Biomedical subjects
Publications and source records attributed to B Ruf.
Pulmonary and extrapulmonary findings in legionelloses generally do not permit any aetiological conclusions. The extrapulmonary phenomena are epiphenomena that can possibly be traced to the effect of a toxin.
In subjects with HIV infection, mycobacteria are frequently identified. The most commonly seen species are M. avium-M. intracellulare. On the other hand, there is considerable variation in the data regarding the incidence of infections with M. tuberculosis; in fact, these data correspond with the differences in prevalence of tuberculosis in the respective general population.
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The importance of blood cultures in diagnosing disseminated mycobacteriosis in AIDS patients was evaluated. Blood samples were screened for mycobacteria by culture and microscopic techniques. Mycobacteremia was proven in 20/136 (14.7%) AIDS patients, the agent being M. avium-M. intracellulare (MAI) in 16 cases and M. tuberculosis in four cases. The rate of cases with positive blood samples in disseminated MAI infection was 59.3% (16/27 cases) and in disseminated tuberculosis 57.1% (4/7 cases). To detect mycobacteria buffy-coat was slightly superior to lysated cell pellets, obtained by a lysis-centrifugation technique. In 4/16 cases with MAI bacteremia, the agent was proven by positive blood smears for acid-fast bacilli only; in these four patients MAI was demonstrated at other body sites. These results illustrate the diagnostic role of blood culture and its use in early diagnosis of disseminated mycobacteriosis, with microscopic examination of blood smears being an important adjunct.
The modulatory activity of dextran sulfate with a relative molecular mass of 8 and 500 kDa and pentosan polysulfate with a relative molecular mass of 6 kDa on human T cell surface molecules CD2, CD3, CD4, CD8 and HLA-DR was investigated by analytical flow cytometry. The 500-kDa dextran sulfate induces a complete disappearance of the CD4 and a 50% diminution of CD2 immune reactivity on peripheral blood lymphocytes after a 4-h incubation while the low molecular mass polyanions do not. This modulation of the CD4 immune reactivity includes all CD4 epitopes investigated. It does not correlate with the antiviral effect of polyanions against human immunodeficiency virus infection. The interaction of polyanions with the CD4 presentation is temperature dependent and differs between fresh lymphocytes and immortal cell lines. From our data it can be concluded that mechanisms other than cell surface effects are responsible for the antiviral potency of these drugs. Implications for the modes of antiviral action of sulfated carbohydrates are discussed.
In a 1-year prospective study, 28 of 476 pneumonia patients (5.9%) were diagnosed as having legionella pneumonia. Legionella pneumonia was diagnosed in 12 (5%) of 240 community-acquired pneumonias and in 16 (6.8%) of 236 nosocomial pneumonias. Four methods of establishing diagnosis were used: serum antibody detection, direct proof of legionellae by immunofluorescence, culture, and legionella antigen detection in urine. The latter method proved to be clearly advantageous to all other methods in establishing the diagnosis. Twelve of the 28 patients (42.8%) died; all of them had severe underlying diseases. The fatality rate in patients treated with erythromycin was 18.8% (3/16 cases) and 75% (9/12 cases) in patients treated with antibiotics other than erythromycin. In 57.1% (16/28 patients) legionella pneumonia was acquired nosocomially. The results of our study underscore the need to use a broad spectrum of legionella diagnostic methods routinely and to administer antibiotics effective against legionellae in cases of pneumonia of unknown cause.
Infections caused by mycobacteria other than Mycobacterium tuberculosis (MOTT) have often been described as common in AIDS patients. To evaluate whether infections with MOTT are specific for HIV related immunosuppression or are also frequent in patients with immunosuppression of different aetiology, data on the frequency of isolation from immunosuppressed patients with HIV infection are important. Blood, stool and urine specimens from 134 patients with non-HIV related immunosuppression, and from 55 immunocompetent subjects were examined for mycobacteria. MOTT have been isolated from one immunocompetent person but from none of the immunosuppressed patients. Since in AIDS patients an initial colonization of the gastrointestinal tract (GI-tract) with MOTT is common, GI-tract biopsy specimens from an additional 80 patients were examined microscopically and histologically for mycobacteria. Mycobacteria were not isolated from these specimens. In the same period of time 72 AIDS patients have been examined; 7 (10%) had infections with M. tuberculosis whereas MOTT have been isolated from 16 (22%) of these patients. Mycobacteria have been found only rarely in immunocompetent patients and have not been isolated from patients with non-HIV related immunosuppression. The isolation of MOTT is highly correlated with an HIV-related immunosuppression.
A case with oral Kaposi's sarcoma (KS) is reported that regressed during therapy with Zidovudine (AZT) which was started 5 months after the first dermal and oral tumours were noted. After 6 months of treatment the absolute number of T-helper cells had increased from 54/microliters to 232/microliters and the ratio of T-helper to T-suppressor cells from 0.15 to 0.3. During the same time the lesions of KS on the gingiva, uvula and the body as well as the face disappeared. The lesion of KS on the hard palate regressed.
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Somnopolygraphic recordings were registered from 29 patients with AIDS, their age ranged from 20 to 55 years (mean: 40.9; median: 44). The patients represent the full range of cerebral disintegration representing the picture of a progressing destruction of physiological sleep organization. Some disturbances begin quite early and progress successively, such as the reduction of REM- and delta-sleep as well as the reduction of sleep spindle- and K-complex-densities. Other changes are not manifest until intellectual capabilities break down; they occur massively such as the shortening of real sleep time and the reduction of sleep stage 2 with a simultaneous increase in waking time. It is remarkable that despite the enormous REM reduction there is no suppression of REM periods corresponding to "REM sine REM". REM periods become very short at an early stage; this is not only because the patients awake more frequently and earlier from their dream periods.
15 male AIDS-patients from 26 to 55 years (mean 41.8 +/- 8.5) with various cerebral manifestations had a whole-night-sleep-EEG registration. As control the recordings of 15 age-matched volunteers (26-55 years, mean 41.8 +/- 9.8) were examined. Spectral characteristics of elementary EEG-epochs of 40 s length were computed, and sleep staging was performed visually for these intervals. The spectral power density of eight EEG-derivations (left and right frontopolar, frontal, central and occipital electrodes, reference montage to the ipsilateral Cb) were measured (sampling rate 64(-1) s, spectral resolution .25 Hz, frequency range from .25 to 24 Hz). Interhemispherical coherences of the frontal and occipital derivation pairs, and intrahemispherical fronto-occipital coherences of the left and right hemisphere, were computed. In the patients the frontal power density of NREM sleep showed lower values in the frequency range of 10 to 14 Hz. In central and in occipital derivations the power density between 12.5 and 15 Hz was lower in the patients, but the difference was less accentuated. The spectral power density of REM sleep showed similar characteristics in both groups. The interhemispherical frontal coherence of the whole frequency range below 13 Hz was markedly lower in the patient group. This was true for the NREM sleep, and, slightly less, for the REM sleep, too. The interoccipital spectral coherence was generally slightly lower in the patient group; the difference was most clearly in the 12.5 to 15 Hz range of NREM sleep.
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In a two-year prospective study of patients hospitalized because of community-acquired pneumonia, the incidence of legionellosis was found to be 3.8% (17/442 cases). After S. pneumoniae, M. pneumoniae and influenzae viruses, legionellae were the fourth most frequently identified pneumonia agents. We evaluated the clinical data from 41 cases with legionellosis, 17 diagnosed in this prospective study and 24 prior to the study. The age range of all patients (22 women, 19 men) was 24-78 yrs (median 61.3 yrs), 14 of 41 cases (34.1%) had extrapulmonary organ involvement. Twelve patients (29.3%) died. The fatality rate was 4.5% (1/22 cases) in patients treated with erythromycin, and 57.9% (11/19 cases) in patients treated with other antibiotics. Antibiotics effective in legionellosis should be added to the routine therapy of community-acquired pneumonia when this aetiology can not be excluded.
Forty-nine episodes of Pneumocystis carinii pneumonia, treated with trimethoprim-sulfamethoxazole among 46 patients with AIDS were analysed retrospectively for any side effects. For only two were there insufficient data. There were 39 toxic reactions, 15 of them serious: leukopenia (n = 23), abnormal liver functions (n = 14), skin changes (n = 12), gastrointestinal complaints (n = 10) and thrombocytopenia (n = 9). In nine patients the treatment had to be discontinued, in six of them so early that a switch to pentamidine was necessary. Gastrointestinal symptoms occurred as early as the sixth day of treatment, while leukopenia and thrombocytopenia were first observed after 12-13 days. Despite the high rate of side effects trimethoprim-sulfamethoxazole remains the drugs of choice, other regimens not having been found to be any better.
In 89 of 3027 (2.9 per cent) patients in whom pneumonia was found at autopsy during the period from 1969 to 1985, legionella pneumonia was diagnosed. Legionellae were demonstrated through the direct fluorescent antibody test by screening lung tissue sections. All 89 cases were caused by Legionella pneumophila. Suspicious typical rod-shaped organisms were demonstrated in all cases by the modified Dieterle stain whereas conventional histological stains failed to detect causative bacteria. The frequency per year of legionellosis in patients with pneumonia at autopsy ranged from 1.4 per cent (3/212 cases) to 6.8 per cent (12/177 cases). In patients who have died of unexplained pneumonia, examinations for the demonstration of legionellae should be carried out.
Pneumonia was present in 70/157 (44.6%) autopsied patients with malignant hematologic diseases. In 16/70 patients (22.9%), legionellae were found to be the causative agents by screening lung tissue specimens with the direct fluorescent antibody method. In 5/16 patients with Legionella pneumonia, in whom legionellosis had been suspected clinically, the diagnosis had already been established by serology, urinary Legionella antigen detection, and culture. These results provide evidence that legionellosis is an important pneumonia etiology in patients with malignant hematological diseases. Thus, Legionella diagnostics should be applied routinely, and antibiotics effective in the treatment of legionellosis should be added to the usual therapy in patients with etiologically unexplained pneumonias. In view of the common occurrence of relapses of Legionella pneumonia, antibiotic therapy should be continued for an extended period.
From January 1983 until December 1985, 35 cases of sporadic nosocomial legionella pneumonia, all caused by Legionella pneumophila, were diagnosed in a university hospital. L. pneumophila serogroup (SG) 1 was cultured from 12 of the 35 cases and compared to corresponding L. pneumophila SG 1 isolates from water outlets in the patients' immediate environment by subtyping with monoclonal antibodies. The corresponding environmental isolates were identical to 9 out of 12 (75%) of those from the cases. However, even in the remaining three cases identical subtypes were found distributed throughout the hospital water supply. From the hospital water supply four different subtypes of L. pneumophila SG 1 were isolated, three of which were implicated in legionella pneumonia. Of 453 water samples taken during the study 298 (65.8%) were positive for legionellae. Species of Legionella other than L. pneumophila have not been isolated. This may explain the exclusiveness of L. pneumophila as the legionella pneumonia-causing agent. Our results suggest that the water supply system was the source of infection.