[Acute pneumonia and cell-mediated immunity in patients with HIV infection]. / Polmoniti acute e immunità cellulo-mediata in pazienti con infezione da HIV.

The aim of this retrospective study is to evaluate the correlation between T-cell immunity and pulmonary disorders in a group of Italian subjects with HIV infection. HIV-infected patients seen at the Institute of Infectious Diseases, University of Verona, were included in this study if they had a specific acute pneumonia, a CD4+ cell count and a CD4+/CD8+ ratio during the 60 days immediately before the onset of pulmonary disease. Cases receiving any antimicrobial prophylaxis were excluded. Pneumonia was recognized by usual clinical and radiologic abnormalities. The diagnostic procedure included sputum examination, bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. The specimens were processed for bacterial, mycobacterial and fungal stains and cultures. Ziehl-Neelsen, periodic acid-Schiff and silver methenamine stains were performed on the transbronchial biopsy specimens in addition to usual pathologic examinations mononuclear. Determination of percentage of peripheral blood mononuclear cells bearing CD4+ and CD8+ markers was done by conventional fluorescent antibody cell-sorter analysis of the mononuclear cell population. Absolute number of CD4+ lymphocytes was determined by multiplying the total lymphocyte count by the percent of mononuclear cells bearing CD4+ marker. From October 1987 to August 1991, 61 patients, 50 males and 11 females, had 65 episodes of specific pneumonia. The average age of patients was 31.4 years (range 29-59 years). The risk factors for HIV infection included intravenous drug abuse (47 patients), homosexuality (6 patients), bisexuality (3 patients) and heterosexual contact (5 patients). Before the onset of pulmonary disorders, patients were classified in the following clinical HIV-related stages: asymptomatic state (22 episodes), ARC (22 episodes) and AIDS (21 episodes). In decreasing order of frequency diagnosis of pneumonias were PCP (29 episodes), community-acquired bacterial pneumonia (16 episodes), pulmonary tuberculosis (8 episodes), nonspecific interstitial pneumonia (4 episodes), PCP and pulmonary tuberculosis (3 episodes), cytomegalovirus pneumonia (2 episodes), and one of each episode of PCP and pulmonary cryptococcosis, pulmonary candidiasis, pulmonary Kaposi's sarcoma. The mean and the standard deviation of immunologic values regarding the four primary diagnostic groups were: PCP CD4+/CD8+ 0.50 +/- 0.42, CD4+/mm3 196 +/- 190; bacterial pneumonia CD4+/CD8+ 0.53 +/- 0.44, CD4+/mm3 247 +/- 139; pulmonary tuberculosis CD4+/CD8+ 0.62 +/- 0.38, CD4+/mm3 260 +/- 170; nonspecific interstitial pneumonia CD4+/CD8 + 0.57 +/- 0.48, CD4+/mm3 240 +/- 189. No significant statistical differences with respect to CD4+/CD8 ratios and CD4+ cell counts among these diagnostic groups were found by standard analysis of variance.(ABSTRACT TRUNCATED AT 400 WORDS)

[Determination of the antiplasmin activity of platelets with a chromogenic substrate]. / Determinazione dell'attivita antiplasminica delle piastrine con substrato cromogeno.

The synthesis of chromogenic substrate has opened new prospects to the study of haemostasis factors and particularly to the determination of coagulation inhibitors and components of fibrinolysis. In this paper we propose a new and simple method to anti-plasmin activity of platelets, by using H-D-Valyl-L-Leucyl-L-Lysine-p-nitroanilide HCl (S-2251) (Kabi Company, Sweden) as a chromogenic substrate.

[The role of methods using immunofluorescence (platelet suspension immunofluorescence test and granulocyte immunofluorescence test) in the diagnosis of autoimmune thrombocytopenia and neutropenia]. / Ruolo dei metodi che impiegano l'immunofluorescenza (PSIFT e GIFT) nella diagnosi delle trombocitopenie e neutropenie autoimmuni.

The authors examined 46 patients with autoimmune thrombocytopenic Purpura and 17 patients with autoimmune neutropenia, with the direct and indirect immunofluorescence method. They intended to verify the sensibility of such methods and to determine the class of immunoglobulins. In the PTA the direct PSIFT was positive in 26 of the 46 examined patients, while the indirect in 15 cases. In the GPA the direct GIFT was positive in 9 of the 17 patients and the indirect in 6 cases. By using FITC-labelled monospecific anti-immunoglobulin reagents, in the PTA we have found IgG in the 57.7% of the patients, IgM in the 11.5% and IgG + IgM in 30.8%; in the GPA we have found IgG in the 66% of the cases, IgM in 11% and IgG + IgM in 23%. These methods have shown a good reliability and sensibility, but also delicacy.

[Howie's antithrombin activity and thrombin inhibitors in the nephrotic syndrome]. / Attività antitrombinica secondo Howie ed inibitori della trombina nella sindrome nefrosica.

A prospective study was carried out on a group of 28 patients affected by nephrotic syndrome in order to compare the antithrombin activity, measured by the technique of Howie, the antithrombin III, measured with chromogenic substrate and by radial immunodiffusion, the alpha 2-macroglobulin and the alpha 1-antitrypsin. An increased level of alpha 2-macroglobulin and of the antithrombin activity, measured by the technique of Howie and a reduction of the level of antithrombin III and of alpha 1-antitrypsin was observed. It is suggested that the increased antithrombin activity is related to the increase of alpha 1-antitrypsin was observed. It is suggested that the increased antithrombin activity is related to the increase of alpha 2-macroglobulin concentration in spite of the simultaneous decrease of antithrombin III.

[Clinical and laboratory study of 7 cases of lupus anticoagulant]. / Studio clinico e di laboratorio su sette casi di "lupus anticoagulant".

The clinical and laboratory data from seven patients with "Lupus anticoagulant" are reported. Laboratory tests are reliable as far as identification and properties of this kind of anticoagulant are concerned. Clinically, it is dramatic how often these patients show thrombotic phenomena. Clinical or laboratory tests which could point out whether these patients are at risk of incurring into thrombotic or hemorrhagic phenomena are not available, which underlines the critical situation one has to confirm with in case a patient with "Lupus anticoagulant" has to undergo surgery.

Severe factor X deficiency in pregnancy: case report and review of the literature.

Isolate factor X deficiency is an extremely rare clotting factor disorder inherited in autosomal recessive fashion and pregnancy in a homozygous patient is frequently complicated by recurrent miscarriage, uterine bleeding and premature labour. Eleven pregnancies in seven patients affected by FX deficiency have been reported in the literature. Two additional pregnancies have been reported in a FX variant (FX Friuli). We present a new case of successful at term pregnancy in a homozygous patient.

Presence and significance of cold agglutinins in patients with HIV infection.

BACKGROUND: HIV-infected patients may contract a variety of other concurrent infections, including Mycoplasma pneumoniae, cytomegalovirus (CMV) and Epstein-Barr virus (EBV), that are known to be causes of transient cold agglutinins (CA). The aim of this study was to search for the prevalence, the persistence and the significance of CA in HIV antibody-positive patients. METHODS: Ninety patients belonging to different risk groups (drug addicts, homosexuals and hemophiliacs), including 15 with AIDS, 20 with ARC, 25 with PGL, 30 symptom-free individuals and 100 healthy blood donors were assessed for the presence of CA for at least six months. RESULTS: In 20 cases (22%) CA were found: 3, 7, 5 and 5 respectively, in each of the above mentioned HIV-positive groups, while the group used as control was CA-negative. There were no differences between CA-negative and CA-positive patients with regard to the presence of anemia, frequency of other infections, or development of lymphatic malignancy during the follow-up period. Serological specificity of CA included 14 of type anti-I, 5 of anti-i and 1 of anti-Pr specificity. CONCLUSIONS: It appears that CA production is another immune disorder of patients with HIV infection.

Insulin dependent diabetes mellitus epidemiology: HLA genotype study in 12 north eastern Italian families with two siblings affected by type I diabetes.

The purpose of our study was to evaluate the relationship between the histocompatibility antigens and type I diabetes mellitus in families living in the north-eastern part of Italy. In each family two siblings were affected by diabetes. HLA-antigens were determined with the lymphocytotoxicity test, utilizing antisera of the series A-B-C-DR. The phenotypic frequencies were compared with those observed in controls. We showed that diabetes has a strong association with HLA DR 3 and/or DR 4 antigens. In particular we registered high frequency of compound heterozygous DR 3 - DR 4 subjects, and this fact supports the hypothesis of the existence of two different genes for diabetes associated with these HLA antigens. Moreover we observed a particular haplotype segregation with a very high percentage of HLA identity between patients belonging to the same family, confirming the association between HLA and genetic susceptibility to insulin dependent diabetes. These results confirm data in the literature and, completed by other data from other patients' families living in our area, will be useful in providing reliable genetic counselling.

HLA gene and phenotype data of 60 insulin-dependent diabetic patients from north-eastern Italy. A negative association with DR5 rather than DR2?

The purpose of our study was to evaluate what kind of relationships exist between HLA antigens and insulin-dependent diabetes mellitus (IDDM), in 20 families and in 40 single patients coming from and living in North Eastern Italy. The subjects studied show a strong association with HLA-DR3 and/or -DR4; at least one of these antigens is present in 88% of the diabetic subjects; this confirms that these antigens play a role in the pathogenesis of IDDM. We also noticed a negative association between IDDM and DR5 rather than DR2 and DR7. This result supports the hypothesis of a specific protective effect of DR5, at least as regards the population studied. Possibly, the gene(s) hypothetically involved in the protection against IDDM is (are) in linkage disequilibrium with DR2 and/or DR7 in some Caucasian populations and with DR5 in others. Another important result is the frequent HLA identity (75% of cases) among diabetic siblings of the same families. This result indicates that HLA identity is the main condition responsible for the susceptibility to the disease in the healthy siblings with HLA antigens identical to the diabetic siblings.

Neutrophil function and humoral immunity in children with recurrent infections of the lower respiratory tract and chronic bronchial suppuration.

Neutrophil motility and superoxide anion production and serum immunoglobulin levels were assessed in 51 children with recurrent infections of the lower respiratory tract and chronic bronchial suppuration, not due to anatomic or functional cause. In 26 children (50.9%), a significant defect of the immunologic defenses, likely to be responsible for the disease, was observed. A precocious diagnosis and an adequate therapy could result, at least in some patients, in the prevention of progressive lung damage.

Immunoresponse to hepatitis B vaccination and adherence campaign among injecting drug users.

Fifty injecting drug users (IDUs) were recruited to evaluate the efficacy of an hepatitis B virus (HBV) vaccination campaign to be carried out in a Public centre for Drug Users (PCDU). The vaccination schedule was successfully performed in most patients, who showed a great interest in this problem. After three doses of vaccine the seroconversion rate, with antibodies against HBV, proved similar to the one obtained in another group of healthy men of same age, while the antibody titres against HBV were lower after the second and third dose of vaccine. Vaccination campaigns for IDUs could lead to successful results in terms of compliance and efficacy, but they need to be closely monitored considering the IDUs relatively low antibody response.

[Chemotaxis deficiency in patients with HIV infection]. / Deficit della chemiotassi in pazienti con infezione da HIV.

Increased susceptibility to bacterial recurrent infection is characteristically associated with impaired B cells function but also with a defective PMN function. We studied PMN CT in 15 HIV positive drug addicts patients with persistent generalized lymphoadenopathy (PGL), in 15 symptom free HIV negative drug addicts (SFDA) and in 15 healthy blood donors to evaluate influence of HIV infection on PMN functions. CT of patients with PGL was reduced to 78% (p < 0.0001) and 75% (p < 0.00001) of CT in SFDA patients and healthy blood donors, respectively. We conclude that HIV infection causes defective PMNL CT and then it can increase susceptibility to bacterial recurrent infections in these patients.