Anaesthesia mumps: much to do about nothing

Anaesthesia mumps is an uncommon postoperative complication resulting in unilateral or bilateral swelling of the parotid glands following surgical and endoscopic procedures. Our case illustrates the benign course of anaesthesia mumps in a postoperative vaginal hysterectomy patient with no underlying illness and also discusses previous cases in the literature and management strategies.

The pathogenesis of iodide mumps: A case report

RELATION

Iodide mumps is an uncommon condition, induced by iodide-containing contrast, and is characterized by a rapid, painless enlargement of the bilateral or unilateral salivary gland. At present, the pathogenesis of iodide mumps is not yet clear. It may be related to an idiosyncratic reaction, a toxic accumulation of iodine in the gland duct, or renal function damage leading to an iodine excretion disorder. This paper reports the clinical manifestations and magnetic resonance imaging results of one case of iodide mumps, which occurred after digital subtraction angiography.

PATIENT CONCERNS

A 66-year-old Chinese man presented to our department with a 1-month speech barrier and 1 day of vomiting. He had the history of high blood sugar, the history of high blood pressure and the history of Vitiligo. He had no history of allergies and had never previously received iodide-containing contrast. His renal function and other laboratory examinations were normal. During the digital subtraction angiography (DSA), the patient received approximately 130 mL of nonionic contrast agent (iodixanol). Five hours postsurgery, the patient experienced bilateral parotid enlargement with no other discomfort, such as pain, fever, skin redness, itching, hives, nausea, vomiting, or respiratory abnormalities.

DIAGNOSES

We thought the diagnosis was iodide mumps.

INTERVENTION

Intravenous dexamethasone (5 mg) was administered.

OUTCOME

20 hours post-DSA, after which the bilateral parotid shrunk. By 4 days postsurgery, the patient's bilateral parotid had recovered completely.

LESSONS

We found no obvious abnormal sequence signal in diffusion magnetic resonance imaging or the corresponding apparent diffusion coefficient. Our findings suggest that vasogenic edema may play an important role in the pathogenesis of iodide mumps.

Molecular biology, pathogenesis and pathology of mumps virus

Mumps is caused by the mumps virus (MuV), a member of the Paramyxoviridae family of enveloped, non-segmented, negative-sense RNA viruses. Mumps is characterized by painful inflammatory symptoms, such as parotitis and orchitis. The virus is highly neurotropic, with laboratory evidence of central nervous system (CNS) infection in approximately half of cases. Symptomatic CNS infection occurs less frequently; nonetheless, prior to the introduction of routine vaccination, MuV was a leading cause of aseptic meningitis and viral encephalitis in many developed countries. Despite being one of the oldest recognized diseases, with a worldwide distribution, surprisingly little attention has been given to its study. Cases of aseptic meningitis associated with some vaccine strains and a global resurgence of cases, including in highly vaccinated populations, has renewed interest in the virus, particularly in its pathogenesis and the need for development of clinically relevant models of disease. In this review we summarize the current state of knowledge on the virus, its pathogenesis and its clinical and pathological outcomes.

Mumps: burden of disease in France

This article provides a review of the epidemiological data on mumps in France since 1986. The results of 26 years of monitoring in general practice by the Sentinel network are analysed, such as hospitalisation data between 2004 and 2010, as well as mortality data between 2000 and 2009. The annual incidence rate has plummeted between 1986 and 2011, from 859 cases per 100,000 inhabitants [95% CI: 798-920] to 9 cases per 100,000 inhabitants [95% CI: 4-14]. A change in the age distribution is significant with an increase of Relative Illness Ratio (RIR) for patients over 20 years. Since 2000, vaccine status has also changed, and the majority of recent mumps cases occur among previously vaccinated patients. The average annual hospitalisation rate is 3.2 per 1 million inhabitants. Mumps was identified as the initial cause of death in 1 case every 5 years. This study estimates the burden of mumps disease in France.

[Mumps--infectious disease with various faces]

Mumps is a world-wide distributed human infectious disease. The causative agent is mumpsvirus, a single-stranded RNA virus belonging to the Paramyxoviridae. Mumpsvirus causes a variety of illnesses, which depend in part on humans' age and sex. Parotitis and meningitis as well as respiratory tract infection in children and orchitis in pubertal and postpubertal males are very common. Asymptomatic infections have also been frequently described. The treatment for mumps infection is symptomatic, there is no specific antiviral therapy. Immune prophylaxis with an attenuated life vaccine is the most important strategy of mumps prevention. During the last years, an increased number of mumps cases have been observed in several countries with a general recommendation for mumps vaccination. Young adults have been most frequently affected. The lack of immunity in this population is likely to be responsible for the increasing number of mumps cases.

Increase in Adhesion Molecules in Cerebrospinal Fluid of Children with Mumps and Mumps Meningitis

Adhesion molecules play a key role in leucocyte migration into the central nervous system (CNS). Concentrations of endothelial-derived soluble intercellular adhesion molecule-1 (sICAM-1) and leucocyte-originated soluble L-selectin (sL-selectin) in cerebrospinal fluid (CSF) of children with mumps meningitis (mononuclear pleocytosis, n = 33) and mumps (absence of pleocytosis, n = 9) were compared with values from age-matched control group (n = 19). In 14 patients from the meningitis group, adhesion molecule levels together with albumin concentration were estimated in paired CSF/serum samples to calculate concentration quotients and determine molecule intrathecal release. Both sICAM-1 (median 3.44 versus 0.86 ng/ml; P < 0.0001) and sL-selectin (median 29.91 versus 8.52 ng/ml; P < 0.0001) concentrations in CSF were increased in mumps meningitis patients compared with controls. Increased levels of the selected adhesion molecules were also observed in mumps patients without CNS involvement when compared with controls (median sICAM-1: 1.14 versus 0.86 ng/ml, sL-selectin: 13.54 versus 8.52 ng/ml; P < 0.01). Additionally, the concentration of adhesion molecules was found to correlate with CSF leucocyte count. Considerable correlation of sICAM-1 and sL-selectin quotients and corresponding albumin quotients suggests that a majority of the soluble adhesion molecules originated from the bloodstream. Analysis of adhesion molecule levels demonstrated indirect evidence of brain-derived fractions. Our results suggest the involvement of adhesion molecules during the early phase of mumps meningitis.

[Diagnostic image (248). A girl with swollen cheeks]

Mumps was diagnosed in an 11-year-old girl with bilaterally swollen cheeks. She had received mumps-measles-rubella vaccine as an infant.

Changes in mumps virus gene sequence associated with variability in neurovirulent phenotype

Mumps virus is highly neurotropic and, prior to widespread vaccination programs, was the major cause of viral meningitis in the United States. Nonetheless, the genetic basis of mumps virus neurotropism and neurovirulence was until recently not understood, largely due to the lack of an animal model. Here, nonneurovirulent (Jeryl Lynn vaccine) and highly neurovirulent (88-1961 wild type) mumps virus strains were passaged in human neural cells or in chicken fibroblast cells with the goal of neuroadapting or neuroattenuating the viruses, respectively. When tested in our rat neurovirulence assay against the respective parental strains, a Jeryl Lynn virus variant with an enhanced propensity for replication (neurotropism) and damage (neurovirulence) in the brain and an 88-1961 wild-type virus variant with decreased neurotropic and neurovirulent properties were recovered. To determine the molecular basis for the observed differences in neurovirulence and neuroattenuation, the complete genomes of the parental strains and their variants were fully sequenced. A comparison at the nucleotide level associated three amino acid changes with enhanced neurovirulence of the neuroadapted vaccine strain: one each in the nucleoprotein, matrix protein, and polymerase and three amino acid changes with reduced neurovirulence of the neuroattenuated wild-type strain: one each in the fusion protein, hemagglutinin-neuraminidase protein, and polymerase. The potential role of these amino acid changes in neurotropism, neurovirulence, and neuroattenuation is discussed.

Suppression of thermotolerance in mumps virus-infected cells is caused by lack of HSP27 induction contributed by STAT-1

Viral infection modulates the regulation of apoptosis in host cells. Here, we report a novel mechanism by which human cells infected with mumps virus become susceptible to apoptosis caused by extracellular stresses. Mumps virus stimulates proteasome-dependent degradation of STAT-1 by action of viral accessory protein V, resulting in a severe decrease in STAT-1 protein in infected cells. We exposed mumps virus-infected and uninfected cells to heat and chemical stress. The infected cells failed to acquire resistance to apoptotic stimuli (thermotolerance) after exposure to these mild stresses. The induction of HSP27 by stress exposure was dramatically suppressed in the infected cells, but HSP70 induction was not affected. STAT-1 was required for transcriptional activation of the HSP27 gene, but not for the HSP70 gene, and cDNA transfection of STAT-1 in mumps virus-infected cells restored thermotolerance. Phosphorylated heat shock factor-1 (HSF-1) and STAT-1 phosphorylated on neither tyrosine nor serine residues were co-transported to the nucleus in response to stress. Furthermore, overexpression of unphosphorylatable mutants of STAT-1 also restored thermotolerance in mumps virus-infected cells. These lines of evidence indicate that the induction of HSP27 by stress requires STAT-1 in addition to the activated HSF-1. Furthermore, STAT-1 required for the induction of HSP27 worked independent to its phosphorylation. Thus, HSP27-dependent thermotolerance is suppressed by mumps virus infection through the destruction of STAT-1. The lack of thermotolerance should allow the infected cells to be eliminated by apoptosis and might be a host defense against viral infection.

Experimental inoculation of the adult rat testis with Sendai virus: effect on testicular morphology and leukocyte population

BACKGROUND

Surprisingly little is known about the interactions between viruses and the male uro-genital tract. These are important, as viral testicular orchitis, induced by mumps or human immunodeficiency virus (HIV) infection for example, can lead to sterility. Moreover, semen is an essential vector in the propagation of sexually transmissible viral diseases. Here, we studied the effects of testicular infection with Sendai virus, a virus related to mumps virus, on the cellular distribution of viral particles and on testicular morphology, with particular attention to the testicular leukocyte population.

METHODS

At 5, 9, 11 or 24 h post-injection of Sendai virus through the scrotum, the testes were fixed for morphological and immunohistological studies. Localization of virus particles and numeration of leukocytes were performed using specific antibodies and morphological criteria.

RESULTS

As early as 5 h post-injection, a rapid and massive infiltration of leukocytes was observed in the interstitial tissue. The peritubular cell layer and the most external part of the basal portion of the seminiferous tubules were altered. The virus was diffusely located within the interstitial tissue 9 h following the injection whereas, after 24 h, viral proteins were restricted to the cytoplasm of infiltrated leukocytes. The number of leukocytes increased with time post-injection. Thus, 24 h post-injection, CD3+ T-cell number was 3-fold higher, ED1+ monocyte number was 4-fold higher and polynuclear cell number was 600-fold higher than in the control testes (P<0.001 all observations). In contrast, the population of resident macrophages was unaffected by Sendai virus.

CONCLUSIONS

Testicular viral infection causes inflammation including rapid recruitment of leukocytes. The experiments presented here provide a model for further studies on the etiopathology of viral orchitis, in particular that caused by mumps virus.

[Functional changes and structural features of the testis in patients after acute parotid orchitis]

Structural changes and functional features of the testes were studied in 20 patients who had had parotid orchitis (PO) 6 months to 1.5 years before the study. The examination including ultrasonography of the testes, investigation of ejaculate, radioimmunoassay for serum testosterone, FSH, LH brought out a significant reduction of the mean volume and echogenicity of the affected testicles by 44.7 and 50%, respectively, in 15 patients; a 58.2% decrease in the number of spermatozoa in ml; a 71.2% rise in FSH level in 6 patients. Morphometry of biopsy specimen of the testicles on the affected side has shown that mean sectional area of the tubules has diminished by 40%, the spermatogenesis index--by 77.1% while the volume of the intertubular connective tissue increased by 47.7%. Thus, after acute PO, the patients develop atrophic changes in the testes and a decline in spermatogenic function up to secretory infertility.

Pathogenicity of mumps virus in the marmoset

The neurovirulence of two mumps virus strains was compared using marmosets. Marmosets were inoculated intravenously with the wild-type mumps virus Odate strain, resulting in evident meningitis in 1 of 3 marmosets at each of the weeks 3, 4, and 5 postinoculation, representing a total of 3 out of 9 marmosets. Nephritis, parotitis, pancreatitis, and tonsillitis were manifest in addition to central nervous system (CNS) sequelae. On the other hand, the Jeryl Lynn vaccine strain did not induce histopathological changes in the CNS and multiplication of the Jeryl Lynn strain was distinctly lower compared to that of the Odate strain in the marmoset. This is the first report to describe the induction of meningitis in non-human primates after peripheral inoculation of a wild-type mumps virus, presenting findings useful for the elucidation of the mechanism of infection and pathology of mumps virus in the CNS. The distinction observed between the Odate and Jeryl Lynn strains suggests the applicability of the marmoset model for the evaluation of any neurovirulence potential of vaccine strains.

[Four levels (types) of immune reponse in children with viral parotitis infections]

Four levels (types) of immune response, differing by expression of cytokines (TNF-alpha, IL-1 beta, IL-4, and gamma-IFN) and immunoglobulins IgG2, IgG3, IgG4, and IgE) and by expression and time course of specific cell-mediated and humoral immune response, were detected in children with different clinical forms of mumps. Types 1 and 3 immune response are predominantly cell-mediated, while types 2 and 4 predominantly humoral during the acute phase of the disease. The cytokine and antigen-specific profiles of each type of immune response correlate with the severity of clinical course of mumps.

No evidence of persistent mumps virus infection in inflammatory bowel disease

BACKGROUND AND AIM

There is controversy regarding whether paramyxovirus infection is causally associated with inflammatory bowel disease (IBD). The latest cohort study claimed that atypical measles and mumps infections in childhood may be risk factors for later IBD. This study was conducted to clarify the validity of a causal link between persistent mumps virus infection and IBD.

SUBJECTS AND METHODS

(1) Amplification of the mumps virus genome was performed in both intestinal specimens (ulcerative colitis 15, Crohn's disease 15, control 10) and peripheral blood lymphocytes (PBL) (ulcerative colitis seven, Crohn's disease six, control three) by reverse transcription-polymerase chain reaction (RT-PCR) followed by Southern hybridisation using primers specific to the viral genome encoding phosphoprotein or haemagglutinin-neuraminidase. (2) Titre of serum antimumps IgG was measured in 16 patients with ulcerative colitis, in 16 patients with Crohn's disease, and in 16 normal controls using an enzyme linked immunosorbent assay.

RESULTS

(1) The mumps virus genome was not detected by RT-PCR in intestinal specimens or PBL in any case. (2) Antimumps IgG titre was positive in 7/16 ulcerative colitis, 10/16 Crohn's disease, and 11/16 control specimens. The mean (SEM) titre of antimumps IgG was 12.281 (7.831) in ulcerative colitis, 7.675 (1.608) in Crohn's disease, and 8.637 (1.969) in controls, with no significant difference between the three groups.

CONCLUSION

We could not find any evidence to support a causal link between persistent mumps virus infection and IBD.

Experimental mumps virus-induced hydrocephalus: viral neurotropism and neuronal maturity

In order to elucidate the relationship between virus neurotropism and neuronal maturity, two experiments were performed. First, mumps virus infectivity was compared among the different developmental stages of hamster brains inoculated with mumps virus by examining the immunohistochemical distribution of mumps virus antigen. Second, brain lesions resulting from mumps virus infection during the period of neuronal migration were histologically and ultrastructurally analyzed. Three groups of Syrian hamsters, Group E12 (fetuses on the 12th day of gestation), and Groups P2 and P30 (2 and 30 days old, respectively), were injected with mumps virus intraplacentally or intracerebrally. In Group P30, mumps virus antigen was observed specifically in ependymal cells and the choroid plexus. In addition to these areas, in Group P2, some neurons in layers II and III of the cerebral cortex also showed virus antigen immunoreactivity. In Group E12, mumps virus antigen accumulated primarily in the neuroepithelial cells within the ventricular zone. Neither specific intranuclear changes related to viral replication nor the formation of complete virions and nucleocapsids was observed. We conclude that mumps virus neurotropism to hamster brains is dependent on the degree of neuronal maturity and that mumps virus can induce an abortive infection and resultant neuronal cell necrosis in the immature developing hamster brain.

The mumps virus neurovirulence safety test in Rhesus monkeys: a comparison of mumps virus strains

Wild type mumps viruses are highly neurotropic and a frequent cause of aseptic meningitis in unvaccinated humans. To test whether attenuated mumps viruses used in the manufacture of mumps vaccines have neurovirulent properties, a monkey neurovirulence safety test (MNVT) is performed. However, results with several mumps virus MNVTs have raised questions as to whether the test can reliably discriminate neurovirulent from nonneurovirulent mumps virus strains. Here, various mumps virus strains representing a wide range of neuropathogenicity were tested in a standardized MNVT. A trend of higher neurovirulence scores was observed in monkeys inoculated with wild type mumps virus versus vaccine strains, although differences were not statistically significant. Results indicated the need for further examination and refinement of the MNVT or for development of alternative MNVTs.

Age-dependent susceptibility in mumps-associated hydrocephalus: neuropathologic features and brain barriers

Central nervous system susceptibility to viral infection is often age dependent for unclear reasons. In this study, we examined the age-dependent susceptibility of the brain in mumps virus-induced hydrocephalus in hamsters, and evaluated the relationship between neuropathologic features and brain barriers using glial fibrillary acidic protein and zonula occludentes 1 (ZO-1) immunohistochemistry. In a group intracerebrally inoculated with mumps virus at 2 days of age, pathologic findings such as periventricular edema, ependymal cell loss, and ventricular dilation were more prominent and the distribution of mumps virus antigen was wider than in a group inoculated at 30 days of age. ZO-1-immunoreactive tight junctions in the hydrocephalic brains of the 2-day group were severely damaged in the choroid plexus and ependyma, and in white matter capillaries as early as 3 days after inoculation. These changes were not apparent in the hydrocephalic brains of the 30-day group. Prominent cortical dissemination of virus in the 2-day group was related to underdeveloped perivascular glial foot processes in brain parenchyma. Periventricular edema in the 2-day group was linked to ependymal and blood-brain barrier tight-junction permeability. Our results suggest that tight junctions in the early postnatal period are more immature and fragile than in the adult. We concluded that brain susceptibility in mumps virus-induced hydrocephalus is intimately related to the maturity of brain barriers.

Fourier transform analysis of human corneal endothelial specular photomicrographs

Fourier analysis of in vivo human corneal endothelial cell structure was investigated using specular photomicrographs for a range of ages from less than one year to over 70. The theoretical basis for this analysis was investigated using mathematical models of cell structures where the elements determining their form could be modified in a controlled and quantified manner. The resulting Fourier transform properties were related to properties of cell structure. The experimental factors underlying this analysis were then studied using digitized images of corneal endothelial cells. It was found that the Fourier transforms provided quantitative descriptions of population cell size and organisation. For the smaller, more regular cell structure from the younger eyes, the expected larger rings of the Fourier transforms were demonstrated. Specular photomicrographs of older eyes gave rise to smaller diameter rings in their Fourier transforms. These results are consistent with the previous studies which used manual tracings of human endothelial cell patterns. This is the first demonstration of the direct Fourier analysis of clinical human corneal specular photomicrographs.

Detection of mumps virus genome directly from clinical samples and a simple method for genetic differentiation of the Hoshino vaccine strain from wild strains of mumps virus

A simple and sensitive method was developed for the differentiation of the Hoshino vaccine strain from wild strains with a restriction fragment length polymorphism (RFLP) analysis in the part of hemagglutinin-neuraminidase (HN) gene. The virus genome was amplified by using a reverse transcriptase-polymerase chain reaction (RT-PCR) directly from clinical samples. The PCR product of the Hoshino vaccine strain was cleaved into 2 fragments after digestion with Sca I and Afl II. All wild strains showed 2 RFLP profiles, A and B, different from that of vaccine strain. Wild A strains were cut into 2 fragments after digestion with Sca I only, while wild B strains were cleaved neither with Sca I nor Afl II. This molecular approach provides an effective method for differentiation of the Hoshino vaccine strain from wild strains of mumps virus in patients after vaccination.

Rapid detection and typing of circulating mumps virus by reverse transcription/polymerase chain reaction

The reverse transcription/polymerase chain reaction (RT-PCR) was used to amplify a 129-bp fragment of the mumps virus F gene from strains circulating in the Siena area from 1993-1995. The nucleic acid was amplified directly from the samples; no growth in cell culture was required. Nucleotide sequence analysis and the comparison with other virus strains enabled the typing of the detected viruses. There appears to be more than one lineage of mumps virus circulating at any given time in the same location. A PCR assay coupled with the sequencing of the 5' end of the F gene seems to be a convenient method for characterizing mumps virus strains. This method, useful in diagnosis, also appears to be suitable for epidemiological studies.

Pathogenesis of cerebellar deformity in experimental Chiari type I malformation caused by mumps virus

We sought to elucidate the pathogenesis of Chiari type I malformation using an experimental model of hydrocephalus produced by inoculating hamsters with mumps virus. Dilatation of the lateral ventricules was detected in all brains inoculated at 2, 10, and 25 days of age. The cerebellum in hamsters inoculated at 2 and 10 days of age showed elongation and flattening of the vermis and protrusion or notching of the uvula. All layers, i.e., the molecular, Purkinje cell, and granular layers, and the white matter were preserved, but had become narrow. Purkinje cells remained normal. Hamsters inoculated at 25 days of age did not develop the cerebellar deformity. Mumps virus antigen was detected in all ependymal cells and in some epithelial cells of the choroid plexus in all hamsters that had been inoculated at 2, 10, or 25 days of age. Results suggest that Chiari type I malformation is caused by two main factors occurring simultaneously, i.e., increasing intracranial pressure and rapid histogenesis of the cerebellar cortex.

Early ependymal changes in experimental hydrocephalus after mumps virus inoculation in hamsters

To elucidate the pathogenesis of early ventricular dilatation in hydrocephalus, we examined early morphological changes in ependymal layers at the lateral ventricles in suckling hamsters without aqueductal stenosis 5 days after the intracerebral inoculation of mumps virus. Mumps virus antigen was detectable in all ependymal cells. The ependymal cilia had almost disappeared and only the microvilli remained. A number of supraependymal cells were also observed on the surface of the lateral ventricles. Transmission electron microscopy revealed intracytoplasmic viral-like inclusions in the infected ependymal cells. These results suggest that functional and morphological disturbances in infected ependymal cells may cause early ventricular dilatation before aqueductal stenosis occurs.

Magnetic resonance imaging in a case of mumps postinfectious encephalitis with asymptomatic optic neuritis

A 5-year-old male patient with asymptomatic optic neuritis and mumps postinfectious encephalitis or acute disseminated encephalomyelitis is reported. Magnetic resonance imaging (MRI) with a short inversion time inversion recovery sequence was valuable in detecting clinically silent lesions of the unilateral right optic nerve in addition to visual evoked potentials. Evidence of concurrent optic neuritis was useful for detecting more extensive neurological involvement, leading to the diagnosis of mumps postinfectious encephalitis. A systematic MRI study should be performed in children with mumps encephalitis, regardless of appreciable clinical deficits.

A calcium-channel antagonist can prevent paramyxovirus-induced neurodegeneration

Mumps virus caused a partially lytic infection in cultivated rat embryonic dorsal root ganglion neurons with a restricted formation of viral components. The neuronal degeneration was markedly enhanced by increasing the calcium concentration of the medium and could be almost totally inhibited by the dihydropyridine calcium channel antagonist nifedipine. The drug had no effect on a productive and completely lytic Sendai virus infection of the neurons. A previous neurophysiological study has shown that a reduced calcium influx occurs during the action potential early during the infection. The present study suggests a crucial role of calcium in neurodegeneration induced by certain viruses.

Mumps mistaken for rubella in the first trimester of pregnancy. The role of the microbiology laboratory in the diagnosis of the infection. A case report

A case of mumps with an exanthema is described. However, the parotid swelling was mistaken for enlarged lymph nodes, and the case was described as one of "typical rubella". As the patient was pregnant in her first trimester, an induced abortion was considered. Serum specimens for rubella antibody testing had been taken, but the information given by the consulting physician was incorrect and led to testing for past infection and immunity. After re-examination of the patient by a gynaecologist, mumps was suspected and the diagnosis verified serologically. The present case shows that in certain situations adequate information must be given to the laboratory in order to ensure a meaningful interpretation of the results of the serological examination.

[Morphologic characteristics of the parotid glands in monkeys in the late period following mumps]

Three monkeys of "Macaca iris" species were examined twice: 3 months and 1 year after having mumps. Morphological data of both parotid glands biopsy are presented. Macrophage lymphocytes and plasmatic cells infiltration around the widened ducts as well as between the acini, growth of fibrosis and lipomatosis, and secretory stasis in glandular cells were observed long time after the disease. These changes are typical of Sjögren disease. This fact allows the authors to consider that virus affection may also be important in the aetiology of parotid glands autoimmune processes.

Isolation of mumps virus from vaginal secretions in association with oophoritis

Mumps virus was isolated from the cervico-vaginal secretions of a 31-year-old woman presenting with mild signs of oophoritis accompanied by xantholeucorrhoea. The serological finding of mumps-specific IgM antibodies was further evidence confirming the casual link between mumps virus and ovarian pathology. Rarely, ovarian involvement may be the only manifestation of mumps infection. The importance of this diagnosis and its relationship to the possible development of secondary oligomenorrhoea and early menopause is discussed.

[Comparative clinico-morphological research on measles and mumps infections in an experiment on guinea pigs]

The pathological process typical of measles and mumps infections was reproduced clinically and morphologically in 250 experimental guinea pigs infected into the anterior eye chamber with different strains of measles and mumps viruses. The intraocular inoculation of measles virus induced in guinea pigs the signs of iridocyclitis and follicular conjunctivitis, whereas inoculation of mumps virus induced dacryoadenitis as well as iridocyclitis and follicular conjunctivitis. The severity of the reproduced process and its dynamics correlated with the pathogenicity of measles and mumps virus strains used in the experiment. The specificity of pathological changes observed in the eye structures was verified virologically by the isolation of virus from the eye membranes and the presence of virus-neutralizing antibodies in the blood sera of the animals.

Experimental mumps virus-induced labyrinthitis. Immunohistochemical and ultrastructural studies

Guinea pigs were inoculated with mumps virus (Torii strain) by the intralabyrinthine or intravascular route and their cochleas were examined by immunofluorescence and electron microscopy. In these animals, viral antigen was detected in the cochleas, most often in the stria vascularis. However, viral infection was produced only in those with intralabyrinthine inoculation. The cochlear lesion commonly observed in this study was severe degeneration of the organ of Corti, which was usually found in the basal turn. Morphological evidence of viral infection, as depicted by intracellular strands of nucleocapsids and budding of the virus at the endolymphatic surface, was prominent in both the stria vascularis and Reissner's membrane. The cochlear location of mumps infection correlated closely with that of the viral antigen formerly reported in newborn hamsters.

Application of the avidin-biotin-complex method for the light microscopic analysis of lymphocyte subsets with monoclonal antibodies on air-dried smears

A study was undertaken of the application of the avidin-biotin-peroxidase complex (ABC) method to the monoclonal antibody MAbs staining of mononuclear cells in hematologic and cytodiagnostic materials. Satisfactory cell morphology and immunoreactivity of surface antigens were observed when the slides were fixed in 80% acetone in phosphate-buffered saline or in 60% acetone in 0.03 M citric acid buffer solution (pH 5.4). Unstained air-dried preparations could be preserved for two weeks at room temperature in a desiccator and for one year at -70 degrees C after fixation. An excellent immunoreaction, even with a weak surface antigen, was observed by inhibition of endogenous peroxidase after the secondary antibody reaction; reactions of weak antigens tended to be obscured when the inhibition was performed before the first antibody reaction. Use of the Giemsa stain as a counterstain made it possible to readily observe the cell morphology; therefore, white blood cell analysis could be performed simultaneously when peripheral blood smears were studied. The positive rate of immunoreaction by an immunofluorescent method was well correlated with that obtained by the ABC method. The ABC method proved to be an excellent immunocytochemical technique for detecting cell surface antigens with high sensitivity and specificity; furthermore, it is useful for cell morphology studies and yields permanent preparations.

Experimental mumps labyrinthitis in monkeys (Macaca irus)--immunohistochemical and ultrastructural studies

Three monkeys (Macaca irus) were inoculated with mumps virus into unilateral cochleas and their inner ear were examined by immunofluorescent microscopy and transmission electronmicroscopy. The temporal bones were removed after survival period of 14 days when serological tests disclosed elevation of anti-mumps antibody titers. Immunofluorescent microscopy revealed that the viral antigen was positive in the stria vascularis. The ultrastructural study revealed that the pathologic changes in the cochleas were marked in the organ of Corti and stria vascularis. The outer hair cells were more susceptible to the infection than the inner hair cells. In the stria vascularis, both marginal and intermediate cells were affected. It was possible to find some of marginal cells in the basal turn shedding a large number of mature virions into the endolymph. These pathologic changes observed in the cochleas of the monkeys were similar to those previously revealed in the guinea pig cochleas and thus were considered as the specific features of acute mumps labyrinthitis.

Inclusion body myositis: a chronic persistent mumps myositis?

Among the generalized chronic idiopathic inflammatory myopathies, inclusion body myositis (IBM) has emerged as a clinico-pathologic variant during the past two decades. It occurs primarily in elderly persons (in approximately the sixth decade of life), but young adults (in approximately the second decade of life) may also be affected. Slowly progressive weakness of distal as well as proximal muscle groups in IBM is usually not associated with skin rash, malignancy or collagen-vascular disease, and is refractory to treatment with steroids or other immunosuppressants. Exceptions to each of these general rules have been found. Muscle biopsy and electromyography may suggest a neurogenic process mixed with myopathic features. Rimmed vacuoles with basophilic granules in cryostat sections stained with hematoxylin-eosin are strongly suggestive of IBM if accompanied by the histopathologic triad of polymyositis. The presence of eosinophilic intranuclear or cytoplasmic inclusions in affected myofibers is further suggestive of IBM. The ultimate diagnosis, however, depends on ultrastructural demonstration of characteristic microtubular filaments resembling the nucleocapsids of the paramyxovirus group. Recent reports of immunostaining of the inclusions for mumps virus antigen strongly suggest a chronic persistent mumps virus infection as the cause of IBM. IBM is considered to be pathologically related to both distal myopathy (DM) and oculopharyngeal muscular dystrophy (OPMD).

Developmental disturbances in the hamster retina caused by a mutant of mumps virus

Newborn hamsters were inoculated intracerebrally with either the neurovirulent Kilham strain of mumps virus or a mutant (M13) strain of this virus. The M13 strain has an alteration in the haemagglutinin-neuraminidase protein of its envelope and causes a low-grade infection of the brain. Both strains spread consistently to the retina where the Kilham strain caused an extensive necrotizing infection. In contrast, the M13 strain predominantly caused an infection of the retinal pigment epithelium (RPE) with the involvement of scattered neurons in the retina. Only minimal degenerative or inflammatory changes were seen, but at 12 days of age developmental alterations were seen in all eyes. These included stretches with failure of photoreceptor segment development and the formation of folds in the outer nuclear layer. The former changes occurred in areas with loss of RPE cells and the latter generally in connection with displaced pigment-loaded cells from the RPE layer. It is suggested that these retinal alterations are mainly secondary to the RPE infection with the M13 strain.

Double infection of the CNS with herpes simplex and mumps viruses. Serological and ultrastructural studies

Clinical, serological and ultrastructural features are described in a case of acute encephalitis. The ultrastructural study of brain biopsy specimens revealed herpes-and paramyxovirus-like particles in neurons and glial cells that were characterized as herpes simplex and mumps viruses by serological study in serum and CSF. Of the few cases previously reported with double encephalitis, this is the only one in which ultrastructural and serological evidence of combined brain infection has been found.

Study of mumps virus invasiveness in monkeys

Invasiveness of mumps virus strains, differing in the degree of attenuation was studied in green and Macaca mulatta monkeys infected either into salivary glands or intramuscularly. Peripheral infection with all strains under study resulted in their penetration into CNS irrespective of the attenuation degree. Specific morphological changes were observed in the brain of monkeys as confirmed by detection of virus antigen using fluorescent antibodies (FA) staining. Morphological changes and time of virus antigen detection in the brain differed depending on the neurovirulence of the strains based on different degree of their attenuation.

Measles- or mumps virus-infected cells forming rosettes with lymphocytes from patients with multiple sclerosis

Peripheral blood lymphocytes (PBLs) from patients with multiple sclerosis (MS) were studied to determine the frequency at which they formed rosettes with target cells persistently infected with measles or mumps virus. Results were compared with (1) the rosette-forming capability of lymphocytes from age- and sex-matched normal control subjects and (2) the rosette-forming capability of lymphocytes with uninfected target cells from patients with MS. Comparison of mean measles antibody titers in patients with MS was significantly higher than in control subjects. A similar comparison for mumps antibodies showed a significant differences. There was no significant difference between patients and control subjects in the frequency of lymphocytes that formed rosettes, no matter which target cell was used. When data obtained using target cells infected with measles were analyzed according to sex or clinical classification, no significant difference was observed. Lymphocytes from patients or control subjects formed significantly more rosettes when reacted with virus-infected rather than uninfected target cells. These data suggest that PBL rosette formation with measles- or mumps-infected cells may represent nonspecific adherence rather than specific adherence.

Experimental encephalitis induced by various strains of mumps virus

Non suppurative periventricular encephalitis and lymphoid infiltration of choroid plexus were induced by intracerebral inoculation of non neuroadapted strains of mumps virus in cercopithecus monkeys. Inflammatory lymphoid infiltration showed an obvious connection with a mild damage of ependymal cells. No signs of neuronal involvement and no inclusions were seen in light microscopy. Proliferation of viral microtubules, though without the typical budding of virions, were visible in ependymal cells in electron microscopy. Subependymal and inflammatory cells which clearly take no part in the virus proliferation were affected by the alteration.

Fatal mumps myocarditis in an 8-month-old child

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Genetic studies in azoospermic patients with the Klinefelter pattern of testicular biopsy

82 male patients presenting functional azoospermia and klinefelter pattern of testicular biopsy were subjected to genetic, histopathologic, anthropometric and clinical studies. With finer methods of analysis, heterogeneity, within a disorder previously thought to represent one entity is usually revealed. Results of the present investigation suggest that sex chromatin counts cannot substitute chromosomal analysis for the discover of mosaiscism. The study also showed a marked phenotypic overlap between the X-chromatin positive Klinefelter disease and the X-chromatin negative Klinefelter syndrome. This overlap occurs both at the clinical level, documented by anthropometry and histopathologic findings in the testicular biopsy, emphasizing the importance of cytogenetic studies. Cases without the chromosomal aberration in whom we suspect environmental etiology may be described a sphenocopies of the genetic disorder.