Plant-herbivorous beetle networks: molecular characterization of trophic ecology within a threatened steppic environment.

DNA barcoding facilitates many evolutionary and ecological studies, including the examination of the dietary diversity of herbivores. In this study, we present a survey of ecological associations between herbivorous beetles and host plants from seriously threatened European steppic grasslands. We determined host plants for the majority (65%) of steppic leaf beetles (55 species) and weevils (59) known from central Europe using two barcodes (trnL and rbcL) and two sequencing strategies (Sanger for mono/oligophagous species and Illumina for polyphagous taxa). To better understand the ecological associations between steppic beetles and their host plants, we tested the hypothesis that leaf beetles and weevils differ in food selection as a result of their phylogenetic relations (within genera and between families) and interactions with host plants. We found 224 links between the beetles and the plants. Beetles belonging to seven genera feed on the same or related plants. Their preferences were probably inherited from common ancestors and/or resulted from the host plant's chemistry. Beetles from four genera feed on different plants, possibly reducing intrageneric competition and possibly due to an adaptation to different plant chemical defences. We found significant correlations between the numbers of leaf beetle and weevil species feeding on particular plants for polyphagous taxa, but not for nonpolyphagous beetles. Finally, we found that the previous identifications of host plants based on direct observations are generally concordant with host plant barcoding from insect gut. Our results expand basic knowledge about the trophic relations of steppic beetles and plants and are immediately useful for conservation purposes.

Serum carotene deficiency in HIV-infected patients. Berlin Diarrhoea/Wasting Syndrome Study Group.

OBJECTIVE: To assess total serum carotene concentration in HIV-infected patients as an indicator of fat malabsorption in correlation with diarrhoea, secondary enteric infections, and blood lymphocyte subsets. DESIGN: Prospective study. SETTING: Two referral-based tertiary care centres in Berlin, Germany. PATIENTS: A total of 33 controls and 116 HIV-infected patients who had complete microbiological evaluation of stools and biopsies obtained at upper endoscopy because of diarrhoea (n = 54), or other symptoms (n = 62), were studied. MAIN OUTCOME MEASURES: Total serum carotene concentration was determined spectrophotometrically. RESULTS: Total serum carotene concentration was abnormal (< 0.88 mumol/l) in 77% of HIV-infected patients and significantly decreased compared with controls [0.47 mumol/l (range, 0.06-1.69 mumol/l) versus 1.37 mumol/l (range, 0.88-2.92 mumol/l); P < 0.0001]. Total serum carotene concentration did not differ between AIDS patients and patients at earlier disease stages, between patients with or without secondary enteric infections, or between patients with or without fever. In patients at earlier disease stages, but not in AIDS patients, total serum carotene concentration was lower for patients with than without diarrhoea. The percentage of CD4 lymphocytes (r = 0.364; P < 0.001), CD4 count (r = 0.28; P = 0.0013), and CD4/CD8 ratio (r = 0.38; P < 0.001) in the peripheral blood correlated with total serum carotene levels in HIV-infected patients. CONCLUSION: HIV-infected patients frequently have abnormal total serum carotene concentrations indicating fat malabsorption which may contribute to diarrhoea. Furthermore, total serum carotene concentrations correlate with immunologic abnormalities in HIV infection.

Mucosal abnormalities in microsporidiosis.

OBJECTIVE: To determine the prevalence of microsporidiosis in HIV-infected patients with and without diarrhoea and to characterize alterations in mucosal architecture and brush border enzyme activities in patients with microsporidiosis. PATIENTS: A total of 259 HIV-infected patients undergoing oesophago-gastroduodenoscopy because of diarrhoea (n = 123) or other symptoms (n = 136) were studied. METHODS: Patients were evaluated for the presence of microsporidia by electron microscopy of duodenal biopsies. Brush border enzyme activities were measured by histochemistry and mucosal architecture was determined by three-dimensional morphometry in biopsies from patients with microsporidiosis and compared with biopsies from a subgroup of HIV-infected patients with or without other enteropathogens. RESULTS: Enterocytozoon bieneusi was detected in 17 patients and Encephalitozoon intestinalis was detected in two patients. Microsporidiosis was significantly more frequent in patients with chronic diarrhoea (19.1%; P < 0.0001) or in patients with acute diarrhoea (7.2%; P = 0.04) than in patients without diarrhoea (1.5%). Microsporidiosis was associated with lactase deficiency (P = 0.03) and a reduced activity of alkaline phosphatase (P = 0.028) and alpha-glucosidase (P = 0.025) at the basal part of the villus compared with brush border enzymes in patients without enteropathogens. Patients with microsporidia had reduced villus height (P = 0.043) and a villus surface reduced by 40% (P = 0.004) compared with patients with enteropathogens other than microsporidia. CONCLUSIONS: Our study confirms the association between microsporidia and diarrhoea. The pathophysiologic mechanism by which microsporidia cause diarrhoea appears in part to be malabsorption, caused by a reduction of absorptive mucosal surface and impairment of enterocyte function.

HIV-1 p24 but not proviral load is increased in the intestinal mucosa compared with the peripheral blood in HIV-infected patients.

OBJECTIVE: To investigate differences in viral and proviral load between the peripheral blood and the intestinal mucosal immune system in HIV-infected patients. DESIGN: HIV-1 p24 and HIV DNA content were compared in blood samples and intestinal biopsies from HIV-infected patients. METHODS: Intestinal biopsies and peripheral blood were simultaneously obtained from 27 HIV-infected patients undergoing diagnostic endoscopy. The p24 concentrations were measured in serum and homogenized intestinal biopsies by enzyme-linked immunosorbent assay after acid-dissociation of immune complexes. Proviral load was determined in blood and intestinal biopsies by a quantitative competitive polymerase chain reaction amplifying the HIV-1 nef gene from genomic DNA. RESULTS: No significant differences were found in proviral load comparing HIV copies per 1.5 x 10(5) cell equivalents in blood [2650 (600-44000)] and intestinal biopsies [4200 (1325-19 625)]. Paired analysis revealed a strong positive correlation between serum and mucosal proviral load. In contrast, HIV core protein p24 was detected in intestinal biopsies from 18 patients in much higher concentrations than in serum [858 (262-4111) pg/g versus 34 (9-242) pg/g; P < 0.005]. The p24 concentrations in serum and intestinal biopsies did not correlate and no significant correlation was observed in serum or intestinal biopsies between proviral load and p24 concentrations. No clear correlations were observed between clinical parameters and HIV DNA or HIV p24 levels in blood or biopsies. CONCLUSIONS: Our findings demonstrate a homogenous distribution of HIV proviral load in the peripheral blood and the intestinal mucosal immune system. The high viral antigen load in the intestine therefore indicates that mucosal HIV production is upregulated at the transcriptional and/or translational level. The intestinal mucosa is a major reservoir for HIV in HIV-infected patients.

Lack of gonadotropic activity in the rabbit blastocyst prior to implantation.

Recent reports of an LH-like hormone in the rabbit preimplantation blastocyst and of elevated serum progesterone levels in the presence of unimplanted blastocysts prompted us to characterized further the biological activity of the presumed gonadotropin. Progesterone was measured by a highly specific radioimmunoassay in sera obtained from pregnant and pseudopregnant rabbits after mating (day 0) to fertile or vasectomized males. On days 3, 4, 5, and 6, which represent the preimplantation period, mean progesterone concentrations (ng/ml +/- SE) were 4.3 +/- 0.7, 5.1 +/- 0.5, 6.8 +/- 1.1, and 9.0 +/- 1.9 in 5 pseudopregnant rabbits and 4.1 +/- 0.4, 6.7 +/- 0.6, 5.9 +/- 0.9, and 7.0 +/- 0.8 in 7 pregnant rabbits. In a separate experiment, serum progesterone concentrations in 6 pseudopregnant and 8 pregnant rabbits were 10.1 +/- 0.7 ng/ml and 13.7 +/- 1.1 (P less than 0.02), respectively on days 11-12. Thus, serum progesterone concentrations were not different in pregnant and pseudopregnant rabbits before the time of implantation (day 7), but were higher in pregnant rabbits after implantation. Blastocysts obtained on day 6 and incubated with a cell suspension of immature rat ovaries failed to stimulate the accumulation of progesterone in medium, in contrast to hCG, which was active even in the presence of blastocysts. Day-6 blastocysts also failed to stimulate the accumulation of testosterone from decapsulated rat testes and of progesterone from rabbit ovarian tissues in vitro. A gonadotropic effect of the conceptus can be observed in the rabbit within 4 to 5 days after implantation. However, we find no evidence for the existence of an LH-like hormone in the preimplantation blastocyst which stimulates the rabbit ovary to secrete progesterone.

Spongiform encephalopathy in AIDS dementia complex: report of five cases.

We describe the morphological findings in the brain of five AIDS patients who died with a clinical diagnosis of dementia. We have found a spongiform change (small rounded vacuoles) in different parts of the brain and a similar but morphologically different sponginess, the status spongiosus, characterized by looser and coarser microcystic cavitations of the grey matter in which the tiny cysts and vacuoles are enmeshed by glial fibrils. At the ultrastructural level, round and oval clear spaces, divided by septae into several smaller ones, appeared in the neuropil. The pathogenesis of the majority of the vacuoles and cavitations is not clear yet but a focal loss of cortical neurons was evident and furthermore some of the vacuoles were identified as remnants of dendrites. The light and electron microscopic findings can not be interpreted as artefacts or as a simple edema of the brain and also can not be explained by the different infective complications. We have found spongiform alterations in all cases of clinically diagnosed dementia and therefore it seems obvious that these findings are quite frequent in AIDS dementia.

Intestinal T-cell lymphoma: a reassessment of cytomorphological and phenotypic features in relation to patterns of small bowel remodelling.

Intestinal T-cell lymphoma (ITCL) is an uncommon entity among primary gastrointestinal lymphomas. In this study we evaluated tumours from 20 patients presenting with (n = 8) or without (n = 12) a history of coeliac disease (CD). Neoplastic lesions were composed of predominantly small (n = 4), small-to-medium (n = 2), medium/mixed-to-large (n = 7) or large and anaplastic (n = 7) cells. Different patterns of tumour growth and remodelling of the small bowel wall were observed. Pattern a (n = 4) was characterized by an intramucosal spread of small tumour cells with a small growth fraction. This pattern resembles mucosal inflammation in CD. In pattern b (n = 2), ulcerated solitary or multiple tumours composed of small to medium-sized cells were observed. The adjacent or distant mucosa showed a nearly normal architecture. In pattern c (n = 7), ulcerated lesions were composed of medium-sized to large cells. Mucosal flattening occurred in all segments infiltrated by lymphoma. In pattern d (n = 7), bowel remodelling was observed along the small intestine even at sites not affected by lymphoma. The main neoplastic lesions were composed of pleomorphic large or anaplastic cells frequently expressing the CD30 molecule. Intramucosal spread of a small epitheliotropic T-cell population was observed in the vicinity or even at distant segments of the small bowel. The demonstration of clonal rearrangements of T-cell receptor genes helped to trace widespread occurrence of this small intraepithelial neoplastic component. We suggest that different features of tumour cells such as the expression of activation antigens may contribute to the remodelling of small bowel mucosa. The addition of immunophenotyping data to macroscopic and microscopic features of specimens provided evidence that this uncommon lymphoma exhibits a spectrum in cytological composition and growth patterns. However, despite the considerable heterogeneity of the cases analysed, most of them shared a characteristic immunohistochemical profile (CD3+, CD8+/-, CD103+), further substantiating the view that ITCL is the neoplastic equivalent of an intraepithelial T-cell subset of the small intestine. This phenotype and the intraepithelial accumulation of lymphoma cells observed in the surviving mucosa are clues to the diagnosis of this clinicopathological lymphoma entity characterized by a broad range of morphological expressions.

Gastric lymphomas: aspects of follow-up and after-care.

In recent years, new insights into gastric lymphomas and their etiology and pathogenesis have been gained. The predominant role of infection with Helicobacter pylori in the pathogenesis as a pre-malignant condition of a special lymphoma entity [gastric lymphoma of the mucosa-associated lymphoid tissue (MALT) type], has defined new diagnostic procedures and concepts of treatment. Therefore, prognostic factors (e.g. stage of lymphoma, histopathologic grading, resectability etc.) are extremely important for the intensity and efficacy of follow-up and after-care. Surveillance programs in gastric lymphoma include sequelae of surgical resection, chemotherapy and radiotherapy, and the efficacy of follow-up procedures have to be measured by the prevention of tumor relapse in comparison to the intensity of diagnostic procedures. Since lymphoma relapse may occur both as local or disseminated recurrence in 13%-35% of cases, follow-up procedures have to regard both aspects during surveillance. While these follow-up programs are standardized in epithelial tumors (e.g. colon carcinoma), they are not yet established or comparable for each type of gastric lymphoma. Low-grade MALT lymphomas have to be considered as a new lymphoma entity. In addition, new diagnostic procedures (e.g. molecular parameters such as polymerase chain reaction (PCR) for clonality, endosonography, "gastric mapping") have been found to be important parameters for diagnosis and staging of gastric lymphoma and may therefore be relevant for the course of the disease. The definition of "lymphoma cure" and the impact of these procedures as prognostic factors will have to be discussed and may influence the follow-up of gastric lymphoma.

Severe toxoplasmic ventriculomeningoencephalomyelitis in two AIDS patients following treatment of cerebral toxoplasmic granuloma.

Two patients with acquired immunodeficiency syndrome (AIDS) who were successfully treated for cerebral toxoplasmosis presented a few weeks later with neurologic abnormalities. Brain CT scan showed ventricular dilatation, ependymitis, and meningoencephalitis. Both patients died despite extensive treatment. Neuropathological examination showed enlargement of the cerebral ventricles, severe ventriculoencephalitis with large ependymal and subependymal necrosis, and numerous pseudomembranes within the ventricle lumen. Microscopic examination revealed severe necrotizing ventriculoencephalitis, meningoencephalitis and myelitis. Immunohistochemical studies revealed the presence of miriads of tachyzoites within and around the necrotic areas. Such form of toxoplasmosis as a diffuse meningo-encephalo-ventriculo-myelitis appear unique to AIDS and, to our knowledge, have not been previously documented.

[Spontaneous pneumothorax in AIDS. Observations in 10 patients]. / Spontanpneumothorax bei AIDS. Beobachtungen bei 10 Patienten.

Ten of our AIDS patients developed a unilateral or bilateral spontaneous pneumothorax. Four patients previously had pneumocystis carinii pneumonia and one had pulmonary tuberculosis. In six patients the pneumothorax occurred during the acute period of pneumocystis carinii pneumonia. Five patients were admitted to hospital because of the pneumothorax. The radiological findings varied from a small pneumothorax to almost total pulmonary collapse. Five of the ten patients were discharged after successful treatment of the pneumothorax but, in two, cystic lung segments had to be removed surgically.

[Cerebral and meningeal manifestations of AIDS: sensitivity of CT and T2-weighted MRT (129 patients)]. / Zerebrale und meningeale Manifestation des AIDS: Sensitivität von CT und T2-gewichteter MRT (129 Patienten).

We studied 129 AIDS patients with suspected or proved intracranial manifestations of the disease. The purpose of this study was to compare the diagnostic sensitivity of unenhanced and contrast enhanced CT and unenhanced T2-weighted MR. In 35/129 patients CT and MR findings were normal. In 37/129 patients equivalent findings were obtained with both methods. Although CT and MR demonstrated intracranial pathology in 25 cases, MR was clearly superior. Six of these cases had solitary lesions in CT, while MR demonstrated multiple lesions. MR detected more foci than CT. In 24 patients with normal CT, MR detected intracranial manifestations of AIDS, namely solitary lesions in 8, multiple lesions in 12 and meningeal alterations in 4 patients. In only 8 patients with normal MR findings, CT revealed pathological contrast enhancement in 2 and parenchymal calcifications in 6 patients. Thus, in 20% of our patients MR but not CT was diagnostic. In another 20% MR provided additional diagnostic information. In conclusion, MR is recommended as the imaging modality of choice in AIDS patients with non-conclusive cranial CT.

[Treatment of mild to moderately severe Pneumocystis carinii pneumonia with cotrimoxazole versus pentamidine aerosol. Preliminary results of a prospective randomized therapy study]. / Die Behandlung der leichten bis mittelschweren Pneumocystis-carinii-Pneumonie mit Cotrimoxazol versus Pentamidin-Aerosol. Zwischenergebnisse einer prospektiven randomisierten Therapiestudie.

In an open, prospective, randomized study we compared efficacy and side effects of 8 g/d cotrimoxazole (TMP/SMX) i.v. vs. 600 mg aerosolized pentamidine. 29 of 60 planned case record forms are now evaluated. Efficacy in both groups was comparable, but side effects in the pentamidine arm were very rare (7.2% vs. 40% in the TMP/SMX group). In moderate pneumocystis carinii pneumonia aerosolized pentamidine could be the first choice therapy. Necessary conditions are to use proper inhalation systems, experience, and the treatment of relevant accompaning bacterias, which we found in 80% of pneumocystis carinii positive bronchoalveolar lavages.

[Manifestations of AIDS in the gastrointestinal tract]. / AIDS-Manifestationen im Gastrointestinaltrakt.

Besides central nervous system, pulmonary and cutaneous manifestations, the gastrointestinal tract and the hepatobiliary system are major organs in AIDS. Gastrointestinal symptoms due to opportunistic infections or HIV-associated tumours are common in AIDS patients. Nevertheless, a huge variety of endoscopically diagnosed mucosal lesions may not always be correlated to microbiological findings, clinical symptoms and histological aspects. Cytomegalovirus being the most important opportunistic infection in the GI tract in symptomatic AIDS patients, is correlated with erosive and ulcerative lesions, often accompanied by complications like perforation or bleeding. HIV-associated tumours in the GI tract like Non Hodgkin-lymphoma or Kaposi sarcoma may present with atypical endoscopic findings. Diagnostic procedures should include microbiological and histological investigations of biopsies looking for opportunistic infections. Besides, typical immunological changes involving the mucosa as direct target organ of the HIV virus, are important to understand morphological and functional abnormalities in HIV-patients with GI symptoms.

[Histoplasmosis of the skin as an initial opportunistic infection in AIDS]. / Histoplasmose der Haut als opportunistische Erstinfektion bei AIDS.

A 55-year-old homosexual Indonesian (last stay in Indonesia 2 years previously), known to be HIV positive since 1986, developed desquamating, in part ulcerating, skin eruption over the face and shoulder region. On admission his temperature was 38.2 degrees C, erythrocyte sedimentation rate 72/95 mm, white cell count 3.100/microliters, and the CD4 cell count 30/microliters. Examination of lung, oesophagus, stomach, duodenum and colon for possible opportunistic infections was negative. Fundoscopy revealed an infiltrate in the right eye with destruction of the vitreous. Skin biopsy suggested histoplasmosis, confirmed by culturing H. capsulatum varietas capsulatum. It is likely that this was the reactivation of a latent, previously symptom-free infection, in this case the first opportunistic infection in the presence of AIDS. For 30 days he received infusions of amphotericin B (initially 0.1 mg/kg daily, after the 5th day 0.5 mg/kg), resulting in rapid healing of the skin lesions. Subsequently he has received (for 6 months so far) itraconazole, 400 mg daily, without further complications.

[Retinitis in AIDS patients: diagnosis, follow-up and treatment]. / Retinitis bei AIDS-Patienten: Diagnose, Verlauf und Behandlung.

Of 147 patients with AIDS (Walter Reed 3-6), 28 showed signs of retinal infection. Toxoplasmic retinochoroiditis had developed in 5 eyes of 4 patients, whereas cytomegalovirus (CMV) retinitis occurred in 40 eyes of 24 patients. All patients with toxoplasmosis complained of visual symptoms at the first visit, but only 60% of patients with CMV retinitis had ocular symptoms at this time. The important problems involved in making a timely and correct diagnosis (early CMV retinitis vs cotton wool spots vs toxoplasmic retinitis; significance of laboratory data) are presented and discussed. The course of CMV retinitis is sometimes fast and devastating and requires immediate treatment to prevent blindness in patients who are in otherwise still fair general health. Eighteen patients (28 eyes) were treated by intravenous ganciclovir (DHPG) for 1-9 months. Initial therapy (10 mg/kg body wt., 2-4 weeks) led to regression of fundus lesions in all eyes. Under maintenance treatment (5 mg/kg BW body wt., 5 times a week), 14 eyes still demonstrated significant regression or cicatrization of the lesions, 9 eyes showed little progress and 5 eyes moderate recovery. However, 8 of 12 untreated eyes became legally blind before the patient died. None of the 23 treated eyes with useful initial visual acuity (greater than or equal to 0.2) lost visual function. Only in three cases did the drug have to be stopped because of serious side effects (severe leukopenia, pancytopenia, psychosis). Toxoplasmic retinochoroiditis healed in all affected eyes after specific treatment (pyrimethamine, sulfamethoxydiazine, clindamycin, and spiramycin in double or triple combination).(ABSTRACT TRUNCATED AT 250 WORDS)

[AIDS and pain management-a survey of German AIDS and pain management units.]. / Schmerz und Schmerztherapie bei AIDS-Patienten : Eine Umfrage an deutschen AIDS- und Schmerztherapie-Einrichtungen.

UNLABELLED: The number of AIDS patients is steadily increasing. According to the literature these patients are often in severe pain. METHODS: We evaluated pain diagnoses and treatments with two almost identical questionnaires for AIDS treatment units (ATU) and pain management units (PMU). Questions dealt with unit type and size, number of patients treated per year and the proportion of intravenous drug users. The units were also asked to give an estimate of pain aetiologies, pain types and localizations and treatment modalities offered. RESULTS: Completed questionnaires were returned by 38 of 235 ATU and 85 of 127 PMU. In the ATU, 16% of the patients (estimated at 580 patients per year) had pain requiring treatment. In 26 of the PMU approximately 120 AIDS patients per year were treated, while 59 PMU had not yet seen any AIDS patients. Pain was caused mainly by opportunistic infections and by neurological syndromes connected with AIDS. Pain aetiologies could not be differentiated in the ATU in 22% of patients (PMU 9%), and pain types in 33% (PMU 9%). Neuropathic pain (ATU 38%, PMU 89%) was more frequent than nociceptive pain (ATU 29%, PMU 36%). The treatment modalities were systemic pharmacotherapy in 76% of ATU and 73% of PMU and nerve blocks in 37% of ATU and 42% of PMU. In 82% of ATU the staff thought their analgesic therapy was adequate, and in 92% staff were interested in closer cooperation with PMU such as was currently practised in only 6 of the 38 units (16%) that responded. CONCLUSIONS: The high incidence of complicated neuropathic pain syndromes in AIDS patients requires a sophisticated therapeutic approach. Closer cooperation between AIDS specialists and pain specialists, comparable to that already existing for other patient groups, is therefore desirable.

[The therapy of Candida esophagitis in AIDS patients with fluconazole]. / Die Therapie der Candida-Osophagitis bei AIDS mit Fluconazol.

Esophageal candidosis was found endoscopically in 135 of 496 AIDS patients with upper gastrointestinal symptoms. Vomiting, dysphagia and retrosternal pain were the leading symptoms. Endoscopy showed different stages of esophagitis with Candida patches as early changes up to severe esophagitis with hemorrhage. 36 patients were treated with fluconazole orally or intravenously administered (100 mg per day). In 33 of 36 patients clinical, endoscopic and microbiological results were good with complete cure of the lesions after 7, 14 or 21 days of treatment. In 3 patients with wasting syndrome and severe opportunistic infections a resistance to the drug was discussed because of lack of sufficient therapy results. Maintenance therapy seems to be necessary to prevent relapses.

[Gastrointestinal findings in HIV infection. Clinical aspects, microbiological findings and endoscopic picture]. / Gastrointestinale Befunde bei der HIV-Infektion. Klinik, mikrobiologische Befunde und endoskopisches Erscheinungsbild.

Among 200 hospitalized patients treated for HIV infections there were 98 with gastrointestinal symptoms, independent of the stage of the disease. Only 22 had abnormal stool findings. But histological examination and culture of endoscopically obtained biopsies revealed opportunistic infection in 62, of whom 28 had a cytomegalovirus infection. Mycobacterium avium-intracellulare was found in the gastrointestinal mucosa of 25 patients, but its clinical significance is unclear. In 33 of the 98 patients previously classified as positive for HIV or AIDS-related complex, endoscopic demonstration of an opportunistic infection required amendment of their HIV stage. In over 60% endoscopy revealed mucosal changes. A distinction from Crohn's disease or ulcerative colitis could only be made by histology or exclusion of the causative microorganism. Demonstration of the causative microorganism from the biopsy is thus essential in patients with gastrointestinal symptoms, because specific treatment is in principle possible and successful for some opportunistic infections.