Cytomegalovirus in bronchoalveolar lavage specimens from patients with AIDS: comparison with antigenaemia and viraemia.

Pulmonary infection with cytomegalovirus (CMV) is a well recognised complication of AIDS. It is often possible to detect CMV-infected cells in bronchoalveolar lavage (BAL) specimens with monoclonal antibodies, but the clinical significance of their presence remains unclear. To investigate this, 24 AIDS patients were tested for CMV antigenaemia and viraemia, in addition to CMV detection in BAL. CMV was detected in the BAL of nine patients (38%), five with clinical and laboratory evidence of pulmonary infection and four without pulmonary involvement. Blood samples positive for CMV antigen were observed in two patients with CMV-positive BAL specimens and, in both cases, antigenaemia resolved without therapy. No case of viraemia was detected. Pneumocystis carinii was detected concomitantly with CMV in the BAL of four of the patients with pulmonary involvement and in one without signs of pulmonary infection. These data suggest that CMV-positive BAL results are of limited significance in the diagnosis of CMV pneumonia in AIDS patients, unless associated with high levels of antigenaemia or viraemia and compatible clinical symptoms.

Helicobacter pylori diagnosis in patients with liver cirrhosis.

BACKGROUND: In cirrhotics, Helicobacter pylori infection is the major cause of peptic lesions, which are an important cause of upper intestinal haemorrhage in these patients. However, some diagnostic methods are not accurate for H. pylori detection in cirrhotics. AIMS: The study assessed the accuracy of different diagnostic methods for H. pylori detection in cirrhotics with and without gastroduodenal lesions. METHODS: The study population comprised of 53 cirrhotics. All patients underwent upper endoscopy: three biopsies were taken in the antrum and three in the gastric body. Four biopsies were used for Giemsa staining, while two were used for a rapid urease test. A blood sample was obtained for serology using Western blotting, and a [13C]urea breath test was performed in all patients. Histological assessment was regarded as the gold standard for diagnosis of H. pylori infection. RESULTS: H. pylori infection was detected at histological assessment in 28 (52.8%) patients. The [13C]urea breath test, rapid urease test, and serology were positive in 27 (51%) patients, 23 (43.4%) patients, and 34 (64.1%) patients, respectively. Sensitivity and specificity were 92.9 and 96% for the [13C]urea breath test, 78.6 and 96% for the rapid urease test, and 78.6 and 52% for serology. CONCLUSIONS: The [13C]urea breath test is very accurate in cirrhotics, whilst both serology and the rapid urease test give disappointing results.

[Epidemiologic surveillance of influenza in Rome (1981-1982)]. / Sorveglianza epidemiologica dell'influenza in Roma (1981-1982).

In the period from September 1981 to April 1982, one strain of influenza virus (A-H3N2) was isolated from 121 throat cultures obtained from patients with acute febrile respiratory disease. A sero-epidemiological survey on 520 serum samples and evaluation of excess mortality from respiratory diseases did not show significant activity of influenza viruses during the period from October 1981 to October 1982.

Specificity of anti-phospholipid antibodies in infectious mononucleosis: a role for anti-cofactor protein antibodies.

The antigen specificity of anti-phospholipid antibodies in infectious mononucleosis (IM) was studied using ELISA for the detection of anti-beta2-glycoprotein I (beta2-GPI), anti-annexin V, anti-protein S and anti-prothrombin antibodies and TLC immunostaining for the detection of anti-phospholipid antibodies. This technique enabled us to look at antibodies reacting to 'pure' phospholipid antigens in the absence of protein contamination. Sera from 46 patients with IM, 18 with systemic lupus erythematosus (SLE), 21 with primary anti-phospholipid antibody syndrome (PAPS), 50 with Helicobacter pylori infection and 30 healthy blood donors were tested. This study highlights anti-phospholipid antibodies in patients with IM as specific 'pure' anti-cardiolipin antibodies, while in PAPS and SLE patients anti-phosphatidylserine and anti-phosphatidylethanolamine antibodies were also found. This investigation also shows that the anti-cardiolipin antibodies found in IM can be present with anti-cofactor protein antibodies. The higher prevalence of anti-cofactor antibodies found in IM sera than in Helicobacter pylori sera may be due to the immunostimulatory effect and/or the polyclonal activation often observed in course of Epstein-Barr virus infection. However, anti-beta2-GPI and, to a lesser extent, anti-prothrombin antibodies occur with a significantly lower prevalence in IM than in PAPS patients. This finding suggests that these antibodies should be regarded as the expression of the broad autoimmune syndrome involving the phospholipid-binding plasma proteins.

[Epidemiologic surveillance of influenza in Rome 1982-1984]. / Sorveglianza epidemiologica dell'influenza in Roma nel periodo 1982-1984.

In the periods from July 1982 to June 1983 and July 1983 to June 1984, 31 strains of influenza virus, of which 19 A/H3N2 6 A/H1N1 and 6 type B, were isolated from 242 throat cultures obtained from patients with acute febrile respiratory disease. A seroepidemiological survey on 520 serum samples confirms significant activity of influenza viruses during the winterly period of 1983-1984. In the period July-August 1983 the evaluation of mortality from respiratory diseases presents an excess in respect of epidemic threshold probably ascribable to heat stroke.

[Quantitative Detection of cytomegalovirus (CMV) DNA in leukocytes of patients with HIV infection by using the Digene Hybrid Capture System (DHCS)] / Il test Digene Hybrid Capture System (DHCS) nella determinazione quantitativa del DNA di cytomegalovirus (CMV) nei leucociti di pazienti con infezione da HIV.

The aim of the present study was to evaluate the usefulness of the Digene Hybrid Capture System (DHCS) for the detection and quantitation of cytomegalovirus (CMV) DNA in 95 blood samples from 57 HIV-positive patients with low CD4+ T-cell count (<100 cells/ l). The DHCS was compared with pp65 antigenemia assay and the results were correlated with active CMV disease, anti-CMV therapy and occurrence of disease relapses. Our data suggest that the detection of CMV DNA by DHCS seems to be a rapid, sensitive and specific assay for the diagnosis of CMV disease in HIV-infected patients, showing a good correlation with pp65 antigenemia assay. Overall, the DHCS provides a quantitative and objective measure of CMV activity in leukocytes and it may also represent a useful tool for the monitoring of anti-CMV therapy.

[Acyclovir in the treatment of varicella in immunocompetent children]. / L'acyclovir nel trattamento della varicella nei bambini immunocompetenti.

We evaluated safety and tolerance of acyclovir ACV per os in immunocompetent children affected by chicken-pox admitted to our department from January 1993 to December 1994. 183 subjects (102 males and 81 females) aged between 0 and 14 years were treated by ACV (80 mg/kg/daily in 4 divided doses): 88 children were treated within 24 hours and 95 subjects within 48 hours from the onset of symptoms. The control group consisted of 83 children (52 males and 31 females) aged between 0 to 14 years. In all patients routine blood-test were performed and in those with respiratory illness Chest-Rx was also done. We evaluated clinical course, degree of eruption, the appearance and kind of complications, duration of hospitalization, the compliance and the potential consequences on specific antibody response. Our results show a faster improvement of clinical symptoms in treated patients with respect to the control group with shortening of the period of the fever, itch and appearance of new vescicles. The percentage of complications was lower in treated than in untreated patients. 16 cases tested for specific antibody response showed protective titers six months after treatment. In conclusion, ACV administered per os within 48 hours from onset of exanthema causes reduction of the period and the degree of general symptoms and exanthema, a lower incidence of complications even if non statistically significant. The drug is safe and well-tolerated.