[One case of nosocomial A(H1N1)v2009 influenza in Réunion Island]. / Un cas de grippe A(H1N1)v2009 nosocomiale à la Réunion.

A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low.

[Macro-AST and myeloma: An incidental association?] / Macro-ASAT et myélome : une association fortuite ?

INTRODUCTION: Macro-AST is recognized as a classical aetiology of isolated and persistent increase of serum aspartate aminotransferase (AST) levels. Macro-AST are high molecular weight complexes associating AST and a macromolecule, often an immunoglobulin. Although those macroenzymes of unknown pathogenesis are usually non-pathogenic, association with several diseases, including autoimmune diseases and liver diseases has been described. CASE REPORT: We report here the case of a 45-year-old patient with previously normal liver enzymes in whom an AST elevation and an IgA monoclonal gammopathy were discovered concomitantly. Following the diagnosis of multiple myeloma, we could evidence in the patient's serum a complex between AST and the monoclonal IgA. AST levels course followed closely the progression of monoclonal gammopathy. CONCLUSION: This is the first report demonstrating a clear link between macro-AST and a monoclonal gammopathy.

Frequent detection of minimal residual disease by use of the polymerase chain reaction in long-term survivors after bone marrow transplantation for chronic myeloid leukemia.

The polymerase chain reaction (PCR) allows the detection of minimal amounts of nucleic sequences and has been successfully used to test for the chronic myeloid leukemia-specific bcr/abl transcripts. We studied blood samples from 17 patients who had undergone allogeneic bone marrow transplantation for CML, using a modified polymerase chain reaction-based assay for the detection of leukemic mRNA. This nested PCR technique was found to be highly sensitive, detecting the chimeric bcr/abl transcript in 16 of 17 patients including several long-term survivors. Cytogenetic techniques failed to detect Ph mitoses. The clinical significance of the persisting bcr/abl transcript for long periods following BMT is poorly understood and remains to be elucidated by further studies.

Gene analysis in 18 cases of cutaneous lymphoid infiltrates of uncertain significance.

BACKGROUND AND DESIGN: Patients with cutaneous lymphoid infiltrates that appear reactive histologically and immunophenotypically may develop clinically overt cutaneous lymphoma, suggesting the possibility of misdiagnosis by classical methods. We investigated DNA rearrangement in such cases of lymphoid infiltrates of uncertain significance to determine whether this more sensitive method could detect an occult monoclonal lymphoid proliferation. METHODS AND PATIENTS: Skin biopsy specimens were taken from 18 cutaneous lymphoid infiltrates diagnosed as reactive on the basis of clinical, histopathological, and immunohistochemical criteria. Specimens included 12 cases with mixed lymphoid infiltrates rich in polytypic B cells and inconstant follicle formation and 6 cases with exclusive T-lymphoid infiltrates. Southern blot analysis for immunoglobulin and T-cell-receptor beta-chain gene rearrangements was performed in all cases. RESULTS: No specimen showed T-cell-receptor beta-chain gene rearrangement. Clonal immunoglobulin gene rearrangement was demonstrated in one case with polytypic B cells, but no clinical malignancy has appeared 19 years after disease onset duration and 7 years after detection of the B-cell clone. CONCLUSIONS: In the present series, the results suggest that histological and immunohistological criteria are appropriate to establish the diagnosis of most cases of cutaneous lymphoid infiltrates. The detection of a B-cell clone is remarkable by absence of clinical malignancy, suggesting that such a discovery does not necessarily mean an aggressive evolution. Nevertheless, there is presently no way to predict the prognosis of a clonal lymphoid proliferation, indicating that a long-term follow-up is necessary.

Quantification of red blood cell fragmentation: usefulness of heating cells and of automatic counting devices.

Spontaneous red blood cell (RBC) fragmentation occurs in some membrane erythropathies like hereditary elliptocytosis (HE); this phenomenon is produced in normal RBC by heating at 49 degrees C, but not at temperatures below this limit; fragmentation is usually quantified by counting the number of fragments/1000 RBC under light microscopic examination. The present work demonstrates: i) that enumeration of fragments is performed more precisely with an automatic blood cells counter on the 'platelet' channel; and ii) that heating at 48 degrees C enhances the fragmentation of RBC when they have a severe disruption of skeletal lattice, like in HE.

[Xeroderma pigmentosum. A study in 40 Algerian patients]. / Xeroderma pigmentosum. Etude de 40 malades algériens.

INTRODUCTION: Xeroderma pigmentosum (XP) is a rate autosomal recessive disorder related to DNA repair defects. Recently, modifications of oncogenes and mutations of the p53 suppressor gene have been reported in skin tumors of XP patients. The purpose is to study, through a series of 40 patients admitted to the Dermatologic Clinic of Algiers, the characteristics of XP in Algeria. PATIENTS AND METHODS: For each patient, familiarity, clinical and biological examinations and therapeutic results were studied. Biological studies have been axed mainly on analysis of DNA extracted from skin tumors of 18 patients to detect oncogene modifications by Southern blot and hybridization. A technic, based on single strand DNA conformation polymorphism (SSCP), has been carried out to detect rapidly mutations on the p53 gene. RESULTS: A consanguinity in the first degree is noted in 95 p. 100 of cases and a familiarity in 63 p. 100 of cases. The median age of patients is 10 years; sex ratio is close to one; 32 patients (80 p. 100) are classic XP and 8 (20 p. 100) are XP variant. In 18 tumors analysed, the Ha-ras gene is amplified and/or modified in 50 p. 100 of cases. Only 3 tumors (16.6 p. 100) show mutations of the p53 gene (transitions C-T). Surgical treatment isolated or associated to polychemotherapy permitted to resolve tumors in 75 p. 100 of cases. DISCUSSION: In Algeria, XP are mainly classic with a particularly high frequency of occular (62 p. 100) and neurological manifestations (62 p. 100). Genetic studies confirm modifications of the Haras gene in direct relation with unrepaired UV lesions in classic XP and mutations of the p53 tumor suppressor gene characteristic of mutation spectra induced by UV. Surgery is the treatment of choice for tumors; polychemotherapy is an alternative in advanced cases.

[Detection of residual disease in onco-hematology: the contribution of molecular biology]. / Détection de la maladie résiduelle en onco-hématologie: apport de la biologie moléculaire.

The development of the tools of recombinant DNA technology has implications for clinical oncology. We briefly describe in this article the use of DNA probes as diagnostic tools for the study of leukemias and other malignancies and for the detection of minimal residual disease. Useful DNA markers can be used to assess successful engraftment in bone marrow transplanted patients and to detect mixed chimerism. Immunoglobulin and T cell receptor gene rearrangements can be analysed to investigate the presence of clonal lymphoid populations with pathologic samples and to determine their B or T cell lineage. Point mutations associated with oncogene activation can be detected by hybridization with allele specific oligonucleotide probes, allowing molecular analysis of certain tumors. The level of sensitivity of the different assays are discussed along with their usefulness in the detection of residual malignant cells after appropriate therapy.

Red cell kinetics in thalassaemia intermedia: its use for a prospective prognosis.

A kinetic study of erythroid cell production and destruction (radioactive iron incorporation, red blood cell survival time, bone marrow scintigraphy) was performed in 12 cases of thalassaemia intermedia (six adults and six children), classified retrospectively, and compared to that performed in 17 cases of Cooley's anaemia. Our results confirm the genetic heterogeneity of these cases, the level of Hb F varies from 30% to 100% and the non alpha/alpha chain synthesis is only statistically superior to that seen in Cooley's disease. On the other hand, the kinetic study clearly separates the cases who are, or will be, clinically intermediate, showing a higher radioactive iron medullary uptake, a less ineffective erythropoiesis than that seen in Cooley's disease, and a greater peripheral haemolysis. In our study, no overlap was seen between the two groups. Iron kinetic study is then of prognostic interest and may help in therapy decisions, transfusion regimen and iron chelation, and splenectomy.

alpha-Thalassaemia associated with the deletion of two nucleotides at position -2 and -3 preceding the AUG codon.

The nucleotide sequence of three single alpha-globin genes resulting from a rightward 3.7-kb deletion is described. The alpha genes were isolated from the DNA of three subjects homozygous for this deletion, the first being in addition homozygous for the structural mutation alpha G Philadelphia (genotype -alpha G/-alpha G), the second, heterozygous for this structural mutation (genotype -alpha A/-alpha G) and the third homozygous for an alpha + -thalassaemic gene (genotype -alpha +thal/-alpha +thal). The latter subject produced HbH in contrast to the two others. Whereas the two alpha A and alpha G genes are identical to the normal alpha 1-globin gene (except for the alpha G point mutation), the alpha +thal gene has (i) a deletion of the two nucleotides at position -2 and -3 preceding the ATG codon, and (ii) a fusion between the 5' part of the normal alpha 2 gene and the 3' part of the normal alpha 1 gene. Using a dot-blot assay, we show that reticulocytes from the HbH subject contain at least as much alpha mRNA as reticulocytes from the two other subjects. In a transient expression system, the alpha +thal gene leads to normally spliced transcripts. We conclude from these data that the defective output of alpha chains by the alpha +thal gene, as evidenced by HbH production, results from a decreased efficiency of alpha-mRNA translation due to the two nucleotides deletion preceding the AUG codon.

Occurrence and characteristics of hereditary spherocytosis in Algeria.

In a survey of more than 12,000 persons referred to a hematological outpatient clinic in Algiers, we estimated that the incidence of hereditary spherocytosis (HS) is 1/1000. Another 9 cases were found in nine of the corresponding families. Anemia was present in a total of 44 subjects (81%). The transmission was dominant in five of eight informative families (63%). No firm conclusion could be reached concerning the amount of spectrin and ankyrin in nine families; however two-dimensional peptide maps ruled out any alphaII domain abnormality in these families. We estimate that HS has roughly the same incidence and features among Algerians as in Europeans or people of European descent.

Beta thalassemic mutations recognized by DNA mapping with Hph I and Rsa I in the Algerian population.

By using Hph I and Rsa I restriction enzymes and beta globin large intervening sequence as a probe, we have investigated the DNA of 20 Algerian patients with beta(0) or beta(+) thalassemia. In any of them, we detected the nucleotide change which is known to generate an additional Hph I site at the 5' splice junction of the beta globin large intervening sequence and which yields a beta(0) phenotype. In one of them, we detected the nucleotide change which is known to generate an additional Rsa I site within the beta globin large intervening sequence and which is supposed to yield a beta(+) phenotype. These results indicate that these two types of mutation are relatively rare in the Algerian population.

Mapping the alpha-globin genes in an Algerian HbH patient and his family.

The organization of alpha-globin genes in normal white European, normal Algerian, and alpha-thalassemic Algerian DNA was examined by restriction endonuclease mapping using HindIII, HpaI, Bamhi, EcoRI, BgIII, and PstI. The results for normal DNA confirm and add to the findings of Surrey et al. and Orkin; the two alpha-genes are approximately 3.0 kb apart. The restriction enzymes BgIII and HpaL cut between the two alpha-genes. Four PstL sites are located: two surrounding each alpha-gene. The physical maps for a number of Algerian controls (normal alpha- and beta-globin biosynthesis profiles) are identical to that of the European controls. The Algerian alpha-thalassemic presenting with HbH disease was found to be homozygous for a 3.5-3.7 kb deletion at the alpha-gene locus, leaving one alpha-gene per chromosome. The patient's mother and father are both found to be heterozygous for this deletion. An unaffected sibling carries both normal chromosomes. The deletion could be the result of a Lepore-like crossover fusion event between the two alpha-globin genes, or of a 3.7 kb deletion of either the entire 5' alpha-gene or the entire 3' alpha-gene. The Algerian case of HbH disease studied differs from Asian cases in both the mode of inheritance and the molecular pathology of the alpha-thalassemia mutation. If this type of deletion is the major cause of Algerian alpha-thalassemia, it would explain the apparent absence of Hydrops fetalis in this geographical area.

Alpha-thalassemia haplotypes in the Algerian population.

DNA mapping was performed in seven unrelated Hb H patients and nine carriers for alpha-thalassemia trait originating from Algeria. This study has allowed us to identify four alpha-thalassemia haplotypes: the (-alpha 3.7) haplotype, which is the most frequent (18 of 23 alpha-thalassemic chromosomes), the (-(alpha)20.5) haplotype, a (--) haplotype, and an (alpha alpha)T haplotype. Our results also show that the (-alpha 3.7) haplotypes encountered in the Algerian population are heterogeneous and differ by the site of the unequal crossover responsible for the 3.7-kb deletion and the size of the interzeta fragment. In addition, during this survey we observed that normal chromosomes bearing a polymorphic BglII site are associated with different interzeta fragments.

Alpha globin gene triplication in severe heterozygous beta thalassemia.

In an Algerian family, three sibs with an unusually severe heterozygous beta-thalassemia and two sibs with a typical heterozygous beta-thalassemia were found. Both conditions were transmitted vertically. Globin chain synthesis and DNA restriction enzyme analysis showed that the unusual severity of heterozygous beta-thalassemia observed in this family is related to an overproduction of alpha-globin chains originating from an alpha-globin gene triplication.

Hemoglobin H disease from Algeria: genetic and molecular characterization.

A case of Hb H disease from Algeria was studied at the genetic and molecular level in order to delineate the pattern of alpha-thalassemia in the Mediterranean population. The family study indicated that both parents had the hematological and clinical manifestation of alpha-thalassemia trait and that the affected sibling had homozygous alpha-thalassemia with 5.6% Hb H, microcytosis and an alpha-/non-alpha-biosynthetic ratio of 0.64. Hybridization in globin cDNA alpha excess suggested that the molecular defect responsible for this form of alpha-thalassemia is a partial deletion of the haploid stock of alpha-globin genes. The Algerian case of Hb H disease studied thus differs from Asian and Negro cases by the mode of inheritance of the alpha-thalassemia mutation involved.

Hemoglobin Bart's in Northern Algeria.

The hemoglobin patterns of 293 cord bloods from Northern Algeria were examined by electrophoresis on cellulose-acetate strips. A fast-moving component, identified as Hb Bart's, was found in about 10% of the cases. The levels of Hb Bart's ranged from 0.1 to 10% of the total hemoglobin. There was a significant correlation between the Hb Bart's levels and the decrease in MCV. The relative rates of globin chain synthesis measured by 3H-leucine incorporation was estimated in 15 cord bloods. It was found imbalanced in the 5 cord bloods which contained more than 0.5% Hb Bart's. These findings suggest that elevated Hb Bart's levels in the Algerian population are due to the presence of alpha-thalassemia.

Lymphomatoid granulomatosis in a patient with acute myeloblastic leukemia in remission.

In a patient treated for acute myeloblastic leukemia (AML), we saw an angiocentric and angiodestructive lymphoma that resembled lymphomatoid granulomatosis (LG). The lesions tended to involve extranodal sites such as the lung, the parotid gland, and the skin. The immunologic studies showed that the proliferating lymphoid cells were mature T cells. Furthermore, genotypic studies disclosed a clonal rearrangement of the beta T-cell receptor gene. It is concluded that this case of LG is related to a neoplastic T-cell lymphoproliferative disorder. The relations between LG and the previous AML are discussed.

Mixed blood chimerism in T cell-depleted bone marrow transplant recipients: evaluation using DNA polymorphisms.

We have used DNA sequence polymorphism analysis to document engraftment after T cell-depleted bone marrow transplantation (BMT), with a selected panel of four DNA probes. In contrast to nondepleted BMT recipients, the patients who received T cell-depleted marrow exhibited a mixed blood chimerism. This mosaicism was observed before graft failure or relapse in six patients. However, in five other patients, this mixed chimerism was not followed by these complications with a follow-up of 9 to 31 months after transplantation. Our results support the hypothesis that transplanted bone marrow T cells may help to maintain engraftment by eliminating host cells that can cause graft failure.