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[Immunization with targeted fusion anticaries DNA vaccine via intramuscular route:experiment with murine].

OBJECTIVES: To observe the expression of a targeted fusion anticaries DNA vaccine pGJA-P in muscular in vivo. To compare the levels of specific antibodies and anticaries efficacy generated by pGJA-P and fusion anticaries DNA vaccine pGLUA-P in gnotobiotic rats, and observe the kinetics of antibody responses in BALB/c mice. METHODS: (1) Twelve 28-day-old female Wistar rats were randomly divided into 2 groups of 6 rats to be injected with the plasmid pGJA-P containing the signal peptide and extracellular regions of human CTLA(4), hinge and Fc regions of human IgG, the glu sequence of gtfB gene and A-P fragment of pac gene of Streptococcus mutans or the eukaryotic expression plasmid pCI into the quadriceps muscle of thigh respectively. Three days after the rats were killed and specimens of quadriceps muscles of thigh were taken. Immunohistochemical SP staining was used to examine the in situ expression of pGJA-P. (2) Twenty-four 18-day-old female Wistar rats were randomly divided into 4 groups of 6 rats. The rats were fed with cariogenic food. During the age of 20 - 22 days cariogentic food containing broad-spectrum antibiotics was fed. Then aseptic cotton stick was used to swab the oral cavity and be smeared onto the solid medium so as to observe the growth of bacteria under anaerobic culture for 48 hours. During the age of 24 - 26 days, S. mutans Ingbritt cultured anaerobically was swab onto the surface of teeth of the rats twice with an interval of 30 minutes. After the inoculation aseptic cotton stick was used to wipe the oral cavity and be smeared onto the solid medium so as to observe the growth of bacteria under anaerobic culture for 48 hours. When the gnotobiotic rats were 28 days old they were injected with pGJA-P, pGLUA-P, fusion anticaries DNA vaccine against both PAc, cell surface protein antigen, and glucosyltransferase (GTF), pCI or normal saline into the quadriceps muscle of thigh respectively, 2 weeks later a booster shot was given. When the rats were 63 days old their saliva and blood samples were collected. The serum IgG and salivary IgA were assayed by using ELISA. The gnotobiotic rats were killed and their maxillary bone the mandibles were isolated. The anticaries effect was evaluated by Keyes caries scores. (3) Twenty-four 4-week-old BALB/c mice were randomly divided into 4 groups of 6 mice: to be injected with pGJA-P, pGLUA-P, pCI, or normal saline respectively into the quadriceps muscles of thigh, 2 weeks later a booster shot was given. Before the injection and every 2 weeks after the immunization specimens of saliva and blood were collected. The serum IgG and salivary IgA were assayed by using ELISA. RESULTS: (1) Recombinant protein could be detected in the quadriceps muscles of the rats immunized with pGJA-P, but not in the muscles of the rats immunized with pCI. (2) The levels of serum anti-PAc IgG (1:200 000) and anti-GTF IgG (1:58 000) of the rats immunized with pGJA-P were significantly higher than those of the rats immunized with pGLUA-P (1:23 000 and 1:11 000 respectively) (both P < 0.01). The levels of salivary anti-PAc IgA (1:8) and anti-GTF IgA (1:6) of the rats immunized with pGJA-P were significantly higher than those of the rats immunized with pGLUA-P (1:2 and 1:2 respectively) (both P < 0.01). The Keyes scores of the pGJA-P group were significantly lower than those of the pGLUA-P group and the control groups (all P < 0.01). The effective serum IgG and salivary IgA in the pGJA-P group and effective serum IgG in the pGLUA-P group all persisted to the end of the experiment. (3) Two weeks after the initial immunization the serum anti-PAc IgG level of the mice immunized with pGJA-P increased remarkably, 4 times that of the mice immunized with pGLUA-P, and 33 times those of the mice injected with pCI or normal saline. Two weeks after the booster immunization, the serum anti-PAc IgG level of the mice immunized with pGJA-P was 14 times that of the mice immunized with pGLUA-P, and 117 times those of the mice injected with pCI or normal saline. The serum anti-PAc IgG immunized with pGJA-P reached its peak 10 weeks after the initial immunization, 4 times that of the mice immunized with pGLUA-P, and 160 times those of the mice injected with pCI or normal saline. The serum anti-PAc IgG of the mice immunized with pGLUA-P reached its peak at 16 weeks, however, significantly lower than the peak of the mice immunized with pGJA-P (P < 0.01). The serum anti-Pac IgG levels of the mice injected with pCI or with normal saline were not significantly different (P > 0.05). Since the second week after the initial immunization, significant difference in the serum anti-PAc IgG level could be seen between the mice immunized with pGJA-P or the mice immunized with pGLUA-P, and between the mice immunized with pGJA-P and the mice immunized with pGLUA-P and those injected with pCI or normal saline (all P < 0.01). Six weeks after the initial immunization the salivary anti-PAc IgA level of the mice immunized with pGJA-P was 18 times those of the mice injected with pCI or with normal saline (both P < 0.01), 10 weeks after the salivary anti-PAc IgA level of the mice immunized with pGJA-P reached its peak, 24 times those of the mice immunized with pCI or normal saline without a significant difference between the latter 2 groups (P > 0.05). No effective salivary IgA response was seen in the mice immunized with pGLUA-P. CONCLUSION: pGJA-P can be expressed in vivo. Immunization with pGJA-P intramuscularly induces effective mucosal and systematic humoral responses. It is an effective DNA vaccine against dental caries.

Animals↗

[Ambulatory surgery in the hospital--analysis of a 1978-1994 patient sample].

In the outpatient department of the University hospital of the Technology University Dresden ambulatory surgery has been performed since 1965. The patients of 16 years were analyzed. From 1978 till VI/1994 we have carried out 13948 elective operations. The personal wish of a cooperative patient without risk factors and an orderly social surrounding are the prerequisites for carrying out outpatient operations. Applied anaesthetic techniques were: general anaesthesia 9.2%, spinal anaesthesia 7.1%, sacral anaesthesia 14.8%, nerveblock of the upper extremity 11.1 and infiltration anaesthesia 57.8%. On the day of operation 61 patients had to be admitted to the hospital because of intraoperative events, expansion of the operation and complications of anaesthesia. Between the first to eight postoperative day 23 patients were hospitalised due to bleeding and 1 patient due to a wound infection. After aseptic elective operations 33 patients (0.35%) and after proctology operations with primary wound closure 10% of the patients developed wound infections. The cooperation of the general practitioner must be ensured in the post-operative days. Outpatient operations lower the financial burden of the health insurance companies, medical care services can be reduced.

Adolescent↗

The reliability of diagnosis of infection during revision arthroplasties.

BACKGROUND: Follow up studies have shown that 0.5 to 4% of the total joint arthroplasties will be complicated by infection. Distinction between aseptic loosening and infection is important for prediction of the final outcome after revision arhtroplasty but also for the choice of operative treatment. However, diagnosis of low grade chronic infection is extremely demanding. MATERIALS AND METHODS: 68 hip and knee revision arthroplasties were reviewed retrospectively in order to evaluate the reliability of pre- and perioperative analysis of infection during total joint revision arthroplasties. The sensitivity and specificity for clinical signs, blood white-cell count, C-reactive protein level, radiographic analysis, bone and leukocyte scans, joint aspirations, and gram staining were determined. Tissue sample were harvested and cultured in all cases. Positive cultures were regarded as a true infection. RESULTS: We were not able to characterize the infection by clinical signs. Also no single test was able to show the presence of infection in all cases. The best results were obtained from pre- and perioperative joint aspirations. Joint aspiration showed 1.0 specificity and 0.75 sensitivity. CONCLUSION: It is clear from this study that no single test is able to show the presence of infection in every case. Classical clinical signs, laboratory tests, special imaging studies and joint aspirations have all yielded a notable rate of false negative results. Therefore, we recommend that, if arthroplasty patients have pain in prosthetic joint without clear radiological evidence of loosening, bone scans and preoperative joint aspirations should be undertaken. Also, if radiological evidence of loosening is accompanied with one or more of following criteria; C-reactive protein level elevated, radiologic evidence of infection, loosening within the first five years after implantation. In case of infection a delayed two-stage reconstruction should be managed.

Aged↗

Organ distributions and clearance studies of 99mtechnetium-labeled Corynebacterium parvum in patients with leukemia.

The clearance, metabolism and localization of Corynebacterium parvum (C. parvum) labeled with 99mtechnetium (99mTc) given intravenously was studied in various leukemia patients to develop the method and to evaluate reticuloendothelial systems (RES) function. A computer program was utilized to characterize the clearance. C. parvum 0.05 mg was labeled aseptically with 10 mCi of 99mTc with a reducing agent. It was injected intravenously over 5 s and clearance was characterized over the next 60 min. The low dose of C. parvum did not cause any symptoms. The blood or plasma clearance time (t 1/2) was in the range of 0.65 to 1.96 min, in eight patients. By whole body imaging, the distribution of C. parvum was found mainly in the liver, and to a much lesser extent in the spleen, lungs, and bone marrow. Nonparticulate 99mTc (which was not sedimented by centrifugation of blood samples at 3000 rpm for 30 min) appeared rapidly in the blood after i.v. injection accounting for more than half of the radioactivity in a few minutes. In vitro incubation of 99mTc labeled C. parvum with saline, whole blood, serum or leukocytes revealed that the release of free 99mTc resulted from the combined action of serum and leukocytes. The rapid clearance will limit the utility of this preparation in characterizing RES function in man and its modification by disease or therapy.

Adult↗

[Diagnosis and outcome of neurotropic enterovirus infections in childhood].

BACKGROUND: Enterovirus infections are among the most common causes of aseptic meningitis. Worldwide there are reports about recurring outbreaks, especially during the summer. They are favoured by conditions of bad hygiene and contaminated water, transmission is predominantly through the faeco-oral route or by droplet infection. The most common species are Coxsackie B and ECHO (Enteric Cytopathogenic Human Orphan) virus. ECHO viruses have a worldwide distribution and usually occur as "summer flu" or aseptic meningitis and meningoencephalitis in toddlers and infants. Type 30 caused an outbreak of aseptic meningitis in the Rhein-Main region in summer 1997. During five months 63 children younger than 16 years were reported. PATIENTS AND METHODS: During this outbreak 18 children with prooved enterovirus infections were treated at the Frankfurt/Main University Children's Hospital. Standardized infectiological diagnostic procedures were performed and risc factors, clinical symptoms, inflammatory marker, neurophysiological findings (electroencephalography, evoked potentials) and outcome were assessed. RESULTS: The affected children were between 3 and 11 years old. Clinical symptoms were cephalgia, nausea, vomiting, meningism and seizures with fever. Virus isolation from faecal and cerebrospinal fluid (CSF) samples and the use of polymerase chain reaction (PCR) was superior to serological methods. Erythrocyte sedimentation rates showed more significant increase than C-reactive protein (CRP) and blood leukocytes. CSF pleocytosis showed high variation. Clinical course as well as prognosis and outcome were favourable. CONCLUSION: Virusisolation in stool and CSF is most promising in the diagnostic of cerebral enterovirus infections. Usually the outcome is favourable, encephalitis can occur as serious complication.

Adolescent↗

Health status of experimental pigs.

Due to the increase in the use of pigs in research, there seems to be a demand from the scientific community for an improved quality of experimental pigs. Germ-free pigs may be produced by removing fully developed foetuses aseptically from the uterus by hysterectomy and rearing them in isolators, alternatively embryo transfer may be used. Such rederived pigs may be maintained in isolators in the gnotobiotic status or gnotobiotic pigs may be used for the upstart of a breeding colony housed under conditions (i.e. a barrier) protecting them against certain agents, for which a monitoring system is operated. Different categories of barrier-bred pigs, such as, minimal disease, specific pathogen-free and microbiologically defined, are presented and differences between these categories are discussed. Basic principles of health monitoring in pigs, e.g. sample size, testing frequency and methods, are outlined. It is discussed how the lack of positive findings in health monitoring may be due to other factors than freedom from infection, e.g. treatment with antibiotics or a statistically invalid examination. Finally, the risk of infection with certain porcine agents when housing barrier-bred pigs in conventional experimental units is discussed.

Animal Diseases↗

mRNA expression of matrix metalloproteinases and tissue inhibitors of metalloproteinase in interface tissue around implants in loosening total hip arthroplasty.

Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) play an important role in tissue destruction and remodeling. Nine samples of cement interface tissues from nine patients who had failed cemented total hip arthroplasty (THA) were obtained for revision of THA and analyzed on mRNA expression of MMPs and TIMPs. The preoperative serial radiographic examinations revealed an apparent clear zone around all implants. We excluded septic loosening as one of the factors affecting THA. Three samples were obtained from three different sites of the acetabular interface tissue in each patient. After extraction of total RNA from 27 samples, we used the reverse-transcriptional polymerase chain reaction (RT-PCR). mRNA of MMP-1, -2, -3, -9, and TIMP-1 and -2 was detected in the interface tissue. MMP-10 mRNA was not detected, yet MMP-1 and MMP-3 mRNA were commonly observed. TIMP-2 mRNA was also strongly expressed compared to TIMP-1. It was thus demonstrated that MMPs and TIMPs were produced locally in the cemented tissue of THA loosening. These findings may suggest that MMPs and TIMPs expressed around the implants play a critical role in the progression of aseptic loosening of THA.

Aged↗

Sternal bone biopsy in standing horses.

OBJECTIVE: To develop a technique for sternal bone biopsy in standing horses. STUDY DESIGN: Experimental study. ANIMALS: Five adult horses. METHODS: Horses were restrained in a standing stocks and sedated. The sternal biopsy site, identified by ultrasonographic examination, was clipped and prepared for aseptic surgery and infiltrated with local anesthetic. An electric bone biopsy drill (Osteocore; Institut Straumann AG, CH-4437, Waldenburg, Switzerland)), which yielded 4-mm-diameter bone specimens, was used to obtain sternal biopsies through a small skin incision. Sections (7 microm) of the bone specimens were stained with toluidine blue and Goldner's green trichrome and observed microscopically to determine suitability for histological and histomorphometric evaluation. RESULTS: The most suitable sternal biopsy site was at the 4th or 5th sternebra. The surgical procedure was easy to perform and well tolerated by the horses, and adequate samples were obtained on the first attempt. The only complications were incisional edema in all horses and wound drainage in 1 horse. CONCLUSIONS: Sternal bone biopsy may be successfully performed in standing horses, and the technique described in this report yields architecturally intact bone specimens. CLINICAL RELEVANCE: The sternum is an accessible site for cancellous bone biopsy specimens in standing horses.

Animals↗

[The legal and ethical aspects of nerve tissue transplantation].

The authors have specified the following criteria for the withdrawal of embryonal tissue at their department: 1) only tissue from dead fetus is allowed to be used in neurotransplantation; 2) embryonal tissue is to be obtained after spontaneous abortions from volunteers or from women asking for artificial abortion; 3) the women should be informed about the curative purposes of embryonal tissue voluntary donorship and they must give a written consent; 4) decision on abortion should be separated from the use of embryonal tissue; 5) women should not know recipients; no payments should be made for tissue; 6) the donor is not permitted to impregnate in order to use embryos for research or clinical purposes; 7) sampling of BWR, HBsAG, anti-HIV, cytomegalovirus, herpes I and II is to be made for serologic examinations and that from the cervix for cultivation and sensitivity, as well as ultrasound verification of a germinal age is done in potential donors; 8) consent should be signed to embryonal brain transplantation by recipient or his legitimate deputy if the recipient is certifiable. The above criteria should protect both the donor and the recipient. The use of embryonal tissue cultures seems to be promising. In addition to legal and ethic problems, immunological problems and problems concerning the aseptic withdrawal of embryonal tissue are falling off.

Brain Tissue Transplantation↗

Fluctuations in the glucose level of cow's milk from normal and subclinically diseased udders.

Individual quarter samples from some 19 cows on average were investigated monthly over 12 months for determining the udder health status of cows and the glucose concentrations of foremilk and strippings. Foremilk showed a mean 0,1311 mM concentration of glucose which remained fairly stable during the period of investigation and lactation. A fluctuating mean value of 0,2037 mM was determined in strippings in which glucose levels were consistently and appreciably higher than those of foremilk. Foremilk from completely normal quarters and others affected by non-specific cellular reaction, relevant or irrelevant teat canal infection and aseptic or septic subclinical mastitis, showed mean glucose concentrations of 0,1410; 0,1392; 0,1337; 0,1417; 0,1262 and 0,1248 mM, respectively. Strippings from the same quarters showed corresponding values of 0,2056; 0,2861; 0,2100; 0,1733; 0,1661 and 0,1617 mM glucose.

Animals↗

Effects of Ureaplasma diversum on bovine oviductal explants: quantitative measurement using a calmodulin assay.

Calmodulin (CAM) acts as an intracellular regulator of calcium, an important mediator of many cell processes. We used the CAM assay and electron microscopy to investigate the effects of Ureaplasma diversum on bovine oviductal explants obtained aseptically from slaughtered cows. A stock suspension of U. diversum (treated specimens) and sterile broth (controls) was added to replicates of cultured explants and incubated at 38 degrees C in an atmosphere of 5.5% CO2 for 48 hours. Explants were examined for ciliary activity, extracellular CAM loss, and for histological and ultrastructural changes. Explants and their culture media were examined for changes in CAM concentration. All experiments were replicated three times. In addition, U. diversum, medium and broth were assayed for CAM content. The concentrations of CAM in explants and media changed significantly (p < 0.05) in samples which were inoculated with U. diversum when compared to controls. The controls and infected specimens did not differ histologically or ultrastructurally, but U. diversum was seen to be closely associated with infected explant tissue. In view of this close affinity it is assumed the loss of CAM from the oviductal cells was causally related, but this was not proven. The failure to show cell membrane injury on light and electron microscopic examination was probably related to the short duration of the experiment and may only point out the sensitivity of the CAM assay in detecting early cell membrane injury. Compromise in characteristics of the medium to support both, the viability of oviductal cells and U. diversum limited the experimental time to 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

In vivo behavior of acrylic bone cement in total hip arthroplasty.

Polymethylmethacrylate (PMMA) bone cement serves as the primary fixation material between bone and the prosthetic component in cemented total hip arthroplasty. In vivo degradation of bone cement may lead to a decrease in mechanical properties of PMMA and result in aseptic loosening. However, other factors such as porosity and location of the cement relative to the bone implant interface may also contribute to mechanical behavior in vivo. This study investigated the mechanical properties of Simplex cement retrieved from 43 patients undergoing revision total hip arthroplasty. The time in vivo was between 1 month and 27 years. The variables studied included fracture toughness (KIC), porosity, molecular weight, time in vivo of the cement, and relative in vivo location of the cement with respect to the implant and bone. KIC did not correlate with time in vivo of the samples or with molecular weight. This suggests that time in vivo may not be the limiting factor in the mechanical integrity of the bone cement, A significant and inverse relationship was found between porosity and KIC. This implies that porosity is the most important factor in the mechanical behavior of bone cement during in vivo use.

Arthroplasty, Replacement, Hip↗

Contamination of disposable tonometer prisms during tonometry.

AIM: Due to the theoretical possibility of prion transmission in applanation tonometry, many ophthalmological units in the United Kingdom now use disposable tonometer prisms. We have investigated the potential for bacterial and viral transmission from the health practitioner to the patient via disposable prisms. METHODS: All staff who perform applanation tonometry at the Sussex Eye Hospital (SEH) received a questionnaire to evaluate if the applanating face of the prism is touched during tonometry and the ease of use of the disposable prism compared to the reusable prisms that were previously used. We then cultured prisms handled by a random sample of staff members for common bacteria. Finally, we constructed a model to investigate the possibility of interpatient adenoviral transmission via disposable tonometer prisms. RESULTS: The questionnaire revealed that almost 50% of the staff admit to touching the applanating face of the tonometer prism prior to applanation. Cultures of the prisms grew a range of bacteria including Staphylococcus epidermidis, Staphylococcus aureus, and Bacillus species. The viral model suggested that adenovirus could be transmitted by applanation tonometry. CONCLUSION: The use of disposable prisms for applanation tonometry may reduce the risk of prion transmission but is not bacteriologically or virologically aseptic. This is a potential infection risk to patients.

Adenoviridae↗

Aseptic bone necrosis.

The post-traumatic and vascular necrosis of broken bones were studied in rabbits. AFter experimental traumatization and vascular lesion a similar type of necrosis was encountered. There were, however, differences in the distribution of the necrotic areas and in the position of the fracture-line. In the case of post-traumatic necrosis the fracture line was situated at the border of the intact and the necrosed tissue, whereas in vascular necrosis of secondarily broken bones it was found in the necrobiotic area. Surveying morphometrically the distribution of necrotic areas it was observed that in traumatic necrosis large fields occur on either side of the fracture-line which retained in 95% the nuclear staining of their osteocytes while in vascular necrosis such areas were not seen. On this basis traumatic and vascular necrosis can be differentiated provided the sample is taken from the surroundings of the fracture-line.

Animals↗

UHT milk: production, quality, and economics.

The review attempts to deal with the state of the art of UHT milk processing, economics, packaging, and quality maintenance. Various methods of processing are covered in detail. A sample system was considered for material and energy balances. A major factor in UHT milk technology is the economics of the process adopted. This is considered for the major processes currently in operation. Packaging and handling of UHT milk is of vital importance for the maintenance of the quality and flavor of the milk. A review of the different packaging systems describes the advantages and disadvantages of each one. The review is divided into the following sections: (1) major direct and indirect processes, (2) energy requirements and economics, (3) material and energy balances for fluid milk processing, storage, and distribution systems, (4) aseptic packaging, and (5) quality effects.

Animals↗

Comparison of cerebrospinal fluid C-reactive protein and lactate for diagnosis of meningitis.

Levels of C-reactive protein and lactate were determined on 562 consecutive cerebrospinal fluid (CSF) samples from adult patients with a wide variety of central nervous system diseases to compare the sensitivity and specificity of CSF lactate and C-reactive protein for the rapid diagnosis of bacterial meningitis. Neither test alone, together, or in combination with elevated CSF leukocyte count and protein had a predictive value over 60% for a positive test in this group of patients with diverse central nervous system problems. Neither test is useful as a screening test for bacterial or mycotic meningitis. Also, in patients with partially treated bacterial meningitis, the tests are often negative. CSF lactate may be useful in differentiating aseptic from septic meningitis in selected patients.

Bacterial Infections↗

Assessing cross infection prevention measures at the Dental Clinic, University College Hospital, Ibadan.

The dental clinic is an environment where disease transmission occurs easily. Prevention of cross infection in the dental clinic is therefore a crucial aspect of dental practice and dental clinic workers must adopt certain basic routines while practising. This study evaluates basic routines in prevention of cross-infection in the dental clinic, University College Hospital Ibadan. The sample comprised 77 dental clinic workers, who completed closed-ended questionnaires. The questionnaires enquired into practices of the workers in the clinic as well as in the laboratories Physical inspection of dental equipment, instruments and materials was also carried out. The results highlight poor compliance of workers, especially the dental surgeons and students, with the hepatitis B vaccination programme of the Hospital. History to identify high risk individuals was often overlooked and was practised by less than 50% of the clinic workers. Barrier technique with the exception of the use of eye shield, was well practised by all the clinic workers. Aseptic technique was well practised in the dental clinic. Inadequate number of dental surgery assistants, faulty sterilizing equipment, poor monitoring of sterilization, coupled with inadequate number of instruments contributed to the poor success of prevention of contamination and instrument processing procedures. Less than 30% of dental surgeons and fewer than 50% of students discarded sharp materials into the yellow/sharp bin. Liquid waste was well disposed off through the drain for onward flow into the sewer, whilst the disposal of solid contaminated waste did not conform to stipulated international standard. The study found that successful infection control in the dental clinic was highly dependent on the dental surgery assistants, because highly technological equipment were lacking. The management/administration also plays an important role in the number of physical and human resources available and in the overall surveillance of nosocomial infections.

Asepsis↗

Chronic meningitis and Lyme disease in Sweden.

We studied 35 patients with chronic meningitis. The neurological abnormalities included aseptic meningitis, cranial neuropathy (mostly facial palsy), motor and sensory peripheral radiculoneuropathy, and myelitis. Neurological symptoms were sometimes preceded by erythema chronicum migrans or an insect bite and were often accompanied by fever, malaise, profound fatigue, and weight loss. The cerebrospinal fluid (CSF) abnormalities consisted of a predominantly mononuclear pleocytosis, an elevated CSF protein (mean 2.3 g/l), intrathecal synthesis of oligoclonal immunoglobulin G, and, in half of the patients, a fall in the CSF/blood glucose ratio. High antibody titers to the Lyme spirochete and the Swedish Ixodes ricinus spirochete were demonstrated by immunofluorescence in 26 of the 35 patients. By imprint immunofixation of electrofocused samples of serum and CSF, intrathecal production of oligoclonal Lyme-spirochete-specific IgG was demonstrated in one patient with chronic meningitis. Four sequential paired samples of serum and CSF from this patient showed local synthesis of spirochete-specific antibodies in CSF. The 35 patients improved or recovered, sometimes dramatically, during a two-week course of intravenous penicillin G.

Adolescent↗