Unusual presentation of progressive systemic sclerosis.

A female 38 years old, housewife, presented to the Department of Dermatology and Venereology, Mymensingh Medical College Hospital (MMCH) on 08.04.07 with the complaints of i) pain and reduced movement of hand, knee, shoulder and neck joints for 1 year and 9 months ii) tightness of skin over face, neck, limbs and trunk for 1 year and 6 months iii) patchy depigmentation over same areas for 1 year and 3 months iv) deformity of hands with flexion contractures for 6 months and v) dysphagia to solid food for 3 months. She had no complaints of Raynaud's phenomenon. On general examination, she was ill looking, anemic and nutritionally poor. Examination of integumentary system showed smooth, shiny, thick, hard and hidebound skin with pigmentary alteration of 'salt and pepper' appearance over fingers, hands, limbs, face, neck and trunk. Hands appear claw like but more on the right side than the left and there were no other obvious changes suggestive of digital ischaemia (atrophy, ulceration, scarring, gangrene etc). Face has got suggestive features of scleroderma. Examination of the respiratory system showed restriction of chest movement and reduced expansibility of chest wall. No other abnormality was found on examination of other systems. Laboratory investigations showed histopathology typical of scleroderma. X-ray of hands and feet showed suggestive changes, lung function test-showed restrictive lung disease. Barium swallow x-ray of esophagus in supine position showed mild dilation of lower oesophagus. But serology was non-reactive (negative ANA, Negative RA test, Negative VDRL). So, she was diagnosed as a case of progressive systemic sclerosis (PSS) with some atypicality.

The infant rat as a model for assessment of the attenuation of human influenza viruses.

The intranasal infection of infant rats with Haemophilus influenzae type b can be considerably enhanced by prior infection of the rats with influenza virus. When influenza virus A/England/939/69 was used to infect the animals a minimum of 10(4-0) EID50 was required to enhance H. influenzae infection; infection with 4 x 10(6) H. influenzae bacteria was needed to reveal this enhancement and infant rats two days old at the time of virus inoculation had to be used. By this method, nine strains of influenza virus were assessed for their ability to enhance H. influenzae infection, and the results were compared with their known virulence for man. The results showed a close correlation in this respect for all of the viruses, except strain A/PR/8/34. The replication of these viruses in infant-rat turbinates and lungs was also studied; virus concentrations in turbinate tissues 48 h after infection showed a close correlation with virulence for man. Thus, three influenza virus strains known to be virulent for man reached concentrations in infant-rat turbinates ranging from 10(4-8) to 10(5-7) EBID50/0-05 ml at 48 h; the concentrations of six viruses known to be attenuated or non-infectious for man grew less well in infant rat turbinates, and reached concentrations at 48 h of 10(1-0) to 10(3-5) EBID50/0-05 ml. The results are discussed in relation to the use of the infant-rat model for assessment of the attenuation of candidate live influenza virus vaccine strains.

Rapid and specific serodiagnosis of western equine encephalitis virus infection in horses.

Paired sera from 28 nonvaccinated horses with serologically confirmed western equine encephalitis (WEE) virus infections were evaluated for immunoglobulin (Ig)M and IgG directed against WEE virus, by use of enzyme immunoassay. Twenty-one of the horses developed greater than or equal to 4-fold increases or decreases in serum IgM titers in paired serum samples, confirming the diagnosis of WEE in these horses. Of the remaining 7 horses, 1 had stable IgM titers, 1 had a 2-fold increase in IgM titer between paired sera, 2 had 2-fold decreases in IgM titer, and for 3 horses adequate volumes were not available for both sera of the pair. Twenty-nine of 56 blood samples collected from these 28 horses had been collected within the first 3 days after clinical disease was recognized; all 28 horses and 48 of 53 available serum samples had IgM antibody to WEE virus. Immunoglobulin M also was detected in sera of 27 of 45 other nonvaccinated horses that had illnesses clinically compatible with WEE. Sera with IgM did not have cross-reacting IgM against eastern equine encephalitis virus. Therefore, the sensitivity, specificity, and lack of persistence of IgM was useful in the rapid diagnosis of WEE virus infections in horses.

Crimean-Congo haemorrhagic fever virus in Iraq: isolation, identification and electron microscopy.

Crimean-Congo haemorrhagic fever (CCHF) virus was isolated for the first time in Iraq from the blood of three patients. It caused a cytopathic effect in lamb kidney and BHK-21 cell cultures. The virus particles were spherical, enveloped and had 90 nm in diameter similar particles were found in ultrathin sections of the liver from two fatal cases. The isolated virus proved to be antigenically closely related to CCHF virus.

Influenza virus infection in newborn rats: a possible marker of attenuation for man.

The growth of parent influenza viruses A/England/939/69 and A/PR/8/34, and clones 6, 7, and 64C, derived by recombination, was studied in newborn rats. Using an inoculum of 10(4.0) EID50, influenza virus A/England/939/69 produced the highest titres of virus in rat turbinates at 48 hours after inoculation; clones 6 and 7 and A/PR/8/34 grew to lower titres; and clone 64C grew to the lowest titre. These differences were less apparent when 10(2.0) EID50 of virus was used as an inoculum, and rats were not infected by smaller inoculum of any of the virus strains. Infection with 10(4.0) EID50 of all viruses produced lung infection; at 48 hours after infection, the highest titres were recovered from rats infected with A/PR/8/34 and A/England/939/69 virus. Prior infection with A/England/939/69 or A/PR/8/34 increased the incidence of bacteraemia and meningitis following intranasal inoculation of Haemophilus influenzae type b; infection with clone 64C did not enhance bacterial meningitis, while infection with clone 6 gave an intermediate result. Volunteer studies with these viruses have shown that influenza virus A/England/939/69 was virulent, clones 6 and 7 were attenuated, clone 64C was over-attenuated, and A/PR/8/34 virus was noninfective for man. The relative titres of virus recovered from turbinates taken 48 hours after infection with 10(4.0) EID50 of virus and the ability of virus infection to enhance bacterial infection correlated with the property of virus attenuation for man for four of the five strains tested; however, no correlation was seen for A/PR/8/34 virus, which is a result also found in other laboratory tests designed to measure virulence for man.

The replication of type A influenza viruses in the infant rat: a marker for virus attenuation.

Twenty recombinant influenza virus strains bearing HSw1N1, H1N1 or H3N2 surface antigens, together with their respective wild-type or laboratory-propagated parent viruses, were inoculated into 2 day-old infant rats and their replication in the turbinates and lungs of these animals observed over a period of 5 days. In addition, the ability of each of the recombinant and parent viruses to enhance a subsequent infection of these infant rats by Haemophilus influenzae type b was determined. The results showed that both parent and recombinant viruses replicated less well in the lungs than in the turbinates of infant rats, but the titres in both tissues were generally lower for the recombinant strains. The capacity of the majority of the recombinant influenza viruses to promote bacterial infection of the infant rats, as determined by the incidence of H. influenzae bacteraemia and meningitis, was also markedly less than that of their parent viruses. A correlation between virulence for man and both the replication in infant rat turbinates and the ability to enhance H. influenzae infection, was established for the virus strains studied. The data are discussed in relationship to the value of the infant r-H influenzae system as a laboratory marker for the determination of the virulence of influenza virus strains.

Influenza virus infection of a newborn rats: virulence of recombinant strains prepared from a cold-adapted, attenuated parent.

Infant rats were infected with one of a series of influenza A viruses. The growth of viruses in the turbinates or lungs, and the ability of virus infection to potentiate a subsequent bacterial infection by Haemophilus influenzae (HIb), were measured. The three virus strains known to be virulent for man grew to relatively high titres of 10(5.2)--10(6.8) EBID50/ml in the turbinates of infant rats at 48 hours post-infection, and virus infection enhanced subsequent systemic infection following intranasal inoculation of rats with HIb. In contrast, influenza virus A/Ann Arobr/6/60--P17 and the three recombinant viruses prepared from this strain, all of which are attenuated for man, replicated to significantly lower titres of 10(2.6)--10(4.1) EBID50/ml in infant rats turbinates, and failed to promote systemic infection by HIb to the samest that the behaviour of influenza viruses in infant rats may be an indication for virus virulence for man, and thus provide a test which could facilitate the development of live, attenuated virus vaccines.

Congo/Crimean haemorrhagic fever in Iraq: a seroepidemiological survey.

A seroepidemiological survey to determine the prevalence of Congo/Crimean haemorrhagic fever virus activity in Iraq was carried out during 1979 and 1980. Sera were collected from 1680 people including contacts of known patients, abattoir workers and animal husbandry workers in various parts of the country. These were tested by complement fixation and agar gel precipitin tests. Among patients' relatives and contacts, 29% had antibodies to Congo/Crimean haemorrhagic fever; 11% of hospital staff, 7% of abattoir workers and 29% of those engaged in animal husbandry had antibodies. Inapparent infections were common in hospital staff caring for patients known to have had the disease. No antibodies were detected in the sera of 151 people who were not believed to have had contact with a known case of the disease.

Relevance of detection of immunoglobulin M antibody response in birds used for arbovirus surveillance.

Young chickens were inoculated with 5,000 PFU of eastern equine encephalitis (EEE) virus and bled at intervals thereafter for determinations of hemagglutination-inhibiting (HI), neutralizing (N), immunoglobulin M (IgM), and IgG antibodies. HI, N, and IgM antibodies were first detected 4 days after infection, and IgG was detected 7 days after infection. All four antibodies persisted through day 90 after infection. HI, N, and IgM antibody titers remained elevated and were not cross-reactive with the related alphavirus western equine encephalitis (WEE) virus. IgG antibody titers also remained high, but heterologous reactivity to WEE virus increased with time after infection. Serum samples from sentinel chickens and wild birds infected in nature with EEE, WEE, or St. Louis encephalitis virus and submitted to this laboratory from state and local health departments were tested for IgM antibody by using anti-chicken IgM for capture and for IgG antibodies to the EEE and WEE viruses. There was essentially complete correlation between HI, N, and either IgM (indicating recent infections) or IgG (indicating more remote infections) antibody. We conclude that the IgM antibody capture enzyme immunoassay can be used as a specific and sensitive assay to replace the routinely used HI test for detecting antibody in sentinel chickens and in young, wild birds used for arbovirus surveillance. The test is rapid and relatively inexpensive and can be performed in essentially all adequately supplied laboratories.

Complex-specific immunoglobulin M antibody patterns in humans infected with alphaviruses.

Sera from humans with serologically confirmed eastern equine encephalitis, western equine encephalitis, Pogosta (Ockelbo), Mayaro, Ross River, and chikungunya virus infections were tested by immunoglobulin M (IgM) antibody capture enzyme immunoassay. Diagnostically useful IgM antibody titers were detected, and selected sera with high IgM antibody titers were tested for IgM antibody with nine heterologous alphaviruses. The results provide evidence for the complex specificity of IgM antibody and indicate the usefulness of this test in both individual cases and epidemic situations.

Congo/Crimean haemorrhagic fever in Iraq.

Congo/Crimean haemorrhagic fever was recognized for the first time in Iraq in 1979. The first case was reported on 3 September 1979 and since then a further 9 patients have been investigated. Eight patients gave a history of previous contact with sheep or cattle, while 2 patients, a resident doctor and an auxiliary nurse, acquired their infections in hospital by direct contact with patients. The causal virus was isolated from patients' blood and postmortem liver specimens. The virus isolates were found to be closely related if not identical serologically to members of the Congo/Crimean haemorrhagic fever virus group. Eight of the patients had no epidemiological relationship to one another and lived in widely separated areas around Baghdad and Ramadi (110 km to the west of Baghdad).