Bortezomib as the sole post-renal transplantation desensitization agent does not decrease donor-specific anti-HLA antibodies.

Persistence of donor-specific anti-HLA antibodies (DSA) associated with antibody-mediated graft injuries following kidney transplantation predicts evolution toward chronic humoral rejection and reduced graft survival. Targeting plasma cells, the main antibody-producing cells, with the proteasome inhibitor bortezomib may be a promising desensitization strategy. We evaluated the in vivo efficacy of one cycle of bortezomib (1.3 mg/m(2)x 4 doses), used as the sole desensitization therapy, in four renal transplant recipients experiencing subacute antibody-mediated rejection with persisting DSA (>2000 [Mean Fluorescence Intensity] MFI). Bortezomib treatment did not significantly decrease DSA MFI within the 150-day posttreatment period in any patient. In addition, antivirus (HBV, VZV and HSV) antibody levels remained stable following treatment suggesting a lack of efficacy on long-lived plasma cells. In conclusion, one cycle of bortezomib alone does not decrease DSA levels in sensitized kidney transplant recipients in the time period studied. These results underscore the need to evaluate this new desensitization agent properly in prospective, randomized and well-controlled studies.

Fetal-maternal hydrops syndrome in human parvovirus infection.

A case of maternal generalized edema with hyponatremia, hypoosmolality and secondary hyperaldosteronism was associated with pseudomolar plasma human chorionic gonadotropin (hCG) concentrations in a case of fetal and placental hydrops due to parvovirus B19 infection. Digoxigenin in situ hybridization techniques were effective in demonstrating parvovirus B19 infection on fixed tissues. Hydropic changes in the placenta may have massively increased the maternal plasma hCG concentration with subsequent fluid imbalance leading to maternal hydrops mimicking molar pregnancy.

Differential transcription, without replication, of non-structural and structural genes of human parvovirus B19 in the UT7/EPO cell as demonstrated by in situ hybridization.

Erythroid progenitor cells are the main target for B19 parvovirus infection. The UT7 cell line demonstrates a marked erythroid differentiation on induction by erythropoietin (EPO) (UT7/EPO cells) and therefore appears to be a potential target for B19 parvovirus. We aimed to evaluate the presence and localization of B19 nucleic acids in UT7/EPO cells by in situ hybridization. Three digoxigenin-labelled probes were used: two recognized specifically the non-structural region of the B19 genome and one probe was structural region-specific. In our experiment UT7/EPO cells were not permissive to B19 infection. Transcription led to nonstructural and structural gene transcripts without DNA replication or capsid protein synthesis.

The role of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of ectopic pregnancy in Gabon.

OBJECTIVE: To study the association between ectopic pregnancy and Chlamydia trachomatis and Neisseria gonorrhoeae. DESIGN: A prospective observational study with two comparison groups. SETTING: A general hospital in Franceville, Gabon. SUBJECTS: Forty-five women with ectopic pregnancies and two comparison groups each of 45 women, one at 5 to 12 and the other at 32 to 41 weeks gestation. MAIN OUTCOME MEASURES: Serum levels of IgG and IgA antibodies to C. trachomatis (L1 and rMOMP) and N. gonorrhoeae (pili) in all the women. In the women with ectopic pregnancy peritoneal adhesions were scored and in 40 women samples of tube were cultured for organisms being studied. RESULTS: IgG and IgA antibodies to C. trachomatis (L1) were detected in 84% of the ectopic group and 53 and 39% of the comparison groups (P less than 0.0001). IgG and IgA antibodies to N. gonorrhoeae occurred in 49, 28 and 18% and 49, 28 and 26% of the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatis was cultured from the tubes of 71% of the women with ectopic pregnancy. CONCLUSIONS: Infection with chlamydia, and probably with N. gonorrhoeae, is an important factor in the causation of ectopic pregnancy in Gabon.

PIP: A general hospital in Franceville, Gabon was the site for this prospective, observational study with 2 comparison groups which studied the association between ectopic pregnancy and Chlamydia trachomatous and Neisseria gonorrhoea. 45 women with ectopic pregnancies and 2 comparison groups, each with 45 women, were part of the study, 1 group from 5-12 weeks and the other at 32-41 weeks gestation. Serum levels of IgG and IgA antibodies to C. trachomatous (L1 and rMOMP) and gonorrhoea (pili) in all of the women were measured. In women with ectopic pregnancy, peritoneal adhesions were scored and in 40 women, samples of tube were cultured for organisms under study. IgG and IgA antibodies to C. trachomatous (L1) were detected in 84% of the ectopic group and 53% and 39% of the comparison groups (p0.001). IgG and IgA antibodies to N. gonorrhoea occurred in 49, 28, and 18%, and 49, 28, and 26% for the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatous was cultured from the tubes of 71% of the women with ectopic pregnancies. It was concluded that infection with chlamydia, and probably with N. gonorrhoea, is an important factor in the causation of ectopic pregnancy in Gabon.

Human T-cell lymphotropic virus type I infection and pregnancy: a case-control study and 12-month follow-up of 135 women and their infants.

Human T-cell lymphotropic virus type I (HTLV-I) infection is common in Gabon, but its influence on pregnancy is unknown. A single case of acute T-cell leukemia in a pregnant woman has been reported in the literature, but, as far as we know, we present the first case-control study analyzing the relationship between HTLV-I seropositivity and the course and outcome of pregnancy. The study concerned 45 HTLV-I seropositive pregnant women matched with 90 seronegative pregnant women. None has clinical features of HTLV-I infection during pregnancy or during the year after delivery. HTLV-I seropositivity did not significantly affect the course or outcome of pregnancy. After losing maternal antibodies to HTLV-I, none of the infants had seroconversion to HTLV-I 1 year after birth. Filaria infection was correlated with HTLV-I seropositivity, but confounding factors may account for this observation.

Tubal schistosomiasis as a cause of ectopic pregnancy in endemic areas?; a report of three cases.

Tubal schistosomiasis as a cause of ectopic pregnancy is uncommon. We are reporting three cases of tubal pregnancies in which the histopathological examination showed a bilharzial disease of the tube. Schistosomiasis to Schistosoma haematobium occurs in Gabon with an incidence of 8% to 44% of the adult population, and schistosoma ova have been found in 2.5% of histopathological examinations in removal of any genital tissue. Even if schistosomiasis was not the main causative agent of infertility, in this population which has the lowest fertility index in subsaharan Africa, it might impair an already altered tubal function by salpingitis. We suggest that parasitic examination should be made as a part of the management program of infertility and after an ectopic pregnancy in endemic areas.

[Fertility after extra-uterine pregnancy in Africa. Follow-up of a cohort of 145 patients over 5 years]. / Fertilité après grossesse extra-utérine en Afrique. Suivi d'une cohorte de 145 patientes pendant 5 ans.

Gabon has one of the lowest fertility rates in Central Africa (116 children per 1,000 women); and ectopic pregnancy occurs in 1 per 62.5 live births. We have studied fertility following ectopic pregnancy with a 5 years follow-up in a cohort of 145 women treated for an ectopic pregnancy in the general hospital of Franceville, Gabon. 17% of these women had an intra uterine pregnancy, 10% had a repeat ectopic pregnancy and 73% were infertile 5 years after the ectopic pregnancy. We compared the fertile group and the infertile group after ectopic pregnancy: the main factors for fertility were the fertility of these women before the ectopic pregnancy and the staging of the Fallopian tube and pelvic cavity. Pelvic adhesions following pelvic inflammatory diseases were correlated with infertility. The main causative agent of infertility after ectopic pregnancy were sexual transmitted diseases and their sequelae and late diagnosis.

Prevalence of Staphylococcus aureus and coagulase-negative staphylococci with decreased sensitivity to glycopeptides as assessed by determination of MICs.

The prevalence of staphylococci with decreased sensitivity to glycopeptides was assessed at a Paris hospital by determination of the MICs. The values obtained using the MIC method were compared to those obtained using the routine disk agar diffusion method. One hundred independently isolated strains were tested including 57 Staphylococcus aureus isolates and 43 coagulase-negative staphylococci (CNS). For all strains vancomycin MICs were less than or equal to 4 mg/l but for 5.3% of the Staphylococcus aureus isolates and 25.6% of the CNS isolates teicoplanin MICs were high (greater than or equal to 8 mg/l). Moreover, teicoplanin MICs did not correlate well with zone sizes. The MIC method is therefore recommended for evaluating the susceptibility of staphylococci to teicoplanin.