Cell wall antigens of Pneumocystis carinii trophozoites and cysts: purification and carbohydrate analysis of these glycoproteins.

We have purified and biochemically analyzed individual cell wall glycoproteins of Pneumocystis carinii. Our results show that corresponding core glycoproteins constitute the cell wall antigens in both trophozoites and cysts, and glycosylation of these glycoproteins does not appear to be significantly altered during development. Cysts and trophozoites in rat-derived organism preparations were separated from each other by counterflow centrifugal elutriation, then treated with Zymolyase to obtain the cell wall fractions. Gel electrophoresis patterns of these fractions from both life-cycle stages were qualitatively similar. Ten major antigenic glycoproteins in these fractions were purified by preparative continuous elution gel electrophoresis. All ten glycoproteins from cysts and trophozoites contained mannose, glucose, galactose, and N-acetylglucosamine, and some contained traces of fucose. The glycoproteins of cysts had more mannose than their trophozoite counterparts. The trophozoite glycoproteins differed from those of the cyst by the presence of xylose. To examine the species-specificity of glycoprotein glycosylation, preparations of human-derived P. carinii (comprised of mixed life-cycle stages) were also examined and found to contain the same sugars as those found in rat-derived organisms. Most of the purified rat-derived glycoproteins bound Concanvalin A, which was abolished by treatment with N-glycanase. This suggested that the majority of the oligosaccharides were N-linked to the proteins, but attempts to identify carbohydrate linkage sites by amino acid sequencing were hampered by apparent modifications of residues. The peptides derived by cyanogen bromide cleavage revealed distinct size patterns for each glycoprotein, suggesting that they were distinct proteins. Most of the glycoproteins reacted with monoclonal antibodies which recognize a highly conserved epitope on rat P. carinii. Four of the individually purified glycoprotein preparations elicited in vitro cellular immune responses, implicating their involvement in the recognition of P. carinii by host T cells. The identification and characterization of P. carinii cell wall proteins will be helpful in analyzing the relationship of the organism to its mammalian host.

[Efficacy of the EMLA cream in the reduction of pain caused by venipuncture in children premedicated with oral midazolam]. / Eficacia de la crema EMLA en la disminución del dolor a la venopunción en niños premedicados con midazolam oral.

OBJECTIVE: EMLA cream, a lidocaine-prilocaine mixture, penetrates skin easily. Our aim was to compare EMLA and placebo to assess the efficacy of EMLA in decreasing the pain of venipuncture in children premedicated with oral midazolam 0.5 mg/kg. PATIENTS AND METHODS: This was a prospective study enrolling 100 children 3 to 9 years of age (5.6 +/- 2) randomly distributed in 2 groups of 50. EMLA cream was applied in group 1 while placebo was applied in group 2 (control group). All were premedicated with oral midazolam. Either EMLA or placebo was applied at least 30 minutes before transfer to the operating theater and the area was covered with a transparent dressing. Parameters recorded upon arrival in the operating room and upon hand puncture with a 22-G needle were systolic and diastolic arterial pressures (SAP and DAP) and heart rate (HR). Pain was assessed on a behavior scale, a visual analog scale evaluated by the anesthesiologist (VAS-anesthesiologist) and a VAS evaluated by a nurse (VAS-nurse). Adverse events were also recorded. A Student t-test and a Mann-Whitney U-test were used for statistical analysis; the level of significance was p < 0.05. RESULTS: There were no significant differences in mean age or weight between the 2 groups. In the area EMLA was applied, 2 children presented erythema and 2 pruritus. Mean scores on the pain scales were lower in the EMLA group (p < 0.05) than in the control group: behavior scale 1.8 +/- 1.3 versus 3.2 +/- 1.7; VAS-anesthesiologist 2.8 +/- 2.3 versus 5.1 +/- 2.7; VAS-nurse 2.7 +/- 2.1 versus 5.9 +/- 1.9. HR increased in both groups (with placebo from 105 +/- 16 to 118 +/- 19, and with EMLA from 99 +/- 19 to 109 +/- 21), but the increase in SAP was statistically significant only in the placebo group, in which it rose from 113 +/- 11 to 125 +/- 16. CONCLUSION: EMLA cream decreases the pain of hand venipuncture in children premedicated with oral midazolam.

Fractionation of Pneumocystis carinii developmental stages by counterflow centrifugal elutriation and sequential filtrations.

Immunomagnetic sorting, sequential filtrations, and counterflow centrifugal elutriation were compared for their ability to obtain enriched populations of Pneumocystis carinii developmental stages from infected rat-lung homogenates. Elutriation combined with sequential filtrations resulted in highly (> 95%) enriched populations of P. carinii cysts and trophozoites with excellent viability. This approach offers advantages over previously described methods of obtaining enriched P. carinii cell populations and should have important applications to research on this organism.

Flow cytometric analyses of lectin binding to Pneumocystis carinii surface carbohydrates.

Pneumocystis carinii obtained from infected rat lung homogenates was incubated with fluorescein isothiocyanate-conjugated lectins, counterstained with the nuclear stain, propidium iodide (PI), and analyzed by dual parameter histograms for lectin-associated green and PI-associated red fluorescence using a fluorescence-activated cell sorter. The presence of glucose/mannose moieties was evidenced by the binding of all organisms to concanavalin A and Wisteria floribunda. From the lectin group specific for N-acetyl-D-glucosamine, P. carinii reacted strongly with wheat germ agglutinin and less intensely with Solanum tuberosum. Reaction with lectins specific for N-acetyl-D-galactosamine/galactose was variable, probably reflecting the secondary binding affinities of the lectins used. Soybean agglutinin, Bauhinia purpurea agglutinin, and Maclura pomifera agglutinin reacted moderately, whereas Dolichos biflorus agglutinin, and Griffonia simplicifolia I reacted less avidly. The organisms reacted partially with Ulex europaeus agglutinin, a lectin specific for fucose, and did not react well with Arachis hypogaea, Viscum album agglutinin, and Griffonia simplicifolia I beta 4, lectins specific for galactose. A very weak fluorescent signal was detected with Limax flavus agglutinin, suggesting little or no sialic acid was present. All lectin-binding reactions were confirmed for specificity by inhibition with the relevant carbohydrates. Flow cytometric analysis of lung-derived Pneumocystis organisms stained with fluorescent surface and nuclear dyes provides a rapid method for characterization of large parasite populations.

Isolation of Pneumocystis carinii cysts by flow cytometry.

Pneumocystis carinii cysts were separated as enriched populations from suspensions of lung homogenate obtained from infected rats containing all developmental stages of this organism. Isolation of cyst populations was achieved by incubating filtered lung homogenate with the fluorescent phospholipid analog 1-palmitoyl-2-C6-NBD-phosphatidylcholine. Whereas cysts did not fluorescence as a result of outer-wall restraint of lipid integration, trophozoites and young intermediate stages readily incorporated the fluorescently labeled lipid analog into their outer membrane. The two distinct labeling patterns displayed by cysts and other developmental phases of P. carinii constitute a novel, easy, and reproducible means of isolating cysts from infected lung homogenate by flow cytometry.

Analysis of Pneumocystis carinii cyst wall. I. Evidence for an outer surface membrane.

It has long been thought that the cyst form of Pneumocystis carinii, which can resist host defenses and antimicrobial drugs, is responsible for relapses of P. carinii pneumonia. The thick wall of the cyst is immunogenic and rich in glucosyl/mannosyl and N-acetyl-D-glucosamine residues. In this study we have demonstrated the presence of a hitherto unreported outer membrane in the cyst wall of P. carinii. This membrane was detected by a combination of techniques, including transmission electron microscopy, freeze-fracture electron microscopy, and membrane labeling with fluorescent lipid analogs following treatment of P. carinii cysts from infected rats for 30 min with Zymolyase, a beta-1-3 glucanase. As in gram-negative bacteria and blue-green algae, this 2nd membrane may have an important role in osmoregulation and nutrient utilization; it may also mediate the interaction of P. carinii with its host and serve as a target for drug therapy.

Analysis of Pneumocystis carinii cyst wall. II. Sugar composition.

Pneumocystis carinii cysts are capable of resisting host defenses and antimicrobial drugs and are therefore thought to be responsible for relapses of P. carinii pneumonia in AIDS and other immunocompromised patients. The interaction of P. carinii with its host, and other P. carinii, might be mediated by molecules which form the outer surfaces of this organism. Carbohydrates are known to play many roles in cell-cell adhesion, and have been detected on the surface of P. carinii by lectin labeling experiments. In this study P. carinii cyst wall material was obtained from Zymolyase treatment. Alditol acetate derivatives of neutral and amino sugars or trimethylsilyl derivatives of methyl glycosides were prepared from the monosaccharides released from the sample by acid hydrolysis. Analyses were done by a combination of gas chromatography and mass spectrometry. Glucose was found to be the major sugar constituent. Mannose and galactose were present in equal ratios. A lesser amount of N-acetyl-D-glucosamine, and trace amounts of ribose and sialic acid were present in the cyst wall samples analyzed. These sugars may mediate P. carinii-host interaction and play an important protective role by creating a permeability barrier around the cyst.

[Preanesthetic consultation in pediatrics: experience with the use of drawings]. / La consultation pré-anesthésique en pédiatrie: une expérience d'utilisation du dessin.

69 children scheduled for ENT surgery have been asked by the anesthesiologist to draw a picture. A analysis of some of those drawings provides information about the psychological reactions of children facing surgery, determined by their current situation, personality and past history. This simple method proved to be an useful adjunct to the psychological preparation of children to anesthesia and surgery. It contributes to a better relationship between anesthesiologist and child, and to a better knowledge of the reactions of children; it could be used in a more systematic manner.

Lectins as probes to Pneumocystis carinii surface glycocomplexes.

The binding characteristics of a panel of commercially available FITC-conjugated lectins to Pneumocystis carinii (Pc) were assessed by fluorescence microscopy and flow cytometry. Rat Pc obtained from infected lung homogenates were incubated with FITC-conjugated lectins in a series of concentrations, counterstained with propidium iodide, and analyzed for percent fluorescence and fluorescence intensity. All organisms bound concanavalin A and Wisteria floribunda agglutinin, 2 representatives of the glucose/mannose-binding group. From the lectin group specific for N-acetylglucosamine, Pc reacted more strongly with wheat germ agglutinin than with Solanum tuberosum agglutinin or Griffonia simplicifolia II lectin. Pneumocystis treated with lectins specific for N-acetyl-D-galactosamine and galactose exhibited much variation; the cells reacted moderately well to soybean agglutinin and less to Bauhinia purpurea, Maclura pomifera and Dolichos biflorus agglutinins and Griffonia simplicifolia I lectin. Arachis hypogaea agglutinin, Viscum album agglutinin and Griffonia simplicifolia I-beta 4 lectin had not effect. The organisms reacted weakly with Ulex europeus I agglutinin which is specific for fucose and did not react with Limax flavus lectin, which is specific for sialic acid. Competitive inhibition studies using relevant carbohydrates were performed to indicate that the positive reactions were specific. These studies should help to elucidate the mechanisms of attachment and pathogenesis of this organism.