Persisting Haemophilus influenzae strains induce lower levels of interleukin-6 and interleukin-8 in H292 lung epithelial cells than nonpersisting strains

Nonencapsulated Haemophilus influenzae strains isolated from patients with chronic bronchitis can be divided into those that persist in the lower respiratory tract and those that do not. We tested the hypothesis that persisting and nonpersisting strains differ in the extent to which they activate epithelial cells to produce two potent inflammatory mediators, interleukin (IL)-6 and IL-8. A suspension of 10(7) and 10(8) colony forming units (cfu) x mL(-1) of H. influenzae, persisting and nonpersisting, induced a dose- and time-dependent production of IL-6 and IL-8 by the human pulmonary mucoepidermoid carcinoma-derived cell line H292, but levels of IL-6 were lower after exposure to persisting H. influenzae (p<0.05). IL-8 production showed a similar trend (p<0.02; analysis of variance). H. influenzae bacteria that adhered to H292 cells were equally distributed over persisting and nonpersisting isolates and induced IL-6 and IL-8 levels similar to their nonadhering counterparts. The difference between persisting and nonpersisting H. influenzae was not due to cytotoxic, antimetabolic or antiproliferative effects on H292 cells. Furthermore, pre-exposure of cells to persisting and nonpersisting isolates did not block subsequent IL-1beta-induced IL-6 production. We conclude that persisting clinical isolates induce less interleukin-6 and interleukin-8 in H292 cells than nonpersisting isolates, probably because they excrete lower amounts of a stimulus of H292 cells. The stimulus is heat stable, hydrophilic and nonproteinous and probably not lipopolysaccharide alone. These findings support the suggestion that some strains of Haemophilus influenzae that persist in the airways of patients, may do so because they induce only a weak inflammatory response.

Chylous pleural effusion associated with primary lymphedema and lymphangioma-like malformations

We describe a patient with a chylous pleural effusion associated with primary lymphedema of his right leg and abdominal wall. On evaluation a generalized, severe hypoplasia of the lymphatic system turned out to be associated with hyperplastic, lymphangioma-like malformations.

Idiopathic retroperitoneal fibrosis of the bladder

A patient is described with isolated idiopathic retroperitoneal fibrosis (IRPF) of the bladder causing overhydration due to postrenal oliguria. IRPF is known to spread to the bladder; restriction of the bladder, however, is extremely rare. The patient was successfully treated with corticosteroids. The potential role of corticosteroids in the management of IRPF is discussed.

[Current developments in the diagnosis and therapy of cytomegalovirus infections]

We describe the case history of a 40-year-old, negroid woman with systemic lupus erythematosus who acquired a severe cytomegalovirus infection on immunosuppression; this infection was successfully treated with ganciclovir. New ideas in the management of CMV infections in immuno-compromised hosts are discussed. The traditional diagnostics are unsatisfactory, antibody detection being very insensitive and culture techniques too slow. A new diagnostic approach by detection of the immediate early antigens of the cytomegalovirus (CMV-IEA) using monoclonal antibodies is fast and reliable (sensitivity 93%, specificity 92%), even in case of immuno-deficiency. Finally we discuss the efficacy of the antiviral agent ganciclovir in the management of severe CMV infections.