Naval Medical Research Unit No. 3 Research Articles

Biomedical Response to Neisseria gonorrhoeae and Other Sexually Transmitted Infections in the US Military.

Sexually transmitted infections (STIs) continue to plague militaries and defense forces. While the historical recognition of the impact of STIs on operations is evident, contemporary surveillance and research activities are limited. As Neisseria gonorrhoeae and other sexually transmitted pathogens become increasingly resistant to antibiotics, the role of the Department of Defense (DoD) in disease surveillance and clinical research is essential to military Force Health Protection. The Infectious Disease Clinical Research Program (IDCRP) of the Uniformed Services University of the Health Sciences partnered with the DoD Global Emerging Infections Surveillance (GEIS) program to monitor the distribution of gonorrhea antimicrobial resistance (AMR) both domestically and abroad. The DoD gonococcal reference laboratory and repository was established in 2011 as a resource for confirmatory testing and advanced characterization of isolates collected from sites across the continental United States (CONUS) and GEIS-funded sites outside the continental United States (OCONUS). The IDCRP is currently implementing surveillance efforts at CONUS military clinics, including Madigan Army Medical Center, Naval Medical Center Camp Lejeune, Naval Medical Center Portsmouth, Naval Medical Center San Diego, and San Antonio Military Medical Center (efforts were also previously at Womack Army Medical Center). The reference laboratory and repository receives specimens from OCONUS collaborators, including Armed Forces Research Institute of Medical Sciences (AFRIMS; Bangkok, Thailand), Naval Medical Research Unit No. 3 (NAMRU-3), Ghana Detachment (Accra, Ghana), Naval Medical Research Unit No. 6 (NAMRU-6; Lima, Peru), U.S. Army Medical Research Unit - Georgia (USAMRD-G; Tbilisi, Republic of Georgia), and U.S. Army Medical Research Directorate - Kenya (USAMRD-K; Nairobi, Kenya). The gonococcal surveillance program, to include findings, as well as associated clinical research efforts are described. Among N. gonorrhoeae isolates tested within the United States, 8% were resistant to tetracycline, 2% were resistant to penicillin, and 30% were resistant to ciprofloxacin. To date, only one of the 61 isolates has demonstrated some resistance (MIC=1 μg/ml) to azithromycin. No resistance to cephalosporins has been detected; however, reduced susceptibility (MIC=0.06-0.125 μg/ml) has been observed in 13% of isolates. Resistance is commonly observed in N. gonorrhoeae isolates submitted from OCONUS clinical sites, particularly with respect to tetracycline, penicillin, and ciprofloxacin. While no azithromycin-resistant isolates have been identified from OCONUS sites, reduced susceptibility (MIC=0.125-0.5 μg/ml) to azithromycin was observed in 23% of isolates. Continued monitoring of circulating resistance patterns on a global scale is critical for ensuring appropriate treatments are prescribed for service members that may be infected in the U.S. or while deployed. Domestic surveillance for gonococcal AMR within the Military Health System has indicated that resistance patterns, while variable, are not dramatically different from what is seen in U.S. civilian data. Global patterns of gonococcal AMR have been described through the establishment of a central DoD gonococcal reference laboratory and repository. This repository of global isolates provides a platform for further research and development into biomedical countermeasures against gonococcal infections.

Drug resistance in bacteria isolated from patients presenting with wounds at a non-profit Surgical Center in Phnom Penh, Cambodia from 2011-2013.

BackgroundEmerging antibiotic resistance amongst clinically significant bacteria is a public health issue of increasing significance worldwide, but it is relatively uncharacterized in Cambodia. In this study we performed standard bacterial cultures on samples from wounds at a Non-Governmental-Organization (NGO) Hospital in Phnom Penh, Cambodia. Testing was performed to elucidate pathogenic bacteria causing wound infections and the antibiotic resistance profiles of bacterial isolates. All testing was performed at the Naval Medical Research Unit, No.2 (NAMRU-2) main laboratory in Phnom Penh, Cambodia.MethodsBetween 2011–2013, a total of 251 specimens were collected from patients at the NGO hospital and analyzed for bacterial infection by standard bacterial cultures techniques. Specimens were all from wounds and anonymous. No specific clinical information accompanied the submitted specimens. Antibiotic susceptibility testing, and phenotypic testing for extended-spectrum beta-lactamase (ESBL) were performed and reported based on CLSI guidelines. Further genetic testing for CTX-M, TEM and SHV ESBLs was accomplished using PCR.ResultsOne-hundred and seventy-six specimens were positive following bacterial culture (70 %). Staphlycoccus aureus was the most frequently isolated bacteria. Antibiotic drug resistance testing revealed that 52.5 % of Staphlycoccus aureus isolates were oxacillin resistant. For Escherichia coli isolates, 63.9 % were ciprofloxacin and levofloxacin resistant and 96 % were ESBL producers. Resistance to meropenem and imipenem was observed in one of three Acinetobacter spp isolates.ConclusionsThis study is the first of its kind detailing the antibiotic resistance profiles of pathogenic bacteria causing wound infections at a single surgical hospital in Cambodia. The reported findings of this study demonstrate significant antibiotic resistance in bacteria from injured patients and should serve to guide treatment modalities in Cambodia.

A molecular investigative approach to an outbreak of acute hemorrhagic conjunctivitis in Egypt, October 2010

BackgroundDuring October 2010, Egypt reported an outbreak of acute hemorrhagic conjunctivitis (AHC). A total of 1831 cases were reported from three governorates; 1703 cases in El Daqahliya, 92 cases in Port Said, and 36 in Damietta. The purpose of this study was to identify and characterize the causative agent associated with this outbreak.MethodsThe U.S. Naval Medical Research Unit No.3 (NAMRU-3) was contacted by the Egyptian Ministry of Health and Population to perform diagnostic laboratory testing on eighteen conjunctival swabs from patients with conjunctivitis from El Daqahliya Governorate. Conjunctival swabs were tested by molecular methods for human adenovirus (HAdV) and enteroviruses (EV). Virus isolation was performed; the isolated virus was further characterized by molecular typing and phylogenetic analysis.ResultsThe majority of the samples (17/18) were positive for enterovirus and all were negative for HAdV. Molecular typing and sequencing of the isolated virus revealed the presence of coxsackievirus A24 variant. Phylogenetic analysis based on the VP1 and 3C regions demonstrated that the Egyptian viruses belonged to Genotype IV and are closely related to coxsackievirus A24 variant, reported in a similar outbreak in China in August 2010.ConclusionsThis study strongly suggests that coxsackievirus A24 variant was associated with the acute hemorrhagic conjunctivitis outbreak reported in Egypt in October 2010. There is a possibility that the same strain of CV-A24v was implicated in the AHC outbreaks in both China and Egypt in 2010.

Impact of NSF/ANSI 49 and Risk Assessment on Exposure Frequency to Formaldehyde during Decontamination of Biological Safety Cabinets at U.S. Naval Medical Research Unit No. 3, Cairo, Egypt

Formaldehyde gas, a probable carcinogen, was routinely used for decontamination prior to recertification of Class II Type A2 biological safety cabinets (BSCs) at U.S. Naval Medical Research Unit No. 3 (NAMRU-3) in Cairo, Egypt. During decontamination, the gas is released when paraformaldehyde is heated, causing exposure risks. This article describes methods used to reduce the frequency of potential exposure to formaldehyde of a NAMRU-3 staff member accredited by the National Sanitation Foundation International/American National Standards Institute for Biosafety Cabinetry (NSF/ANSI 49). Risk assessments were performed according to guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and Biosafety in Microbiological and Biomedical Laboratories (CDC/NIH BMBL) (U.S. Department of Health and Human Services, 2009). The process was also performed as a mandatory requirement before changing the biological pathogens worked with any given BSC. Of the NAMRU-3 BSCs that had previously undergone more than 78 paraformaldehyde decontaminations prior to recertification over a 3-year period (2009–2011), 27% required decontamination. This has reduced the use of mandatory formaldehyde gas decontamination prior to any service on a NAMRU-3 BSC by 60%, supporting compliance to the Code of Federal Regulations (CFR 1910.1048) (OSHA, 2012) to reduce exposure to formaldehyde.

Zika Virus Infection, Cambodia, 2010

To the Editor: Zika virus (ZIKV), a member of the family Flaviviridae, genus Flavivirus, was first isolated from the blood of a sentinel rhesus monkey from the Zika Forest of Uganda in 1948 (1). Since that time, serologic studies and virus isolations have demonstrated that the virus has a wide geographic distribution, including eastern and western Africa; the Indian subcontinent; Southeast Asia; and most recently, Micronesia (2–5). The virus is transmitted primarily through the bite of infected mosquitoes and most likely is maintained in a zoonotic cycle involving nonhuman primates (1), although recent evidence suggests the possibility of occasional sexual transmission in humans (4). Few case reports have described the clinical characteristics of ZIKV infection in humans. Most reports describe a self-limiting febrile illness that could easily be mistaken for another arboviral infection, such as dengue or chikungunya fever. We report a confirmed case of ZIKV infection in Cambodia. Since 2006, the US Naval Medical Research Unit No. 2 (NAMRU-2) has conducted surveillance for acute fever to determine causes of the infection among patients who seek health care at local clinics in Cambodia. Patients were enrolled by the health clinic physician after they gave informed consent in accordance with an institutional review board protocol approved by NAMRU-2 and the National Ethics Committee for Human Research of Cambodia. At enrollment, the physician administered a questionnaire and collected specimens (blood and throat swabs). All items were transported to the NAMRU-2 laboratory in Phnom Penh, where testing was conducted for a variety of viral, bacterial, and parasitic pathogens. In August 2010, a blood specimen was collected from a 3-year-old boy at a health clinic in Kampong Speu Province, Cambodia. The child’s reported clinical symptoms included 4 days of fever and sore throat and cough and a headache for 3 days. A maculopapular rash was not observed, and the boy was not hospitalized. The clinic staff conducted a follow-up interview and reported that the patient recovered fully. ZIKV infection was confirmed in this patient by using PCR, sequencing, and serology and through virus isolation. ELISA for chikungunya and dengue virus IgM and IgG antibodies on acute- and convalescent-phase serum was negative. A universal flavivirus real-time PCR screen that targets the nonstructural (NS) 5 gene (6) determined that the patient’s serum was positive for flavivirus RNA, but subsequent species-specific PCR ruled out 2 other flaviviruses that are highly endemic to the region (dengue and Japanese encephalitis viruses) (7–9). This result was the first nondengue, non–Japanese encephalitis virus flavivirus detected after samples from ≈10,000 enrolled patients were tested. Nucleic acid sequencing of the amplicon isolated by gel purification produced a 100-bp fragment with 100% sequence identity to ZIKV (nucleotide position 8,969 of the NS5 gene of the isolate GenBank accession no. {type:entrez-nucleotide,attrs:{text:EU545988,term_id:189092757}}EU545988). ZIKV infection subsequently was serologically confirmed by hemagglutination-inhibition tests on paired serum samples. The patient’s acute-phase sample was negative, but a convalescent-phase sample gave a positive reaction with ZIKV antigen to a serum dilution of 1:320 and was negative to antigens for the 4 dengue serotypes and yellow fever and West Nile viruses. These results demonstrate that the patient had a clear monotypic flavivirus immune response with seroconversion against ZIKV, indicating a recent primary infection. The most common signs and symptoms reported in confirmed ZIKV infections are fever, headache, malaise, maculopapular rash, fatigue or myalgia, and arthritis and arthralgia (Table). In addition to fever and headache, the patient in this study had a sore throat and cough. Because of the patient’s age, additional information about symptoms was difficult to obtain. Table Reported or observed clinical signs and symptoms in persons with Zika virus infection, 1962–2010 The clinical characteristics exhibited by this case-patient are similar to those of shown in a small cluster of ZIKV infections described in Indonesia during 1977–1978 in which maculopapular rash was not observed (5). Maculopapular rash was reported as a common sign in case-patients from the recent Yap Island outbreak (3), as well as in case reports from Uganda (2), Senegal, and the United States (4), A case report of laboratory-acquired ZIKV infection also noted the lack of maculopapular rash (10). The clinical features of ZIKV infection are similar to those of dengue virus and chikungunya virus infections, and both arboviruses are found in Southeast Asia. In this region, laboratory-based confirmation is essential. The extent of ZIKV infections in Cambodia is unknown; further studies are needed to clarify the prevalence and geographic distribution of ZIKV infection in the country.

Virus isolations and high population density implicate Culex antennatus (Becker) (Diptera: Culicidae) as a vector of Rift Valley Fever virus during an outbreak in the Nile Delta of Egypt

In June, 2003, Egypt's hospital-based electronic disease surveillance system began to record increased cases of acute febrile illness from governorates in the Nile Delta. In response to a request for assistance from the Egyptian Ministry of Health and the World Health Organization (WHO), the U.S. Naval Medical Research Unit No. 3 (NAMRU-3) provided assistance in identifying the cause and extent of this outbreak. Testing of human clinical samples (n=375) from nine governorates in Egypt identified 29 cases of RVF viremia that spanned the period of June to October, and a particular focus of disease in Kafr el Sheikh governorate (7.7% RVF infection rate). Veterinary samples (n=101) collected during this time in Kafr el Sheikh and screened by immunoassay for RVFV-specific IgM identified probable recent infections in cattle (10.4%) and sheep (5%). Entomologic investigations that focused in rural, rice growing villages in the Sidi Salim District of Kafr el Sheikh during August–September, 2003, collected, identified, and tested host-seeking female mosquitoes for the presence of pathogenic viruses. Three isolates of RVF virus (RVFV) were obtained from 297 tested pools of female mosquitoes and all three RVFV isolates came from Cx. antennatus (Becker). While Cx. pipiens has been considered the primary vector of RVF virus in Egypt and is often the most common man-biting species found, Cx. antennatus was the dominant species captured at the 2003 outbreak location in Kafr el Sheikh governorate. This is the first time that Cx. antennatus has been found naturally infected with RVFV in Egypt.

Identification of a Rotavirus G12 Strain, Indonesia

To the Editor: Group A rotaviruses are the most common etiologic agents of acute gastroenteritis in infants and young children, each year resulting in ≈100 million diarrhea episodes and 600,000 deaths worldwide (1). The genome of rotavirus comprises 11 segments of double-stranded RNA, which encode 6 structural viral proteins (VPs) and 6 nonstructural proteins (NSPs). Recent scientific reports have identified novel rotavirus strains, such as G12 (2–5), which were first described in 1987 among Filipino children with diarrhea (6). In Indonesia, a rotavirus study showed that a broad variety of VP7 types (G1, G2, G3, G4, G8, G9) and VP4 types (P[4], P[6], P[8], P[9], P[10], P[11]), especially G9 and P[8] and G9P[8], were the genotype combinations most frequently encountered (7). From 2005 through 2008, we conducted a nationwide surveillance study among children who had diarrhea to determine etiologies among Indonesian children seeking health services for diarrhea at hospitals and health clinics. Patients were enrolled after obtaining consent from parents/guardians of those eligible in accordance with an institutional review board protocol approved by the US Naval Medical Research Unit No. 2 (NAMRU-2) and the Ethical Committee of the Indonesian National Health Research and Development Institute. Stool specimens and clinical enrollment data were collected for each eligible patient, and all collected items were transported to NAMRU-2 in Jakarta, Indonesia. In December 2007, a stool specimen was collected from a 14-day-old afebrile infant brought to Sumber Waras Hospital in West Jakarta with diarrhea, vomiting, moderate dehydration, and malnutrition. This patient was infected with the rotavirus G12 strain, was hospitalized for 6 days, and was discharged after recovering fully. Bacterial cultures and ova/parasite evaluations were negative for enteric pathogens. Rotavirus was detected in this specimen and genotyped by multiplex, seminested reverse transcription–PCR (RT-PCR) targeting the VP4 and VP7 genes (8,9). The specimen was typed as P[4]P[6] but was G-nontypeable. Primers to detect G12 were then used for RT-PCR and identified the proper G12 amplicon size (2,3). By use of published primers (9), sequencing of the VP7 gene segment confirmed the presumptive G12 genotype. Sequencing reactions were performed by using the BigDye Terminator v3.1 Cycle Sequencing Kit (Applied Biosystems, Foster City, CA, USA) on the Applied Biosystems 3130xl sequencer. Sequence analysis was done by using Sequencher 4.8 version (Gene Codes Corporation, Inc., Ann Arbor, MI, USA). Nucleotide sequences were submitted to GenBank for a BLASTN search (http://blast.ncbi.nlm.nih.gov) on the National Center for Biological Information website. We then created alignments of nucleotides and deduced amino acid sequences and compared them with a selection of reference strains from the GenBank database. Genetic relationships among G12 were determined by using PAUP version 4.0 beta 10 software (http://paup.csit.fsu.edu). A phylogenetic tree was constructed on the basis of nucleotides 1–971 of the VP7 gene by using the neighbor-joining method and applying the Kimura 2-parameter method with 1,000 bootstrap replicates of the neighbor-joining model. The BLASTN search of the VP7 989 nucleotide sequence of the putative G12 Indonesian rotavirus (Indo SWJ0806) showed 98% similarity with published VP7 sequences of rotavirus G12 strains from Japan (CP727; GenBank accession no.{type:entrez-nucleotide,attrs:{text:AB125852,term_id:49065032,term_text:AB125852}}AB125852), Argentina (Arg721; GenBank accession no. {type:entrez-nucleotide,attrs:{text:EU496255,term_id:169835103,term_text:EU496255}}EU496255), and Thailand (T152; GenBank accession no. {type:entrez-nucleotide,attrs:{text:AB071404,term_id:19912798,term_text:AB071404}}AB071404). The Indonesia G12 clustered into the lineage II composed of rotavirus G12 reference strains from Japan, Argentina, South Korea, and Thailand (Figure). Lineage II is a minority cluster when compared with lineage III, which consists of rotavirus G12 from the United States (US6588, Se585), Saudi Arabia (MD844), India (13B2), Bangladesh (RV161), and other Thailand strains (MS051) (4). The nucleotide sequence divergence between lineage II and lineage III ranges from 2.6% to 3.2%. Analysis of the deduced amino acid sequence alignment on the neutralization epitopes that code for the antigenic regions A, B, and C show high conservation of the most immunodominant sites (data not shown). Antigenic regions A, B, C, D, E, and F of Indonesia SWJ0806 show 100% amino acid similarity to Japan G12 strains; K12 and CP727 (9). The amino acid residue at position 142 of the antigenic region B has characterized lineage I and II (Val) and lineage III (Leu). Figure Phylogenetic analysis of the viral protein (VP) 7 genotype G12 rotavirus of Indonesia with reference strains downloaded from GenBank. The GenBank accession numbers of each strain appear next to the strain. The multiple alignment was constructed by using ... Phylogenetic analysis showed that the virus clusters into lineage II and that the deduced amino acid sequence is highly conserved compared with other reported rotavirus G12 strains identified. The combination of the P[6] genotype in this rotavirus strain suggests the possibility of a zoonotic transmission (10). Continued surveillance for rotavirus is an essential component of a country’s public health infrastructure and diarrhea prevention programs. Rotavirus genotyping from the data obtained provides necessary information for vaccine development and identification of novel and emerging rotavirus strains.

Nutrition classics. Federation Proceedings, volume 23, 1964. Water and electrolyte losses in cholera by R.A. Phillips.

Federation Proceedings R.A. Phillips R.A. Phillips United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipei, Taiwan, San Lazaro Hospital, Manila, Republic of the Philippines Search for other works by this author on: Oxford Academic PubMed Google Scholar Nutrition Reviews, Volume 40, Issue 4, April 1982, Pages 113–115, https://doi.org/10.1111/j.1753-4887.1982.tb05283.x Published: 01 April 1982

NAMRU-3: forty-six years of infectious disease research.

The United States Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt, has been in continuous operation studying infectious diseases of military importance since its establishment in 1946, even during the lapse in diplomatic relations from 1967-1974. Other overseas research laboratories of the Naval Medical Research and Development Command include NAMRU-2 in Jakarta, Indonesia, with a detachment in Manila, and the Naval Medical Research Institute Detachment Lima, Peru. Comparable U.S. Army overseas research laboratories are located in Thailand, Brazil, Korea, and Kenya. Department of Defense overseas laboratories conduct research on infectious diseases endemic to their respective geographic regions which could adversely impact on the health of deployed military forces. This article describes the history of one such laboratory, NAMRU-3, and the important infectious disease research it conducts to enhance the health of military forces deployed to its strategic geographical region of the world.

Acute brucellosis presenting as fever of unknown origin (FUO)

Journal Article Acute brucellosis presenting as fever of unknown origin (FUO) Get access Z. Farid, Z. Farid U.S. Naval Medical Research Unit No. 3 (NAMRU-3), and Abbassia Fever Hospital, Ministry of Health, Cairo, Egypt Search for other works by this author on: Oxford Academic PubMed Google Scholar B. Trabolsi, B. Trabolsi U.S. Naval Medical Research Unit No. 3 (NAMRU-3), and Abbassia Fever Hospital, Ministry of Health, Cairo, Egypt Search for other works by this author on: Oxford Academic PubMed Google Scholar W. Yassin, W. Yassin U.S. Naval Medical Research Unit No. 3 (NAMRU-3), and Abbassia Fever Hospital, Ministry of Health, Cairo, Egypt Search for other works by this author on: Oxford Academic PubMed Google Scholar R.H. Watten, R.H. Watten U.S. Naval Medical Research Unit No. 3 (NAMRU-3), and Abbassia Fever Hospital, Ministry of Health, Cairo, Egypt Search for other works by this author on: Oxford Academic PubMed Google Scholar G.I. Higashi G.I. Higashi U.S. Naval Medical Research Unit No. 3 (NAMRU-3), and Abbassia Fever Hospital, Ministry of Health, Cairo, Egypt Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 74, Issue 3, 1980, Pages 402–404, https://doi.org/10.1016/0035-9203(80)90112-1 Published: 01 January 1980 Article history Accepted: 07 August 1979 Published: 01 January 1980

The Subgenus Persicargas (Ixodoidea: Argasidae: Argas). 17. A Neurohemal Organ in A. (P.) Arboreus Kaiser, Hoogstraal, and Kohls

A paraesophageal neurohemal organ is described in the adult Argas (Persicargas) arboreus Kaiser, Hoogstraal, and Kohls. The tissue of this organ, studied by light and electron microscopy, consists of several large neuronal cell bodies and nerve axons, both containing neurosecretory vesicles, and numerous glial cells. The cellular structure of this organ suggests a structural homology to the corpora cardiaca of insects and to neurohemal endocrine organs in other arachnids. Neurohemal endocrine organs with structural and functional homology to the insect corpora cardiaca have been described for several arthropods (Scharrer and Scharrer, 1944; Gabe, 1952a, b, 1954a, b, c, 1955; Legendre, 1953, 1954). Among Ixodoidea, Gabe (1955) and Eichenberger (1970), working on Ornithodoros erraticus and 0. lahorensis, and 0. moubata, respectively, described paired plaques paraganglionaires as neurohemal organs in these ticks. During histological studies of the central nervous system of the adult Argas (Persicargas) arboreus Kaiser, Hoogstraal, and Kohls (Shoukrey and Roshdy, in preparation), we observed the neurohemal paraesophageal organ described here. MATERIALS AND METHODS Adult A. (P.) arboreus were taken from a NAMRU-3 Medical Zoology laboratory colony originating from rookeries of the heron Bubulcus i. ibis at the Nile Barrage near Cairo, and maintained according to the procedure of Kaiser (1966). Received for publication 27 October 1972. * From Research Project MF12.524.009-3010B, Bureau of Medicine and Surgery, Department of the Navy, Washington, D. C. The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or of the naval service at large. This work was also supported in part by a special grant from the Office of Naval Research and by Agreement 03-005-01 between the NIAID (NIH) and NAMRU-3. t Department of Zoology, Faculty of Science, Ain Shams University, Cairo, and Medical Zoology Department, U. S. Naval Medical Research Unit No. 3 (NAMRU-3), c/o Spanish Embassy, Cairo, Arab Republic of Egypt. t Medical Zoology Department, NAMRU-3. ? Department of Entomology, North Carolina State University, Raleigh, North Carolina 27607. For histological studies, ticks were dissected in saline and the internal organs, including the central nervous mass, were removed directly into Bouin's fixative. Tissues were dehydrated, cleared in xylene, and embedded in paraffin. Sections 5 to 6 u thick were stained with Mallory's triple stain, azan, toluidine blue, chrome-hematoxylin-phloxine (CHP), and paraldehyde-fuchsin (PF); the latter stains are specific for neurosecretion (Gabe, 1955; Pearse, 1961). For electron microscopy, freshly dissected adult A. (P.) arboreus were fixed for 30 min in cold 2.5% glutaraldehyde buffered with 0.05 M sodium cacodylate containing 0.15 M sucrose. The central nervous mass and adjacent tissues were removed and placed in fresh fixative for 1 to 3 hr, washed for 12 hr in cacodylate buffer containing 0.3 M sucrose, postfixed in cold 1% osmium tetroxide in Millonig phosphate buffer (Millonig, 1961), and dehydrated in a graded series of cold ethanol. Material was then transferred through 3 changes of propylene oxide and embedded in Epon 812 (Luft, 1961). Thin sections, cut with a diamond knife on a Reichert Om U2 ultramicrotome, were double-stained with uranyl acetate and lead citrate (Venable and Coggeshall, 1965), and examined in a Siemiens Elmiskop 1A at 80 kv.

CEREBRAL SALT-WASTING ASSOCIATED WITH THE GUILLAIN-BARR'E SYNDROME.

INAPPROPRIATE secretion of antidiuretic hormone has been implicated as the cause of the hyponatremia and renal salt-wasting associated with certain cases of intracranial and intrathoracic disease. Cases of traumatic, infectious, and neoplastic intracranial disease, and of neoplastic thoracic disease have been associated with the salt-wasting syndrome. 1-6 The following is a report of the simultaneous occurrence in a patient of an illness clinically indistinguishable from the Guillain-Barre syndrome and of an electrolyte disturbance marked by transient loss of renal sodium-conserving ability, plasma hypo-osmolality, and plasma hyponatremia. Immunologic features of this patient's illness suggested to us that the etiology of the polyradiculoneuropathy was hypersensitivity to viral antigens. Report of a Case A 32-year-old Taiwanese man, a virology technician at the US Naval Medical Research Unit No. 2 (NAMRU-2), was admitted to Taiwan University Hospital on Sept 16, 1961, with the chief complaint of walking disturbance and pain in the left

Trachoma vaccine studies on Taiwan.

Annals of the New York Academy of SciencesVolume 98, Issue 1 p. 352-367 TRACHOMA VACCINE STUDIES ON TAIWAN* J. Thomas Grayston, J. Thomas Grayston The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipai, Taiwan Dr. Grayston's present address is: Department of Preventive Medicine, University of Washington School of Medicine, Seattle 5, Washington.Search for more papers by this authorRobert L. Woolridge, Robert L. Woolridge The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipai, TaiwanSearch for more papers by this authorSan-pin Wang, San-pin Wang The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipai, TaiwanSearch for more papers by this author J. Thomas Grayston, J. Thomas Grayston The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipai, Taiwan Dr. Grayston's present address is: Department of Preventive Medicine, University of Washington School of Medicine, Seattle 5, Washington.Search for more papers by this authorRobert L. Woolridge, Robert L. Woolridge The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipai, TaiwanSearch for more papers by this authorSan-pin Wang, San-pin Wang The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipai, TaiwanSearch for more papers by this author First published: March 1962 https://doi.org/10.1111/j.1749-6632.1962.tb30558.xCitations: 56 † This study was supported in part by funding under public law 480, Section 104 (c) and in part by a Public Health Service research grant, No. B-3144, from the Institute of Neurologic Diseases and Blindness, National Institutes of Health, Public Health Service. The opinions and assertions contained herein are those of the authors and are not to be construed as official or reflecting the views of the Navy Department or the Naval Service at large. Reprint requests should be addressed to the Commanding Officer, NAMRU-2, Box 14, APO 63, San Francisco, California. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume98, Issue1The Biology of the Trachoma AgentMarch 1962Pages 352-367 RelatedInformation

Antigenic relationshkps of trachoma virus strains in the mouse toxicity prevention test.

Annals of the New York Academy of SciencesVolume 98, Issue 1 p. 347-351 ANTIGENIC RELATIONSHIPS OF TRACHOMA VIRUS STRAINS IN THE MOUSE TOXICITY PREVENTION TEST* Ik-chin Chang, Ik-chin Chang The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipei, Taiwan Dr. Chang was a NAMRU-2 fellow from Yonsei University Medical School, Severance Hospital, Seoul, Korea.Search for more papers by this authorSan-pin Wang, San-pin Wang The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipei, TaiwanSearch for more papers by this authorJ. Thomas Grayston, J. Thomas Grayston The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipei, Taiwan Department of Preventive Medicine, University of Washington School of Medicine, Seattle 5, Wash.Search for more papers by this author Ik-chin Chang, Ik-chin Chang The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipei, Taiwan Dr. Chang was a NAMRU-2 fellow from Yonsei University Medical School, Severance Hospital, Seoul, Korea.Search for more papers by this authorSan-pin Wang, San-pin Wang The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipei, TaiwanSearch for more papers by this authorJ. Thomas Grayston, J. Thomas Grayston The United States Naval Medical Research Unit No. 2 (NAMRU-2), Taipei, Taiwan Department of Preventive Medicine, University of Washington School of Medicine, Seattle 5, Wash.Search for more papers by this author First published: March 1962 https://doi.org/10.1111/j.1749-6632.1962.tb30557.xCitations: 15 † This study was supported in part by funding under Public Law 480, Section 104 (c) and in part by the Office of Naval Research, contract Nonr-2121 (07). The opinions and assertions contained herein are those of the authors and are not to be construed as official or reflecting the views of the Navy Department or the Naval Service at large. Reprint requests should be addressed to the Commanding Officer, NAMRU-2, Box 14, APO 63, San Francisco, Calif. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume98, Issue1The Biology of the Trachoma AgentMarch 1962Pages 347-351 RelatedInformation