Immunological Alterations in Haemophiliacs Treated with Lyophilized Factor VIII Cryoprecipitate from Volunteer Donors

We studied immune function in Belgian haemophiliacs treated with Factor VIII from volunteer donors. No patient had clinical evidence of immune deficiency. We found a decrease in T-helper cells (p <0.0005), in the ratio of T-helper over T-cytotoxic/ suppressor cells (1.72 ± 0.47 versus 2.24 ± 0.82 in controls, p <0.005) and in lymphocyte responsiveness to mitogens (p <0.05).

These findings could not be linked to the amount of F VIII received over the last year, the time since last F VIII administration, circulating immune complexes (54% positive patients, 7% positive controls, p <0.005), increased ALT levels, antibodies to cytomegalo-virus (85% of the patients, 45% of the controls, p <0.005), antibodies to Epstein-Barr virus, nor to the presence of HLA-DR 5 which was found in 56% of the haemophiliacs (20% of the overall Belgian population, p <0.005).

Either F VIII induces long lasting immunological alterations unrelated to AIDS, or haemophilia is itself associated with such changes.

Epidemiology of infective endocarditis in a large Belgian non-referral hospital

OBJECTIVES

Guidelines for diagnosis of infective endocarditis are largely based upon epidemiological studies in referral hospitals. Referral bias, however, might impair the validity of guidelines in non-referral hospitals. Recent studies in non-referral care centres on infective endocarditis are sparse. We conducted a retrospective epidemiological study on infective endocarditis in a large non-referral hospital in a Belgian city (Kortrijk).

METHODS

The medical record system was searched for all cases tagged with a putative diagnosis of infective endocarditis in the period 2003-2010. The cases that fulfilled the modified Duke criteria for probable or definite infective endocarditis were included.

RESULTS

Compared to referral centres, an older population with infective endocarditis, and fewer predisposing cardiac factors and catheter-related infective endocarditis is seen in our population. Our patients have fewer prosthetic valve endocarditis as well as fewer staphylococcal endocarditis. Our patients undergo less surgery, although mortality rate seems to be highly comparable with referral centres, with nosocomial infective endocarditis as an independent predictor of mortality.

CONCLUSION

The present study suggests that characteristics of infective endocarditis as well as associative factors might differ among non-referral hospitals and referral hospitals.

Three cases of destructive native valve endocarditis caused by Staphylococcus lugdunensis

Described here are three cases of acute native valve endocarditis due to the coagulase-negative pathogen Staphylococcus lugdunensis with serious complications. Two of the three patients died despite optimal antibiotic therapy and cardiovascular surgery. These cases demonstrate the aggressive nature of S. lugdunensis and emphasize the importance of identifying coagulase-negative staphylococci to the species level and not considering the isolation of S. lugdunensis from normally sterile body fluids as contamination. On the contrary, when this organism is found in patients with endocarditis, early surgery should be considered. The possibility that this organism could be misidentified as S. aureus because of "autocoagulation" and that commercial identification systems may misidentify it as S. haemolyticus, S. hominis or S. warneri should also be remembered.

Susceptibility testing of Pseudomonas aeruginosa by the Vitek 2 system: a comparison with Etest results

P. aeruginona infections need accurate antimicrobial susceptibility data, as treatment mainly relies on antibiotic efficiency in debilitated patients. Vitek 2, a popular automated susceptibility testing method, was compared with Etest to assess its reliability on 150 Belgian P. aeruginonas isolates. Vitek 2 and Etest exhibited a high degree of concordance, but some discrepancies in clinical category were evident for cefepime (high minor and borderline very major error rate) and for piperacillin/tazobactam (high very major error rate). Vitek 2 appears to yield valuable information to the clinician concerning the antimicrobials amikacin, ceftazidime, ciprofloxacin and meropenem, in the setting of pseudomonas infection. For cefepime and piperacillin/tazobactam, a confirmatory testing by means of disk diffusion is worth considering.

Isolation of Enterococcus avium from bile and blood in a patient with acute cholecystitis

The isolation of Enterococcus avium from bile fluid and blood of an uncompromised patient with acute cholecystitis is reported. As advanced identification of Enterococcus sp. by biochemical and physiological tests is not routinely done, the occurrence of E. avium infections may be underestimated.

Destructive endocarditis caused by Staphylococcus lugdunensis. Case report and review of the literature

A case of highly invasive native valve endocarditis, occurring in a young man with a preexisting cardiac anomaly, and caused by Staphylococcus lugdunensis is described. Despite treatment with antibiotics the disease progressed with further growth of the bacterial vegetations and invasion of the myocard. The patient was successfully treated by surgery. Twenty three cases of endocarditis by S. lugdunensis have now been described. This organism is a major cause of destructive endocarditis accompanied by high mortality. As the outcome usually is more favourable in patients who underwent valve replacement surgery, rapid identification to the species level of coagulasenegative staphylococci is required. S. lugdunensis endocarditis should be treated preferably by surgical intervention.

Significance of Clostridium difficile and its cytotoxin in children

Stools of 147 children belonging to different age groups were examined for the presence of Clostridium difficile, its cytotoxin and other enteric pathogens. None of the 31 full-term neonates, 5 (16%) of the 32 premature neonates, 27 (46%) of the 59 infants and 1 (4%) of the 25 older children excreted C. difficile in their stools. Faecal cytotoxin was only detected in four infants (7%). There was no correlation with diarrhoea, previous antibiotic therapy, type of diet, or the concomitant presence of other intestinal pathogens. We conclude that colonisation of the intestine by C. difficile is probably acquired from environmental sources and that it cannot be regarded as a significant cause of diarrhoea in children.

Immunological alterations in haemophiliacs treated with lyophilized Factor VIII cryoprecipitate from volunteer donors

We studied immune function in Belgian haemophiliacs treated with Factor VIII from volunteer donors. No patient had clinical evidence of immune deficiency. We found a decrease in T-helper cells (p less than 0.0005), in the ratio of T-helper over T-cytotoxic/suppressor cells (1.72 +/- 0.47 versus 2.24 +/- 0.82 in controls, p less than 0.005) and in lymphocyte responsiveness to mitogens (p less than 0.05). These findings could not be linked to the amount of F VIII received over the last year, the time since last F VIII administration, circulating immune complexes (54% positive patients, 7% positive controls, p less than 0.005), increased ALT levels, antibodies to cytomegalo -virus (85% of the patients, 45% of the controls, p less than 0.005), antibodies to Epstein-Barr virus, nor to the presence of HLA-DR 5 which was found in 56% of the haemophiliacs (20% of the overall Belgian population, p less than 0.005). Either F VIII induces long lasting immunological alterations unrelated to AIDS, or haemophilia is itself associated with such changes.

Non-A, non-B hepatitis-like nuclear particles in nonparenchymal cells of the liver

Nuclear particles, morphologically similar to those seen in hepatocytes during non-A, non-B (NANB) hepatitis, were detected in several types of nonparenchymal cells in 10 human liver-biopsy specimens, including cases of hepatitis A and B and nonviral hepatic disease. They were also found in nonparenchymal cells of the liver in two of four normal chimpanzees and in two of four chimpanzees during experimental NANB viral hepatitis. In nonparenchymal cells the particles formed loose-to-intermediate aggregates, similar to those first described in hepatocytes during NANB hepatitis. Tightly packed aggregates, the predominant pattern in hepatocytes, were generally missing. The high prevalence of morphologically identical particles in various liver diseases and their presence in healthy livers, both in hepatocytes and in nonparenchymal cells not presumed to support the growth of hepatitis viruses, speak against their specificity for NANB hepatitis viruses. It is proposed that the particles represent a newly recognized and widespread cellular feature, of as yet unknown function.

Syphilis, hepatitis A, hepatitis B, and cytomegalovirus infection in homosexual men in Antwerp

In a homosexual communication centre in Antwerp 196 homosexual men were screened for seromarkers of syphilis, hepatitis A (HAV), hepatitis B (HBV) and cytomegalovirus (CMV). A comparison group consisted of 118 heterosexual men attending a venereal disease clinic in Antwerp. Treponemal antibodies were found in 7.1% of homosexual men, of whom half gave no history of past or present infection. Anti HAV was present in 43.3%, HBV seromarkers in 34.4%, and CMV antibodies in 71.2% of homosexual men. Hepatitis B surface antigen (HBsAg) was detected in eight homosexual men, but not in the heterosexual control group. Prevalence rates of infections other than HAV were significantly higher in homosexual men than in heterosexual men. Answers to a questionnaire were used to evaluate risk factors for different diseases, which were: duration of active homosexuality for all infections, promiscuity (greater than or equal to 10 partners in the past six months) for syphilis and hepatitis B, and anal intercourse for hepatitis B. Visiting saunas and travelling for sexual contacts also indicated a higher risk for STD, but were an indirect expression of promiscuity.

Efficacy of heat-inactivated hepatitis B vaccine in haemodialysis patients and staff. Double-blind placebo-controlled trial

The efficacy of a heat-inactivated hepatitis B vaccine, 3 micrograms of surface antigen (HBsAg), given at 0, 1, 2, and 5 months, was evaluated in 401 haemodialysis patients in 18 centres by a placebo-controlled, double-blind, randomised trial. The attack-rate of hepatitis B virus (HBV) infections in the control group was 18% over 435 days. The protective efficacy rate of the vaccine was 78% against all HBV infections in the entire study (p = 0.00016), and 94% against HBsAg-positive hepatitis more than 3 months after day 0. Those patients in whom HBV developed showed no evidence of vaccine-acquired anti-HBs. Among 152 similarly randomised staff members receiving three monthly injections, all 5 HBsAg-positive infections occurred in the placebo group (p = 0.022). The vaccine induced anti-HBs in 88% of the patients and 100% of the staff. Immediately after the fourth injection, anti-HBs levels were as high in responding patients as in staff. There were no serious side effects. In the four-dose schedule the vaccine provides dialysis patients with protection of the same order as that given by other hepatitis B vaccines to normal subjects.

Are nuclear particles specific for non-A, non-B hepatitis?

This study reports the findings of an electron microscopic search for so-called non-A, non-B nuclear particles in liver biopsies from patients with mainly chronic or prolonged liver disease and from chimpanzees. In patients without hepatitis B virus or acute hepatitis A virus serological markers, non-A, non-B-like nuclear particles were seen in hepatocytes in 28 of 31 cases of presumed non-A, non-B hepatitis, but also in 11 of 12 cases of liver disease not usually attributed to hepatitis viruses. They were also seen in 22 of 24 patients with HBsAg, in 3 of 3 patients with anti-HBc and no HBsAg, in 1 of 2 patients with hepatitis A, in a case of cytomegalovirus hepatitis, and in 16 of 19 patients whose serology was not available or inconclusive. The particles were present in 1 of 8 untreated HBsAg-negative chimpanzees and in 2 of 2 HBsAg-positive chimpanzees. They appeared in 4 of 4 chimpanzees developing non-A, non-B hepatitis following exposure to various inocula. Three patterns of particle aggregates were distinguished, all of which had been shown by others in non-A, non-B hepatitis. Dense aggregates were predominant, while others have shown intermediate aggregates more often; reasons for this difference could be technical. No pattern was specific for any condition. Either non-A, non-B-like nuclear particles, although associated with non-A, non-B hepatitis, are not specific for this condition, or non-A, non-B hepatitis viruses are extremely more common than is currently appreciated.

In vitro activity of ceftazidime (GR 20263) and other beta-lactam antibiotics against Haemophilus influenzae

Minimal inhibitory concentrations (MIC) and minimal bactericidal concentrations (MBC) were determined for ceftazidime (GR 20263 - pentahydrate), RO 13-9904, cefoperazone, cefotaxime, lamoxactam, cefamandole and ampicillin using clinical isolates of beta-lactamase-producing and beta-lactamase-negative Haemophilus influenzae. RO 13-9904 and cefotaxime were the most active, followed by ceftazidime, lamoxactam and cefoperazone. Ceftazidime displayed high stability against the beta-lactamase-producing strains with a low MBC:MIC ratio.

Syphilis in Swaziland: a serological survey

Sera from 536 adults and children in Swaziland were examined for their reactivity in the rapid plasma reagin (RPR) and Treponema pallidum haemagglutination (TPHA) tests. None of 130 sera from children was reactive in either test; 8.6% of sera from 185 healthy adults were reactive in the RPR test and 33% in the TPHA test; 24.5% of 220 sera from patients with genital ulcers were RPR-positive and 45.9% TPHA-positive. The RPR positivity rates were not related to age, but the percentage of RPR-negative, TPHA-positive sera increased with age in both the healthy adults and the patients with genital ulcers. Thus venereal syphilis appears to be responsible for these high positivity rates. Estimates of the yearly incidence of syphilis are identical for both groups--approximately 1.4%, an unusually high figure.

Antibiotic susceptibility of Neisseria gonorrhoeae strains from Europe and Africa

The in vitro activities of 16 antimicrobial agents were tested by a plate dilution method against 268 unselected isolates of Neisseria gonorrhoeae from Belgium, Rwanda, Swaziland, and Zaire. Fifteen beta-lactamase-producing strains isolated in Europe from various origins were also tested. There were significant regional variations in antimicrobial agent susceptibility, even among the African isolates, with the Rwandan and Zairean strains being most resistant. Benzylpenicillin and ampicillin were equally active in all but the beta-lactamase-producing strains. Among the cephalosporins, cefotaxime was by far the most active, followed by cefuroxime, cefamandole, cefoxitin, and cefaclor, in that order. All strains were susceptible to spectinomycin, thiamphenicol, kanamycin, and rifampin, with the exception of one highly rifampin-resistant isolate and a moderately thiamphenicol-resistant strain. Twenty-six percent of the isolates were highly resistant to streptomycin. Six percent of the gonococci had a minimal inhibitory concentration for tetracycline greater than 2 mug/ml. Clavulanic acid inhibited the beta-lactamase activity of the gonococci tested and improved markedly the activities of ampicillin and amoxicillin against beta-lactamase-producing strains.