Less HLA-G expression in Plasmodium falciparum-infected third trimester placentas is associated with more natural killer cells.

During pregnancy, maternal immune tolerance of the fetal semi-allogeneic graft is partly the consequence of extravillous trophoblast HLA-G expression and its interaction with natural killer (NK) cells. Plasmodium falciparum malaria is frequently associated with maternal and fetal complications. Local HLA-G expression and the number of NK cells were evaluated immunohistochemically in P. falciparum-infected and uninfected placentas (15 each) collected in a seasonal malaria-hypoendemic area. In control placentas, HLA-G was almost always expressed in extravillous trophoblast whereas, in infected placentas, it was significantly more weakly expressed in extravillous trophoblast but was also detected in intervillous space macrophages. NK cells were evaluated in intervillous and intravillous spaces and in basal plate. NK cells were always more abundant in basal plate than in intervillous and intravillous spaces in infected or control placentas. For each area, more NK cells were seen in infected than control placentas. These data suggest that HLA-G down-regulation and more NK cells in placentas may be among the mechanisms involved in poor birth outcome associated with P. falciparum infection.

Increased multiplicity of Plasmodium falciparum infections and skewed distribution of individual msp1 and msp2 alleles during pregnancy in Ndiop, a Senegalese village with seasonal, mesoendemic malaria.

Pregnancy is associated with a greater susceptibility to Plasmodium falciparum infections, which may result in serious complications affecting both the mother and the fetus. To compare allelic diversity and multiplicity of infection in the same women during and outside pregnancy, we conducted a retrospective analysis of the monthly fingerprick blood samples collected during a longitudinal survey conducted in Ndiop, a Senegalese village with mesoendemic malaria. Merozoite surface protein-1 (msp1) block 2 and merozoite surface protein-2 (msp2) genotypes were determined for 308 blood samples collected from 20 women. Pregnancy was associated with a significantly higher prevalence of P. falciparum infection, higher parasite densities, and a higher multiplicity of infection. The highest multiplicity of infection was observed in the youngest pregnant women. Because of co-linearity, it was not possible to dissociate the impact of age from that of parity on multiplicity of infection. Some individual msp1 and msp2 alleles showed a highly skewed pregnancy-associated distribution. These results indicate that pregnancy is associated with increased permissiveness to a large number of clones, as well as with infection by specific genotypes.

[Mycobacterium avium infection presenting as a mass in the right lung]. / Mycobacterium-avium-Infektion als Raumforderung der rechten Lunge.

BACKGROUND: The diagnostic procedure of pulmonary masses in patients with AIDS is presented. CASE REPORT: A 39-year-old patient with AIDS was admitted to hospital because of a non-productive cough and radiologic evidence of mediastinal and right hilar masses suggestive of lymphoma associated with pneumonia of the right lower lobe. Bronchoscopy revealed a stenosis of the right lower lobe bronchus with small endobronchial lesions. Biopsies showed granulomatous inflammation, but no microorganisms were detected. Chest pain with dyspnea developed and was relieved by evacuation of pus during mediastinoscopy. The diagnosis of Mycobacterium avium infection was established via culture of sputum and bronchoalveolar lavage fluid and via mediastinoscopy. The patient was commenced on a 3-drug regimen with rifabutin, ethambutol and clarithromycin and has remained asymptomatic now for over 9 months. CONCLUSION: Mycobacterium avium infection needs to be included in the differential diagnosis of patients with AIDS presenting with mediastinal and hilar masses. When procedures such as bronchoscopy and chest CT-scans are non-diagnostic, mediastinoscopy may become necessary in order to establish the diagnosis.

Diagnostic quality in rural health centres in Burkina Faso.

OBJECTIVE: To study the quality of diagnostic practice in rural Burkina Faso. METHOD: In 9 health centres of 3 districts, 313 outpatient consultations were observed, and 417 diagnoses by 15 nurses were analysed. Criteria for evaluation of patient history and clinical examination were based on the diagnostic guidelines distributed by the Ministry of Health. RESULTS: In only 20% of the diagnoses the nurses took a sufficient history and in only 40% they conducted a sufficient clinical examination. In 21% patients underwent no clinical examination at all. Only 12% of all diagnoses were based on sufficient history-taking and adequate clinical examinations. The individual elements of clinical examination were performed correctly in 82% of cases. The variation between nurses was immense, but no correlation could be found with regard to their basic training. However, nurses who had received the diagnostic guidelines examined patients more carefully than those who had not. Larger numbers of patients per day are not associated with shorter nurse-patient contact, and neither is sufficiency of patient history associated with duration of the consultation. CONCLUSION: The low diagnostic quality of the outpatient consultations in the studied area indicates that this issue has been neglected in national public health initiatives. But examination skills are good and diagnostic guidelines may have had a positive effect on the diagnostic quality.