A four-point clinical criteria distinguishes immune thrombocytopenia from acute lymphoblastic leukaemia.

Immune thrombocytopenia is the most common diagnosis of isolated thrombocytopenia. The dilemma encountered by paediatricians is missing diagnosis of acute leukaemia in children with isolated thrombocytopenia. We demonstrated childhood ITP could be diagnosed using a four point clinical criteria without missing a diagnosis of acute leukaemia. Hence, bone marrow examination is not necessary in children with typical features compatible with ITP prior to steroid therapy. This can encourage paediatricians to choose steroid therapy, which is cheaper and non-blood product, as first line platelet elevating therapy in children with significant haemorrhage.

The effect of recent vaccination on the dose-response to experimental Dermatophilus congolensis infection in rabbits.

Dermatophilus congolensis infection of rabbits was used to investigate the effects of active immunity on epidermal challenge following vaccination. Rabbits (three groups of four) were vaccinated intradermally with live whole-cell preparations of D. congolensis strains SS18C and FD11 (groups SSVAC and FDVAC respectively); a third group (UNVAC) remained as unvaccinated controls. Two weeks after vaccination, separate 1.5-cm2 clipped and ether-swabbed skin sites were inoculated with a 10-fold dilution range (10(7) to 10(1) zoospores per cm2 of skin) of SS18C or FD11. Lesion scores at each site were calculated from the sum of individual scores (0 to 4+) for erythema, oedema and scab formation multiplied by the percentage of the inoculated area affected. A clear dose-response relationship between the size of inoculum and the severity of lesions was seen for both D. congolensis stains in the control group (UNVAC). In the SSVAC and FDVAC groups the lesions were less severe and developed more quickly. The number of zoospores required to cause infection in the vaccinated animals was up to 10,000-fold higher for homologous inoculated sites and 100-fold for heterologous sites. Serological analysis was carried out with an ELISA system. Vaccination and challenge resulted in increases in specific antibody against D. congolensis antigens. Cross-reacting antibody to the heterologous strain of D. congolensis used was demonstrated in both vaccinated groups but did not correlate with equal protection to homologous or heterologous challenge. The dose-response relationship demonstrated by this model enabled semi-quantitative analysis of the effects of vaccination on D. congolensis infective dose and severity of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of malnutrition on vaccination against Dermatophilus congolensis infection in ruminants.

Vaccination against Dermatophilus congolensis was carried out in groups of lambs raised on optimal or energy deficient diets. The groups differed significantly in weight, body condition score and plasma total protein and albumin. All animals were then challenged with D. congolensis in a dose response infection model. The vaccine was effective in the well nourished animals, reducing the number of affected lambs in the vaccinated group and the severity of the lesions and increasing the minimum dose required to cause infection. In contrast, all of the vaccinated energy-deficient lambs developed lesions. There was some evidence of vaccine effect in these animals but this was not as marked as that seen in the well nourished lambs. The malnourished lambs, vaccinated and non-vaccinated, took longer to heal than the well nourished groups. Resistance to challenge was not associated with serum antibodies or skin test reactivity to D. congolensis antigens.

The effect of energy malnutrition in ruminants on experimental infection with Dermatophilus congolensis.

The ability of malnourished and optimally fed animals to resist infection with D. congolensis was assessed by the dose-response to experimental inoculation. The severity of infection, as measured by scoring the lesions, was the same in both groups of lambs. However marked differences were seen between the two groups in the appearance of scabs and in the time taken for them to resolve. The malnourished animals had more persistent, chronic lesions compared with the more obvious, acute type lesions seen on the skin of the healthy controls. These results were probably related to the reduced rates of wool growth and lanolin production found in the malnourished lambs, which may reflect a reduction in the rate of cellular turnover in the skin of these animals.

Use of a monoclonal antibody in the diagnosis of infection by Dermatophilus congolensis.

A monoclonal antibody (McAb) to Dermatophilus congolensis was produced from murine hybridoma cultures and purified by affinity chromatography. Species specificity was demonstrated using indirect immunofluorescent staining; the McAb was shown to react with 10 D congolensis isolates but not with 10 Nocardia species isolates, a Rhodococcus and a Streptomyces species isolate. The McAb was used to demonstrate D congolensis in clinical material from confirmed bovine and ovine cases and presumptive equine cases of dermatophilosis by indirect immunofluorescent staining.

Activity of ciprofloxacin against genital tract pathogens.

The in vitro activity of the quinolone carboxylic acid, ciprofloxacin, against a variety of genital tract pathogens was examined. Each of 35 isolates of Neisseria gonorrhoeae, including some beta-lactamase producing strains and strains resistant to tetracycline, was inhibited at a concentration of 0.01 mg/l. Most (13 of 20) strains of Gardnerella vaginalis were inhibited at 1 mg/l but three isolates had minimum inhibitory concentrations (MICs) of 8 mg/l or more. Each of seven strains of Chlamydia trachomatis was completely inhibited at a concentration of 2 mg/l. Prolonged (72 hours) exposure of the chlamydiae to ciprofloxacin was required for inhibition at this concentration.

A comparison of the in-vitro activity of antimicrobials against Chlamydia trachomatis examined by Giemsa and a fluorescent antibody stain.

Minimum concentrations for the inhibition of normal chlamydial inclusions (MICN) and abnormal inclusions (MICA) were obtained for a range of antimicrobials titrated against Chlamydia trachomatis in McCoy cell cultures. Each antibiotic titrated produced an MICN which was the same whether examined by Giemsa or fluorescent antibody staining methods (rifampicin 0.007 mg/l, tetracycline, erythromycin and penicillin 0.062 mg/l, chloramphenicol and spiramycin 0.25 mg/l, ciprofloxacin 1.0 mg/l, and cycloserine 250 mg/l). With the exception of penicillin the MICA (Giemsa) was between two- and four-fold higher than the MICN, and the MICA (fluorescent antibody) a further two-fold higher. Penicillin was alone in the wide concentration range over which abnormal inclusions were detected (0.0062 mg/l to 5 g/l).

An in-vitro investigation of synergy and antagonism between antimicrobials against Chlamydia trachomatis.

Chequerboard titrations of antimicrobials were carried out against Chlamydia trachomatis in vitro to assess possible synergy or antagonism. None of the antimicrobial pairs produced any detectable antagonism. Penicillin and ciprofloxacin showed independent activity. Tetracycline and penicillin, tetracycline and erythromycin, tetracycline and chloramphenicol, erythromycin and penicillin, and erythromycin and chloramphenicol showed additive inhibitory activity and limited synergy. Trimethoprim and sulphamethoxazole was the only combination to produce clear synergistic activity against Chlam. trachomatis in vitro.

Ciprofloxacin treatment of chlamydial infections of urogenital tracts of women.

Ciprofloxacin was evaluated in chlamydial infections of the urogenital tracts of women treated with a dosage regimen of 500 mg orally twice a day for seven days. Of the 40 women evaluated, 30 were infected with Chlamydia trachomatis only, two were infected with Neisseria gonorrhoeae only, and a further eight had combined gonococcal and chlamydial infections. Ten were found to be harbouring Chlamydia trachomatis in the urethra as well as the cervix. Neisseria gonorrhoeae was eradicated from all patients with or without concomitant chlamydial infection. The overall chlamydial reisolation rates were 14% (5/35) four weeks after treatment and 23% (6/26) 11 weeks after treatment. The organism was not reisolated from the urethra of any of the patients after treatment. Ciprofloxacin was effective against Mycoplasma hominis, but almost completely ineffective against Ureaplasma urealyticum.