CF Antibody Research Articles

MRI Findings of the Japanese Encephalitis

Japanese encephalitis (JE) is a disease caused by the mosquito-borne Japanese encephalitis virus (JEV). It is prevalent in Southeast Asia and East Asia. Diagnosis of JE is generally accomplished by testing of serum or cerebrospinal fluid (CSF) to detect virus-specific antibodies. Magnetic resonance imaging (MRI) is a useful adjunct for the diagnosis. Thalamic invasion is classical findings of MRI. Other areas in the brain may be invaded are midbrain, pons, cerebellum, basal ganglia, cerebral cortex. Case 1: A 60-year-old man presented with headache and fever. Neurological examination showed consciousness Kernig’s sign. CSF: JEV HI antibodies: X320. (Figure 1) Axial T2-weighted MR image (4 days after onset) shows high intensity area in the left thalamus (arrow) and the left putamen (curved arrow). Case 2: A 91 year-old woman presented with deteriorated consciousness. CSF: JEV CF antibodies: X32, JEV HI antibodies: X160. (Figure 2) Axial T2-weighted MR image (8 days after onset) shows high intensity area in the bilateral thalamus (arrow).

Detection of Antibodies against <i>Mycoplasma mycoides</i> subsp. <i>capri</i> in Goats with the Complement Fixation Test

Mycoplasma mycoides subsp. capri is the causative agent of severe and acute respiratory problems in goats, which spreads rapidly and represents high mortality. The serological profile of the goat population, from nine regions in seven states of Mexico, was screened by the Complement Fixation test (CF) in sera from asymptomatic goats and animals with mild respiratory symptoms. Sera and nasal swabs of 827 goats were collected for the isolation of the organism. An antiserum was prepared against a previously isolated field strain of Mycoplasma mycoides subsp. capri. CF Antibody titers were associated with the results of the isolates to determine the cutoff point. The CF was considered as positive if its result was ≥1/16. The CF registered 251 positive goats (30.35%) and 576 (69.65%) negative; the test showed high sensitivity (93.33%) and specificity (72.27%). In the specific case of diagnosis for mycoplasmosis associated with respiratory problems in goats, the CF proved to be a good diagnosis test, this study determined that 30% of the goat population showed antibody titers against Mycoplasma mycoides subsp. capri and revealed those animals who have had contact with this microorganism during their lives regardless of the presence or absence of respiratory symptoms.

Clinical Characteristics of Adult Onset RSV Infection During Two Consecutive Winter Seasons

We performed a retrospective study examining adult patients with RSV infection who were diagnosed at our hospital during two consecutive winter seasons, 2011-2012 and 2012-2013; these patients were compared with, adult patients who had been diagnosed as having influenza during the same periods. RSV infection was confirmed by a 4-fold increase in the CF antibody titer, while influenza was diagnosed based on a rapid antigen test. Forty-three patients with RSV infection and pneumonia patients (39 inpatients and 4 outpatients) and 25 patients with influenza and pneumonia (23 inpatients and 2 outpatients) were detected. Overall, 54 patients with RSV infection and 42 patients with influenza, were hospitalized during the two seasons. A history of the influenza vaccination was verified for 48% of the influenza patients with pneumonia and 35% of the non-pneumonia influenza patients who were hospitalized, and neuraminidase inhibitors were used for the treatment of all the influenza patients and 88% of the non-pneumonia influenza patients who were hospitalized. Overall, 5.3% of the adult cases with pneumonia (43/817) during the two seasons were diagnosed as having RSV related illness, and within the peak period, in particular, 14.6% were judged as having RSV pneumonia. Furthermore, 63% of the patients with RSV infection and pneumonia had mixed infections with other common respiratory pathogen, such as Streptococcus pneumoniae, and within the peak period, almost 15% of the patients with pneumonococcal pneumonia were confirmed to have mixed infections that included RSV. In both groups, one-fourth of the patients had been living in nursing homes or had been receibing home medical care. Up to 20% of the RSV pneumonia patients were initially diagnosed as having aspiration pneumonia. We suspect that some of these elderly patients might have developed pneumonia as a result of preceding viral infection or following vomiting or aspiration. The overall clinical picture, such as the mean age, maximum body temperature, hypoxemia, CRP, and WBC, did not differ significantly between the two groups. The 30-day mortality and overall hospital mortality rates were similar in both groups, but the lengths of the hospital stay were significantly longer, and several patients survived but continued to have a reduced activities of daily living score at the time of their discharge in the RSV pneumonia group.

Immunological and Microbiologic Changes during Caries Development in Young Children

We explored the association between caries development, colonization with caries-associated microflora, and immunity as children begin the transition to mixed dentition. Forty children received dental examinations at 3–4 years of age, repeated a year later. Children were grouped into caries-free (n = 23; CF) and caries-active (n = 17; CA ≧3 new lesions on follow-up). Salivary IgA and IgA antibody to Streptococcus mutans virulence epitopes were measured by Luminex assay. Mutans streptococci (MS), lactobacilli and total microorganisms were enumerated on selective media from plaque samples. There was no significant difference in baseline levels of MS or lactobacilli between CF and CA groups. However, both MS and lactobacilli levels were higher at follow-up in the CA group. Furthermore, children with detectable lactobacilli at baseline had significantly higher caries risk. Salivary IgA concentrations increased significantly in both groups during the study. Both CF and CA groups also displayed significant increases in salivary IgA antibody levels to glucosyltransferase, glucan-binding protein (Gbp) and antigen I/II salivary binding region. CF antibody levels to seven peptides associated with domains of biological importance increased at follow-up, in contrast to increases to only three peptides in CA saliva samples. Multivariate modeling showed that a lower baseline level of salivary IgA anti-GbpB was associated with higher caries risk. These data indicate that MS and lactobacilli are associated with caries in this population, that the secretory immune system is undergoing significant maturation during this period, and that the breadth of mucosal IgA response to epitopes of S. mutans virulence components may influence the degree to which these cariogenic microorganisms can cause disease.

Retrospective Investigation of an Influenza A/H1N1pdm Outbreak in an Italian Military Ship Cruising in the Mediterranean Sea, May-September 2009

BackgroundClinical surveillance may have underestimated the real extent of the spread of the new strain of influenza A/H1N1, which surfaced in April 2009 originating the first influenza pandemic of the 21st century. Here we report a serological investigation on an influenza A/H1N1pdm outbreak in an Italian military ship while cruising in the Mediterranean Sea (May 24-September 6, 2009).MethodsThe contemporary presence of HAI and CF antibodies was used to retrospectively estimate the extent of influenza A/H1N1pdm spread across the crew members (median age: 29 years).FindingsDuring the cruise, 2 crew members fulfilled the surveillance case definition for influenza, but only one was laboratory confirmed by influenza A/H1N1pdm-specific RT-PCR; 52 reported acute respiratory illness (ARI) episodes, and 183 reported no ARI episodes. Overall, among the 211 crew member for whom a valid serological result was available, 39.3% tested seropositive for influenza A/H1N1pdm. The proportion of seropositives was significantly associated with more crowded living quarters and tended to be higher in those aged <40 and in those reporting ARI or suspected/confirmed influenza A/H1N1pdm compared to the asymptomatic individuals. No association was found with previous seasonal influenza vaccination.ConclusionsThese findings underline the risk for rapid spread of novel strains of influenza A in confined environment, such as military ships, where crowding, rigorous working environment, physiologic stress occur. The high proportion of asymptomatic infections in this ship-borne outbreak supports the concept that serological surveillance in such semi-closed communities is essential to appreciate the real extent of influenza A/H1N1pdm spread and can constitute, since the early stage of a pandemic, an useful model to predict the public health impact of pandemic influenza and to establish proportionate and effective countermeasures.

Development of SN, HI and CF antibodies in Infected Horses with Getah Virus

Development of SN, HI and CF antibodies in Infected Horses with Getah Virus

Therapeutic effectiveness of prednisolone in Mycoplasma pulmonis-infected pneumonia in mice

The present investigation was designed to analyze the therapeutic efficacy of prednisolone in the development of pulmonary lesions in Mycoplasma pulmonis-infected mice. Mice were treated every day from day 3 to day 9 after M. pulmonis inoculation with minocycline (group M), prednisolone (group P), or with minocycline and prednisolone (group MP) and a control group was left untreated. Mice from each group were sacrificed at days 7, 14, and 21. The macroscopic lung lesion scores of group MP at days 7, 14, 21, and of group M at day 7 were significantly lower (p < 0.05) compared with the control group. Pathological findings in group M and MP showed reduction of the polymorphonuclear leukocyte response in the alveoli compared with the controls. However, infiltration of lymphocytes around the bronchioles and blood vessels of group M was not less than that in group MP. The titer of CF antibody in group MP was the lowest of the four groups. Among the four groups, M. pulmonis was cultured in the joints of group P. These results suggest that combination therapy with minocycline and prednisolone was effective because the mice of group MP had a more marked reduction of infiltration of lymphocytes around the bronchioles and blood vessels as compared with group M. Simultaneously, with prednisolone alone therapy, a risk of dissemination of the mycoplasma organism and diminution of antibody production were suggested.

Clinical and virological evaluation of the efficacy of an inactivated EHV1 and EHV4 whole virus vaccine (Duvaxyn EHV 1,4). Vaccination/challenge experiments in foals and pregnant mares

Pregnant mares and young foals were vaccinated with Duvaxyn EHV 1,4, an inactivated and adjuvanted vaccine containing both the EHV-1 and 4 antigens. SN and CF antibody titres were induced two weeks after first vaccination. Antibody levels were boosted after second vaccination, however they never reached the levels induced after virus challenge. Young foals were challenged with virulent EHV-1 and EHV-4 field viruses. Pregnant mares were challenged with the highly abortigenic EHV-1 strain Ab4. Vaccinated animals showed a clear reduction in clinical signs and virus excretion compared to unvaccinated control animals. Log transformed antibody levels could be correlated to duration of virus excretion. The incidence of EHV-1 induced abortions was drastically reduced in vaccinated mares. Therefore, although vaccinated animals are not fully protected against disease, Duvaxyn EHV 1,4 clearly reduces clinical symptoms, the duration of virus shedding and the quantity of virus shed. It can be concluded that vaccination of foals and pregnant mares with Duvaxyn EHV 1,4 significantly reduces the risk of abortions and outbreaks of respiratory disease caused by circulating field viruses.

Cytomegalovirus (CMV) infection in infants may result intractable stridor

We found ten cases of human cytomegalovirus (CMV) infection who were intractable stridor. Their symptoms were not improved by the treatment with aminophyllin nor beta stimulants. They were admitted repeatedly complaining of stridor, fever and diarrhea. In two cases, the immunological findings showed a decrease of bacterial sterilizing activity of the neutrophils. Additionally, blood count showed leukocytosis more than 15,000/ul in all cases. Total serum IgE and specific IgE antibodies to many antigens were not elevated. Transaminase was elevated. Chest X-p findings of interstitial pneumonia or atelectasis continued for a long time in some cases. Virological examinations revealed high concentrations of specific IgM or CF antibodies against CMV in all cases. CMV DNA in saliva were examined by polymerase chain reaction (PCR) with primer sets for the immediate early (IE) region of CMV and showed positive in seven cases. CMV in bronchoalveolar lavage (BAL) was isolated in two cases, and CMV PCR in BAL was positive in three cases. The sequence of the CMV-PCR products showed almost same sequence except one point mutation in bp 1203. We considered that CMV infections in infants may induce stridor for a long period.

Mapping of a Coccidioides immitis-specific epitope that reacts with complement-fixing antibody.

We have previously cloned the cDNA fragment that encodes the complement fixation antigen of Coccidioides immitis. The recombinant protein was highly sensitive in detecting CF antibody in sera from patients with coccidioidomycosis but was not specific to C. immitis, as evidenced by its reactivity with sera from patients with histoplasmosis and, to lesser extent, blastomycosis. We undertook this study to determine if the epitope(s) that reacts with CF antibody is the same or differs from the epitopes that are shared with Histoplasma capsulatum and Blastomyces dermatitidis. PCR-generated CF/chitinase cDNA fragments were cloned and examined for their reactivity in enzyme-linked immunosorbent assays using sera from patients with coccidioidomycosis, histoplasmosis, or blastomycosis. A peptide domain comprised of amino acid residues 20 through 310 was shown to express an epitope(s) that is specific to anti-Coccidioides CF antibody. The peptide detected serum antibody in 21 (95%) of 22 patients with active coccidioidomycosis and was without reactivity with sera from 20 patients with histoplasmosis, 15 patients with blastomycosis, and 14 healthy subjects. Antibody titers to the recombinant peptide directly correlated with CF antibody titers (P < 0.01), and preadsorption of reference CF antiserum with the peptide ablated the reactivity of the antiserum in the immunodiffusion assay for CF antibody. The delineation of a recombinant peptide that has both sensitivity and specificity will provide a valuable tool for detecting CF antibody and for evaluating the role of CF antibody in the host response to C. immitis.

ルファモノメトキシン・オルメトプリム合剤のSPF豚Gl&amp;auml;sser病予防効果

Two each of SPF pigs were feed 240, 160 and 80ppm of a mixture (SO) of sulfamonomethoxine (3%) andorimethoprim (1%) in three group for 5 days, and at day 3 they were challenged with Haemophilus parasuis. Glässer's disease was produced in two un-infected control pigs and the 80ppm group, but the 160 and 240ppm groups showed no clinical signs and no bacteria were recovered. Two SPF and two conventional pigswere reared with a pen, and treated with 240, or 160 ppm of SO for 3 weeks. The SO-treated groups showedno clinical signs, while one of two pigs of the non-SO control group showed signs of Glässer's disease. Allthe SO-treated and non-treated SPF pigs developed CF antibody at 2 weeks of pen-mating, and H. parasuiswas isolated from the nasal mucosa.

Studies on shared antigenic/allergenic components among fungi

Fungal allergens have been found to be one of the most prevalent aeroallergens in India. Knowledge of shared/unique components among different fungi is necessary for proper diagnosis and treatment of patients allergic to fungi. In the present study, crude extracts (CE) of 11 common fungi (Alternaria alternata, Aspergillus flavus, Asp. fumigatus, Asp. niger, Asp. tamarii, Asp. versicolor, Cladosporium herbarum, Curvularia lunata, Mucor hiemalis, Penicillium citrinum, and Fusarium solani) were characterized by isoelectric focusing (IEF), SDS-PAGE, and immunoblot. On IEF (pI 3-9), the number of protein bands was found to be greatest (46) in M. hiemalis extract. SDS-PAGE exhibited a varied number of bands, generally 18-40, with mol. mass ranging from 14 to 100 kDa. IgG-specific immunoprint using rabbit anti-F. solani CF antibodies demonstrated a mol. mass distribution of shared antigenic proteins of 14-100 kDa in most of the fungi. Shared allergenicity was observed in a number of allergenic proteins in fungal extracts with mol. mass ranging between 14 and 70 kDa on IgE-specific immunoblot using pooled sera of patients allergic to Fusarium. A 45-kDa protein was found to be common among these fungi on immunoblot with patients as well as with rabbit antibodies. F. solani CF extract contained more antigenic/allergenic proteins than F. solani CE. It was concluded that F. solani CF shared several antigenic/allergenic components with CE of other common fungi. This fact needs to be taken into account when fungal extracts are used in diagnosis and immunotherapy of allergic patients.

Is Bell's palsy a reactivation of varicella zoster virus?

Despite various pointers to an infectious aetiology, the cause of Bell's palsy remains obscure. We examined paired sera from 62 patients with facial palsy and 50 age and sex matched contemporaneous controls. Significantly more patients than controls had IgM antibodies by ELISA to varicella zoster virus (56.5% vs. 20%, P = 0.0001) and herpes simplex virus (41.9% vs. 18%, P = 0.006). Additionally, significantly more patients than controls were positive for CF antibody to varicella zoster virus (14.5% vs. 0%, P = 0.004) but not to herpes simplex or cytomegalovirus. Significantly more controls than patients (54% vs. 25.8%, P = 0.002) had no evidence of antigenic stimulation by any of the herpesvirus group. No significant difference between patients and controls in seropositivity by IgM ELISA to cytomegalovirus. Epstein-Barr virus and IFA for human herpes virus 6 was found. Furthermore, there was no significant difference between the two groups as to evidence of recent infection by the following agents: rubella virus and Borrelia burgdorferi by IgM ELISA, influenza A. influenza B, adenovirus, respiratory syncytial virus, mumps and measles. Mycoplasma pneumoniae, Coxiella burnetii and chlamydia spp. by complement fixation test. The first reported case of clinically and serologically proven Mycoplasma pneumoniae pneumonia associated with Bell's palsy is described. The rate of complete recovery at 6-8 weeks after onset was not significantly different in patients who were given steroids compared to those who were not. Ear related symptoms were the most common, occurring in 12 of 65 cases, but only three (4.6%) had clinical shingles (vesicles in ear).(ABSTRACT TRUNCATED AT 250 WORDS)

Human herpesviruses infections (I)--EBV infection and immunity in cancer patients

Human herpesviruses have been known to be reactivated from latent infection iin immunosuppressed individuals. To assess the immunity, antibodies to human herpesviruses (VZV, HSV, CMV and EBV) were measured in patients with gastrointestinal cancer and normal persons ranging from 40 to 80 in age. CF antibodies to herpesviruses except for EBV were negative in normal persons below the age of 60 and cancer patients aged 60 and over. The CF antibody titer higher than 1:64 occurred only in young cancer patients and older normal persons. The titer of VCA antibody to EBV ranged from 1:40 to 1:160 in more than 80% of normal persons and was higher than 1:640 in less than 7%. The ratio those with antibody negative or below 1:40 increased with the age. In contrast, the titer was higher than 1:320 in 70% of the patients, and the antibody was negative in none of them. In addition, the low titer occurred only in less than 5%. The rate of patients having higher VCA antibody titers increased with age, and the titer was high in more than 50% of patients in the 8th decade. In cancer patients, the higher the VCA antibody titer was, the less number of mature B cells, target cells of EBV, and the B cell functions were observed. This suggests that reactivation of EBV in hosts bearing carcinomas results in a fall of production of the specific antibody.

Prevalence ofMycoplasma pneumoniaein children with pneumonia in Zaria, Nigeria

The prevalence of Mycoplasma pneumoniae in children suffering from pneumonia was investigated, using complement fixation and growth inhibition tests. From the sera of 104 children with pneumonia, 32 (31%) showed a CF titre greater or equal to 1:64, while all the 52 control children of the same age and sex had a CF titre less than 1:16. Children 6-10 years of age had the highest positive titre (41%) while the age groups 3-5 years and 0-2 years had positive titres of 30 and 28%, respectively. Both sexes were equally affected (33% male, 29% female). Mycoplasma pneumoniae was isolated in two children whose CF antibody titres were 1:16. It is concluded that M. pneumoniae plays an important role as an aetiological agent of pneumonia in children in Zaria, Nigeria, and could be included in the routine diagnostic protocol of pneumonia, especially during the dry harmattan months when cases of lobar pneumonia are prevalent.

Coccidioidomycosis during Human Immunodeficiency Virus Infection

Through a retrospective review, we identified 77 previously unreported cases of coccidioidomycosis during HIV infection. Patients were classified into 1 of 6 categories based on their primary clinical presentation: 20 had focal pulmonary disease (Group 1), 31 had diffuse pulmonary disease (Group 2), 4 had cutaneous coccidioidomycosis (Group 3), 9 had meningitis (Group 4), 7 had extrathoracic lymph node or liver involvement (Group 5), and 6 has positive coccidioidal serology without a clinical focus of infection (Group 6). Coccidioidal serologies were positive on initial testing in 83% of the patients in whom such serologic testing was performed. Sera from 39% of patients were positive for TP antibodies while 74% had CF antibodies. Eleven of 12 seronegative patients had pulmonary disease (Group 1 or 2). Serologic results of other patients sent to a single reference laboratory were similar, with 26% positive for immunodiffusion TP antibodies and 79% positive for immunodiffusion CF antibodies. For the 77 patients in this study, the CD4-lymphocyte count was below 0.250 X 10(9) cells/L in 46 of the 55 patients who had this test performed, and a low CD4 count was significantly associated with mortality (p less than 0.01). At the time of follow-up, 32 of the 77 patients (42%) had died. There were significantly more deaths in those with diffuse pulmonary disease (Group 2) than in other groups (p less than 0.001). Amphotericin B, ketoconazole, fluconazole, and itraconazole were all used as antifungal therapies. Outcome could not be related to the therapy used. Of note, 3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Complement fixing antibodies against arboviruses in horses at Lagos, Nigeria.

Sixty-two sera horse collected from two stables at Lagos, Nigeria, were tested for complement fixing antibody to 8 arbovirus antigens; Chikungunya, Igbo-Ora, Yellow fever, Wesselsbron, West Nile, Potiskum, Uganda S and Rift Valley fever. Ten per cent of the horse sera examined contained CF antibody to one or more of the test antigens and indicated considerable arbovirus activity in the two stables. Reactions with flavivirus antigens were most common and the highest antibody titres were obtained with Wesselsbron and Yellow fever viruses. Eleven per cent of the sera tested reacted with alphavirus antigens while 10 per cent were positive for Rift Valley fever virus CF antibodies.

抜歯後生じた三叉神経第一枝領域の帯状ほう疹 虹彩炎が晩発した症例

In spite of the causative organism being identified, the onset mechanism of herpes zoster remains unknown, and until recently there have been no satisfactory therapeutics. Therefore, the form of treatment of this disease had been mainly symptomatic. However, newly developed antiviral agents such as Ara-A, Ara-C, and Acyclovir are showing good results in combating viral disease and we are now in a new age in herpes zoster treatment.A case of post-extraction herpes zoster in the first division of the trigeminal nerve treated by an antiviral agent together with other drugs which showed complete remission, followed by iritis of the left eye is herein reported, and the onset mechanism of herpes zoster subsequent to the extraction is discussed.Under local anesthesia, a 25-year-old female patient, who had an episode of pericoronitis, had an extraction of a completely impacted left lower third molar. Tingling was noted on the left side of her forehead 9 days after the procedure and a vesicular lesion on the erithematous base appeared on the 10th day. Based on a diagnosis of herpes zoster, vitamin B 1 2 and bufexamac ointment were given first, but the symptoms were aggravated by severe pain and vomiting. Then, the patient was administered for 5 days an antiviral agent, Ara-A, 300mg. per day intravenously by drip from 4 days after the onset of the disease. Human immunoglobulin, steroid hormone and antibiotics were also given for 3, 7 and 10 days respectively. Almost all symptoms of the disease such as pain, vesicles and erithema disappeared within 1 week. The elevation of serum CF antibody titer in herpes zoster remained low.Approximately 1 year after discharge a slit-lamp examination of the left eye showed a flare and cells from iritis. Now, there is no sign of iritis but because of the tendency of high ocular tension, the patient is still under observation in the out-patient clinic of the ophthalmology department.According to retrospective study, except for the extraction of left lower third molar, there was no triggering factor such as trauma, fever, attack of other diseases, or excessive fatigue. It is suggested that the extraction in the region of the third division of the trigeminal nerve provided the impulse in the Ggl. trigeminale or in the N. oplithalmicus, reactivating Varicella-Zoster virus and causing dermal bullous eruptions in the region of the first division of the trigeminal nerve. Varicella-Zuster virus might have also caused the iritis because the iris sensory nerve is a branch of the trigeminal nerve.

Serodiagnosis of Q fever by enzyme-linked immunosorbent assay (ELISA)

Indirect enzyme-linked immunosorbent assays (ELISAs) specific for IgG and IgM antibodies against Coxiella burnetii were applied to test 208 serum samples collected within 1983 to 1986 from 128 individuals suspected of having Q fever, and from 1611 serum samples of normal blood donors. Among them were 2 patients with Q fever endocarditis, one patient with myocarditis, one patient with chronic hepatitis, 3 patients with pneumonia, one woman who had aborted a monstrous child, 38 state veterinarians, 26 farms workers, 21 persons employed in veterinary medicine, and 4 laboratory workers. Comparison with the complement fixation test (CF) revealed 46 (38%) subjects seropositive by CF and 77 (60%) seropositive by IgG and/or IgM ELISA. Among the normal blood donors 22% had antibodies to C. burnetii by ELISA. With exception of two CF titers of 1:2 and 1: 8, all positive results detected by CF were confirmed by ELISA. Early stages of C. burnetii infections could be diagnosed in four cases with a single serum sample through demonstration of specific IgM by ELISA before appearance of CF antibodies. In 9 patients with acute Q fever and rising CF titers or IgG levels, diagnosis was already possible with the first serum sample by demonstration of high IgM levels by ELISA. In the two cases of endocarditis investigated, high CF titers against phase I antigen of C. burnetii confirmed the diagnosis “chronic Q fever”.

Common-source outbreak of blastomycosis in hunters and their dogs.

Most cases of blastomycosis are sporadic, and few outbreaks have been reported. We report here an outbreak associated with raccoon hunting in Southampton County, Virginia. Four patients, ranging in age from 15 to 21 years, had onsets of illness during March 1984. All were white men, and each presented with fever, cough, and an infiltrate on chest radiograph. Diagnosis was established by culturing Blastomyces dermatitidis, by using standard techniques [1], from sputum or lung tissue from three of the four patients. The fourth patient had budding yeast cells consistent with B. dermatitidis visualized on microscopy of his sputum. Subsequently, serum specimens collected within one month of illness onset demonstrated CF antibodies to the A antigen of B. dermatitidis at a titer of ^ 1132 for two of four patients, A precipitin bands on blastomycin immunodiffusion (ID) testing for three of the four, and antibody titers of ^1:32 (range, 1:32-1:256) by the blastomycosis enzyme immunoassay (EIA) for all four specimens. All patients were successfully treated either with amphotericin B or ketoconazole or both, and none developed skin lesions. Each patient was acquainted with the others, all were avid raccoon hunters, and all went hunting together on a weekly basis during the raccoon hunting season that extends from October through February. Hunting was done locally, at night, in wooded, frequently swampy areas. The patients were usually accompanied by several trained hunting dogs (one Doberman pinscher and six Bluetick hounds) supplied by one patient's grandfather. Three of the dogs had onset of illness at approximately the same time as the hunters, and a fourth dog developed chronic disseminated blastomycosis approximately one month later. By using standard techniques [1], we cultured B. dermatitidis from pus or tissue from three of the dogs. Diagnosis for one of the four ill hunting dogs was based on clinical presentation alone (fever, shortness of breath, and weight loss). All four dogs died. There was no history of any hunter having been bitten by one of these dogs. To confirm the hypothesis that the hunters and their dogs acquired blastomycosis while hunting raccoons, we conducted a case-control study that included serological testing and obtaining information on hobbies and selected activities from the four patients and matched controls. We also conducted serological testing of all the dogs owned