Long-term chikungunya infection clinical manifestations after an outbreak in Italy: a prognostic cohort study.

OBJECTIVES: Following a Chikungunya (CHIKV) outbreak in Italy, a cohort study was conducted to describe the infection long-term clinical course and outcome. METHODS: Persons identified through active and passive surveillance as confirmed or possible CHIKV cases during the outbreak were enrolled and interviewed by trained public health nurses, between 4-5 and 12-13 months following the acute stage. Patients reporting persistent clinical symptoms were evaluated by rheumatologists. Serum samples were obtained and anti-CHIKV specific IgG and IgM immune responses detected. Only confirmed cases who completed the follow-up were analysed. RESULTS: Out of 250 patients, 66.5% still reported myalgia, asthenia or arthralgia (most frequent sign) after 12 months. Functional ability, measured by the ROAD index, was more impaired for lower extremities (3.75; Inter Quartile Range - IQR 4.4), and the activities of daily living (average 4.2; IQR 5). Variables independently associated with the presence of joint pain at 12-13 months were increasing age, and history of rheumatologic diseases). Elderly, females, and persons with history of rheumatologic diseases had higher anti-CHIKV IgG titres at 12-13 months. CONCLUSIONS: This study confirms, in an unselected population, that the long-lasting burden of CHIKV infection is significant.

Cytoskeleton organization of normal and neoplastic lymphocytes and lymphoid cell lines of T and B origin.

An anomalous organization of the cytoskeleton has been described in lymphocytes from chronic lymphatic leukaemia and in only few cell lines. We have now studied normal and neoplastic lymphocytes and lymphoid cell lines of both T and B lineage in order to detect morphological differences in the expression of microfilaments and intermediate filaments. Microfilaments appear to be well expressed by all the B cells, whereas a rich network of intermediate filaments is present in T cells and plasma cells. Most prominent changes occur in the latter system, which is almost lacking in cells of B chronic lymphatic and hairy cell leukaemia. Although the significance of the present findings is not yet clear, one might speculate that such alterations account for some of the aberrant functions and peculiar biologic properties of neoplastic lymphocytes.

Close association between antibodies to cytoskeletal intermediate filaments, and chronic graft-versus-host disease.

Chronic graft-versus-host disease can mimic various autoimmune disorders, although autoantibodies are rarely detected in the sera of affected patients. Antibodies to cytoskeleton are a frequent finding in patients affected by autoimmune disorders. In all the sera of 16 patients who were submitted to allogeneic bone marrow transplantation, we have found antibodies against cytoskeletal intermediate filaments. Moreover, the titer of such antibodies is quite elevated when compared with those reported in autoimmune disorders. A statistically significant difference between the titers found in patients without and with cGVHD (median 1:40 vs. 1:256, P less than 0.05) has been found. This would suggest that such antibodies might be relevant in monitoring clinical course. Furthermore, since certain cytoskeleton antigens have been shown to be expressed also on cell membrane, antibodies against intermediate filaments might also play a more important role by interfering with such surface structures.

Comparison of various cell types as substrates for the detection of antiactin antibodies in chronic liver disease.

Human cultured fibroblasts and Raji and peripheral blood mononuclear cells have been compared as substrates for the immunofluorescent detection of antiactin microfilament antibodies in sera from chronic liver disease. Raji and mononuclear cells, which exhibit a rich microfilament network, proved to be the most sensitive substrates for this purpose. The clinical relevance of these findings in the diagnosis of "autoimmune" chronic liver disease is discussed.

Vimentin and keratin intermediate filaments expression by K562 leukemic cell line.

The expression of intermediate filaments (IMF) by K562 leukemic cell line has been studied by the use of polyclonal and monoclonal antibodies. These cells exhibited an extremely rich network of IMF reacting with both anti-vimentin and anti-keratin antibodies. Although these results need to be confirmed by different techniques, such as immunoblotting, they suggest the possibility that leukemic cell lines can express different types of IMF similarly to other cultured cells.

Prevalence of autoimmune atrophic gastritis in vitiligo.

Gastric biopsies, and measurements of fasting serum gastrin levels and titers of antihuman parietal cell antibodies have been performed in 65 unselected patients with vitiligo. Histologic evidence of autoimmune atrophic gastritis has been obtained in 10 cases (15%), who were all positive for the antibodies and who had elevated gastrin levels. The study of gastric secretion after pentagastrin stimulation, performed in 7 of these patients, showed a markedly reduced acid output. The present study provides definite evidence of the association of autoimmune atrophic gastritis with a proportion of vitiligo cases and suggests the need for surveillance of these patients in terms of gastric neoplasia.