Biomedical subjects
Publications and source records attributed to A Stary.
Lichen planus/lupus erythematosus/overlap syndrome (OS) comprises those dermatoses which show the clinical, histologic, and immunopathologic characteristics of both diseases. On account of this heterogeneity, the diagnosis of OS may be difficult. About 35 cases have been reported on in the literature so far. We are going to discuss the clinical, histologic, and immunofluorescence findings in OS in detail.
In order to evaluate the epidemiological importance of Chlamydia trachomatis (C. trachomatis) as a genital microorganism, data were obtained from 3,367 patients with sexually transmitted diseases in Vienna and analyzed by computer-assisted methods. C. trachomatis was cultured in 26.1% of 2,594 patients investigated for the first time. The microorganism was found more often in male patients (31.3%) than in female patients (21%). 32.2% of positive Chlamydia cultures were obtained from patients with non-gonococcal urethritis (NGU) and 64% from postgonococcal urethritis (PGU) patients. A high coincidence with Neisseria gonorrhoeae (N. gonorrhoeae) was detected in males (31.2%) and females (43.5%). Data on Mycoplasma hominis (M. hominis), and Ureaplasma urealyticum (U. urealyticum) show that, in contrast to the low incidence of M. hominis and U. urealyticum in males, the organisms were found predominantly in females.
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Four weeks after the introduction of a therapeutic regimen with 80 mg 13-cis-retinoic acid/day, a 16-year-old male patient developed oozing hypergranulation with vulnerable masses within acne lesions. These local symptoms were accompanied by fever, fatigue, weight loss, polyarthralgia and myalgia, similar to acne fulminans. In spite of these unusual reactions treatment was continued. Local steroid ointments were additionally applied. Within a short period of time regression of granulations and normalization of the general health condition was observed. After 4 months, therapy was discontinued. The patient's acne had totally healed and did not relapse within an observation period of 2 years.
Monoclonal antibodies do not only allow a rapid identification of herpes simplex viruses (HSV) on smear specimens, but also a differentiation between HSV type 1 and type 2. Their specificity and sensitivity correspond to conventional molecular biologic methods. Newer insights into epidemiology and recurrency mechanisms are gained by restriction enzyme analysis of the viral genome, which allows accurate determination of types and strains. Finally, hybridization techniques are utilized for further investigations concerning the latency and oncogenic potency of HSV. Thus the spectrum of diagnostic possibilities of HSV infections has considerably been broadened during recent years.
Several failures of gonorrhea treatment due to neisseria producing penicillinase (PPNG), resistance against other antibiotics, side effects like allergies, gastrointestinal problems, and other factors are the reasons for continuing trials with new drugs in the treatment of gonorrhea. With regard to modern aminoglycosides, the development of early resistance has not been observed so far. Especially with Netilmicin, no such disadvantages have been reported in the literature. Therefore a single dose schedule was introduced with Netilmicin given to 600 patients suffering from uncomplicated gonorrhea in order to evaluate the efficacy and safety of the drug. 300 mg Netilmicin were administered intramuscularly in a one shot therapy. With all patients, the diagnosis had been confirmed by culture. The efficacy of therapy was controlled by a second culture, which proved to be negative in all 600 cases. Gonorrhea was also clinically cured in all patients.
As reported in the recent literature, eye infections caused by Chlamydia trachomatis are increasing in number. Modern laboratory techniques were used in this study to scan a total of 114 patients with unilateral follicular conjunctivitis for these organisms. The authors describe the clinical picture, course, and results of therapy in a total of 6 (5.3%) young patients with chlamydial infections diagnosed by scraping and cell culture.
To evaluate the sensitivity and specificity of the direct specimen test with monoclonal antibody conjugated with fluorescein isothiocyanate (FITC), cervical smears from 700 Viennese prostitutes were investigated by immunofluorescence microscopy and compared with the results of cultures for Chlamydia trachomatis in McCoy cells. Inclusion bodies in cell culture and elementary bodies on the smear slide were counted and evaluated in four categories. Cultures were obtained from 12.6% (88) of all women investigated, whereas the direct specimen test gave positive results in 10.4% (73). The results indicate that in asymptomatic people with only few inclusion bodies and latent infections, culture on McCoy cells is the more adequate method of identifying Chlamydia trachomatis.
Genital herpes simplex virus (HSV-)infection is a disease of growing importance in sexually transmitted diseases. It is the most common cause of genital ulcerations throughout the industrialized nations. It is caused by either herpes simplex virus type 1 or 2. Genital herpes displays variable clinical manifestations in a primary or recurrent form. Various seroepidemiologic studies suggest that asymptomatic infection is common. Primary infection causes severe genital lesions and has a relatively high incidence of neurologic and extragenital manifestations. Recurrent episodes are, in contrast, of much milder expression. To exclude the diagnosis of other possible causes of genital ulcers, laboratory confirmation of the diagnosis of genital HSV-infections has to be established, before antiviral therapy is introduced. HSV can be cultivated in cell culture. Rapid diagnostic techniques such as immunofluorescence, cytologic examination and electronmicroscopy are also available. The most promising antiviral drug seems to be acyclovir. It is effective in reducing some of the manifestations of genital HSV infections. However, the most important problems like the prevention of recurrent infections in patients with genital herpes and the transmission of the disease to newborns or to sexual partners, have not yet been solved.
Investigations for Chlamydia infections of the genital tract were performed in 270 Viennese registered, as well as in 51 non-registered prostitutes. The results were compared with findings obtained in 56 female patients attending an out-patient STD clinic and 48 pregnant women seeking antenatal care in a department of obstetrics. Diagnosis of Chlamydia infection was the organisms on cultured McCoy cells after treatment with cycloheximide. The highest infection rate (31%) was found in non-licensed prostitutes. In registered prostitutes, 20.4% of the cervical smears proved to be positive for Chlamydia. The control groups showed lower infection rates of 9% and 4%, respectively. These results indicate that women who frequently change their sexual partners are considerably more at risk of contracting Chlamydia infections. Hence, this group of persons should be more regularly investigated and--if necessary--given appropriate treatment in order to prevent further spread of the disease.
In 28 subjects the diagnosis of an erosive-ulcerative herpes simplex blepharitis was confirmed by laboratory tests. The clinical manifestations were characterized by the presence of erosions of the intermarginal portion of the lid or the presence of skin ulcers located at the lid margin or the combination of both features, and usually by an absence of vesicular eruptions. Erosions of the intermarginal portion of the lid can readily be made visible by staining with fluorescein. The involved lid portion usually exhibits mild swelling and tenderness on palpation. Conjunctival injection usually is not pronounced adjacent to the lid lesion, the regional lymph nodes being swollen. Laboratory confirmation can be achieved readily by the indirect immunofluorescence technique. The treatment modality consists of the combination of antibiotic and virustatic ointments.
In 14 patients the diagnosis of an erosive-ulcerative type of herpes simplex of the lids was made. It is characterized by erosions of the intermarginal portion of the lid or by erosions or ulcers of the skin, especially close to the lid margin. A combination of both clinical forms is possible. Characteristic herpetic vesicles have been observed only in one case, being situated in close proximity to the erosive lesion of the lid margin. The visualisation of erosions located at the intermarginal portion of the lid can be facilitated by staining with fluorescein. The lack of vesicular eruptions impedes a proper diagnosis; hence one should search for the history of recurrent herpetic infections. A presumptive diagnosis can be confirmed by the immunofluorescence technique. For treatment, topical application of virustatic and antibiotic ointment is recommended.
A commerical preparation of gamma-globulin with 16% protein content for i. m. administration, as well as two commercial preparations of 5% protein content for i.v. administration, were tested for their antibodies to different viruses. The highest antibody titres were found in the 16% gamma-globulin. Sufficient levels of antibodies to justify prophylactic use were demonstrated in the case of rubella, measles, polio and EBV, whilst antibodies to mumps, coxsackie A9, B1-5 and herpes simplex type I and II were present to a moderate degree. Only low concentrations of antibodies or none at all were found with respect to influence A and B, para-influenza 1--3, vaccinia, adeno 3 and 7, and echo 4, 6, 9, 18 and HBs-antigen. This study shows that normal gamma-globulin can be used prohylactically against many different viral diseases.
Sera were investigated of patients possibly suffering from an EBV infection, without showing clinical features characteristic of infectious mononucleosis. The method of investigation was the detection of antibodies of the IgM-type by means of the immunofluorescent method using a three-layer technique. Diagnosis of EBV infection was established in 10 out of 90 patients with facial palsy, one with myelitis, one with sudden deafness and one with polyneuritis. In addition, 4 out of 19 cases of hepatitis (Hbs-negative) proved to be due to infection with EBV. The specific IgM test proved to be superior to the heterophil agglutination test.
401 cases of viral pneumonia diagnosed between January 1973 and August 1975 were investigated serologically by the complement-fixation test. The percentage distribution of the responsible pathogenic organism in this series of cases was as follows: influenza virus A 45.9%, Mycoplasma pneumoniae 19.5%, Coxsackie B viruses 9.2%, cytomegalovirus 7.5% and Chlamydia psittaci 8.5%. The remaining 9.4% cases were caused by adeno, parainfluenza, measles, influenza B, herpes simplex and respiratory syncytial viruses. Influenza virus was found mainly in elderly people (mean age 58.4 years), whilst pneumonia due to Mycoplasma occurred mainly in young adults (mean age 24.4 years). Infections with Coxsackie B viruses were almost entirely restriced to the warmer months; by contrast, the influenza virus was usually found in epidemic form and only during a few weeks in winter.
The vaccine used contained formalin-inactivated TBE virus that was grown in chick embryo cells and adsorbed to Alhydrogel. In a first study, conducted in 1973, a total of 81 volunteers were given subcutaneously two doses of vaccine 4 weeks apart, and a third dose 7-9 months later. After each vaccination, the rates of seroconversion were assayed in the hemagglutination inhibition test. The values obtained were 76%, 96% and 98%, respectively. The geometric mean titers found were 1:26, 1:36 and 1:44. The vaccine was well tolerated locally and systematic reactions such as fever headache and fatigue were only recorded after the first dose of vaccine. In 1974 and 1975 a total of 30,000 persons were vaccinated in areas where the disease is endemic. Most of the vaccinees work in forests and are, therefore, at high risk of infection. Circumstantial evidence indicates that the vaccine is protective.
In order to determine the infection rate of Chlamydia trachomatis in young males in Austria an epidemiological study was performed on 335 male Austrian soldiers attending the military hospital for a health check-up procedure. Three hundred twenty-nine (98.2%) of the screened males were clinically asymptomatic. Chlamydial diagnosis was established by testing first catch urine (FCU). Urine sediment was tested by an enzyme immunosorbent assay (EIA) and by a direct immunofluorescent test (DIF test). Positive results in both tests were defined "true positives." In 41 (12.2%) of all the 335 soldiers a genital chlamydial infection could be demonstrated by a positive result of the sediment of the FCU in both tests. 93% of the positive results in the DIF test could be confirmed by the EIA whereas only 77% of the positive EIA tests were also positive in the DIF test. Data on genital symptoms and the history of sexually transmitted diseases (STDs) as well as information about sexual relationships were available from all persons included in the study and did not differ between chlamydia positive and negative ones. The study demonstrates a high infection rate with C. trachomatis in mostly asymptomatic young males when using FCU for chlamydial diagnosis. Due to the discrepancy between the EIA and the DIF test, positive results of the sediment of FCU in the EIA test should be confirmed by the DIF test to eliminate false positive cases.
To investigate the diagnostic value of a direct immunofluorescence test (DIF-test), urethral samples and first catch urine (FCU) from 153 male patients attending an outpatient clinic for sexually transmitted diseases (STD) were studied. Of the male patients, 40 (26.1%) had a positive urethral culture, 39 (25.5%) had a positive urethral DIF-test, and 32 (20.9%) were positive in urine according to the DIF-test. The sensitivity and the specificity of the DIF-test in male urine specimens were 75% and 98.2%, respectively, as compared with the chlamydial culture, and 69.2% and 95.6%, respectively, as compared to the DIF-test of the urethral samples. Out of the positive urethral samples, 31% had less than 5 elementary bodies (EBs) and 41% greater than 10 EBs, detected by the DIF-test. The corresponding data for FCU were 47% and 22%, indicating a smaller number of chlamydiae in urine than in urethral samples. False negative results in the urine DIF-test were mostly observed in males with a low number of EBs in the urethra. The DIF-test was less sensitive for FCU than for urethral specimens. Therefore, urine DIF-tests cannot replace conventional methods for chlamydial diagnosis in symptomatic STD patients, but may be recommended when genital sampling is not possible and may serve as an important approach in the control of genital chlamydial infections.