[Diagnostic value of serum amyloid A, procalcitonin and hypersensitive C-reactive protein for pulmonary tuberculosis complicated by pneumonia].

OBJECTIVE: To assess the value of serum amyloid A (SAA), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the diagnosis of pulmonary tuberculosis (PTB) complicated by pneumonia. OBJECTIVE: We collected serum samples from patients with pneumonia, patients with PTB, patients with PTB complicated by pneumonia and patients with PTB complicated by sepsis hospitalized in our hospital between April, 2019 and April, 2020. Serum levels of SAA, PCT and hs-CRP were tested, and receiver- operating characteristic (ROC) curves were used to evaluate their efficacy for predicting PTB with concurrent pneumonia and the possibility of differentiating PTB cases with pneumonia from those with sepsis using these 3 parameters. We also tested serum levels of SAA, PCT and hs-CRP in patients with PTB and those with PTB complicated by pneumonia admitted from May to July in 2020 to verify the accuracy of these 3 parameters combined for predicting the complication of PTB by pneumonia. OBJECTIVE: Compared with the patients with PTB, the patients with pneumonia had significantly higher SAA and hs-CRP levels; serum SAA, PCT and hs-CRP levels were all significantly elevated in patients with PTB complicated by pneumonia (all P < 0.05). The levels of hs-CRP, white blood cell, D-dimer, FIB, APTT and neutrophil ratio were positively correlated with serum SAA level (all P < 0.05). The areas under the ROC curve (AUC) for serum SAA, PCT, and hs-CRP were 0.762, 0.781, and 0.800, respectively, and their combined AUC was 0.849 (all P < 0.001). For predicting PTB complicated by pneumonia, SAA combined with PCT had the same sensitivity (53.85%) and specificity (90.48%) as SAA, PCT and hs-CRP all combined. Serum SAA and PCT levels were similar between PTB patients with pneumonia and those with sepsis. OBJECTIVE: Combined detection of serum SAA and PCT levels can be helpful in the diagnosis of PTB complicated by pneumonia, but neither of them is capable of differentiating the complication of pneumonia from sepsis possibly due to influence by abnormal blood coagulation.

[Medical reconciliation for hospitalized patients in orthopedic surgery department: Return of experience over 2 years of practice]. / Conciliation médicamenteuse à l'entrée des patients dans une unité de chirurgie orthopédique : retour d'expérience sur plus de 2 ans de pratique.

OBJECTIVES: Some medication errors can be prevented by pharmacist action such as medication reconciliation. The main objective of this study was to evaluate the medication reconciliation activity after two years of practice. The secondary objective was to assess the medical staff's satisfaction following the setting up of the activity. METHODS: This retrospective study was realized over a period of two years in our hospital. Patients meeting the following criteria were included: 65 years and over, hospitalized in orthopedic surgery department, preferentially after a discharge of the emergency room. After the best possible medication history was established, it is compared to medicines ordered. The discrepancies were defined as intended or unintended. Study data were collected and analyzed using Excel and SPSS statistics®. RESULTS: A total of 899 patients met the inclusion criteria during the study period, mean age was 78 years (27; 104). A total of 84 % of our cohort was admitted after a discharge of the emergency room. Seventy five percent of the population had at least an unintended discrepancie, a mean of 2,3 unintended discrepancies per patient was identified. Seventy five percent of the unintended discrepancy were discussed and resolved. The medical staff was mostly satisfied of the activity. CONCLUSION: The medication reconciliation secured the drug management of hospitalized patients.

Distinct functions of CXCR3+ and CCR4+CD4+ T-cells accumulated in human tuberculosis pleural fluid.

BACKGROUND: Chemokine receptors and their ligands play a prominent role in regulating leucocyte migration. In the local milieu of inflammation, a high concentration of chemokines can recruit different chemokine receptor-expressing lymphocytes. OBJECTIVE: To understand the distinct immunological functions of CXC chemokine receptor 3 (CXCR3+) and CC chemokine receptor 4 (CCR4+) cluster of differentiation 4 (CD4+) T-cells accumulated in human tuberculosis (TB) pleural fluid after tuberculous antigen stimulation. METHODS: Mononuclear cells were isolated from the peripheral blood of healthy donors, cord blood and TB pleural fluid, and expression of CXCR3 and CC chemokine receptor 4 (CCR4), cytokines and cytolytic molecules by CD4+ T-cells with or without stimulation were analysed using fluorescence-activated cell sorting. RESULTS: CXCR3 and CCR4 expression on CD4+ T-cells from pleural fluid mononuclear cells (PFMCs) was significantly higher than in peripheral blood mononuclear cells (PBMCs). T-cell receptor signalling resulted in the upregulation of CXCR3 and CCR4 expression on CD4+ T-cells from cord blood mononuclear cells (CBMCs) and PBMCs in a time-dependent manner, but not from PFMCs. After stimulation with Mycobacterium tuberculosis antigens, CXCR3+CCR4-CD4+ T-cells were dominated by multifunctional T-helper 1 cells; however, CXCR3+CCR4+CD4+ T-cells exhibited cytotoxicity and degranulation by expressing granzyme B, perforin, CD107a/b and tumour necrosis factor-related apoptosis-inducing ligand. CONCLUSION: Our results indicated that CXCR3 or CCR4 expression on CD4+ T-cells had different biological activities against tuberculous infection, and could be a potential marker for the diagnosis of TB.

The DPYSL2 gene connects mTOR and schizophrenia.

We previously reported a schizophrenia-associated polymorphic CT di-nucleotide repeat (DNR) at the 5'-untranslated repeat (UTR) of DPYSL2, which responds to mammalian target of Rapamycin (mTOR) signaling with allelic differences in reporter assays. Now using microarray analysis, we show that the DNR alleles interact differentially with specific proteins, including the mTOR-related protein HuD/ELAVL4. We confirm the differential binding to HuD and other known mTOR effectors by electrophoretic mobility shift assays. We edit HEK293 cells by CRISPR/Cas9 to carry the schizophrenia risk variant (13DNR) and observe a significant reduction of the corresponding CRMP2 isoform. These edited cells confirm the response to mTOR inhibitors and show a twofold shortening of the cellular projections. Transcriptome analysis of these modified cells by RNA-seq shows changes in 12.7% of expressed transcripts at a false discovery rate of 0.05. These transcripts are enriched in immunity-related genes, overlap significantly with those modified by the schizophrenia-associated gene, ZNF804A, and have a reverse expression signature from that seen with antipsychotic drugs. Our results support the functional importance of the DPYSL2 DNR and a role for mTOR signaling in schizophrenia.

Avian influenza surveillance in Central and West Africa, 2010-2014.

Avian influenza virus (AIV) is an important zoonotic pathogen, resulting in global human morbidity and mortality and substantial economic losses to the poultry industry. Poultry and wild birds have transmitted AIV to humans, most frequently subtypes H5 and H7, but also different strains and subtypes of H6, H9, and H10. Determining which birds are AIV reservoirs can help identify human populations that have a high risk of infection with these viruses due to occupational or recreational exposure to the reservoir species. To assess the prevalence of AIV in tropical birds, from 2010 to 2014, we sampled 40 099 birds at 32 sites in Central Africa (Cameroon, Central African Republic, Congo-Brazzaville, Gabon) and West Africa (Benin, Côte d'Ivoire, Togo). In Central Africa, detection rates by real-time RT-PCR were 16·6% in songbirds (eight passerine families, n = 1257), 16·4% in kingfishers (family Alcedinidae, n = 73), 8·2% in ducks (family Anatidae, n = 564), and 3·65% in chickens (family Phasianidae, n = 1042). Public health authorities should educate human cohorts that have high exposure to these bird populations about AIV and assess their adherence to biosecurity practices, including Cameroonian farmers who raise small backyard flocks.

[Extravasation of radiopharmaceuticals: preventive measures and management recommended by SoFRa (Société Française de Radiopharmacie)]. / Extravasation des médicaments radiopharmaceutiques : mesures préventives et prise en charge recommandées par la SoFRa (Société française de radiopharmacie).

Radiopharmaceuticals extravasation is rare but may have serious clinical issues. Because no specific recommendations are being proposed to date, the goals of our working group created within the French Society of Radiopharmacy are to determine preventive measures and to establish a pragmatic management of extravasation of these drugs. Our preventive measures are to recognize the symptoms (erythema, venous discoloration, swelling), to know the risk factors (which are related to radiopharmaceutical, patient, site of injection, injection technique) and severity (from erythema to skin necrosis, depending on the radionuclide) and how to avoid them (training and awareness of staff, choice of injection site, route of drug administration test, use of a catheter for administration of therapeutic radiopharmaceuticals). Management should be immediate. It can be facilitated by a specific emergency kit. General measures recommended are the immediate cessation of injection, aspiration of fluid extravasation, delimitation of the extravasated area with an indelible pen, informing the doctor. Specific measures taking into account the radiotoxicity of the radionuclide and the type of radiopharmaceutical were also established. The patient should be informed by the doctor about the risks and how to take care of. Traceability of the incident must be ensured. A multidisciplinary reflexion is essential to manage the extravasation as early and effectively as possible.

ESAT-6- and CFP-10-specific Th1, Th22 and Th17 cells in tuberculous pleurisy may contribute to the local immune response against Mycobacterium tuberculosis infection.

Th1 cell-mediated adaptive immune response is very important but may not be sufficient to control Mycobacterium tuberculosis (M. tuberculosis) infection. The roles of the various T cell subsets and cytokines in the inflammatory processes are not clearly elucidated. We investigated whether Th1, Th22 and Th17 cells mediated cellular immunity at the local site of M. tuberculosis infection in patients with tuberculous pleurisy (TBP). The results showed that the cytokines IFN-γ and IL-22 but not IL-17 were elevated in tubercular pleural fluid. Following stimulation with immune-dominant peptides of early secreted antigenic target-6 (ESAT-6), culture filtrate protein-10 (CFP-10) or Bacille Calmette-Guerin, pleural fluid mononuclear cells expressed high levels of cytokines IFN-γ, IL-22 and IL-17 as revealed by mRNA and protein measurements. In addition, we showed that cytokines IFN-γ, IL-22 and IL-17 were produced in M. tuberculosis-specific immune response by distinct subsets of CD4+ T cells with the phenotype of CD45RA-CD62L-CCR7+CD27+ . Our results demonstrated for the first time that ESAT-6- and CFP-10-specific Th1, Th22 and Th17 cells existed in the patients with TBP and might play an essential role against M. tuberculosis infection. The findings of this study raised the possibility of unravelling the critical targets for therapeutic intervention in chronic inflammatory diseases such as TBP.

Optimization of GC-MS conditions based on resolution and stability of analytes for simultaneous determination of nine sesquiterpenoids in three species of Curcuma rhizomes.

GC-MS is a powerful tool for analysis of volatile oil, and resolutions of analytes were exclusively used as marker for optimization of the conditions. However, volatile oil usually contains heat labile components which may degrade and result in wrong results during GC analysis. In present study, based on both resolutions and stabilities of 11 sesquiterpenoids, GC-MS conditions were optimized for simultaneously quantitative determination of nine compounds including beta-elemene, curzerene, curcumol, isocurcumenol, germacrone, curdione, curcumenol, neocurdione and curcumenone in Ezhu. However, the other two compounds, i.e. furanodienone and furanodiene, were still thermal sensitive and not available for GC analysis. The results showed that both resolutions and stabilities of analytes should be considered for optimization of GC conditions because the properties of most components in volatile oil are unknown. Under optimum conditions, a capillary column (30 m x 0.25 mm i.d.) coated with 0.25 microm film 5% phenyl methyl siloxane was used for separation. Pulsed splitless inlet with temperature of 190 degrees C was selected for sample injection (0.2 microl). The calibration curves of nine sesquiterpenoids showed good linearity (r2>0.9989) within test ranges. The optimized method showed good repeatability for quantification of these nine components in Ezhu with intra- and inter-day variations of less than 1.42% and 2.79%, respectively. The validated method was successfully applied to quantify 9 sesquiterpenoids in 18 samples of 3 species of Curcuma used as Ezhu.

Optimization of pressurized liquid extraction for Z-ligustilide, Z-butylidenephthalide and ferulic acid in Angelica sinensis.

Pressurized liquid extraction, one of the most promising and recent sample preparation techniques, offers the advantages of reducing solvent consumption and allowing for automated sample handling. It is being exploited in diverse areas because of its distinct advantages. However, because the extraction is performed at elevated temperatures using PLE, thermal degradation could be a concern. Z-ligustilide, one of the biologically active components in Angelica sinensis, is an unstable compound, which decomposes rapidly at high temperature. In this study, we carried out a comparative study to evaluate PLE as a possible alternative to current extraction methods like Soxhlet and sonication for simultaneous extraction of Z-ligustilide, Z-butylidenephthalide and ferulic acid in A. sinensis. The operating parameters for PLE including extraction solvent, particle size, pressure, temperature, static extraction time, flush volume and numbers of extraction were optimized by using univariate approach coupled with central composite design (CCD) in order to obtain the highest extraction efficiency. Determination of Z-ligustilide, Z-butylidenephthalide and ferulic acid were carried out by means of high performance liquid chromatography with diode-array detector. The results showed that PLE was a simple, high efficient and automated method with lower solvent consumption compared to conventional extraction methods such as Soxhlet and sonication. PLE could be used for simultaneous extraction of Z-ligustilide, Z-butylidenephthalide and ferulic acid in A. sinensis.

Identification and quantitation of eleven sesquiterpenes in three species of Curcuma rhizomes by pressurized liquid extraction and gas chromatography-mass spectrometry.

In this paper, GC-MS and pressurized liquid extraction (PLE) was developed for identification and quantitative determination/estimation 11 sesquiterpenes including germacrene D, curzerene, gamma-elemene, furanodienone, curcumol, isocurcumenol, furanodiene, germacrone, curdione, curcumenol and neocurdione in Ezhu which are derived from three species of Curcuma, i.e., Curcuma phaeocaulis, Curcuma wenyujin and Curcuma kwangsiensis by using an analogue as standard. The results showed the methodology could quantitatively compare the quality of three species of Curcuma. The contents of investigated sesquiterpenes in three species of Curcuma were high variant. Hierarchical clustering analysis based on characteristics of 11 identified peaks in GC profiles showed that 18 samples were divided into two main clusters, C. phaeocaulis and C. wenyujin, respectively. C. kwangsiensis showed the characters closed to C. phaeocaulis or C. wenyujin based on its location. Five components such as furanodienone, germacrone, curdione, curcumenol and neocurdione were optimized as markers for quality control of Ezhu.

Treatment of turtle-breeding wastewater and domestic fecal sewage with soil cultivating system.

Turtle-breeding wastewater and domestic fecal sewage were treated by means of soil cultivating system. Results indicated that more than 50% CODCr and BOD5 of wastewaters were removed, removal rates of NH4(+)-N could reach about 70%-80%, but PO4(3-) could not be removed. The thesis analyzed functional mechanisms for pollutants and put forward main elements affecting treatment efficiencies, thus provided conditions for further research.

Antigen presentation capacity of murine macrophages infected with Leishmania amazonensis amastigotes.

Leishmania-infected M phi are potential candidates for the presentation of parasite Ag to Leishmania-specific CD4+ T lymphocytes. To assess whether infected cells could function as APC, we examined the ability of bone marrow-derived M phi infected with Leishmania amazonensis amastigotes to stimulate various CD4+, l-Ad- or l-Ed-restricted T-cell hybridomas specific for the bacteriophage lambda repressor cl protein, the human chorionic gonadotropin or OVA. A reduced capacity of infected M phi to present native Ag to most T-cell hybridomas tested was noted that was probably a result of a lower expression on their plasma membrane of stimulatory [la-peptide] complexes. Neither a reduced Ag uptake nor an altered Ag processing appeared to be at the origin of the partial inability of infected M phi to present Ag. As regards the level of plasma membrane la expression, no quantitative difference could be detected between uninfected and infected M phi. Moreover, after fixation with paraformaldehyde, the ability of plasma membrane la molecules to bind immunogenic peptides was apparently not reduced in infected M phi. So, these cells most likely expressed functional la molecules on their cell surface. Interestingly, infected M phi and M phi infected then cured by a treatment with a leishmanicidal compound were similarly impaired in their capacity to present native Ag or peptides to the hybridomas, and no recovery was noted even 24 h after the leishmanicidal treatment. Furthermore, infected M phi and M phi incubated with heat-killed amastigotes or with an amastigote homogenate exhibited similar inhibitions of Ag presentation. Taken together, these results suggest that the functional failure of infected M phi to present exogenous Ag could be because either of interferences with the events leading to the meeting of la molecules with peptides derived from these exogenous Ag or to a competition for binding to la molecules between these peptides and parasite molecules.

Human papillomaviruses and other influences on survival from cervical cancer in Panama.

OBJECTIVE: To determine the influence on survival from cervical cancer of human papillomaviruses (HPVs) and other factors including age, herpes simplex virus type 2 (HSV-2) antibody status, and number of pregnancies. METHODS: We followed 196 women diagnosed with invasive cervical cancer in Panama for an average of 32 months. Clinical and risk-factor information was obtained from these women through an interview and review of medical records. We assessed HPV DNA status by testing tumor specimens using polymerase chain reaction, Southern blot, and slot blot techniques. Kaplan-Meier survival curves and Cox proportional hazards model were used to assess the risk of mortality associated with selected variables. RESULTS: Eighty-one percent (N = 144) of the women tested for HPV were positive. Absence of HPV DNA was associated with a 1.9-fold excess risk of mortality (95% confidence interval [CI] 1.1-3.3) after controlling for age, clinical stage at diagnosis, number of pregnancies, and HSV-2 seropositivity. Women diagnosed with cervical cancer before the age of 30 had a ninefold excess risk of dying compared with those diagnosed at age 50 or older (relative risk [RR] 9.3, 95% CI 3.4-25.5). Parity was also an independent prognostic factor. Women with six or more pregnancies had a 2.5-fold excess risk of dying compared with women with three or fewer (95% CI 1.2-5.3). Years of education, presence of HSV-2 antibodies, age at first intercourse, number of sexual partners, oral contraceptive use, and cigarette smoking were not significantly associated with prognosis. CONCLUSION: These findings suggest that women negative for HPV DNA, those who are diagnosed at an early age, and those who have multiple pregnancies might have more aggressive tumors.

Occurrence of IgA and IgG antibodies to select peptides representing human papillomavirus type 16 among cervical cancer cases and controls.

We used an enzyme-linked immunosorbent assay to test sera from 186 cases of invasive cervical cancer and 172 age-matched controls for IgG and IgA antibodies to an human papillomavirus 16 E7 peptide and to peptide 245, representing an epitope in E2. Cases had significantly higher mean absorbance values than controls for both immunoglobulin isotypes to E7 and elevated mean values for IgG to peptide 245. Since absorbances were not normally distributed we analyzed cervical cancer risk for seropositive and seronegative women. Of the traditional cervical cancer risk factors, cigarette smoking, educational level, number of pregnancies, time interval since last Papanicolaou smear, and age at first intercourse influenced the distribution of seropositivity to some of the viral antigens. Adjusting for these variables, the odds ratios of cervical cancer associated with IgG to E7 was 5.28 [95% confidence (95% CI) = 2.4-11.6] and that with IgA to E7 was 2.67 (95% CI = 1.3-5.3). IgG to peptide 245 was less strongly associated, odds ratio 1.68 (95% CI = 1.2-3.3), and IgA to peptide 245 was not significantly associated with disease. These findings suggest that antibodies to E7 are markers for invasive cervical cancer. However, seropositivity correlated poorly with clinical state, survival, or the presence of human papillomavirus DNA in the cancer tissue.

Epidemiology of epilepsy in Guaymi Indians from Bocas del Toro Province, Republic of Panama.

This cross-sectional study was conducted to describe the epidemiology of epilepsy in Guaymi Indians residing in Changuinola, a small town on Panama's Caribbean coast near Costa Rica. We randomly selected households and attempted to enroll all residents aged less than or equal to 1 year; 337 eligible subjects agreed to participate (93% response rate). We administered a standard neurologic disease screening examination to all subjects and, if any abnormality was found, we administered a standard neurologic evaluation. We detected 19 cases of active epilepsy; the mean age at onset was 12 years, and generalized tonic-clonic seizures were the most common diagnosis (10 of 19, 53%). The prevalence of active epilepsy among Caribbean coastal Guaymi (57/1000) is considerably greater than that in lower class Panama City populations (22/1000) or in other parts of the world. To identify risk factors for epilepsy, we collected epidemiologic data and serum (for Cysticercus antibody) from subjects with active epilepsy and from 44 age/sex-matched controls. Significantly more cases (47%) than controls (6%) had other family members with epilepsy (relative risk, RR = 14); 44% of cases and 13% of controls reported a history of febrile seizures during childhood (RR = 6).

Human T cell lymphotropic virus infection in Guaymi Indians from Panama.

Preliminary studies found that 9% of Guaymi Indians from Bocas del Toro province have antibody to human T cell lymphotropic virus (HTLV-I/II). The present study enrolled 317 (21% of the population) Guaymi Indians from Changuinola, the capital of Bocas del Toro province and 333 (70% of the population) from Canquintu, an isolated rural village. Demographic information and family relationships were ascertained and subjects were screened for neurologic diseases. Serum specimens were screened by an enzyme-linked immunosorbent assay for HTLV-I/II antibody and positives were confirmed according to U.S. Public Health Service criteria. Twenty-five (8%) Guaymi residing in Changuinola and 7 (2.1%) from Canquintu were confirmed seropositive. In Changuinola, antibody was virtually limited to residents greater than or equal to 15 years of age (24 [16%] of 153) and rates were slightly higher in males than in females; in Canquintu, antibody rates did not increase significantly with age and appeared higher in females than in males. In Changuinola, there was no evidence for household clustering of infection. In contrast, HTLV antibody among Canquintu residents clustered significantly by household. HTLV-associated neurologic disease was not detected in either population. The atypical seroepidemiology observed in both locations might be explained if the virus endemic to the Guaymi differed from HTLV-I previously described in the Caribbean basin and Japan.

[Neurologic diseases associated with the HTLV-1 virus in Panama]. / Enfermedades neurológicas asociadas al virus HTLV-1 en Panamá.

Studies of the prevalence of the human T-cell lymphotropic virus (HTLV-1) in 1984 to 1986 in the Republic of Panama revealed a national seroprevalence of 1 to 2%. Since 1985 clinical epidemiological studies of neurological diseases associated to HTLV-1 are being done. Two hundred and fitly six clinical cases of thirty eight different neurological diseases of unknown etiology studied in the Neurology Services of the Santo Tomas Hospital and the Social Security Metropolitan Hospital Complex have been associated in some way to the HTLV-1. Twelve cases of progressive spastic paraparesis were identified and related to HLTV-1 as an etiologic agent. The ratio of men to women was maintained at 1:1 with the average age at onset at 44 years and without racial preference. There are important doubts about the association of this virus to multiple sclerosis. The seroprevalence of the HTLV-1 virus in Panama is found to be similar to that reported in neighboring countries and the association of tropical spastic paraparesis to THLV-1 infection is identified.

Genital human papillomavirus infection in Panama City prostitutes.

Little is known of the natural history of genital human papillomavirus (HPV) infections in women from high-risk populations. Samples were collected from 183 Panama City prostitutes and assessed for HPV (filter in situ DNA hybridization) and for sexually transmitted agents. The cohort was followed for 8 mo; 51% of subjects completed four monthly return visits and 16% were sampled eight times. The proportion of women found infected with HPV increased significantly with increasing numbers of consecutive samples tested; 38 (21%) of 183 women were positive after one visit and 46 (82%) of 56 who completed six visits were infected. The pattern of viral detection over time was not random, which implied that most prostitutes were persistently infected with genital HPVs and that either scattered foci of infection or periodic reactivation of latent virus occurred. Our findings suggest that multiple sampling is necessary to accurately estimate HPV infection rates and to define whether patterns of DNA expression are present.

Human immunodeficiency virus infection in the Republic of Panama.

Thirty-one documented acquired immune deficiency syndrome (AIDS) cases occurred in Panama during 1984-1987. Twenty-three (74%) patients were homosexual males and all but 2 patients recognized prior to June 1987 have died. To identify risk factors for human immunodeficiency virus infection, 287 male homosexual residents of Panama City were enrolled in a cross-sectional study. Nine had human immunodeficiency virus (HIV) antibody. Travel to the United States, homosexual relations with United States nationals in Panama, and sexual contacts in Panamanian clubs and bars were associated with human immunodeficiency virus infection by logistic regression analysis. Number of different male sex partners per year was identified but did not enter the logistic model at a significant level. To estimate seroprevalence in other high risk populations, 183 Panama City female prostitutes and 55 homosexual males from the rural Azuero peninsula were screened; none were seropositive. Eighty-four percent of Panamanian hemophiliacs had antibody; infection was related to factor VIII transfusions. Two of 182 sickle cell anemia patients and 15 of 7,720 volunteer blood donors were positive.