Biomedical subjects
Publications and source records attributed to D L Huxsoll.
Rickettsia tsutsugamushi organisms were identified in Giemsa and fluorescent antibody stained monocyte cell cultures derived from experimentally infected monkeys and dogs. The identification of organisms in monocyte cell cultures compared favorably with the standard technique of mouse inoculation.
An epidemiological study in a mature oil palm estate in Peninsular Malaysia has demonstrated a low prevalence of R. tsutsugamushi infection in small mammals. The direct fluorescent antibody technique for assaying infections in chiggers proved more sensitive than mouse inoculation. Most infections in both chiggers and rodents were caused by the Karp strain.
Four ponies experimentally infected with Ehrlichia equi developed substantial cell-mediated immune responses, as measured by the leukocyte migration-inhibition test. Serum anti-E equi antibodies up to 1:1,280 were demonstrated by the indirect fluorescent antibody test. Cell-mediated immune responses returned to a base-line value by day 200 after primary inoculation, but serum antibody titers persisted for at least 300 days after inoculation. Two additional susceptible ponies, which were inoculated with convalescent blood or organ homogenates from ponies recovered from acute equine ehrlichiosis, treated with tetracycline, and subsequently challenge exposed with E equi-infective blood, did not develop clinical disease. This study suggested that ponies are resistant to reinfection with E equi following clinical ehrlichiosis.
Most silvered leaf monkeys inoculated with selected strains of Rickettsia tsutsugamushi developed rickettsemia. The time of onset and the duration of rickettsemia were related to the infecting strains, but these parameters could not be correlated with the virulence of the strain. The rickettsemia was not terminated by the appearance of humoral antibody, as detected by the indirect fluorescent antibody test. The specificities of the antibody responses were related to the antigens present in the infecting strains.
Dogs inoculated with Rickettsia rickettsii developed a clinical syndrome ranging in severity from a mild febrile exanthema to death within six days after inoculation. The severity of the disease appeared to be dose-related, and the signs were comparable to R. rickettsii infection in humans on a clinical and hematological basis. Dogs were rickettsemic for 10 to 14 days after infection. In most animals the level of rickettsemia was greater than or equal to 10(2.5) guinea pig intraperitoneal 50% infectious doses (GPID50). Infected dogs responded serologically as determined by indirect fluorescent antibody methods and were protected when challenged six to 12 months later with 10(7.0) GPID50 of the homologous strain of R. rickettsii. The monocyte culture technique was successfully used for the detection of rickettsemia, and the results compared favorably with those obtained by the guinea pig inoculation method of isolation.
Over 1,200 isolations of R. tsutsugamushi were obtained over 7 generations of L. (L.) arenicola and no reproducible differences in virulence or antigenic markers could be detected among these isolations. The F8 generation yielded rickettsia with the same antigenic makeup and virulence properties as the original female parent mite. When these isolates were inoculated into mice they elicited the same predominant antibody specificities, i.e. they all produced antibody which reacted with the TA 763 and Karp strains. These were the same as the major antigens detected by direct fluorescent antibody staining of the isolates.
Dog sera, collected from different communities throughout Selangor, Peninsular Malaysia, were investigated for the presence of antibodies to R. tsutsugamushi and R. typhi. Scrub typhus antibodies were present in animals from the rural areas only, whereas murine typhus antibodies were observed in equal numbers of dogs from both rural and metropolitan areas. Greater percentage of dogs from suburban areas had demonstrable antibody titers to murine typhus than from the urban area.
A high prevalence of murine typhus was found in the human and rodent populations of Senaling, West Malaysia. In addition to 2 index cases which prompted the investigation, 45% of the humans and 35% of the rodents had IFA titers of 1/50 or greater. Serological studies provided evidence of recent infections in 3 human subjects. In a control group of Malaysian soldiers IFA titers of 1/50 or greater were found in only 13 (5%) of 265 sera tested.
Beagle dogs inoculated with the agent of Rocky Mountain spotted fever, Rickettsia rickettsii, developed a clinical syndrome that extended from febrile exanthema to death and appeared to be dose related. Infected dogs were anorectic and lethargic and developed cutaneous lesions characteristic of Rocky Mountain spotted fever, including petechia, ecchymosis, edema, and necrosis. Hematologic changes after inoculation included anemia, leukopenia proceeding to leukocytosis, and thrombocytopenia. Changes in blood chemistry values included increases in serum alkaline phosphatase and cholesterol, and hyponatremia and hypochloremia. The prominent histopathologic change was necrotizing vasculitis. The canine disease is comparable with human Rocky Mountain spotted fever on a clinical, hematologic, biochemical, and pathologic basis, and may provide a model system for this disease in man. The results suggest the dog may be involved in the epidemiology of R rickettsii infections.
The 51Cr-release technique for detecting cytotoxicity had been adapted to immunologic studies of canine ehrlichiosis. Lymphocytes from dogs infected with Ehrlichia canis, cause of canine ehrlichiosis, were shown to be cytotoxic for autologous monocytes. The effect was dependent on the concentraton of lymphocytes, being optimal at 100:1 lymphocyte:monocyte ratio. Neither immune serum and complement, nor anti-canine globulin had any observable effect on cytotoxicity. The monocytotoxicity bore a temporal relationship to the thrombocytopenia. It is suggested that T lymphocyte activation accompanying ehrlichiosis contributes to pathogenesis of the disease and that the specific immune elimination of parasitized monocytes is antibody independent.
An explanation was sought for the disparity between the low reported incidence of scrub typhus and the high prevalence of antibody to Rickettsia tsutsugamushi in the rural population of Malaysia. A combination of isolation of the organism, titration of antibody by indirect immunofluorescence, and the Weil-Felix test was used to confirm infections. Scrub typhus was found to be very common, causing 23% of all febrile illnesses at one hospital. The infection was particularly prevalent in oil-palm workers, causing an estimated 400 cases annually in a population of 10,000 people living on one plantation. The clinical syndrome, whether mild or severe, was difficult to distinguish from that due to other infections. Eschars, rashes and adenopathy were uncommon. When used to examine early sera, the Weil-Felix test failed to confirm the diagnosis in most infections.20
Silvered leaf monkeys (Presbytis cristatus) inoculated with avirulent strains of Rickettsia tsutsugamushi showed little or no signs of disease, whereas those inoculated with moderately or fully virulent strains developed severe disease. Infection with the virulent strains produced early leukocytosis followed by leukopenia and significant decreases in packed-cell volumes. In animals infected with avirulent strains, these parameters were normal throughout the experimental period.
A microimmunofluorescence (micro-IFA) test has been adapted to the study of naturally occurring antibody to Rickettsia tsutsugamushi in humans. The micro-IFA test was comparable to the present immlnofluorescent assay in sensitivity and reproducibility, but offered distinct advantages in the quantity of reagents necessary. Also the micro-IFA could be used to simultaneously titer a serum to as many as nine strains of the organism resulting in a great saving of time.
A study of 1,437 unselected febrile patients in rural Malaysia yielded a diagnosis of leptospirosis in 86 (6.0%). The clinical syndrome was mild to moderate in all cases, jaundice was observed in only 2 (2.3%) and no deaths were documented. The diagnosis was not clinically obvious in most cases, and it is apparent that many infections must be going unnoticed at present.
Certain aspects of the development of Ehrlichia canis, causative agent of canine ehrlichiosis (tropical canine pancytopenia) in Rhipicephalus sanguineus ticks were studied. It was found that partial feeding of nymphs infected as larvae with E canis was a desirable, if not necessary, preliminary treatment for successful infection of dogs with ground-up ticks. It remains unclear whether feeding increased the number or altered the virulence of ehrlichiae within tick tissues. Ehrlichia canis organisms were detected by immunofluorescent microscopy in the midgut and hemocytes and by electron microscopy in the midgut and salivary glands of partially engorged adult ticks which had been infected as larvae and nymphs. Organisms were not observed in the ovary. Intracytoplasmic inclusions contained 1 to 80 elementary bodies, each provided with 2 distinct membranes. Infection of the midgut and salivary gland was confirmed by injecting homogenates of these tissues into susceptible dogs. Staining of gut smears of partially engorged adult ticks by fluorescein-conjugated anti-E canis antibody was found to be a reliable indicator of the infection.
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A significant (P < 0.025) increase in the mean platelet diameter occurred in five Ehrlichia canis-infected dogs when platelet numbers decreased to 100,000/mul or less. Maximal incorporation of [(75)Se]selenomethionine into platelets of six uninfected dogs was 0.080 +/- 0.019% (mean +/- standard error) and occurred 5 to 6 days after dosage, whereas maximal incorporation was 0.036 +/- 0.004% within 2 to 3 days after dosage in seven chronically infected dogs that had thrombocytopenia. Analysis of the [(75)Se]selenomethionine curves yielded a platelet lifespan of 9 days in uninfected dogs versus 4 days in chronically infected dogs. Thus, megakaryocyte maturation and/or platelet release occurred at an accelerated rate in infected dogs, whereas increased destruction of newly produced labeled platelets diminished their number of peripheral blood. [(51)Cr]sodium chromate-labeled platelet survival was exponential, with a half-life of approximately 1 day in two dogs at 2 to 4 days postinfection and three chronically infected dogs. Platelet survival time was 8 days and rectilinear in four uninfected dogs. Platelet recovery was 39.43 +/- 2.86% in infected dogs as compared with 68.2 +/- 10.72% in uninfected dogs. Whole-body scans of one dog prior to and 7 days after infection showed that labeled platelets were destroyed primarily in the spleen. It is concluded that the thrombocytopenia in E. canis-infected dogs is the result of increased platelet destruction which begins within a few days after infection.
Rickettsia rickettsii was isolated from experimentally infected guinea pigs by culture of blood monocytes and bone marrow cells, and from experimentally infected rhesus monkeys by blood monocyte culture. Rickettsiae were identified in monocyte-macrophage monolayers stained by Giménez or flourescent antibody techniques. A total of 78 culture attempts were made from 20 guinea pigs and 16 monkeys. The success of isolation of R. rickettsii in culture was positively correlated with the numbers of rickettsiae present in the blood and bone marrow. in cultures derived from infected guinea pigs, rickettsiae were usually observed after 5 to 7 days of culture, and in monkeys monocyte cultures they were usually observed within 3 to 5 days. Positive cultures were derived from guinea pigs and monkeys as early as the first day of fever and 1 to 3 days before the appearance of other clinical signs. Monocyte cultures became negative with the resolution of rickettsemia and concomitantly with the appearance of serum antibody. Monocyte culture isolation of R. rickettsii may be as sensitive for the detection of rickettsiae in blood and marrow as the intraperitoneal inoculation of guinea pigs or the plaque assay technique. Because of the simplicity of the method and because rickettsiae were often identified within 3 to 5 days after initiation, the monocyte culture technique may be useful in the early diagnois of human rickettsial disease.