The pp65 antigenaemia test as a predictor of cytomegalovirus-induced end-organ disease in patients with AIDS.

OBJECTIVE: To evaluate the predictive value of pp65 antigenaemia quantitative test for cytomegalovirus (CMV) end-organ disease in patients with advanced HIV infection. DESIGN AND PATIENTS: A prospective study in AIDS patients or HIV-infected subjects with CD4 count < 150 x 10(6)/l or CD4 percentage < 10% was carried out. Patients with a history of CMV disease or positive viraemia or antigenaemia tests and subjects under anti-herpes suppressive therapy were excluded. Clinical, ophthalmoscopic, biochemical and virological (antigenaemia test) evaluations were performed at baseline and every 1-3 months until the onset of CMV end-organ disease. SETTING: Institutional tertiary care centre. RESULTS: Forty-nine patients were evaluable for this study. End-organ disease was observed in 13 patients, 11 with at least one positive test, two with persistently negative assays. Thirteen patients without CMV disease had at least one positive test, whereas 23 always had negative tests. The 12-month Kaplan-Meier estimate of the incidence of CMV disease in our population was 30.9% and was 75% in antigenaemia-positive subjects. The negative predictive value (NPV) of the test was 92%, and the positive predictive value (PPV) was 45.8%. However, the NPV of quantitative (> 20 cells) antigenaemia assay was 92.1% and the PPV was 90.9%. CONCLUSIONS: The antigenaemia test is a quick, simple and easy to perform assay for diagnosing CMV infection. The NPV is fairly good, as is the PPV when the quantitative method (> 20 positive cells) is used. This test could be used as an alternative to polymerase chain reaction in order to select patients at higher risk of CMV disease who can be treated with pre-emptive anti-CMV therapy.

Characterization of hyperlipidemia in two patients with analbuminemia.

The results of plasma lipid and lipoprotein analysis in two related patients, brother (R.U.) and sister (R.R.) with analbuminemia, and three first-degree relatives (parents and sister) are reported. Both patients showed a remarkable increase in cholesterol and phospholipid levels, and there was a corresponding increase in serum apo B and apo A-I. This hyperlipidemia is due to a selective increase in LDL and HDL concentrations. R.U. showed an increase in both HDL2- and HDL3-cholesterol, R.R. only in HDL3-cholesterol. VLDL concentration was reduced in R.U. and normal in R.R. The plasma lipoprotein electrophoretic pattern did not correspond to any of the phenotypes in Fredrickson's classification. Composition of the different lipoprotein fractions was normal in the patients and family members. Serum FFA level in R.R. was very low. An increase in the plasma protein fractions, particularly the transport fractions, was confirmed in both patients. The possible pathophysiology of the hypercholesterolemia in these patients is discussed. Unlike other reported cases, clinical signs of atherosclerotic complications were absent.

The behaviour of specific antibody classes in human hydatid disease.

The behaviour of IgE antibodies was investigated by the micro-ELISA method (IgE-ELISA) in patients affected by hydatidosis or in patients who had already been operated on. The results were correlated with those obtained by IgG-ELISA, IgM-ELISA, IgA-ELISA and IHA tests. In the preoperative phase the IgG-ELISA method proved to be as sensitive (80%) as the IHA test (78.5%); the IgE-ELISA method showed a good sensitivity (72.8%) with a positive rate for the IgE-ELISA/IHA of 92.7%. The IgM- and IgA-ELISA methods were of moderate sensitivity. The IgE-ELISA proved to be much more suitable than the other methods for postoperative control, since the persistence of positivity 4 years after surgery suggests the involvement of a relapse.

Post operative surveillance of human hydatidosis: evaluation of immunodiagnostic tests.

We investigated the kinetics of antibodies detected by indirect hemagglutination (IHA), IgE Elisa and immunoelectrophoresis (IEP) in patients with hydatid disease operated on and continuously followed in the pre-operative and post-operative periods. In the pre-operative phase the IgE Elisa test was found to be adequately sensitive (68.4%) compared with IHA (79%), with a ratio of IgE Elisa/IHA positivity of 87%, while IEP was positive in 55.3% of cases (IEP/IHA ratio = 70%). During post-operative follow-up IHA became negative late in patients who were cured (7 out of 11 were still positive after 4 yrs), whereas IEP and IgE Elisa became negative within 2 yrs of operation (apart from 1 patient with a persisting positive IgE Elisa 3 yrs later). However, IgE Elisa appeared clearly more sensitive in revealing postoperative recurrences (13 out of 13 patients had positive IgE Elisa, vs. 6 out of 13 IEP).

A murine oncornavirus marker in adenovirus 7-transformed mouse cells.

The presence of oncornavirus particles in BALB/c mouse cells transformed by adenovirus 7 was investigated. The particles detected had a buoyant density of 1.16 g/cm3; both p30 and adenovirus T-specific immunofluorescence was demonstrated in the cell cytoplasm. No C-particles were shown by the electron microscope.

Choroidal granuloma caused by atypical mycobacterium in a patient with AIDS: a case report.

The case presented is a chorioretinal granuloma in a patient with AIDS. The neoformation appeared to be caused by atypical mycobacterium, although it was not possible to isolate the germ. The chorioretinal infection caused by atypical mycobacterium in patients with AIDS occurs very rarely and has so far been described only as a post-mortem finding.

[National epidemiologic study on hydatidosis]. / Indagine epidemiologica nazionale sull'idatidosi.

The results of an epidemiological survey on surgical cases of human hydatidosis in 9 italian regions (Central, Southern and Insular Italy) with the highest incidence of disease and a population of 27,054,000 inhabitants are reported. The period considered was from 1980 through 1984. 2,592 cases have been collected and related to sex, age, occupation, residence of surgically treated patients and cyst localization. Comparison of results from the present and a previous survey was carried out.

[Susceptibility of P. aeruginosa and enterobacteriaceae isolated from 1986 to 1994 in the Microbiology laboratory of the Infectious Diseases Institute of Perugia University]. / Variazione della sensibilita agli antibiotici di Pseudomonas aeruginosa e di alcune specie di enterobatteri isolati nel laboratorio di Batteriologia dell'Istituto di Malattie Infettive dell'Università di Perugia dal 1986 al 1994.

From 1986 to 1994, 812 P. aeruginosa, 1997 E. coli, 437 P. mirabilis, 400 Klebsiella spp., 238 Enterobacter spp., 130 Serratia spp. strains were isolated from clinical materials in the Microbiology laboratory of the Infectious Diseases Institute of Policlinico Monteluce, Perugia University. During the study period the Authors observed the following variations in the susceptibility patterns: increased resistance of P. aeruginosa to piperacillin from 20.8% to 27.2% (P<0.05), amikacin from 11.9% to 17.5% (P<0.05), netilmicin from 11.8% to 28.6% (P<0.01), pefloxacin from 74.4% to 87.8% (P<0.01); E. coli to norfloxacin, ciprofloxacin and pefloxacin, respectively from 1.3% to 3.6% (P<0.001), from 1.5% to 3.6% (P<0.05) and from 3.2% to 9% (P<0.001); Serratia spp. to ceftazidime from 14% to 33.3% (P<0.05); Enterobacter spp. to norfloxacin from 5.1% to 13.6% (P<0.05), cotrimoxazole from 12.8% to 23.5% (P<0.05) and chloramphenicol from 19.4% to 31.8% (P<0.05). Moreover cephalotin resistant strains of E. coli decreased from 29.3% to 21.3% in the last 4 years (P<0.001).

[Septicemia and systemic inflammatory response]. / Setticemia e risposta infiammatoria sistemica.

To determine the relation between endocarditis/septicemia and systemic inflammatory response syndrome (SIRS), septic shock, MODS, we performed a retrospective analysis in 196 HIV-negative patients, with endocarditis/septicemia. No deaths were observed between 20 patients with endocarditis without severe infective SIRS/septic shock. On the other hand among 10 patients with endocarditis with severe infective SIRS/septic shock we registered 3 deaths (P = 0.052). No deaths were registered among 93 patients with septicemia without severe infective SIRS/septic shock. Between 73 patients with septicemia and severe infective SIRS/septic shock 9 (12.3%) patients died and, precisely, 7/61 in severe infective SIRS (11.4%) and 2/.12 (16.6%) in septic shock (P = 0.003). The definition of septicemia according to Schottmüller (1914), as a generalized bacterial infection with a persistent bacteremia is still justified. The term "sepsis" has become ambiguous because it has been used as synonym of "acute response to infection", while in the past and presently, at least in Europe, it is synonym of septicemia, persistent bacteremia. The term of SIRS could avoid the misunderstanding. The words: "infective SIRS", "severe infective SIRS", may label properly the reactive events mounted by the host as a useful defence against infections but they become dangerous and bring about septic shock, organ failure and mortality when excessive.

[Present issues in antiviral vaccines (author's tranls)]. / L'attuale problematica in tema di vaccinazioni antivirali.

The conditions are examined, which advise the adoption or discontinuance of a vaccination. In Italy, anti-polio vaccination is compulsory and ought to be enforced also in the future. On the contrary, the vaccination against variola has to be discontinued. Specific vaccines may prevent measles and rubella and their efficacy, expecially in the case of measles, is well ascertained. A vaccine against hepatitis B virus is desirable. Controversial issues on antirabies and anti-influenza vaccines are mentioned and discussed.