[Detection of IgM against the dengue++ virus in whole blood absorbed on filter paper]

This paper presents a standardized procedure for the detection of IgM antibodies to dengue virus in blood samples taken from filter paper. The samples were obtained from 118 patients, of whom 91 had been clinically diagnosed with dengue and 27 with a viral infection unrelated to that disease. The first group of patients came from Costa Rica and Nicaragua and the second group from Cuba. All the samples were tested for IgM antibody against dengue virus by means of a capture enzyme immunoassay (EIA). Analysis of the results for patients from all three countries together yielded a sensitivity of 98.1% and a specificity of 98.5% for the test done on whole blood on filter paper stored at 4 degrees C; agreement between the results of that test and those of the EIA using serum samples was 96%. In a comparison of the results obtained with three samples from the same patient--whole blood on filter paper stored at room temperature, the same type of sample stored at 4 degrees C, and serum--the agreement was 86%. This study demonstrates the high diagnostic sensitivity and specificity achieved when whole blood absorbed on filter paper is processed in the manner described in detail in the article. The authors recommend the use of this method in the dengue surveillance programs in the Region.

Monoclonal antibodies raised to the dengue-2 virus (Cuban: A15 strain) which recognize viral structural proteins

Mouse monoclonal antibodies (MAbs) were raised to dengue-2 virus (D-2V) Cuban (A15) strain and the cell culture supernatants were screened by ELISA using the homologous virus. Three MAb-secreting lines were further characterized using immunoblot, haemaglutination, complement-fixation, and neutralization assays. One of these, MAb 8H8, weakly reacted with the viral nonstructural-1 protein (NS1) but more specifically identified the capsid protein (C), MAb 3E1 recognized in serological assays D-2V A15 but it had a weak reaction to C protein by immunodetection whereas another, MAb 4G3, weakly neutralized the homologous virus isolate and blocked the binding of specific anti-envelope (E) Mab, and its reaction with this protein could not be confirmed using immunoblot assays. These reagents are now being used to compare virulent plus avirulent Caribbean viruses antibody dependent enhancement (ADE) assays.

Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease

OBJECTIVE

To examine neurological, neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease.

METHODS

A consecutive series of patients with probable Alzheimer's disease was assessed with a comprehensive neuropsychological battery, a structured psychiatric evaluation, the unified Parkinson's disease rating scale, MRI, and single photon emission computed tomography with technetium 99m hexamethylpropyleneamine oxime (HMPAO) and regional cerebral perfusion measurements.

RESULTS

Patients with Alzheimer's disease and leukoaraiosis were significantly more apathetic and had significantly more extrapyramidal signs than patients with Alzheimer's disease without leukoaraiosis. Patients with Alzheimer's disease with leukoaraiosis also had significantly lower bilateral perfusion in the basal ganglia, thalamus, and frontal lobes than patients with Alzheimer's disease without leukoaraiosis. On the other hand, there were no significant differences between groups in age, duration of illness, depression scores, severity of delusions, or deficits on specific neuropsychological tasks.

CONCLUSIONS

Leukoaraiosis in Alzheimer's disease may produce significant basal ganglia, and thalamic and frontal lobe dysfunction, which may be associated with more severe apathy and extrapyramidal signs.

Distribution of Aujeszky's disease virus in experimentally infected mink (Mustela vison)

Eight Mink (Mustela vison) were inoculated orally with Aujeszky's disease virus (ADV). Three mink were killed at the onset of clinical signs and the other mink died spontaneously after inoculation. The incubation period ranged from 72 to 96 hours and was followed by a short illness characterised by increasing salivation, vomiting and retching, depression and coma. Microscopically, lesions were confined to the brain stem and consisted of a discrete non-suppurative encephalitis. Viral antigen was detected by an immunoperoxidase technique predominantly in association with specific lesions, although sometimes it was found within non-altered areas in the brain stem. Virus isolation confirmed the presence of ADV in the central nervous system. Fibrinoid degeneration of vessel walls was present in pharynx, larynx and myocardium in association with haemorrhages. Microthrombi were observed in heart and brain.

SPECT findings in Alzheimer's disease and Parkinson's disease with dementia

We examined, with single photon emission tomography (SPECT) and (99mTc)-HMPAO, 18 patients with idiopathic Parkinson's disease and no dementia (PD), 12 patients with PD and dementia, 24 patients with probable Alzheimer's disease (AD), and 14 controls. While the three patient groups showed significantly lower perfusion in frontal inferior and temporal inferior areas as compared to controls, both demented groups showed significantly more severe bilateral hypoperfusion in superior frontal, superior temporal and parietal areas as compared to non-demented PD patients and controls. On the other hand, no significant differences in cerebral perfusion were found between patients with AD and patients with PD and dementia. In conclusion, our findings demonstrated specific but similar cerebral perfusion deficits in demented patients with either AD or PD.

[Dengue in Nicaragua, 1994: reintroduction of serotype 3 in the Americas]

The principal aim of this work was to report the reintroduction of dengue virus serotype 3 in the Americas after an absence of 17 years. In addition, it describes the most common symptoms associated with classical dengue and hemorrhagic dengue and presents data on the distribution of the epidemic in the various comprehensive local health care systems of Nicaragua. The study group consisted of 39 patients hospitalized in Managua and León for dengue with hemorrhagic manifestations and hemorrhagic dengue. Of these patients, 34 were classified as probable or confirmed cases of dengue. The most frequent symptoms were fever, headache, vomiting, and muscle and joint pains. The tourniquet test was positive and thrombocytopenia was confirmed in 56% and 44% of the patients, respectively. Epistaxis (67%) was the most common hemorrhagic sign. Of the 356 serum samples received through the dengue surveillance systems in October 1994, IgM antibodies were detected in 43%. The virus was isolated from 5 of 24 samples tested (serotype 3 from 3 and serotype 1 from 2). The reintroduction of serotype 3 of dengue into the Region was demonstrated, along with its ability to produce epidemics of hemorrhagic dengue. The countries are warned that if they do not quickly take the measures described in the guidelines for the prevention and control of dengue and dengue hemorrhagic fever, new epidemics may occur in the Americas, given the large number of persons susceptible to this serotype and the high density of the mosquito vector in most of the countries of the Region.

[Isolation of Haemophilus influenzae and Haemophilus parainfluenzae in genitourinary infections: a 4-year review]

BACKGROUND

Haemophilus spp. had been previously suggested as a potential pathogen in genitourinary infections that could be sexually transmitted. In order to check that suggestions we have determined the incidence, pathogenic role, possible sexual transmission and susceptibility to antibiotics in isolates of Haemophilus parainfluenzae and Haemophilus influenzae from genital tract infections. The microbiological samples were taken during a period of four years from patients attended in a Service of Sexual Transmission Diseases and the data were further reviewed.

METHODS

The study included 5,572 genital specimens from 2,182 women prostitutes with different genitourinary infections and from 825 men with urethritis. Microbiological samples were cultured in a non-specific media for genital pathogens and species of Haemophilus spp. and clinical circumstances of isolation were evaluated. Susceptibility tests were performed by using a standard microdilution test.

RESULTS

Haemophilus spp. was isolated in 155 samples (2.8%) using a non-selective culture method. H. parainfluenzae was isolated in 100 cases (64.5%), Haemophilus influenzae in 45 cases (29%) and Haemophilus spp. in 10 strains (6.4%). Haemophilus spp. was isolated as a sole pathogen in men with urethritis (8 cases), epididymo-orchitis (2 cases), cervicitis and/or vaginitis (9 cases) and Bartholin's Abscess (2 cases). The most frequent biotypes were H. parainfluenzae biotype II (43%) and III (19%), and H. influenzae biotype IV (35.5%). Beta lactamase activity and ampicillin resistance were present in 29% of the H. parainfluenzae strains and in the 26.7% of clinical isolates of H. influenzae.

CONCLUSIONS

1) Haemophilus spp. was isolated from genitourinary infections at a low frequency in the studied group. 2) The pathogenic role of Haemophilus spp. was suggested when was isolated as a sole pathogen present from some infections of the genitourinary tract such as urethritis in men and Bartholin's abscess in women. 3) The susceptibility to antibiotics in the clinical isolates of Haemophilus spp. from genitourinary infections was similar previously reported studies performed in Spain.

Quantified electroencephalographic correlates of relative frontal or parietal hypoperfusion in dementia

The authors examined the presence of specific quantified electroencephalographic (qEEG) changes in dementia patients with relatively lower frontal or parietal blood perfusion as demonstrated by SPECT. Over all brain regions, patients with relatively lower parietal perfusion showed significantly higher theta relative power than demented patients with relatively lower frontal perfusion or normal control subjects. Dementia patients with relatively lower frontal perfusion showed no differences from age-comparable normal control subjects in qEEG variables. These findings 1) suggest that usefulness of qEEG for the diagnosis of dementia is restricted to a subgroup of patients with the typical SPECT pattern of parietal blood hypoperfusion and 2) demonstrate that the qEEG changes typical of dementia are not related to perfusion deficits in frontal brain areas.

Experimental Aujeszky's disease in blue foxes (Alopex lagopus)

Blue foxes were inoculated orally with Aujeszky's disease virus. Several foxes were killed at the onset of clinical signs and other animals spontaneously died. The incubation period ranged from 3 to 6 days and was followed by a short illness characterized by anorexia, depression and coma. At autopsy, no specific gross findings were observed. Microscopically, lesions included a non-suppurative meningoencephalitis with neuronal necrosis, gliosis, neuronophagia and mononuclear cell cuffing. Viral antigen was detected by immunoperoxidase technique.

Pericentric inversions of chromosome 4: report of a new family and review of the literature

A family was cytogenetically studied because of the birth of a male child with a multiple congenital anomaly pattern, in whom a dup (4q) recombinant was found. His phenotypically normal mother's karyotype showed an apparently balanced pericentric inversion in a chromosome 4. So as to analyze the occurrence of recombinants, the cytogenetic data from this family are compared with those of the 18 previously reported familial cases of pericentric inversions (PIs) of chromosome 4. The congenital anomalies observed in the child strongly suggest Wolf-Hirschhorn syndrome but some of his clinical features seem to be pathogenetically related to the presence of lymphedema during the intrauterine period. In the multiple congenital anomaly pattern observed in this patient, the lymphedema could be the consequence of the large 4q duplication. The review of chromosome 4 PIs with 4q duplication suggests that the q3 region should be examined when edema is detected prenatally.

[Tuberculous prostatic abscess in a patient with AIDS]

Despite of prostate abscesses having become an uncommon disease, a number of cases has been described lately specially in immunodepressed patients caused by infrequent agents, such as Mycobacterium tuberculosis. This paper describes the case of one HIV-positive patient, diagnosed with a prostate abscess within a tuberculous dissemination. The best diagnostic method is considered to be the transrectal ultrasound (TRU), the choice therapy being drainage by ultrasound-guided transperineal percutaneous puncture.

A single-photon emission computed tomographic study of anosognosia in Alzheimer's disease

OBJECTIVE

To examine the presence of specific regional cerebral blood flow correlates of anosognosia in patients with probable Alzheimer's disease.

DESIGN

Case series, group comparisons.

SETTING

Ambulatory care referral center.

PATIENTS

Twelve patients with probable Alzheimer's disease and anosognosia and 12 patients with probable Alzheimer's disease without anosognosia who were matched for age, duration of illness, and cognitive impairments.

MAIN OUTCOME MEASURES

Single-photon emission computed tomographic scan studies with technetium Tc 99m hexamethylpropylene-amine oxime and regional cerebral blood flow measurements.

RESULTS

Patients with Alzheimer's disease and anosognosia showed significant blood flow deficits in the frontal inferior and superior (dorsal) areas of the right hemisphere. On the other hand, no significant between-group differences were found in depression scores and neuropsychological tasks that assessed verbal and visual memory, verbal comprehension, naming, verbal fluency, auditory attention, abstract reasoning, and set-shifting abilities.

CONCLUSIONS

Our study demonstrates that anosognosia may not be related to deficits in specific cognitive domains, but it may result from dysfunction of the right frontal lobe.

Comparison of seven phenotyping methods for Candida albicans

Seven different phenotyping methods for strain differentiation of Candida albicans (auxonotyping, enzymotyping, resistotyping, Phongpaichit's morphotyping, Hunter's morphotyping and Odds and Abbott's biotyping method-1980 and 1983 versions) were compared on a single population of 94 strains. 77.6% of the strains belonged to auxonotyping 1, 59.6% to enzymotyping A, 34% to resistotyping B and 30.8% to BC, 40.4% to Phongpaichit's morphotyping 000,000 and 40.4% to Hunter's morphotyping 'No fringe/Smooth surface'. Using biotyping systems (1980 and 1983 versions), the most frequent biotypes were 145 (29.8%) and 147 (31.9%) respectively. The Discriminatory Index of Hunter and Gaston was employed to carry out comparisons among the different systems. The best discriminatory results, although far from ideal, were found using Phongpaichit's morphotyping (DI = 0.827) and Odds and Abbott's method (DI = 0.815 and 0.831--1980 and 1983 versions). A good discriminatory result was also found using Hunter's morphotyping method together with the biotyping of Odds and Abbott (1983 version). These approximated the ideal (DI = 0.950) and showed minimal difficulty in interpretation. The proposed combined method revealed high discrimination among the vulvovaginal strains, and suggested the absence of transmissible pathogenic strains.

SPECT findings before and after ECT in a patient with major depression and Cotard's syndrome

A patient's major depression and Cotard's syndrome (the delusion of being dead) both resolved completely after 12 ECT treatments. A SPECT study 1 week before ECT showed reduced blood flow in the frontoparietal medial and dorsolateral frontal cortex, basal ganglia, and thalamus; SPECT 1 month after ECT showed perfusion increments in those regions. This case study demonstrates that Cotard's syndrome in the context of major depression may be successfully treated with ECT and suggests that the psychiatric improvement was accompanied by increased blood flow in specific brain areas.

A SPECT study of delusions in Alzheimer's disease

Although delusions are a frequent finding in patients with Alzheimer's disease (AD), their mechanism is not well known. We carried out Tc 99m HMPAO single-photon emission computed tomography studies in 16 AD patients with delusions and 29 AD patients without delusions comparable in age, years of education, duration of illness, and severity of dementia. Although we found no significant between-group differences in performance on neuropsychological tasks, AD patients with delusions had significantly lower mean cerebral blood flow in both the left and right temporal lobes.

[Ulcerative jejunitis: a complication of celiac disease]

We report the case of a 57-year-old woman with celiac disease of long standing, who developed episodes of intestinal obstruction during two months. They were misdiagnosed as intestinal obstructions caused by adhesions. The barium meal and follow-through examination disclosed several jejunal stenoses. Therefore, the patient underwent early surgery where an intestinal resection was carried out. The histological examination showed the presence of benign ulcers at the stenoses. After surgery, the patient began to gain weight and her nutritional state improved remarkably.

[Cerebral metastasis as first manifestation++ of a bladder carcinoma]

The infiltrant vesical carcinoma shows a tendency to become metastatic in a high percentage of cases, so that the preferred sites are usually the retroperitoneal lymph nodes, liver and bone. CNS metastasis is an uncommon fact, but it is even less common to find CNS affectation symptoms even before the appearance of any signs and symptoms related to the vesical affectation itself. Contribution of one case of infiltrant vesical carcinoma which presented with focal neurological symptomatology as its first manifestation.

Specificity of changes in cerebral blood flow in patients with frontal lobe dementia

Eight patients with a clinical diagnosis of probable Alzheimer's disease, eight patients with the clinical diagnosis of frontal lobe dementia, and eight controls were examined with single photon emission tomography (SPECT) using 99Tc-HMPAO. Patients with Alzheimer's disease and those with frontal lobe dementia met DSM-III-R criteria for mild dementia and were in the early stages of the illness. Compared with patients with Alzheimer's disease, the group with frontal lobe dementia had significantly lower blood flow in the frontal lobes (dorsolateral and orbital), the anterior temporal cortex, and the basal ganglia. Within the frontal lobe dementia group, blood flow was significantly lower in the orbital than in the dorsal frontal cortex, and in the anterior temporal than in the dorsal temporal cortex. The present study shows the specificity of changes in regional cerebral blood flow in the diagnosis of different types of dementia, and supports the importance of orbitofrontal, anterior temporal, and basal ganglia dysfunction in the production of the psychiatric syndrome of frontal lobe dementia.

[Design of a curve model for the detection of human immunoglobulin G against herpes simplex virus in ultramicroELISA from a single serum dilution]

The use of a curve model in the application of a ultramicroELISA technique for the detection of human immunoglobulin G against herpes simplex virus is reported. Based on end point titration (linear regression) of 100 initial sera, 51 of these, with r2 > 0.98, were selected, and 4 curve models were elaborated to relate the natural fluorescence logarithm for 4 dilutions with the previously determined natural end point titration logarithm. The curve corresponding to the 1:40 (r2 = 0.9645) was selected to evaluate 39 additional serum samples whose approximate titration was known through the graphic design of the 4 dilutions. An 89% coincidence was found regarding the latter. Divergence of the other 11% was due to the lack of accuracy of the graphic method in the points near the cutline.

Detection of canine distemper viral antigen in foxes (Vulpes vulpes) in northwestern Spain

We describe the lesions of natural distemper in red foxes (Vulpes vulpes) in Spain. The avidin-biotin-peroxidase complex (ABC) technique and a monoclonal antibody against the nucleocapsid protein of canine distemper virus were successfully used to confirm canine distemper diagnosis.

[The use of ELISA and indirect immunofluorescence technics for the rapid detection of eastern equine encephalomyelitis]

We present the results attained in the identification of Eastern equine encephalomyelitis virus isolations in Vero and XL-2 cell systems, using a double-antibody ELISA technique and the indirect immunofluorescence method. The results attained through these two techniques coincided by 100% with identification through neutralization. With the former, the virus was detected within 6-8 hours after inoculation. Better results were attained with XL-2 cells.

SPECT findings in patients with primary mania

Five patients with a manic episode and 7 age-comparable control subjects were studied with single-photon emission computed tomography and [99mTc]d,l-hexamethylpropyleneamine oxime. Manic patients showed significantly lower blood flow in the basal portion of the right temporal lobe compared with normal control subjects. Moreover, manic patients showed a left-right asymmetry (a significantly lower perfusion in the right versus left temporal basal cortex), as well as a dorsal-ventral asymmetry (a significantly lower perfusion in the right temporal basal versus dorsal cortex). These findings suggest that the right basotemporal cortex may play an important role in the production of primary mania.