[Cytogenetics of oral solid tumors]

The tumorigenesiss of oral solid tumors is still uncertain. The underlying mechanisms of epithelial or connective tissue proliferation are not yet fully understood. Also, the transformation of a benign tumor into malignant is obscure. Cytogenetics is the study of chromosome number and structure using a light microscope. Human chromosome nomenclature is based on An International System for Human Cytogenetic Nomenclature (ISCN). The normal human somatic cells have 46 chromosomes, including 22 pairs of autosomes and two sex chromosomes, XX in female and XY in male. The chromosome abnormalities can be numerical and structural. Both types can occur concurrently. Numerical abnormalities involve the loss and/or gain of a whole chromosome and can include both autosomes and sex chromosomes. Cells which have lost a chromosome are categorized as a monosomy, while those with an extra chromosome are trisomy. Structural abnormalities include translocations, deletions, inversions and insertions. Cancer, in its various forms is a result of genetic changes. This concept comes from the finding of chromosomal abnormalities. These abnormalities may arise as a consequence of random replication errors; exposure to carcinogens; or damaged DNA repair process. In clinical oncology, the study of chromosome abnormalities in solid tumors provides valuable information for the diagnosis, evaluating treatment response of metastatic cancer, marker for prognosis and targeted therapy. In tumors which histologic features overlap, cytogenetics plays an important role for diagnosis. Cytogenetics has also been used to monitor the surgical margins of the resection in head and neck carcinoma, where the histology was not definitive. The present report will focus on the role of cytogenetics in the diagnosis and prognosis of benign and malignant oral solid tumors.

Dependence of maternal serum [AFP]/[hCG] median ratios on age of gestation: comparison of trisomy 21 to euploid pregnancies

BACKGROUND

Current risk calculations for trisomy 21, which are based on multiples of median (MoM), do not take into account possible differences between euploid and trisomy 21 pregnancies that may develop with gestational age. In order to optimize the predictive value of screening tests, we calculated the ratio between maternal serum concentration of alpha-fetoprotein (AFP) and that of human chorionic gonadotropin (hCG) in euploid and in trisomy 21 pregnancies.

METHODS

The medians of the concentration ratios, [AFP]/[hCG] at 16-21 weeks of gestation, were plotted as a function of gestational age for 307 cases of trisomy 21 and were compared with the medians of 30 549 normal karyotype cases.

RESULTS

[AFP]/[hCG] ratio medians were independent of body weight and maternal age. There was a significant difference in the [AFP]/[hCG] ratio when comparing trisomy 21 and euploid pregnancies at each week. This difference became greater with advancing gestational age (P < 0.01).

CONCLUSION

There is a significant difference in ratios of [AFP]/[hCG] between euploid and trisomy 21 pregnancies, which may be used to improve detection rates of Down syndrome screening.

Human plasma accelerates immortalization of B lymphocytes by Epstein-Barr virus

OBJECTIVE

Serum and plasma contain species-specific factors that modulate cell population growth and function, and that are required for proliferation of most cell cultures. Foetal calf serum (FCS) is the most common source of these growth factors. We studied the effect of human plasma (HP) on the immortalization process of B lymphocytes by Epstein-Barr virus (EBV) was studied.

MATERIALS AND METHODS

The effect of HP as compared to FCS was done through assessment of cell proliferation.

RESULTS

It was found that HP (autologous and non-autologous plasma) is more effective than FCS in generating lymphoblastoid cell lines, regardless of EBV status of the donors: 65% of HP-supplemented cultures developed into lymphoblastoid cell lines by 7-14 culture days, as compared to 16% of cultures with FCS. In addition, 6% of HP-supplemented cultures did not achieve becoming lymphoblastoid cell lines by day 35 in comparison to 94% of cultures with FCS. The higher proliferative effect of HP was not altered by heat inactivation or filtration. HP maintained its proliferative activity at 4 degrees C over 8 months, thus indicating that HP contains a stable growth factor(s), which accelerates B-lymphocyte immortalization.

CONCLUSION

The results support other studies that recommend the use of autologous plasma for tissue culture, mainly in the case of autologous transplantation. Furthermore, the use of HP allows preparation of lymphoblastoid cell lines from a small amount of peripheral blood in a shorter period of time and with a higher rate of success.

Acquired chromosome instability in the elderly--the effect of diepoxybutane

Aging and Alzheimer's disease (AD) have been the subject of many studies. It has been suggested that chromosomal alterations may be involved in the etiology and/or pathogenesis of ageing and AD. The purpose of the present study was to examine the effect of diepoxybutane (DEB) on lymphocyte chromosomal instability in the elderly. We examined lymphocytes cytogenetically with, as well as, without DEB treatment, in a group of 12 elderly (range of age 72-96 years), nine of them suffering from AD type. Without DEB treatment six of the donors expressed chromosomal instability in at least 6% of the analyzed cells. After treatment with DEB, lymphocytes showed an increase in the chromosomal instability in up to 20% of the analyzed in eight donors. The sex chromosomes were the main chromosomes involved in the acquired chromosomal abnormalities. It is not clear from this study whether this chromosomal instability is related to the AD. The significance of the involvement of sex chromosomes either in ageing or in AD, as well as, the question whether the chromosomal instability is the cause of or part of ageing processes, has to be addressed.

Angiomyoma of buccal vestibule: a rare case with a normal karyotype

Angiomyoma is an uncommon, benign, soft tissue tumour characterised by bundles of smooth muscle cells intermixed with numerous vascular channels, which usually develops in the lower extremities. Oral manifestations are quite rare. Most oral cases occur in the lips and tongue; angiomyoma affecting the buccal vestibule is very rare. A case of angiomyoma in the buccal vestibule with a normal karyotype is reported.

Single clone bearing chromosomal aberrations in amniotic fluid culture

We present our data concerning a single clone bearing chromosomal aberration obtained by routine amniocentesis in 2340 parturients. Single clone chromosomal aberrations in amniocytes were more commonly observed in chromosomes 8,18,21,22,X and as supernumeric marker chromosome. No correlation has been found between the incidental chromosomal changes observed in one or two cells of the cultured amniocytes and obstetrical and demographic parameters.

Prevalence of vectors of the spotted fever group Rickettsiae and murine typhus in a Bedouin town in Israel

A survey of the vectors of spotted fever group Rickettsiae and of murine typhus was carried out in Rahat, a Bedouin town in the Negev Desert, where the diseases are endemic. Houses with known cases of spotted fever group Rickettsiae or murine typhus were compared with those without reported clinical cases. A neighboring Jewish community, Lehavim, where no cases of spotted fever group Rickettsiae and murine typhus were reported in recent years, was used as a control. In the houses of patients with spotted fever group Rickettsiae in Rahat, an average of 7.4 times more ticks were found than in control houses. Out of 190 ticks isolated from sheep and goats or caught by flagging in Rahat, 90% were Rhipicephalus sanguineus (Latreille), 7.9% Rhipicephalus turanicus Pomerantzev, and 2.1% were Hyalomma sp. In the houses of patients with murine typhus, three times more rats were caught and, on the average, each rat was infested with 2.2 times more fleas than rats in the control houses. Out of 323 fleas collected from 35 Norwegian rats (Rattus norvegicus Berkenhout), 191 were Xenopsylla cheopis Rothschild and 132 Echidnophaga murina Tiraboschi. Thus, there was a six to seven times higher probability of encountering a tick or flea vector where infections had occurred than in control houses in Rahat. The percentage of rats seropositive to Rickettsia typhi was similar in study and control households (78.3 and 76.2, respectively). In the control settlement, Lehavim, only three Mus musculus L. were caught, which were not infested with ectoparasites and their sera were negative for murine typhus. Out of 10 dogs examined in this settlement, 15 R. sanguineus and eight specimens of the cat flea (Ctenocephalides felis felis Bouché) were isolated. No rats were caught in this settlement. These data indicate that there is a correlation among the density of domestic animals, their ectoparasites, and the incidence of spotted fever group Rickettsiae and murine typhus in Rahat.

Acute blast crisis with EBV-infected blasts, in a patient with chronic myeloid leukemia, and vasculitis

Unless they undergo transplantation, all patients with chronic myeloid leukemia (CML) will eventually develop a late phase of acute blast crisis (ABC). Although additional chromosomal abnormalities to the Philadelphia (Ph) chromosome may herald ABC in many CML cases, the mechanisms leading to this fatal event are obscure. Viral etiology, including the Epstein-Barr virus (EBV) has never been implicated in the pathogenesis of ABC in CML. Iloprost is an analogue of epoprostenol (prostacyclin; PGI2) commonly used for the treatment of peripheral vascular diseases and acts via inhibition of platelet activation, and by vasodilation. A case of ABC with blasts of undetermined lineage showing EBV infection in a male patient with Ph positive CML is described here. This unusual event developed during a course of treatment with the prostacyclin analogue, iloprost administered for vasculopathic leg ulcers. The proliferating blasts stained positively by immunohistochemistry only for the leukocyte common antigen (LCA/CD-45), and the EBV-latent membrane protein 1 (LMP-1). The only chromosomal abnormality detected by cytogenetic analysis was the conventional Ph-chromosome. It is suggested that ABC in this case of CML, was associated with EBV-activated blasts of undetermined lineage.

Deletion of 8.5 Mb, including the FMR1 gene, in a male with the fragile X syndrome phenotype and overgrowth

A four-year-old boy with severe psychomotor retardation, facial appearance consistent with the fragile X syndrome, hypotonia, and overgrowth was found to have a deletion including the fragile X gene (FMR1). The breakpoints of the deletion were established between CDR1 and sWXD2905 (approximately 200 kb apart) at Xq27.1 (centromeric) and between DXS8318 (612-1078L) and DXS7847 (576-291L) (approximately 250 kb apart) at Xq28, about 500 kb telomeric to the FMR1 gene. The total length of the deletion is approximately 8.5 Mb. The propositus's mother, who was found to be a carrier of the deletion, showed very mild mental impairment. Except for mental retardation, which is a common finding in all cases reported with similar deletions of chromosome Xq, this patient had generalized overgrowth, exceeding the 97th centile for height and weight. Obesity and increased growth parameters have been reported in other patients with deletions either overlapping or within a distance of 0.5 Mb from the deletion in the present patient. Thus, it is suggested that a deletion of the 8-Mb fragment centromeric to the FMR1 gene might have an effect on growth.

Reticulolinear aplasia cutis congenita of the face and neck: a distinctive cutaneous manifestation in several syndromes linked to Xp22

A distinct form of aplasia cutis congenita presenting as linear facial skin defects has been described under a variety of names as Xp deletion syndrome. MIDAS (microphthalmia, dermal aplasia and sclerocornea) syndrome, MLS (microphthalmia and linear skin defects) and Gazali-Temple syndrome. The syndrome is lethal in males, and its severity in females varies from a relatively mild residual facial scarring with short stature to lethal developmental organ malformations. A new case with peculiar ultrastructural findings is presented. A review of the literature suggests that these associations represent a series of contiguous-gene syndromes.

Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients

BACKGROUND

The purpose of this study was to assess the causes of community-acquired pneumonia in adult patients admitted to hospital.

METHODS

A prospective study was performed on 346 consecutive adult patients (54% men) of mean (SD) 49.3 (19.5) years (range 17-94) admitted to a university affiliated regional hospital in southern Israel with community-acquired pneumonia over a period of one year. Convalescent serum samples were obtained from 308 patients (89%). The aetiological diagnosis for community-acquired pneumonia was based on positive blood cultures and/or significant changes in antibody titres to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, respiratory viruses, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella sp.

RESULTS

The aetiology of community-acquired pneumonia was identified in 279 patients (80.6%). The distribution of causal agents was as follows: S pneumoniae, 148 patients (42.8%); M pneumoniae, 101 (29.2%); C pneumoniae, 62 (17.9%); Legionella sp, 56 (16.2%); respiratory viruses, 35 (10.1%); C burnetii, 20 (5.8%); H influenzae 19 (5.5%); and other causes, 21 patients (6.0%). In patients above the age of 55 years C pneumoniae was the second most frequent aetiological agent (25.5%). In 133 patients (38.4%) more than one causal agent was found.

CONCLUSIONS

The causal agents for community-acquired pneumonia in Israel are different from those described in other parts of the world. In many of the patients more than one causal agent was found. In all these patients treatment should include a macrolide antibiotic, at least in the first stage of their illness.

Enrichment of an Israeli ethnic food with fibres and their effects on the glycaemic and insulinaemic responses in subjects with non-insulin-dependent diabetes mellitus

The effects of various sources of dietary fibre on the high glycaemic index of an Israeli ethnic food, melawach, were investigated in subjects with non-insulin-dependent diabetes mellitus (NIDDM). Locust-bean (Ceratonia siliqua) gum significantly decreased the glucose response to, and glycaemic index of, melawach in these diabetic subjects (P < 0.05). It also tended to decrease their insulinaemic response and insulinaemic index, but differences were not significant. Dietary fibre from lupin (Lupinus albus) and insoluble maize-cob fibre did not affect glucose and insulin levels in NIDDM volunteers. Subjects with a BMI < 30 kg/m2 exhibited similar glucose, but not insulin, responses to fibre. Locust-bean gum had no significant effect on glycaemic response in NIDDM subjects with a BMI > 30 kg/m2, whereas insulinaemic response decreased. The results indicate that foods containing the same nutrients in almost the same amounts, but differing in added dietary fibre, lead to different physiological responses in diabetic subjects. Furthermore, insulin response should be considered when fibre is incorporated into the diabetic's diet.

Comparative antigenic analysis of spotted fever group rickettsiae from Israel and other closely related organisms

Spotted fever rickettsiosis in Israel has been considered as possibly somewhat more severe than boutonneuse fever, from which it also differs in having a very low proportion of cases with a tick-inoculation site eschar. This investigation was undertaken to determine whether the Israeli spotted fever group (SFG) rickettsiae differed sufficiently from Rickettsia conorii to be considered as a distinct species. Strains of Rickettsia conorii from Morocco and South Africa, four SGF rickettsial isolates from Israel, one from Russia, and one from Zimbabwe were compared by microimmunofluorescence serotyping, Western immunoblotting, monoclonal antibody reactivity, and polymerase chain reaction amplification of the repeat domain of the rickettsial outer membrane protein A (rOmpA). All are strains and isolates of R. conorii, yet there is considerable molecular and antigenic diversity of both rOmpA and rickettsial outer membrane protein B (rOmpB) among them. The rOmpA gene of the Israeli isolates and the Astrakhan strain from Russia is estimated to encode 15 rOmpA repeat units as compared with 10 for the South African strain and six for the strains from Morocco and Zimbabwe. The Israeli SFG rickettsial strains appear to be R. conorii, a species with substantial antigenic and genetic diversity. The Israeli strains appear to fall within the limit previously described for the genetic and antigenic diversity of R. conorii.

Q-fever pneumonia in the Negev region of Israel: a review of 20 patients hospitalised over a period of one year

BACKGROUND

Three-hundred and forty-six patients with community acquired pneumonia were included in a prospective study of patients hospitalised over a 12-month period in the Soroka Medical Center in Beer-Sheva, Israel. Q-fever pneumonia (QFP) was diagnosed in 20 patients (5.8%). A detailed epidemiological and clinical description of this disease, is presented.

METHODS

QFP was diagnosed by conventional criteria using a commercial immunofluorescent assay.

RESULTS

The age of patients was 41 +/- 14 years (mean +/- S.D., range 20-69). Twelve of the patients were males. No concomitant or chronic disease was present in 16 patients. Chest radiograms revealed alveolar or air space pneumonia in 10 patients, bronchopneumonia in nine and interstitial pneumonia in one patient. The mean febrile period was 10.5 +/- 5.3 days. There was serological evidence of co-infection with Mycoplasma pneumonia in six patients, and with Legionella pneumophila in one patient. Patients treated with beta-lactam antibiotics recovered as quickly as those treated with tetracyclines or erythromycin.

CONCLUSIONS

The Negev region of Israel is an endemic area for Q-fever. The diagnosis of QFP can be made only on the basis of a specific serological test. Clinical, radiologic or laboratory findings are not diagnostically definitive. The importance of specific therapy is unclear.

Rickettsia rickettsii has proteins with cross-reacting epitopes to eukaryotic phospholipase A2 and phospholipase C

The entry, and possibly the exit, of rickettsiae from eukaryotic cells, as well as erythrocyte lysis by some members of this group of organisms, is thought to be mediated by a phospholipase A activity even though the enzyme has not been isolated from these organisms. Evidence for phospholipase C, on the other hand, has not been reported for the genus Rickettsia. In this study, in a preliminary attempt to demonstrate the presence of phospholipase A2 and phospholipase C in the virulent Sheila Smith strain of Rickettsia rickettsii, we performed immunoblotting and immuno-gold electron microscopy using anti-phospholipase A2 and anti-phospholipase C IgG antibodies (raised against mammalian enzymes). We provide evidence for cross-reactivity of the antibodies with proteins present in R. rickettsii. Western blots showed a higher staining intensity with anti-phospholipase C antibody than with anti-phospholipase A2. According to the results obtained with the immuno-gold labeling of phospholipase A2 and phospholipase C reactive epitopes, most of the phospholipase A2 cross-reactive material appears to be associated with the membrane of the organism while the phospholipase C cross-reactive material appears to be randomly distributed throughout the cell.

Intracellular persistence of chlamydial major outer-membrane protein, lipopolysaccharide and ribosomal RNA after non-productive infection of human monocytes with Chlamydia trachomatis serovar K

The replication of Chlamydia trachomatis serovar K was studied in human peripheral blood monocytes (PBMo). The intracellular fate of the bacteria was examined by determining the presence of chlamydial major outer-membrane protein (MOMP), lipopolysaccharide (LPS) and ribosomal RNA (rRNA). In-vitro infection of PBMo with C. trachomatis serovar K was not productive. However, chlamydial MOMP antigen, demonstrated by immunofluorescence, was present in PBMo for up to 14 days. Infected monocytes also contained chlamydial rRNA, measured by in-vitro hybridisation, and LPS, measured by enzyme immunoassay, for up to 14 days. These data are compatible with the hypothesis that the infection of PBMo with C. trachomatis may play a role in the systemic distribution of chlamydial antigens, leading to systemic manifestations of urogenital chlamydial infection.

Ecological studies on the brown dog tick Rhipicephalus sanguineus (Acari: Ixodidae) in southern Israel and its relationship to spotted fever group rickettsiae

An outbreak of spotted fever group rickettsiae (SFGR) was investigated by studying free-living and parasitic stages of ticks in two settlements of equal size and population located 20 km apart in the Negev Desert. Although high morbidity from SFGR was found in one of the settlements (Kibbutz Ze'elim), no clinical cases were observed in the second (Kibbutz Re'im). Using flagging and CO2-trapping, approximately 9 times more ticks were collected in Ze'elim than in Re'im. Rhipicephalus sanguineus (Latreille) was the dominant species in Ze'elim, whereas in Re'im R. turanicus Pomerantzev was the most abundant species. Several physical factors that may account for these differences were investigated. Significantly higher maximum soil temperature as well as ambient temperature above the soil were found in Ze'elim. Differences in soil composition in the two sites were also observed. Tick numbers were especially high during April through October in Ze'elim, whereas in Re'im, ticks were found mainly from April to July. A significant positive correlation was found between temperature and tick population size in Ze'elim. Dogs, sheep, goats, Mus musculus, and Meriones crassus, were more heavily infested with ticks in Ze'elim than in Re'im. The percentage of mice and dogs seropositive to SFGR was the same in both sites. In Ze'elim, 7.1% of dog owners acquired Mediterranean spotted fever during the period 1984-1989 compared with only 1.4% of people without dogs.

Human and tick spotted fever group Rickettsia isolates from Israel: a genotypic analysis

The genomes of spotted fever group rickettsiae isolated in different geographical areas of Israel (two from ticks and four from humans, obtained over a span of 20 years) were studied by polymerase chain reaction (PCR) and restriction endonuclease fragment length polymorphism (RFLP) analysis. The human isolates were obtained from patients suffering from rickettsial disease of different degrees of severity. The PCR products obtained with five pairs of oligonucleotide primers (two primer sets derived from the 190-kDa polypeptide gene and three from the 120-kDa polypeptide gene) and cleaved with restriction endonucleases were used to study the Israeli isolates and reference Rickettsia conorii isolates. Subtle differences between the PCR-RFLP patterns of Israeli isolates and the two R. conorii reference strains (Moroccan and no. 7) were seen when the PCR products derived from the 190-kDa gene-derived primer sets were digested. All of the Israeli isolates were identical by RFLP analysis using all of the primer sets. This study showed that the Israeli spotted fever group isolates (from both ticks and humans) were genetically homogeneous by the criteria used in this study, despite the time and location differences in their original isolation, and different as a group from R. conorii.

Spotted fever rickettsiae in ticks from the northern Sinai Governate, Egypt

A field study was initiated in 1988 to investigate whether spotted fever group rickettsiae occur in geographic areas in Egypt that are adjacent to an area in the southern Israeli Negev that has a defined focus of spotted fever disease. Ticks were collected from dogs, sheep, and camels at four study sites in the northern Sinai. Tick hemolymph was processed for rickettsial detection by staining with fluorescein isothiocyanate-conjugated antibody to Rickettsia rickettsii. Of the 442 hemolymphs examined, 15 contained immunofluorescent rickettsiae. Eight hemolymph test-positive (HT+) ticks were Rhipicephalus sanguineus removed from dogs; the other HT+ ticks comprised three Hyalomma species, H. anatolicum, H. impeltatum, and H. dromedarii. Both HT+ and HT- ticks were tested for rickettsial DNA using the polymerase chain reaction (PCR). Eight of 10 HT+ field-collected ticks were PCR positive (PCR+). All laboratory colony R. rickettsii-infected ticks were PCR+. No HT- ticks from field or laboratory isolates were PCR+.

The effect of monocyte-derived macrophages on the growth of Rickettsia conorii in permissive cells

We examined whether monocyte-derived macrophages (MdM) incubated with rickettsia-infected HEp-2 or BGM cells a) affect R. conorii (Boutonneuse fever) growth, and b) secrete TNF and IL-1 alpha. BGM and HEp-2 cells were infected with R. conorii at multiplicities of infection (MOI) of 1-0.01. After 2 hr of adsorption, the cells were washed and MdM were added at an effector to target ratio of between 3 and 5. At 2, 24, 48, and 96 hr post-infection (p.i.) cells were scraped off; cell-free medium was collected and TNF and IL-1 levels were determined by ELISA and RIA, respectively. MdM caused a 50-70% reduction in the yield of R. conorii in HEp-2 cells as compared to the control (infected HEp-2 cells incubated without MdM). This reduction was more pronounced at MOI 0.1 and 0.01, than at MOI 1. In contrast, no reduction in the rickettsial yield was observed in the BGM cells incubated with MdM. TNF and IL-1 alpha levels in the cell-free medium from infected HEp-2 cells incubated with MdM were higher (2-5 fold) than those from infected BGM cells incubated with MdM. These data suggest the possibility that, and the mechanisms whereby, MdM may modulate rickettsia replication in vivo.

Serum antibodies in rickettsia patients as determined by immunoblotting technique

The Western-blot technique (WB) was used to determine which polypeptides of Israeli spotted fever (ISF) isolates and other spotted fever group rickettssia (SFGR) reference isolates (G212, S484, A828) and two reference strains. R. Rickettsii (Sheila Smith strain) and R. conorii (Boutonneuse fever), were used as antigen sources for the WB. Immunoperoxidase assay (IPA) seropositive (titer greater than 80) and seronegative (titer less than) sera were examined with the separated polypeptides of the above strains. WB analysis of the rickettsial polypeptide-serum reactions showed that R. conorii and the three isolates of ISF reacted identically with the sera, except that in the three ISF strains a 175 kD protein was present. It was also observed that all of the IPA seropositive sera examined reacted with the following polypeptides: 18kD, 20kD, 22kD (28kD to 37 kD LPS group), while each seropositive and seronegative serum reacted differently with polypeptides 23kD, 42kD, 45kD, 46kD, 52kD, 55kD, 70kD, 82kD, 105kD, 125kD, 155kD and 175kD. Using this technique, no heat labile polypeptides (preelectrophoretic treatment: 100 degrees C for 2 min vs 37 degrees C for 20 min) were observed in SFGR strains used in this study. Our results indicate that the immunoblot technique shows no difference between R. conorii and ISF antigens except the existence of 175kD protein antigen in the latter.

Comparison of structural polypeptides, detected by immunoblotting technique, in the sera of spotted fever group rickettsia positive cases--symptomatic versus asymptomatic

In an attempt to characterize the nature of symptomatic versus asymptomatic spotted fever group rickettsia (SFGR) infection, the immune response to R. conorii (boutonneuse fever) structural polypeptides was studied by Western-blot immunoassay. Sera from immunoperoxidase assay (IPA), SFGR seropositive (titre greater than or equal to 80) individuals, symptomatic and asymptomatic and from SFGR seronegative (IPA titre less than 80) individuals living in a kibbutz community in the desert region of Southern Israel were examined by immunoblot. This community suffered from a very high morbidity rate due to SFGR (21-fold higher than the national reported average). The entire community (n-326) has been followed-up since 1985, with serial serum samples being examined for specific IgG antibodies by IPA. The intensity of the immunoblot reaction correlated with specific IgG antibody titres as determined by IPA. This correlation was also observed between the decrease in the IgG titre and the strength of the antibody-antigen reaction by immunoblot over time for a given individual. IPA seropositive sera from asymptomatic as well as symptomatic spotted fever cases reacted to 8 individual polypeptides. In both cases antibodies to 22 kD, 24 kD, 26 kD, 28 kD, 30 kD, 32 kD, 34 kD, and 37 kD were found. In the IPA seronegative sera, antibodies to polypeptides in the range of 24 kD to 32 kD were not detected. The lack of detectable differences by immunoblotting between SFGR symptomatic vs, asymptomatic cases might be explained by other aspects of the immune response of each infected individual, and/or it is possible that virulent and non-virulent antigenically closely related SFGR strains infected symptomatic vs. asymptomatic individuals.

Implications for persistent chlamydial infections of phagocyte-microorganism interplay

In vitro models of Chlamydia trachomatis inhibition by cytokines, human-monocyte derived macrophages (HMDM) and human polymorphonuclear leukocytes (HPMN) are discussed in an attempt to delineate the molecular basis of parasite-host cell interplay in persistent and chronic chlamydial infection. Interferon gamma (IFN) has been found to reversibly inhibit chlamydial growth at an early stage in the replicative cycle, while tumor necrosis factor (TNF) has a more profound effect on chlamydial growth resulting in production of aberrant reticulate bodies and enhancement of production of prostaglandin E2 (PGE2). Chlamydia trachomatis (serovar L2) replicate in HMDM while serovar K has been found to be restricted in these cells. Chlamydiae are killed by HPMN but the cell walls persist undegraded, inducing production of oxygen radicals which can be demonstrated to induce DNA strand scissions in HeLa target cells. Evidence is accumulating that chlamydia specific serum IgA antibodies may serve as a noninvasive serological marker for diagnosis of a number of acute and persistent Chlamydia trachomatis infections.

Inhibition of Rickettsia conorii growth by recombinant tumor necrosis factor alpha: enhancement of inhibition by gamma interferon

Purified human recombinant tumor necrosis factor alpha (rTNF-alpha) inhibited the growth of Rickettsia conorii (Casablanca strain) in HEp-2 cell culture. The effect was observed when the cells were pretreated with rTNF-alpha or when rTNF-alpha was added after adsorption of the rickettsiae. The inhibitory effect of rTNF-alpha on rickettsial growth was enhanced by gamma interferon. Cycloheximide had no effect on inhibition of the rickettsial yield, suggesting that de novo protein synthesis is not required for the inhibitory effect of rTNF-alpha. The addition of tryptophan partially abolished the inhibitory effect of rTNF-alpha and rTNF-alpha plus gamma interferon.

Tumor necrosis factor alpha and prostaglandin E2 production by human monocyte-derived macrophages infected with spotted fever group rickettsiae

Infection of macrophages by intracellular parasites might modulate production of tumor necrosis factor (TNF) and prostaglandin E2 (PGE2), which, in turn, might have a profound effect on the outcome of the infection in vivo. In this study we examined in an in vitro system, the rickettsial yield in human monocyte-derived macrophages (MdM) and the PGE2 and TNF production by MdM infected with Rickettsia conorii RC, Casablanca strain) or Israeli spotted fever (ISF, G-212 strain). TNF and PGE2 were determined in the media of MdM infected with RC or ISF. TNF reached maximum levels 24 h post-infection and then declined, while PGE2 levels increased continuously during the infection up to 96 h post-infection. Addition of dexamethasone inhibited both TNF and PGE2 production and enhanced rickettsial yield in MdM. Inhibition of PGE2 production by indomethacin resulted in increased production of TNF from rickettsial-infected MdM, while addition of PGE2 caused partial inhibition of TNF production from infected MdM.

Inhibition of Chlamydia trachomatis replication in HEp-2 cells by human monocyte-derived macrophages

Monocytes (M) and macrophages are important components of the immune response to foreign agents. Using an in vitro system, we studied the influence of human M and M-derived macrophages (MdM) on the replication of Chlamydia trachomatis (L2/434) in HEp-2 cells. M or MdM were added to infected cells at a ratio of 4:1, and the resultant chlamydial yield was evaluated in one-step growth experiments. Chlamydial DNA production was evaluated by dot hybridization. Both M and MdM reduced chlamydial yield and DNA production, but the reductions caused by MdM were more pronounced. Electron microscopy showed that while control HEp-2 cells at 48 h postinfection contained large inclusions in which most particles were elementary bodies, the infected HEp-2 cells exposed to MdM contained small vacuoles with abnormal reticulate bodies and very few typical elementary bodies. Separation of the MdM from the HEp-2 cells by a membrane reduced the inhibitory effect of the MdM relative to that of MdM in direct contact with the infected cells. Addition of tumor necrosis factor antibodies to C. trachomatis-infected HEp-2 cells exposed to MdM (either in direct contact or separated by a membrane from the infected cells) reduced the inhibition of chlamydial DNA production. These data suggest the possibility that MdM may modulate C. trachomatis replication in vivo.

Inhibition of CMV replication in human fibroblasts by human monocyte-derived macrophages: implication for CMV persistent infection

The effect of monocytes (M) and monocyte-derived macrophages (MdM) on cytomegalovirus (CMV) replication in human fibroblasts (HF) was studied by one step growth experiments, plaque formation and dot hybridization with a labeled CMV DNA probe. HF were infected with CMV at multiplicities of infection (mol) of 0.001 to 1. After virus adsorption, M or MdM were added at an effector target ratio of 2:1. MdM reduced both infectious viral yield and the quantity of viral DNA and inhibited viral plaque formation. M, however, affected these parameters to a lesser extent. Electron microscopic studies showed that MdM treated CMF-infected HF, 4 days pi, contained only a few capsids in their nuclei and many vacuoles in their cytoplasm as compared to CMV infected HF (control). A reduction of CMV DNA inhibition was observed upon incubation of the infected HF cells with MdM separated from the infected cells by a membrane. Addition of tumor necrosis factor (TNF) antibody to CMV-infected HF incubated with MdM either in direct contact or separated by a membrane from the infected cells reduced the inhibition of CMV-DNA production. The results of this study suggest that MdM may modulate CMV replication in vivo and may also have a role in CMV persistence or chronic infection.

Primary lymphoma of the head of the pancreas

Primary and isolated lymphoma of the head of pancreas with secondary involvement of the lungs and obstructive jaundice, in a 31-year-old postpartum woman, is described. The histological diagnosis was diffuse histiocytic lymphoma. Chemotherapeutic treatment resulted in complete remission of the tumor. During therapy a pseudocyst of the pancreas developed and a gastrocystostomy was performed. This is the second reported case of primary pancreatic lymphoma in the English medical literature.

Malignant tumor masquerading as eosinophilic gastroenteritis

A 49-year-old patient presented with urticaria, vomiting, diarrhea and peripheral eosinophilia. A histological diagnosis of eosinophilic gastroenteritis was made. Within 3 weeks of admission a highly papillary adenocarcinoma of the right ovary was diagnosed. The gastrointestinal symptoms and the eosinophilia disappeared after partial resection of the tumor and chemotherapy. A possible relationship between cancer, eosinophilia and eosinophilic gastroenteritis is discussed.

Fate of Chlamydia trachomatis in human monocytes and monocyte-derived macrophages

The fate of Chlamydia trachomatis (L2/434/Bu) in human peripheral blood monocytes and human monocyte-derived macrophages was studied by transmission electron microscopy (TEM) and by measuring the yield of infectious C. trachomatis in one-step growth experiments. Two main types of phagosome were seen by TEM in the cytoplasm of C. trachomatis-infected human monocytes (1 h postinfection [p.i.]): one in which the elementary body (EB) was tightly surrounded by the membrane of the phagosome and another in which the EB appeared in an enlarged phagosome. Later, 24 to 48 h p.i., each phagosome contained a single EB-like particle, an atypical reticulate body, or a damaged particle. One-step growth experiments showed that infection of human monocytes with C. trachomatis results in a decrease of infectious particles between 24 and 96 h p.i., whereas infection of the monocytes by C. psittaci (6BC strain) results in productive infection with, however, a 3.5-log lower yield than in control MA-104 cells. In contrast to the abortive replication of C. trachomatis in monocytes, monocyte-derived macrophages permitted replication as indicated by one-step growth experiments and TEM. in C. trachomatis-infected, monocyte-derived macrophages 72 h p.i., inclusions of two kinds were observed by TEM. One was very similar to the typical inclusions appearing in infected MA-104 (control) cells; the other was atypical, pleomorphic, often contained "channels," and held relatively few EB and reticulate bodies, some of which appeared damaged or abnormal. The significance of the responses to infection with C. trachomatis in monocytes compared with monocyte-derived macrophages and the role of these cells in sustaining chronic or latent infection and in dissemination of the infection to various parts of the body is discussed.

Lead poisoning from ceramics in the Arab population

Despite the widespread use of hand-crafted lead-glazed pottery by the Arab population, no cases of lead intoxication have previously been attributed to these ceramics. Three Arab families were found that used to eat from such earthenware utensils and were afflicted with plumbism. Plumbism was diagnosed by the determination of blood and urine lead levels and in two of the families by the decrease of red cell delta-aminolevulinic acid dehydratase activity. The propositus of the first family was the 23-year-old mother who had abdominal pains and hematuria. Lead intoxication was established and therapy with calcium EDTA institutes. She recovered. Her one-year-old daughter died in another hospital during a similar episode. Family studies revealed subclinical plumbism in her remaining three sons. In another family, a 54-year-old-man had abdominal pains and had a lead line on the gingival margins. Subsequent testing of the surfaces of the earthenware containers from which these families used to eat disclosed excessive amounts of lead. In the third family, eight members had plumbism, four of them with encephalopathy associated with motor palsy. One case was icteric. They also used to eat from primitive pottery with a lead glaze.

Papilledema in endemic typhus

A 21-year-old women developed severe bilateral papilledema during an acute febrile disease. Her optic disk margins were blurred and the disks were elevated up to 5 diopters. Splinter hemorrhages, cotton-wool exudates, cytoid bodies, and sheathing of veins were also present. The pyrexia was caused by murine typhus diagnosed by serologic tests. These tests revealed that Proteus OX-19 agglutination titer rose to 1:12800, and a positive complement fixation test titer was 1:640 with Rickettsia mooseri antigens. Neurological examination results, skull roentgenograms, brain scan, electroencephalogram, and the cerebrospinal fluid were all within normal range, thereby excluding intracranial hypertension. After the patient's recovery from the rickettsial disease, the papilledema abated gradually until her fundi reverted to normal.

Camptodactyly: occurrence in two new genetic syndromes and its relationship to other syndromes

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