Indirect Hemagglutination Antibody Research Articles

Development and evaluation of a multiplex serodiagnostic bead assay (BurkPx) for accurate melioidosis diagnosis.

Burkholderia pseudomallei, the causative agent of melioidosis, is a gram-negative soil bacterium well recognized in Southeast Asia and northern Australia. However, wider and expanding global distribution of B. pseudomallei has been elucidated. Early diagnosis is critical for commencing the specific therapy required to optimize outcome. Serological testing using the indirect hemagglutination (IHA) antibody assay has long been used to augment diagnosis of melioidosis and to monitor progress. However, cross reactivity and prior exposure may complicate the diagnosis of current clinical disease (melioidosis). The goal of our study was to develop and initially evaluate a serology assay (BurkPx) that capitalized upon host response to multiple antigens. Antigens were selected from previous studies for expression/purification and conjugation to microspheres for multiantigen analysis. Selected serum samples from non-melioidosis controls and serial samples from culture-confirmed melioidosis patients were used to characterize the diagnostic power of individual and combined antigens at two times post admission. Multiple variable models were developed to evaluate multivariate antigen reactivity, identify important antigens, and determine sensitivity and specificity for the diagnosis of melioidosis. The final multiplex assay had a diagnostic sensitivity of 90% and specificity of 93%, which was superior to any single antigen in side-by-side comparisons. The sensitivity of the assay started at >85% for the initial serum sample after admission and increased to 94% 21 days later. Weighting antigen contribution to each model indicated that certain antigen contributed to diagnosis more than others, which suggests that the number of antigens in the assay can be decreased. In summation, the BurkPx assay can facilitate the diagnosis of melioidosis and potentially improve on currently available serology assays. Further evaluation is now required in both melioidosis-endemic and non-endemic settings.

ODP110 Parathyroid Hormone Independent Hypercalcaemia Secondary to Granulomatous Inflammation: Could This Be Melioidosis?

Abstract Background Hypercalcemia has been described in patients with most granulomatous disorders, most commonly in sarcoidosis and tuberculosis, but never in melioidosis. Clinical Case A 45-year-old woman presented with two-day history of abdominal pain, nausea, lethargy and intermittent fevers during Darwin's wet season. Medications included daily methadone, diazepam and mirtazapine. On examination she was febrile with stable hemodynamics and left upper quadrant tenderness. Investigations revealed pancytopenia, deranged liver function tests with a cholestatic pattern, raised CRP of 53 (<5mg/L) and normal serum calcium. Blood cultures were negative but melioidosis serology was positive (indirect hemagglutination antibody (IHA) titer 1: 1280). Abdominal computed tomography demonstrated hepatosplenomegaly with peripheral splenic infarcts and a 7mm intrasplenic aneurysm, but no abscesses. PET showed no hypermetabolic lesions. After extensive investigation, she was treated for presumptive culture-negative melioidosis with intravenous meropenem. Clinically she improved despite gradual elevation in serum calcium which peaked at 3.31 (2.1-2.6mmol/L) five weeks after presentation. Initial biochemical investigations revealed suppressed PTH at 0.5 (1.4-9.1pmol/L), low 25-hydroxy-Vitamin D of 26 (50-150nmol/L), elevated phosphate at 2.43 (0.75-1.5mmol/L) and moderate renal impairment (eGFR 34mL/min/1.73m 2). Hypercalciuria was present with urine calcium to creatinine ratio of 812 (100-580mmol/mol). Her 1,25-dihydroxy-Vitamin D (calcitriol) was elevated at 219 (48-190pmol/L) suggestive of PTH-independent hypercalcemia. The patient remained asymptomatic of hypercalcemia and aggressive intravenous hydration produced minimal biochemical improvement. Renal impairment precluded bisphosphonate use. She was commenced on prednisolone 50mg while continuing intravenous meropenem. Serum calcium normalized in 10 days and prednisolone dose was gradually tapered. A liver biopsy was performed due to persistent liver derangement and histology showed granulomatous inflammation. She completed six weeks of antibiotics for melioidosis and was discharged on day 50, with a planned six months of eradication therapy. Outpatient follow-up demonstrated normal serum calcium after cessation of prednisolone with decreasing IHA titer (1: 320). We hypothesize that this case reflects PTH-independent hypercalcemia secondary to granulomatous inflammation, presumptively caused by melioidosis. The rise in calcium after commencement of antibiotics and normalization following initiation of glucocorticoid therapy, with no rebound post cessation, is consistent with successful therapy of an infection with granulomatous inflammation. Activated macrophages within granulomas have unregulated 1-alpha-hydroxylase expression which is thought to increase conversion of 25-hydroxy-Vitamin D to calcitriol and therefore increase intestinal calcium absorption. Treatment with glucocorticoids inhibits calcitriol synthesis leading to quick resolution of hypercalcemia. While use of glucocorticoids are commonplace in the management of granulomatous disease due to sarcoidosis, they have been increasingly recognized as an important risk factor for melioidosis, considered to result from suppression of innate immunity. However, use of glucocorticoids if required is not contraindicated once antibiotic therapy for melioidosis has commenced. Conclusion In areas where melioidosis is endemic, clinicians should be aware of hypercalcemia and the potential risks associated with its treatment. Presentation: No date and time listed

An Unusual Case With a Huge Hepatic Cystic Mass

Question: A 5-year-old Taiwanese girl was admitted to our hospital because of periumbilical abdominal pain for 2 weeks and fever. She had stayed in Guangdong, China, for 2 months. At admission, the liver could be palpated 2 cm below the right costal margin. Her white cell count was 6960/μL (segmented, 89.9%; eosinophils, 2.2%), platelet count was 76,000/μL, and C-reactive protein level was 7.23 mg/dL. Notable laboratory values included aspartate aminotransferase, 140 U/L; alanine aminotransferase, 124 U/L; γ-glutamyl transferase, 63 U/L; and a prolonged prothrombin time, with an international normalized ratio of 1.68. Serum levels of bilirubin, β-human chorionic gonadotropin, α-fetoprotein, vanillylmandelic acid, and indirect hemagglutination antibody for amoeba were within normal limits.

Ongoing transmission of Entamoeba histolytica among newly diagnosed people living with HIV in Taiwan, 2009-2018.

Recent outbreaks of enterically transmitted infections, including acute hepatitis A and shigellosis, have raised the concerns of increasing Entamoeba histolytica infection (EHI) among people living with HIV (PLWH) in Taiwan. This study investigated the prevalence of EHI, its temporal trends, and associated factors among newly diagnosed PLWH in Taiwan. Medical records of newly diagnosed PLWH at six medical centers in Taiwan between 2009 and 2018 were reviewed. The annual prevalence of invasive amoebiasis and seroprevalence of E. histolytica were determined and examined by the Cochran-Armitage test. The clinical characteristics associated with invasive amoebiasis and seropositivity for E. histolytica were analyzed in multivariable regression models. Among 5362 patients seeking HIV care at six medical centers in Taiwan during the 10-year study period, 119 (2.2%) had invasive amoebiasis at the time or within six months of their HIV diagnosis. Among 3499 who had indirect hemagglutination antibody (IHA) determined, 284 (8.1%) had positive IHA (≥1:32) and 205 (5.9%) had high-titre IHA (≥1:128). The prevalence of invasive amoebiasis increased from 1.3% in 2012 to 3.3% in 2018 (p = 0.024). Invasive amoebiasis was independently associated with a greater age, men who have sex with men, rapid plasma reagin titre ≥1:4, and concurrent shigellosis and giardiasis. Increasing prevalence of invasive amoebiasis among newly diagnosed PLWH in Taiwan calls for strategies to prevent ongoing transmission in this population. Routine screening of EHI for early diagnosis and treatment is recommended, especially among men who have sex with men and those who present with other sexually or enterically transmitted infections.

<i>Toxoplasma gondii</i> molecular and immunological identification and risk factors associated with infection in chicken slaughtered at Triângulo Mineiro region, Minas Gerais, Brazil

This study aimed to determine the occurrence of anti-Toxoplasma gondii antibodies in the serum of slaughtered chickens in the region of Triângulo Mineiro, Minas Gerais, Brazil, to detect the parasite in tissues (heart and brain) of serologically positive chickens, based on molecular analysis, and to investigate risk variables associated with the infection. Sera from 417 chickens raised in extensive, semi-intensive, and intensive production systems were tested by an indirect immunofluorescent antibody test (IFAT) and indirect hemagglutination antibody test (IHA). Polymerase chain reaction (PCR) was performed to detect T. gondii DNA in brain and heart tissues. Antibody anti-T. gondii were found in 37.65% (157/417) of chickens by IFAT, and in 75.06% (313/417) by IHA. The Kappa index showed a weak concordance between the techniques (0.087). Association was observed between seropositivity and the variables, age (p < 0.0001), type of feeding (p < 0.0001) and collective raising with other animal’s species (p < 0.0001). Association, based on IFAT, was not observed between seropositivity and the variables, sex (p = 0.0526), presence of cats (p > 0.9999), and presence of rats (p > 0.9999). Presence of parasite DNA was detected in brain samples from two chickens, which were raised in intensive and semi-intensive production systems. The results suggest the meat of these slaughtered animals may serve as a transmission source of this protozoan to humans.

Occurrence of Toxoplasma gondii and risk factors for infection in pigs raised and slaughtered in the Triângulo Mineiro region, Minas Gerais, Brazil

ABSTRACT: The Triângulo Mineiro region from Minas Gerais state, is an important meat-exporting region of Brazil and data about Toxoplasma gondii infection in pigs raised and slaughtered in this area are scarce. Therefore, the aim of this study was to evaluate the occurrence of T. gondii in swine and establish the risk factors associated with the infection. Samples were collected from 600 pigs raised under intensive system in farms located at three different counties (Carmo do Paranaíba, Patrocínio and Perdizes). The samples were submitted to indirect hemagglutination antibody test with dilution of 1:32 and to indirect immunofluorescence antibody test with a cutoff of 1:64. The occurrence of positive pig was 3.3% (n=20) and 51.8% (n=311) respectively. A significant difference was observed between toxoplasmatic infection and factors such as lineage, animal origin, size of the farm, collective raising with others species, presence of rodents and type of water offered (p≤0.05). There was no difference between gender and the farm goals. The results demonstrated an occurrence of anti-T.gondii antibodies higher than expected for intensive pig raising system on the studied area, which could indicate a possible sanitary management problem on the studied proprieties. Improvements on the raising techniques are necessary to reduce T. gondii infection sources.

A nonsense mutation in TLR5 is associated with survival and reduced IL-10 and TNF-α levels in human melioidosis.

BackgroundMelioidosis, caused by the flagellated bacterium Burkholderia pseudomallei, is a life-threatening and increasingly recognized emerging disease. Toll-like receptor (TLR) 5 is a germline-encoded pattern recognition receptor to bacterial flagellin. We evaluated the association of a nonsense TLR5 genetic variant that truncates the receptor with clinical outcomes and with immune responses in melioidosis.Methodology/Principal findingsWe genotyped TLR5 c.1174C>T in 194 acute melioidosis patients in Thailand. Twenty-six (13%) were genotype CT or TT. In univariable analysis, carriage of the c.1174C>T variant was associated with lower 28-day mortality (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.05–0.94, P = 0.04) and with lower 90-day mortality (OR 0.25, 95% CI 0.07–086, P = 0.03). In multivariable analysis adjusting for age, sex, diabetes and renal disease, the adjusted OR for 28-day mortality in carriers of the variant was 0.24 (95% CI 0.05–1.08, P = 0.06); and the adjusted OR for 90-day mortality was 0.27 (95% CI 0.08–0.97, P = 0.04). c.1174C>T was associated with a lower rate of bacteremia (P = 0.04) and reduced plasma levels of IL-10 (P = 0.049) and TNF-α (P < 0.0001). We did not find an association between c.1174C>T and IFN-γ ELISPOT (T-cell) responses (P = 0.49), indirect haemagglutination titers or IgG antibodies to bacterial flagellin during acute melioidosis (P = 0.30 and 0.1, respectively).Conclusions/SignificanceThis study independently confirms the association of TLR5 c.1174C>T with protection against death in melioidosis, identifies lower bacteremia, IL-10 and TNF-α production in carriers of the variant with melioidosis, but does not demonstrate an association of the variant with acute T-cell IFN-γ response, indirect haemagglutination antibody titer, or anti-flagellin IgG antibodies.

Orally-transmitted Chagas disease: Epidemiological, clinical, serological and molecular outcomes of a school microepidemic in Chichiriviche de la Costa, Venezuela

Oral transmission of Trypanosoma cruzi is a frequent cause of acute Chagas disease (ChD). In the present cross-sectional study, we report the epidemiological, clinical, serological and molecular outcomes of the second largest outbreak of oral ChD described in the literature. It occurred in March 2009 in Chichiriviche de la Costa, a rural seashore community at the central littoral in Venezuela. The vehicle was an artisanal guava juice prepared at the local school and Panstrongylus geniculatus was the vector involved. TcI genotype was isolated from patients and vector; some showed a mixture of haplotypes. Using molecular markers, parasitic loads were high. Eighty-nine cases were diagnosed, the majority (87.5%) in school children 6–15years of age. Frequency of symptomatic patients was high (89.9%) with long-standing fever in 87.5%; 82.3% had pericardial effusion detected by echocardiogram and 41% had EKG abnormalities. Three children, a pregnant woman and her stillborn child died (5.6% mortality). The community was addressed by simultaneous determination of specific IgG and IgM, confirmed with indirect hemagglutination and lytic antibodies. Determination of IgG and IgA in saliva had low sensitivity. No individual parasitological or serological technique diagnosed 100% of cases. Culture and PCR detected T. cruzi in 95.5% of examined individuals. Based on the increasing incidence of oral acute cases of ChD, it appears that food is becoming one of the most important modes of transmission in the Amazon, Caribbean and Andes regions of America.

Seroprevalence and risk factors of Toxoplasma gondii infection in stray dogs in northern China.

Toxoplasma gondii is a zoonotic protozoan of almost all species of mammals and birds. However, no information is available about seroprevalence of the pathogen in stray dogs in seven cities from Inner Mongolia, Jilin, Liaoning province, China. Using the indirect hemagglutination antibody (IHA) test with a cutoff titer of 1:64, 129 (14.05%) out of 918 stray dogs were surveyed to be T. gondii seropositive. Analysis of the risk factor showed that there was no statistical difference of seroprevalence of T. gondii between males (13.46%) and females (14.54%) (P > 0.05). The seropositive rates of T. gondii infection in stray dogs among the seven cities in northern China were significant statistically different (P = 0.005). Moreover, seroprevalence of T. gondii in dogs were varied from 11.01% (95% CI 6.94-15.09) to 16.86% (95% CI 12.27-21.46) among different age groups, and the difference was statistically significant (P = 0.03). More importantly, T. gondii seropositive in stray dogs has a declining tendence from 2011 to 2015 (P = 0.004). The results of the present study showed that stray dogs in Inner Mongolia, Jilin, Liaoning province, China are exposed to T. gondii, for the first time, and could also provide a foundation data for prevent and control T. gondii infection in dogs, other animals and humans.

Prevalence and genetic characterization of Toxoplasma gondii in pet dogs in Central China.

The prevalence and genotype of Toxoplasma gondii infection in dogs in Henan Province, Central China was investigated. A total of 125 blood samples were collected from pet dogs during April to June 2013, and all samples were examined by indirect hemagglutination antibody test (IHA) and nested PCR. The overall T. gondii prevalence in pet dogs was 24.0% (30/125), with 20.8% (26/125) in IHA and 10.4% (13/125) in PCR, respectively. No statistical associations were found between animal gender and age and the prevalence of T. gondii infection. Thirteen positive DNA samples were genotyped using 11 PCR-RFLP markers, including SAG1, (3’+5’) SAG2, alt.SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico. Of these, only 2 samples were genotyped with complete data for all loci, and a novel genotype (type III at SAG3 and GRA6 loci, and type I at other loci) was identified. This is the first report of genetic characterization of T. gondii infection in dogs in China.

Control of Coccidiosis in Calves by Vaccination

The immunizing effect of inactivated sporulated oocyst and inactivated sonicated vaccines against bovine coccidiosis was observed in calves. Indirect haemagglutination (IHA) test was developed for detecting antibodies to coccidian. Serum antibody levels in calves were measured against soluble oocyst (sporulated) antigen. IHA antibody titer was significantly higher (P<0.05) in calves vaccinated with inactivated sonicated vaccines as compared to the calves vaccinated with inactivated sporulated vaccines. Results of the challenge experiments indicated that the inactivated sonicated vaccine gave protection to the challenge calves as immune calves contained high level of antibodies that resisted heavy dose of challenge. Disease was observed in control group (non-vaccinated) calves post challenge whereas vaccinated remained healthy. Then the oocyst count per gram of faeces was significantly higher (P<0.05) in control group (unvaccinated) as compared with the vaccinated groups.

Seroprevalence ofToxoplasma gondiiInfection in Domestic Sheep in Liaoning Province, Northeastern China

There is a lack of information regarding the prevalence of Toxoplasma gondii infection in sheep from northeastern China. In the present study, serum samples from 566 domestic sheep were collected from Liaoning Province, northeastern China, to investigate the prevalence of T. gondii antibodies using an indirect hemagglutination antibody test. Twenty-five of 566 samples (4.4%) were seropositive at the cutoff of 1:64 serum dilution. No difference was found among 6 geographic regions (P > 0.05). This is the first report of T. gondii infection in sheep in Liaoning Province.

Seroprevalence ofToxoplasma gondiiInfection in Pet Dogs in Shenyang, Northeastern China

In recent years, surveys of Toxoplasma gondii infection in dogs have been reported throughout the world, including China. However, information is lacking regarding the prevalence of T. gondii infection in pet dogs in northeastern China. In the present study, we report the seroprevalence of T. gondii in pet dogs in Shenyang, northeastern China. Sera samples from 328 pet dogs in 5 districts were examined for T. gondii antibodies with an indirect hemagglutination antibody (IHA) test; 10.0% tested seropositive. There were no significant differences in terms of sex, age, and locality (P > 0.05). The results indicate that infection by T. gondii is widely prevalent in pet dogs in Shenyang, northeastern China, which has potential implications for public health in this area.

Seroprevalence of Toxoplasma gondii infection in dairy cattle in southern China

BackgroundAs an obligate intracellular parasite, Toxoplasma gondii can infect humans and almost all warm-blooded animals. The consumption of raw or undercooked beef and milk is considered a risk for T. gondii infection in humans. However, little is known of T. gondii infection in dairy cattle in metropolitan Guangzhou, southern China. This study was performed to determine the seroprevalence of T. gondii in dairy cattle in Guangzhou, southern China.FindingsSerum samples were collected from 350 dairy cattle on five farms in Guangzhou, China from 2009 to 2010, and all of the 350 serum samples were examined for specific antibodies to T. gondii by indirect hemagglutination antibody test (IHA). The overall seroprevalence of T. gondii in dairy cattle was 5.7% (20/350). Among these examined dairy cattle, dairy cattle which were < 6 year old or ≥ 5 year old had the highest seroprevalence of 12.5% followed by those dairy cattle which were < 5 year old or ≥ 4 year old (8%); dairy cattle with 3 pregnancies had the highest seroprevalence (11.5%), among the examined dairy cattle, although these differences were not statistically significant.ConclusionsThe results of the present survey indicate that T. gondii infection is prevalent in dairy cattle of all age ranges in Guangzhou, southern China, which may be a risk factor for human infection with T. gondii in this region.Dong-Hui Zhou and Fu-Rong Zhao contributed equally.

Seroprevalence of chlamydial infection in dairy goats in Shaanxi Province, Northwestern China

The prevalence of chlamydial infection in dairy goats in Shaanxi province, Northwestern China was determined by indirect hemagglutination antibody (IHA) on serum samples from 729 dairy goats (263 Saanen dairy goats and 466 Guanzhong dairy goats). Antibodies to Chlamydophila sp. were detected in 21 (2.88%) serum samples, with antibody titers ranging from 1:16 to 1:64. Seropositive goats were found only in three (Zhuangli town, Wangliao town and Yangling district) of the nine locations/herds examined in six counties. The prevalence of chlamydial infection was significantly related with locations/herds (χ2 = 54.36, P = 0.00) and breeds (χ2 = 56.50, P = 0.00). Both Saanen and Guanzhong dairy goats were positive for chlamydial infection, with higher seroprevalence in Saanen dairy goats (5.70%, 15/263) than that in Guanzhong dairy goat (1.29%, 6/466). The results of the present study indicate that more integrated strategies should be carried out to prevent and control chlamydiosis in goats in Shaanxi province. Key words : Seroprevalence, chlamydial infection, dairy goats, Shaanxi Province, Northwestern China.

Development and evaluation of Indirect Hemagglutination Antibody Test (IHAT) for serological diagnosis and screening of bovine cysticercosis in Ethiopia

The study was conducted to develop and evaluate an Indirect Hemagglutination Antibody Test (IHAT) for the serological diagnosis of Cysticercus bovis in live animals. IHAT was set-up in-house and used to test serum samples of cattle against sheep red blood cell (SRBC) coated with crude extracts of C. bovis cyst. Serum samples for screening were collected from Addis Ababa abattoir (n=522), a dairy farm from the suburbs of Addis Ababa (n=101), and a traditional extensive farm (n=109). Postmortem inspection was conducted on a total of 522 animals slaughtered in Addis Ababa Abattoir, out of which 39 (7.5%) were positive for C. bovis. Thirty-seven of these had viable C. bovis cysts. IHAT titres were determined from serially diluted sera, with a cut-off value set at a titre of 1:64. Cross reaction with other helminths was either absent or very low. Sensitivity and specificity of the IHAT were 100% and at least 90%, respectively. Based on this test, 149 cattle (28.5%) from the Abattoir, 33 cattle (30.3%) from the extensive farm and 8 cattle (7.9%) from the dairy farm were positive for C. bovis. The difference in prevalence between the dairy farm and extensive farm was significant (P

Crohnʼs Colitis Complicated by “Secondary” Entamoeba Histolytica Infection

Purpose: Amebiasis, caused by Entamoeba histolytica, is a disease of worldwide importance and is estimated to result in 40,000 to 100,000 deaths annually. The clinical characteristics and colonoscopic findings of amebic colitis can resemble Inflammatory Bowel Disease. A 46 year old veteran with a past medical history of Crohn's disease diagnosed in 1993 presented to the outpatient clinic complaining of abdominal pain, intermittent bright red blood per rectum and chronic diarrhea. Previous evaluation of his chronic diarrhea included sigmoidoscopies in 2000, 2004, and 2008, all of which had biopsy proven Crohn's disease. The patient was started on Asacol 800 mg TID and Imuran 50 mg daily in 2000. Due to an inadequate clinical response, he was transitioned to Remicade in 2006. Despite symptom improvement, he stopped taking Remicade in 2009 because of insurance issues. The patient had no other past medical history and took no other medications. He also denied any recent antibiotic use, hospitalizations, or sick contacts. His travel included the East Coast of the U.S., Texas, and Southern California. While in the army, he spent significant time in Germany, France, Italy, and Austria. Stool studies were negative for ova/parasites, C. difficile toxin, Cryptosporidium and Giardia. A colonoscopy revealed flask shaped ulcers within the sigmoid colon and cecum. Sigmoid biopsies revealed trophozoites, consistent with E. histolytica; none of the biopsies were consistent with Crohn's disease. The patient's immune hemagglutination assay for E. histolytica and amebiasis were positive. The patient was started on metronidazole 500 mg 3 times daily for 10 days, followed by paromomycin 30 mg/kg PO daily for 7 days. After completion of metronidazole and paromomycin, the patient had complete resolution of his abdominal pain, bright red blood per rectum, and diarrhea. Patients with IBD have a greater prevalence of amebiasis as compared to the normal population. Diagnosis can be challenging as patients with E. histolytica often present with non specific symptoms such as diarrhea and abdominal pain. Examination of stool may reveal trophozoites of E. histolytica. Diagnosis can also be made using both the serum and indirect hemagglutination antibody and the enzyme linked immunosorbent assay, which are highly sensitive. Colonoscopic findings of amebic colitis can mimic IBD, and the presence of discrete ulcers with normal intervening mucosa is more likely to be mistaken for Crohn's disease. Metronidazole, 500 to 750 mg PO TID for 7 to 10 days, is the treatment of choice for invasive colitis. Because E. histolytica can persist in the intestine, it is recommended that treatment be followed with paromomycin.

Splenic hydatic cyst as a cause of sinistral portal hypertension and isolated gastric variceal bleeding

A 60-year-old male, living in a rural area, presented with recurrent upper gastrointestinal bleeding. Isolated fundal varices were seen on endoscopy. A lesion similar to cyst hydatid was seen in the spleen on abdominal ultrasonography and computerized tomography scanning. Also, sinistral (left-sided) portal hypertension and collaterals were seen due to the compression of the splenic vein by the cyst. Indirect hemagglutination antibody test for Echinococcus granulosus was positive. By screening, no other cyst was found in any other site of the body. The patient underwent open abdominal surgery, and the anterior wall of the cyst was resected partially; within it were multiple daughter cysts and hydatid fluid. After decontamination of the daughter cysts and hydatid fluid, germinative membrane omentoplasty was performed with a part of the omentum. However, the patient suffered from recurrent gastrointestinal bleeding postoperatively and he was re-evaluated. Later, splenectomy was performed in order to relieve left-sided portal hypertension. The patient did not experience further bleeding and gastric varices disappeared following splenectomy.

Seroprevalence of Toxoplasma gondii infection in breeding sows in Western Fujian Province, China

The objective of the present investigation was to estimate the seroprevalence T. gondii infection in breeding sows in Western Fujian Province, the People's Republic of China. Sera collected from breeding sows during 2006-2007 from 6 different regions in Western Fujian Province were assayed for antibodies to T. gondii by an indirect hemagglutination antibody (IHA) test. Antibodies to T. gondii were detected in 87 (14.38%) of 605 breeding sows. Differences in seroprevalence were observed between sampling regions, ranging from 10.14% to 37.50%. The present investigation demonstrated that the prevalence of T. gondii infection in breeding sows in Fujian Province was high. Integrated control strategies and measures should be implemented to prevent and control T. gondii infection in breeding sows, which in turn will have significant implications for the control of human infection with T. gondii in this province.

Seroprevalence of Viral Hepatitis and Sexually Transmitted Disease Among Adults with Recently Diagnosed HIV Infection in Southern Taiwan, 2000–2005: Upsurge in Hepatitis C Virus Infections Among Injection Drug Users

The purpose of this study was to compare the seroprevalence of viral hepatitis and sexually transmitted disease (STD) co-infections among three populations at risk recently diagnosed with HIV infection. A retrospective review of medical records was performed to determine the prevalence of several co-infections among adults recently diagnosed with HIV infection between 2000 and 2005 at National Cheng Kung University Hospital in Tainan, Taiwan. Among a total of 484 adults, 124 (25.6%) were men having sex with men (MSM), 105 (21.7%) were heterosexual adults, and 255 (52.7%) were injection drug users (IDUs). The case number of adults with recently diagnosed HIV infection increased annually, from 27 in 2000 to 142 in 2005 (p < 0.001). This trend appeared to be attributable to the upsurge in HIV infection among IDUs beginning in 2003. At the time of HIV diagnosis, mean CD4+ counts were significantly higher and plasma HIV-1 RNA loads were lower in the IDU group than the MSM or heterosexual groups. The hepatitis B virus (HBV) carrier rate was similar in all three groups, with an average rate of 16.5%. The prevalence of treponemal antibody and Entamoeba histolytica indirect hemagglutination antibody was higher in MSM (37.5% and 9.4%, respectively) than in heterosexuals (19.6% and 7.3%, respectively) or IDUs (3.2% and 2.1%). The seroprevalence of hepatitis A virus infection increased with age, with 94.2% (97/103) of patients who were older than 40 years. Hepatitis C virus (HCV) or HBV-HCV co-infections were noted more often in IDUs (97.9% and 16.9%, respectively) than in heterosexuals (10.9% and 2.2%, respectively) and MSM (5.3% and 3.6%, respectively). There was a recent upsurge in HIV-HCV co-infected IDUs in southern Taiwan. A higher rate of co-infection with STDs among HIV-infected MSM highlights the need for integrated STD control efforts in current HIV prevention programs.