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Anaerobic Periodontal Infections as Risk Factors for Medical Diseases.

Advanced forms of periodontal disease are associated with the overgrowth of a limited number of gram-negative anaerobic species in plaques found in periodontal pockets. Double-blind clinical trials of metronidazole and doxycycline, combined with debriding of the tooth surfaces, have significantly reduced the need for periodontal surgery. Epidemiologic studies have indicated that untreated periodontal disease could be a risk factor for preterm delivery of low birth weight infants, coronary heart disease, and cerebral vascular accidents. This is because gram-negative anaerobic species implicated in periodontal disease, eg, Bacteroides forsythus, Porphyromonas gingivalis, and Treponema denticola, could introduce lipopolysaccharides, heat-shock proteins, and proinflammatory cytokines into the blood stream. If periodontal disease is a risk factor for cardiovascular disease, then it is a modifiable risk factor, as periodontal disease is treatable.

Journal Article↗

Laboratory diagnosis and interpretation of tests for syphilis.

The lack of a method for demonstrating the presence of Treponema pallidum by growth necessitates the use of alternative methods. Traditionally, these methods are divided into direct detection methods (animal inoculation, dark-field microscopy, etc.) and serologic tests for the presence of patient antibody against T. pallidum. Serologic methods are further divided into two classes. One class, the nontreponemal tests, detects antibodies to lipoidal antigens present in either the host or T. pallidum; examples are the Venereal Disease Research Laboratory and rapid plasma reagin and tests. Reactivity in these tests generally indicates host tissue damage that may not be specific for syphilis. Because these tests are easy and inexpensive to perform, they are commonly used for screening, and with proper clinical signs they are suggestive of syphilis. The other class of test, the treponemal tests, uses specific treponemal antigens. Confirmation of infection requires a reactive treponemal test. Examples of the treponemal tests are the microhemagglutination assay for antibodies to T. pallidum and the fluorescent treponemal antibody absorption test. These tests are more expensive and complicated to perform than the nontreponemal tests. On the horizon are a number of direct antigen, enzyme-linked immunosorbent assay, and PCR techniques. Several of these techniques have shown promise in clinical trials for the diagnosis of congenital syphilis and neurosyphilis that are presently difficult to diagnose.

Bacteriological Techniques↗

[Characterization of treponemal axial filament antigens using the Western blot].

Analysis by SDS-PAGE of axial filaments of cultivable treponemes showed 3 major bands: a 33/34 kD doublet and a 37 kD polypeptide. In sera from patients with various stages of syphilis, from biological false positive reactors, and from negative controls the most consistent reaction was detected against the doublet, but only sera from patients with primary or secondary syphilis reacted with the 37 kD axial filament polypeptides. About 6 weeks after antibiotic treatment sera had lost their reactivity with 37 kD antigens in agreement with decreasing antibodies in VDRL-test. Because of their recognition early in infection 37 kD-proteins are postulated to use in serodiagnostic assays, but our data emphasize also the need for use further antigens in tests for diagnosis in later stages of syphilis.

Antigens, Bacterial↗

Comparison of stained smears and culturing for identification of Treponema hyodysenteriae.

A comparative study was made of stained fecal smears and cultured fecal swabs for identification of the large spirochetes Treponema hyodysenteriae and Treponema innocens. Feces were obtained by swabbing rectums, colons, and stools of nonexposed swine and swine experimentally exposed to swine dysentery. In this study there was a significant (P less than 0.001) correlation between the observation of one or more large spirochetes on stained slides and obtaining either a strong or a weak beta-hemolytic reaction in culture. A significant (P less than 0.001) correlation was also found between the observation of one or more large spirochetes on stained smears or obtaining either a strong or a weak beta-hemolytic reaction in culture and the occurrence of either nonhemorrhagic or hemorrhagic diarrhea in the swine. In the diarrheic swine at the time of swabbing, 157 of 393 samples (40%) were negative for both the presence of large spirochetes on stained smears and the production of either a strong or a weak beta-hemolytic reaction; in nondiarrheic swine, 42 of 278 samples (15.1%) were positive in stained smears and 32 of 268 samples (11.9%) were positive by culturing. In swine infected with swine dysentery, 17 of 1,011 samples produced weak beta-hemolytic reactions, and in swine infected with nonpathogenic large spirochetes of T. innocens, three of 34 samples produced strong beta-hemolytic reactions. It was concluded from this study that neither staining rectal smears nor culturing rectal swabs is sufficient, either together or alone, for the diagnosis of swine dysentery; however, these laboratory methods could be highly supportive of a diagnosis of swine dysentery in swine with clinical signs and lesions of the disease.

Animals↗

Evaluation of a Treponema pallidum enzyme immunoassay as a screening test for syphilis.

The CAPTIA Syphilis-G enzyme immunoassay for the detection of antibodies to Treponema pallidum was evaluated as a screening test for syphilis in comparison with the standard rapid plasma reagin (RPR) test. One thousand samples were tested, and the standard fluorescent treponemal antibody absorption test and the standard microhemmaglutination test were used to confirm the presence of treponemal antibodies. Diagnosis of syphilis was based on traditional standard serology results. Clinical data used in the diagnosis of patients whose samples yielded conflicting results were provided by physicians. Initially, 7 patients whose samples were reactive in the RPR test and 14 patients whose samples yielded positive or equivocal results in the CAPTIA Syphilis-G test were diagnosed as not being infected. After discrepancies due to technical problems were reconciled, samples from six patients remained reactive in the RPR test and that from one patient remained positive in the CAPTIA Syphilis-G test. In addition, seven patients whose samples were nonreactive in the RPR test and two patients whose samples were negative in the CAPTIA Syphilis-G test were diagnosed as having untreated syphilis. After discrepancies were reconciled, samples from five patients remained nonreactive in the RPR test and none remained negative in the CAPTIA Syphilis-G test. Final results indicate that the specificities are 99.4 and 99.9%, respectively. In addition to the improved sensitivity and specificity of the CAPTIA Syphilis-G screen, other potential benefits of this assay lead us to believe that this method could serve as a better screening tool than the RPR test.

Evaluation Studies as Topic↗

Assessment of pretreatment orthodontic patients using the BANA test. N-benzoyl-DL-arginine-naphthylamide.

Ninety-two subjects were tested before orthodontic mechanotherapy for the presence of three putative periodontopathogens-Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus-with the BANA test (PerioScan Oral-B). The sample ranged from 9 to 16 years, with a mean age of 13.1 years, and consisted of 51% girls and 49% boys; 48% African American, 46% white, 4% Asian, and 2% Hispanic. Unlike other BANA studies that examined children and adolescents with a 15-minute incubation time, this research used a 5-minute incubation time to increase the specificity and to reduce the false positives obtained from the PerioScan cards. No statistically significant difference was found between the age, gender, or race of the patients and the levels of the three putative periodontopathogens. A Friedman two-way analysis of variance assessed the BANA levels for three groups of teeth: molars, incisors, and premolars. The central incisors and first molars had a significantly higher percentage of positive BANA readings than the first premolars at p < or = 0.05. The clinical importance of this finding has yet to be determined, however, because the central incisor and first molar are the first permanent teeth to erupt, a possible association between dental emergence time and the rate of infection with various organisms may be postulated. In a pilot study, 10 patients from a statistically comparable pretreatment group were assessed longitudinally at two separate collection times separated by 4 months. The Wilcoxon signed rank test indicated no significant changes in these patients over the 4-month period.

Adolescent↗

An endo-acting proline-specific oligopeptidase from Treponema denticola ATCC 35405: evidence of hydrolysis of human bioactive peptides.

An endo-acting proline-specific oligopeptidase (prolyl oligopeptidase [POPase], EC 3.4.21.26) was purified to homogeneity from the Triton X-100 extracts of cells of Treponema denticola ATCC 35405 (a human oral spirochete) by a procedure that comprised five successive fast protein liquid chromatography steps. The POPase is a cell-associated 75- to 77-kDa protein with an isoelectric point of ca. 6.5. The enzyme hydrolyzed (optimum pH 6.5) the Pro-pNA bond in carbobenzoxy-Gly-Pro-p-nitroanilide (Z-Gly-Pro-pNA) and bonds at the carboxyl side of proline in several human bioactive peptides, such as bradykinin, substance P, neurotensin, angiotensins, oxytocin, vasopressin, and human endothelin fragment 22-38. The minimum hydrolyzable peptide size was tetrapeptide P3P2P1P'1, while the maximum substrate size was ca. 3 kDa. An imino acid residue in position P1 was absolutely necessary. The hydrolysis of Z-Gly-Pro-pNA was potently inhibited by the following, with the Ki(app) (in micromolar) in parentheses: insulin B-chain (0.7), human endothelin-1 (0.5), neuropeptide Y (1.7), substance P (32.0), T-kinin (4.0), neurotensin (5.0), and bradykinin (16.0). Chemical modification and inhibition studies suggest that the POPase is a serine endopeptidase whose activity depends on the catalytic triad of COOH ... Ser ... His but not on a metal. The amino acid sequence around the putative active-site serine is Gly-Gly-Ser-Asn-Pro-Gly. The enzyme is suggested to contain a reactive cysteinyl residue near the active site. Amino acid residues 4 to 24 of the first 24 N-terminal residues showed a homology of 71% with the POPase precursor from Flavobacterium meningosepticum and considerable homology with the Aeromonas hydrophila POPase. The ready hydrolysis of human bioactive peptides at bonds involving an imino acid residue suggests that enzymes like POPase may contribute to the chronicity of periodontal infections by participating in the peptidolytic processing of those peptides.

Amino Acid Sequence↗

Serological and clinical correlates of gonorrhoea and syphilis in fertile and infertile Nigerian women.

OBJECTIVE: To test the hypothesis that infertile Nigerian women have higher serum levels of antibodies against Neisseria gonorrhoea and Treponema pallidum compared with fertile controls. DESIGN: The prevalence of serum antibodies against N gonorrhoea and T pallidum was compared in fertile and infertile Nigerian women. SETTING: Population based case-control study in Ile-Ife, southwestern Nigeria. SUBJECTS: 60 women with infertility identified from a community based questionnaire survey of 1075 women were compared with 53 age matched fertile controls. METHODS: Sera of fertile and infertile women were tested for the presence of gonococcal antibodies with indirect agglutination test and syphilis antibodies using rapid reagin method. MAIN OUTCOME MEASURES: Prevalence of anti-gonococcal and anti-treponemal antibodies in cases and controls. Frequency of self reports of sexually transmitted infections (STIs) in cases and controls. RESULTS: In comparison with fertile women, infertile women were more likely to report having had repeated lower abdominal pains (p < 0.01), yellow vaginal discharge (p < 0.004), and whitish vaginal discharge (p < 0.02). There was no significant difference between cases and controls in the proportions reporting previous STI diagnoses. However, two infertile women reported previous gonococcal infection compared with none in the fertile group. Sixteen of the infertile women (26.7%) demonstrated anti-gonococcal antibodies in their sera compared with only four of the 53 fertile controls (7.5%) (p < 0.02; OR 4.5). There was no significant difference between fertile and infertile women in the proportion showing serological reactivity to T pallidum. CONCLUSION: Infertile women have a higher prevalence of anti-gonococcal antibodies compared with fertile controls. Infertile women are also more likely to report previous lower abdominal pains and vaginal discharge. These results provide credible evidence implicating STIs and N gonorrhoea in particular as important factors contributing to female infertility in this population. Public health measures are warranted to address the high rate of STIs and N gonorrhoea in Nigeria.

Adolescent↗

Dermal inflammation elicited by synthetic analogs of Treponema pallidum and Borrelia burgdorferi lipoproteins.

The membrane lipoproteins of Treponema pallidum and Borrelia burgdorferi have potent immunostimulatory properties in vitro, implicating them as major inflammatory mediators in syphilis and Lyme disease. Recently, we reported that synthetic lipohexapeptide analogs (lipopeptides) of the lipoproteins could be used as surrogates for native spirochetal lipoproteins in immune cell activation studies in vitro. The present study was designed to evaluate the inflammatory properties of the lipopeptides in vivo and to correlate the cellular responses to these synthetic analogs with the histopathology of syphilis and Lyme disease. Lipopeptides corresponding to the 47-kDa major membrane lipoprotein of T. pallidum and the outer surface protein A of B. burgdorferi injected intradermally induced dose-dependent dermal inflammation in mice; the initial predominantly neutrophilic (mice) or heterophilic (rabbits) cellular infiltrates were followed by infiltrates consisting predominantly of mononuclear cells. The intradermal response of rabbits to the 47-kDa lipopeptide was strikingly similar to that observed for animals infected intradermally with T. pallidum. In all cases, lipopolysaccharide was substantially more potent as an inflammatory mediator than the spirochetal lipopeptides. In contrast to the lipopeptides, nonacylated hexapeptides elicited minimal or no dermal lesions in mice or rabbits, underscoring the importance of acyl modification to the inflammatory properties of the lipopeptides. This study provides the first in vivo evidence that the spirochetal lipoproteins/lipopeptides contribute to the immunopathogenesis of syphilis and Lyme disease.

Amino Acid Sequence↗

[Screening for markers of transfusion-associated infections in autologous blood donation].

Autologous blood donation is increasingly used in preparing patients for elective surgical procedures. The aim is to diminish the transmission of transfusion-associated infections, to avoid transfusion-related immunosuppression and to relieve the general blood supply. However, autologous blood donation programs do not necessarily incorporate serologic donor screening. From June 1990 to January 1993 we examined 4,038 consecutive autologous donations from 1,708 patients. The median age was 61 years (range 10-88), the sex ratio was 1/1.5 male/female. We tested each unit for serum ALT, anti-HIV1 + 2, HBsAG, anti-HBc, anti-HCV, and Treponema pallidum antibodies (TPHA test). The overall rates of positive test results were: ALT > 45 U/l 0.64%, anti-HBc 15.9%, BHsAG 0.72% and TPHA test 0.32% of all units; anti-HCV (1st gen.) 4.26% of 1,948 and anti-HCV (2nd gen.) 2.34% of 2,090 donations. With respect to the sex-related normal range of the local laboratory, 332 (8.2%) of all components had an elevated serum ALT level. No donation was positive for anti-HIV1/2. The overall rate of components with pathological findings in tests for ALT, HCV antibodies, HBs antigen and/or Treponema antibodies was 11.7%. We conclude from these data that a substantial proportion of autologous blood is potentially harmful in cases of mistake solely with respect to serologic screening results. Procedures to minimize the risk of mistake of autologous blood should routinely include serologic screening and marking of units with pathological findings.

Adolescent↗

Characterization of the low-molecular-mass proteins of virulent Treponema pallidum.

We previously demonstrated that Treponema pallidum cells incubated in vitro in the presence of heat-inactivated normal rabbit serum (HINRS) synthesize, in very small quantities, several pathogen-specific, low-molecular-mass proteins that appear to be localized extracellularly. In this study, we have taken advantage of our ability to metabolically radiolabel T. pallidum cells to high specific activity to further characterize these antigens. We found that the low-molecular-mass proteins are not related to the 15- and 17-kDa detergent-phase proteins (J. D. Radolf, N. R. Chamberlain, A. Clausell, and M. V. Norgard, Infect. Immun. 56:490-498, 1988). The low-molecular-mass proteins did not incorporate 3H-labeled fatty acids and were not precipitated by rabbit immunoglobulin G (IgG) antibodies directed against glutathione S-transferase fusions to the nonlipidated 15- and 17-kDa proteins. We prepared polyclonal antisera to the low-molecular-mass proteins by immunizing two rabbits with the concentrated supernatant of T. pallidum cells. IgG antibodies present in the sera of both rabbits precipitated a 21.5-kDa protein from solubilized extracts of T. pallidum supernatant and cells. IgG antibodies in the serum of the second rabbit precipitated an additional 15.5-kDa low-molecular-mass protein only from solubilized extracts of supernatant. While investigating the effect of eliminating HINRS from the extraction medium, we observed that the low-molecular-mass proteins remained associated with treponemal cells that were incubated in the absence of HINRS. These proteins could be eluted from the cells by the addition of HINRS or rabbit serum albumin, suggesting that they are located on or near the treponemal cell surface. The 15.5- and 21.5-kDa low-molecular-mass proteins were not washed off treponemal cells with buffer containing 1 M KCl. Experiments employing selective solubilization of the T. pallidum outer membrane with 0.1% Triton X-114 and proteinase K accessibility indicated that the 15.5-kDa protein, but not the 21.5-kDa protein, is cell surface exposed.

Animals↗

Treponema pallidum 3-phosphoglycerate mutase is a heat-labile enzyme that may limit the maximum growth temperature for the spirochete.

In the causative agent of syphilis, Treponema pallidum, the gene encoding 3-phosphoglycerate mutase, gpm, is part of a six-gene operon (tro operon) that is regulated by the Mn-dependent repressor TroR. Since substrate-level phosphorylation via the Embden-Meyerhof pathway is the principal way to generate ATP in T. pallidum and Gpm is a key enzyme in this pathway, Mn could exert a regulatory effect on central metabolism in this bacterium. To study this, T. pallidum gpm was cloned, Gpm was purified from Escherichia coli, and antiserum against the recombinant protein was raised. Immunoblots indicated that Gpm was expressed in freshly extracted infective T. pallidum. Enzyme assays indicated that Gpm did not require Mn(2+) while 2,3-diphosphoglycerate (DPG) was required for maximum activity. Consistent with these observations, Mn did not copurify with Gpm. The purified Gpm was stable for more than 4 h at 25 degrees C, retained only 50% activity after incubation for 20 min at 34 degrees C or 10 min at 37 degrees C, and was completely inactive after 10 min at 42 degrees C. The temperature effect was attenuated when 1 mM DPG was added to the assay mixture. The recombinant Gpm from pSLB2 complemented E. coli strain PL225 (gpm) and restored growth on minimal glucose medium in a temperature-dependent manner. Increasing the temperature of cultures of E. coli PL225 harboring pSLB2 from 34 to 42 degrees C resulted in a 7- to 11-h period in which no growth occurred (compared to wild-type E. coli). These data suggest that biochemical properties of Gpm could be one contributing factor to the heat sensitivity of T. pallidum.

Adenosine Triphosphate↗

Evaluation of a new competitive immunoassay (BioElisa Syphilis) for screening for Treponema pallidum antibodies at various stages of syphilis.

The BioElisa Syphilis, a new competitive enzyme immunoassay (EIA) for Treponema pallidum whole antigen that uses specific human immunoglobulin G (IgG) antibodies as the competitor, was evaluated for potential use in screening for syphilis at various stages. The results obtained by this competitive EIA were compared with those obtained by the fluorescent treponemal antibody absorption (FTA-abs) test and the T. pallidum hemagglutination assay (TPHA). Serum samples from 434 patients with positive TPHA and FTA-abs test results, including patients with primary, latent, secondary, and tertiary syphilis and neurosyphilis, were investigated. Two samples tested negative by competitive EIA but were weakly reactive by the TPHA and the FTA-abs test. Sixteen serum samples from patients with clinically documented active syphilis, including several patients infected with human immunodeficiency virus, tested positive by the competitive EIA. There was a direct inverse correlation between EIA indices and titers in the TPHA and the FTA-abs test for all samples that tested positive. Specificity was assessed by testing 358 serum samples which tested negative for syphilis by TPHA and the FTA-abs test, including 100 serum samples from patients with documented infectious or autoimmune diseases. Only two serum samples gave a weakly positive EIA result. Thus, competitive EIA had a sensitivity of 99.5% and a specificity of 99.4% relative to the results of the FTA-abs test and TPHA. Our evaluation shows that BioElisa Syphilis is a sensitive, specific, and simple assay for screening for syphilis.

Antibodies, Bacterial↗

Erythromycin: a microbial and clinical perspective after 30 years of clinical use (1).

Erythromycin is a macrolide that acts by inhibiting the translocation reaction during protein synthesis. Erythromycin is inactive against the Enterobacteriaceae and Pseudomonas aeruginosa except under alkaline conditions. Erythromycin is active against most gram-positive bacteria; some gram-negative bacteria, including Neisseria, Bordetella, Brucella, Campylobacter, and Legionella; and Treponema, Chlamydia, and Mycoplasma. The emergence of resistance to erythromycin is closely associated with its use and is often plasmid mediated. After its oral or parenteral administration, erythromycin diffuses readily into intracellular fluids and is actively concentrated intracellularly by polymorphonuclear leukocytes and alveolar macrophages.

Bacteria↗

The effects on chronic periodontitis of a subgingivally-placed redox agent in a slow release device.

Adjunctive chemical agents can reduce the need for meticulous plaque control. The aim of this investigation was to evaluate the periodontal treatment potential of subgingival application of the redox agent methylene blue in a slow-release device. This randomized, single-blind, split-mouth study included 18 patients aged 35-57 years, with chronic adult periodontitis, pocketing of at least 5 mm and radiographic evidence of regular bone loss. All experimental sites received subgingival debridement at day 0. Test sites received 32% w/w methylene blue in the slow release device at days 0 and 28. Clinical examination and microbiological sampling were performed at days 0, 7, 28, 56 and 84. Clinical improvements were seen in both groups, but test sites showed consistently greater improvements, some of which were statistically significant (as determined by between-group comparisons utilising SNDs). Significant between-group differences in relation to baseline levels were seen in bleeding index at days 7 and 56, in probeable pocket depth at day 56 and for the Perioscan BANA test at day 7. This pilot study thus showed that adjunctive methylene blue in a slow-release device can produce greater clinical and microbiological improvements than subgingival debridement alone.

Adult↗

Molecular analysis of the subgingival microbiota in health and disease.

This investigation provides molecular analyses of the periodontal microbiota in health and disease. Subgingival samples from 47 volunteers with healthy gingivae or clinically diagnosed chronic periodontitis were characterized by PCR-denaturing gradient gel electrophoresis (DGGE) with primers specific for the V2-V3 region of the eubacterial 16S rRNA gene. A hierarchical dendrogram was constructed from band patterns. All unique PCR amplicons (DGGE bands) were sequenced for identity. Samples were also analyzed for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis by multiplex PCR. Associations of patient age, gender, and smoking status together with the presence of each unique band and putative periodontal pathogens with disease were assessed by logistic regression. Periodontal pockets were colonized by complex eubacterial communities (10 to 40 distinct DGGE bands) with substantial individual variation in the community profile. Species diversity in health and disease was determined by the Shannon-Weaver index of diversity and compared by the Mann-Whitney U test. Sequence analyses of DGGE amplicons indicated the occurrence of many nontypical oral species and eubacteria previously associated with this environment. With the exception of T. forsythensis, the putative pathogens were not detected by DGGE. Multiplex PCR, however, detected T. forsythensis, A. actinomycetemcomitans, and P. gingivalis in 9% 16%, and 29% of the patients with disease, respectively. The presence of A. actinomycetemcomitans was significantly associated with disease (P < 0.01). Statistical analyses indicated that the presence of Treponema socranskii and Pseudomonas sp. was a significant predictor of disease (P < 0.05) and that there was no significant difference (P > 0.05) in terms of eubacterial species diversity between health and disease.

Actinobacillus Infections↗

Recombinant Treponema pallidum rare outer membrane protein 1 (Tromp1) expressed in Escherichia coli has porin activity and surface antigenic exposure.

We recently reported the cloning and sequencing of the gene encoding a 31-kDa Treponema pallidum subsp. pallidum rare outer membrane porin protein, designated Tromp1 (D. R. Blanco, C. I. Champion, M. M. Exner, H. Erdjument-Bromage, R. E. W. Hancock, P. Tempst, J. N. Miller, and M. A. Lovett, J. Bacteriol. 177:3556-3562, 1995). Here, we report the stable expression of recombinant Tromp1 (rTromp1) in Escherichia coli. rTromp1 expressed without its signal peptide and containing a 22-residue N-terminal fusion resulted in high-level accumulation of a nonexported soluble protein that was purified to homogeneity by fast protein liquid chromatography (FPLC). Specific antiserum generated to the FPLC-purified rTromp1 fusion identified on immunoblots of T. pallidum the native 31-kDa Tromp1 protein and two higher-molecular-mass oligomeric forms of Tromp1 at 55 and 80 kDa. rTromp1 was also expressed with its native signal peptide by using an inducible T7 promoter. Under these conditions, rTromp1 fractionated predominantly with the E. coli soluble and outer membrane fractions, but not with the inner membrane fraction. rTromp1 isolated from the E. coli outer membrane and reconstituted into planar lipid bilayers showed porin activity based on average single-channel conductances of 0.4 and 0.8 nS in 1 M KCl. Whole-mount immunoelectron microscopy using infection-derived immune serum against T. pallidum indicated that rTromp1 was surface exposed when expressed in E. coli. These findings demonstrate that rTromp1 can be targeted to the E. coli outer membrane, where it has both porin activity and surface antigenic exposure.

Antigens, Bacterial↗

National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part 2. Laboratory results.

The Centers for Disease Control conducted a case-control study to investigate an outbreak of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men. The occurrence of these diseases was found to be associated with certain aspects of lifestyle, including a greater number of male sex partners per year, exposure to feces during sex, history of syphilis and non-B hepatitis, treatment for enteric parasites, and use of various illicit substances. Laboratory studies reflected both this lifestyle and the probable underlying cause of the Kaposi's sarcoma and P. carinii pneumonia--cellular immune deficiency. Patients were found to have lymphopenia, specifically a deficiency of the T-helper subpopulation, resulting in a reversal of the T-helper to T-suppressor ratio. Levels of IgG and IgA were increased. When compared with controls, patients were also found to have significantly higher titers of antibody to Epstein-Barr virus and cytomegalovirus, a higher prevalence of antibody to hepatitis A virus and Treponema pallidum, a lower prevalence of antibody to varicella zoster virus, and a higher frequency of isolation of cytomegalovirus.

Acquired Immunodeficiency Syndrome↗