia. Presentation of a clinical case and review of the literature]

Trans-mesenteric hernia is a rare case of intestinal obstruction. A peculiar characteristic of this form of hernia is the absence of a sack and recess; in the majority of cases, hernia is due to congenital defects of the mesentery. In clinical terms, hernia is manifested by signs of intestinal occlusion in patients of any age. Occasionally, hernias may be found during surgery or autopsy.

[Early gastric cancer: radiologic, endoscopic or combined diagnosis?]

Having underlined the importance of an extremely early diagnosis of gastric cancer, the paper focuses on the diagnostic capacities of endoscopy and bone x-ray using a dual-contrast technique. From an analysis of published reports and on the basis of their own experience, the authors prefer, whenever possible, to combine the two methods, since this is the only way of revealing minimum neoplastic stomach lesions in almost 100% of cases.

[Our experience in the treatment of superior vena cava syndrome]

In clinical practice SVC syndrome is an important problem, given both the nature of the disease and its fast lethal evolution. Therapy must be instituted as soon as possible because the chances of a positive result are directly related to the staging of the primary illness. Surgery, chemotherapy and high energy therapy can be used. From the literature, although controversial, the superiority of surgical therapy is clear; particularly if up-to-date vascular reconstruction techniques are employed. From March 1980 to March 1988 8 cases of SVC syndrome were observed in which the aetiology was as follows: Hodgkin's disease (2 cases); secondary catheter thrombosis (1 cases); lung carcinoma (5 cases). The 2 cases of Hodgkin's disease were treated by chemotherapy; the secondary thrombosis by open thrombectomy. In the other 5 cases an innominate vein right appendage by-pass was used (3 PTFE, 2 pericardial grafts). The results were encouraging: complete, long-term remission was observed in the Hodgkin and thrombectomy patients. A PTFE graft thrombosis occurred in 2 cases but in the other cases the by-pass is functioning well at a mean 13 months follow-up.

Serological study of yeast killer toxins by monoclonal antibodies

Yeast killer toxins coded by determined and undetermined killer plasmids or presumptive nuclear gene(s) in various genera (Saccharomyces, Kluyveromyces, Pichia and Candida) have been serologically investigated by a monoclonal antibody (KT4), produced against the yeast killer toxin of Pichia (Hansenula) anomala UCSC 25F. Double immunodiffusion with the killer toxins as antigens and indirect immunofluorescence on whole cells of the corresponding killer yeast have been used. In both the serological procedures, monoclonal antibody KT4 proved to be reacting only with the killer toxins and the whole cells of yeasts belonging to the genus Pichia.