Waldenstróm's macroglobulinemia with peripheral neuropathy--the role of IgM M-protein in autoimmune mechanism

A total of 11 cases of Waldenstróm's Macroglobulinemia (WM) have been investigated to study the association of the disease with neuropathy. A 53-year-old female patient (Wu) had a pronounced peripheral neuropathy, in which the role of IgM M-protein could be observed. Sections of Wu's biopsied sural nerve were subjected to light and electron microscopy and direct immunofluorescence (IF). Myelin degeneration with axonal change was found, while fluorescence reaction occurred in epineurium only. Sections of a healthy dog's sciatic nerve were submitted to purified IgM M-proteins from Wu and another WM patient (Kon) without neuropathy, respectively. Indirect IF showed a deposit of fluorescence on the myelin sheath by Wu's, but not by Kon's, M-proteins. It is proposed that an autoimmune mechanism underlies the peripheral neuropathy in the WM patient.

Importance of exfoliatin toxin A production by Staphylococcus aureus strains isolated from clustered epidemics of neonatal pustulosis

Clustered epidemics of pustulosis due to Staphylococcus aureus occurred in two geographically distant newborn nurseries. In nurseries A and B an attack rate of pustulosis of 0.8 and 2.0 cases per 100 live births occurred, respectively. Experimental phage type 1046/1116 belonging to phage group II dominated clustered epidemics in nursery A, while group II phage type 3A/3C/55/71 and 3A/3C/55 occurred in nursery B. Other group II strains also occasionally produced clustered epidemics. These epidemic strains were found to be making heat-stable dermal exfoliatin toxin A (ETA) which had a pI of 6.8 and a molecular weight of 32,000 and 33,000. ETA-bearing strains did not make bacteriocin. Children infected with ETA-producing strains developed extensive bullous pustulosis. Surveillance cultures of personnel revealed an ETA-bearing strain in only one person. This strain was not the same phage type as the epidemic cluster. In contrast, ETA-bearing epidemic strains were found in the inanimate environment of both nurseries. ETA protein acts as an important virulence factor in the production of neonatal pustulosis infection and appears to be linked with the ability of S. aureus organisms to stick to the inanimate environment.

[Immunodiagnosis of human clonorchiasis by a micro-enzyme-linked immunosorbent assay]

A micro-enzyme-linked immunosorbent assay (ELISA) utilizing antigen from lyophilized Clonorchis sinensis adult worms extracted with triethanolamine buffered saline (TBS), veronal buffered saline (VBS) or phosphate buffered saline (PBS) were used to test 66, 31 and 9 sera from clonorchiasis patients, uninfected normal humen and patients with other parasitic infections, respectively. Four different combinations of incubation time between serum with antigen and serum with conjugate at either 37 degrees C or room temperature were tried. The combination of 6 hours and 16 hours reaction time processed at room temperature with shaking was chosen in this study because it revealed no pseudo-negative and cross reactions with high sensitivity, specificity and predictive value. There were no statistic difference among mean optical densities in micro-ELISA reactions of 66 sera (in 800 X dilution) from clonorchiasis patients with TBS, VBS or PBS antigen, respectively, but results obtained from TBS antigen seemed better than other two antigens. Good correlation was observed between the antibody titer or ELISA readings of sera form clonorchiasis patients and their worm burden expressed as eggs per gram of feces (EPG).

Two coagulase-variant forms of Staphylococcus aureus isolated from blood cultures

Two coagulase-variant forms of Staphylococcus aureus were isolated from blood cultures of a patient with infective endocarditis. The coagulase-positive isolate was hemolytic, whereas the coagulase-negative isolate was nonhemolytic. All other properties examined were identical in both strains. Since coagulase-negative S. aureus strains have been isolated from clinical specimens, laboratories should consider using a combination of other biological properties along with coagulase production for the identification of S. aureus.

Humoral reactions in human endocarditis due to Streptococcus bovis: evidence for a common S bovis antigen

Humoral reactions to native culture filtrates of Streptococcus bovis were studied in patients with endocarditis by means of two-dimensional crossed immunoelectrophoresis. Serum from patients with S bovis endocarditis produced eight different precipitin arcs. Lex antigen cross-reacted with sera from patients with viridans streptococcal endocarditis, and TA antigen cross-reacted with ribitol teichoic acid-positive sera from patients with Staphylococcus aureus bacteremia. One antigen, common (c), was immunoreactive with all 10 sera from S bovis-infected patients. Antibody to this antigen was not found in sera from 77 patients with gram-positive bacteremia or in 29 other control sera. Common (c) antigen was found in all strains of S bovis isolated from patients. Rabbits immunized with formalinized S bovis cells of human origin also produced antibody to common (c) antigen. Common (c) may be an important antigen of S bovis and may in fact define this organism serologically.

Modification of an experimental mouse Candida infection by human dialyzable leukocyte extract

Human dialyzable leukocyte extract (10(7) - 10(8) leukocyte equivalents, containing transfer factor) was administered intraperitoneally to CFW mice the day of and 2 days after intravenous infection with Candida albicans. Tissue Candida populations were determined immediately after and 2, 4, 7 and 14 days after infection. Kidney populations were significantly reduced on 27% of the days studied. Similar reduction in C. albicans census was obtained after injection of leukocyte extracts from donors skin test-positive to Candida antigens or donors negative to Candida antigens by skin test and migration inhibition analyses. There was no evidence of a dose-response relationship for leukocyte extract in the range 10(5) - 10(9) leukocyte equivalents. When mice were primed with C. albicans antigen 4 weeks prior to challenge the efficacy of leukocyte extracts was not augmented. There was no evidence that the infection-reducing effects were related to augmented polymorphonuclear leukocyte mobilization, increased mononuclear clearance of C. albicans, or to a direct toxic effect on C. albicans blastospores. These studies suggest that the reduction in Candida populations was non-specific and give further impetus to the use of the dialyzable leukocyte extracts as non-specific supplements to antibiotics in overwhelming or recalcitrant infections in man.

Epidemiologic studies of eosinophilic meningitis in southern Taiwan

A study of the epidemiologic characteristics of 125 cases of eosinophilic meningitis or meningoencephalitis, probably caused by Angiostrongylus cantonensis, which occurred in southern Taiwan in 1968 and 1969 revealed a close association of the disease with the rainy season. In contrast to findings in other geographic areas, most such cases in this study occurred among children. A higher attack rate was observed among aborigines than among descendants of mainland Chinese. Most patients had eaten the giant African snail, Achatina fulica, prior to their illness and this mollusc was commonly found infected with third-stage larvae of A. cantonensis. However, in almost all instances the snail was eaten after it had been thoroughly cooked and examination of cooked snail meat revealed only dead larvae. It is suspected that patients became infected by inadvertently ingesting A. cantonensis larvae liberated when the snails were prepared for consumption.

Distribution of Necator americanus and Ancylostoma duodenale in Liberia

In the first country-wide survey of hookworm infection in Liberia, diagnosis by test-tube filter-paper cultivation revealed a prevalence of more than 90%. This sensitive technique also permitted differential species determination. Necator americanus was found to occur in all regions and in a high proportion of the persons examined. Ancylostoma duodenale was mainly confined to a narrow coastal belt, and usually parasitized individuals harbouring N. americanus as well. The average number of eggs per gram of faeces (EPG) of infected individuals was lowest in the population of the hinterland. During the latter part of the studies a modified test-tube filter-paper cultivation technique was used in combination with dilution counting to obtain data on intensity of infection separately for the 2 species. For N. americanus there was little regional difference in the intensity of infection, but the EPG for A. duodenale was much higher in people living in the coastal area.

Inhibition of protease production of various bacteria by ammonium salts: its effect on toxin production and virulence

Production of protease by many bacteria was found to be inhibited by ammonium salts, and the enzyme production was more sensitive to the salts than was growth of the organisms. Inhibition of protease production by some pathogenic bacteria may result in the recognition of an exotoxin which otherwise would have been digested by the protease. In the case of Pseudomonas aeruginosa, qualitatively different toxicities could be demonstrated in the culture fluids, depending on the presence or absence of protease in such a fluid. The toxicity of the culture in the presence of a high titer of protease may be due primarily to the protease, whereas the toxicity exhibited in the absence of protease could be due to proteinacious exotoxin. Producers of high titers of protease tended to be less virulent in vivo than producers of low titers of the enzyme, which exert their toxicities by a separate exotoxin.

Fatal primary Epstein-Barr virus infection masquerading as histiocytic medullary reticulosis in young children in Taiwan

We reported 3 fatal cases of primary Epstein-Barr virus (EBV) infection resembling histiocytic medullary reticulosis (HMR) in young children in Taiwan, where an HMR-like illness has been previously found to be prevalent. The disease ran a fulminant course, manifesting as fever, anemia, jaundice, skin rash, pulmonary infiltration, and/or hepatosplenomegaly lasting for only 1-3 weeks. Laboratory tests revealed no hemolytic anemia and Coombs test was negative. Sepsis or HMR was the main clinical differential. At autopsy, the spleen, liver, lymph node, lung, and bone marrow showed infiltration of atypical "histiocytes" or blasts, lymphocytes, and mature histiocytes with hemophagocytosis. Immunophenotype and gene rearrangement studies of the lymphoid tissues revealed that these atypical "histiocytes" were actually polyclonal B immunoblasts in one case and transformed T lymphocytes in the remaining 2 cases, representing two different types of virus-host interaction. Southern blot and in situ hybridization studies on frozen lymphoid tissues demonstrated the presence of EBV DNA in all 3 patients; the study for cytomegalovirus was negative. The young age of these patients, closely correlated with the prevalent age of primary EBV infection in the general populations in Taiwan, strongly suggest that these childhood cases of previously diagnosed HMR-like disease may actually represent a lethal form of primary EBV infection or fatal infectious mononucleosis.