Positive Complement Fixation Test Research Articles

Alcoholic extracts of kedrowsky's bacillus as antigen for complement-fixation tests in kala-azar

1. (1) Residues from the alcoholic extract of Kedrowsky's bacillus have been shown to behave as good antigens for complement-fixation tests in kala-czar. 2. (2) A white fraction obtained from the alcoholic extract of Kedrowsky's bacillus has been found to be at least as good as the standard antigen for complement-fixation tests in kala-azar. 3. (3) Preparation of the antigen for complement-fixation tests in kala-azar from this alcoholic extract is a very much simpler procedure than the standard method of preparation of this antigen. 4. (4) The view that the antigen giving positive complement-fixation tests with sera from cases of kala-azar is contained in the alcohol-insoluble fraction of the bacilli is discussed.

Infestação domiciliária em grau extremo por Triatoma infestans

Uma pequena cafua com 4 dependências e sòmente um quarto de dormir, com uma área de 60 [metros quadrados] de paredes internas, construída em 1949, foi reconhecida desde 1951 como uma das mais infestadas por triatomas, no Município de Bambuí. De outrubro a dezembro de 1951 foram nela capturados, por meio de 26 expurgos com pós de pirêtro, 2 505 exemplares de T. infestans e 3 de P. megistus. Em dezembro de 1951 foram recolhidos pelo mesmo processo, em 5 dias seguidos, mais de 4 645 T. infestans e 1 P. megistus. A cafua foi demolida em janeiro de 1955, tendo sido capturados ainda 1 398 T. infestans, perfazendo-se assim, um total de 8 552 barbeiros apanhados em uma única cafua! Observou-se uma baixa das percentagens de infecção de T. infestans por S. cruzi, que de 37,7% em 1951, caiu para 6,5% em 154. Nos indivíduos adultos ela baixou de 61,5% para 9,4%, nas ninfas de 33,3% para 3,5%, diferenças essas que se mostraram estatisticamente significativas. Todos os 6 moradores eram portadores de doença de Chagas; a reação de fixação do complemento foi positiva em todos e o xenodiagnóstico em 4 dêles. O hemograma, feito em 5 dêsses indivíduos, revelou graus variáveis de anemia. Sòmente o chefe da família, um homem de 49 anos, era caso de cardiopatia chagásica crônica, apresentando bloqueio completo de ramo direito. O último filho do casal faleceu aos 14 meses com edema generalizado, sendo possìvelmente um caso de esquizotripanose aguda, embora um único exame a fresco tenha sido negativo, pouco antes da morte.

Schistosomiasis mansoni in Puerto Rican soldiers.

Summary and Conclusions The results of a study employing various methods of detecting schistosomiasis in 276 asymptomatic Puerto Rican soldiers are reported. Forty-five per cent showed a positive intradermal test, 43.5 per cent showed a positive complement-fixation test and 18.8 per cent had positive stools for ova. The intradermal and complement-fixation tests appear to be good screening tests and are simple to perform. We wish to express our appreciation to Captain Pablo Morales, MC, AUS, and 1st Lt. James L. Sullivan, MSC, AUS, for their valuable assistance in collecting and handling the specimens used in this study.

Serologic Studies on North American Blastomycosis

Summary and Conclusions A soluble antigen, obtained by sonic vibration of washed yeast-phase cells of Blastomyces dermatitidis, was used to test for complement-fixing antibodies in 165 sera, including 69 samples from patients with proved cases of blastomycosis and 15 from patients with a clinical diagnosis or suspected diagnosis of other fungus infections. The antigen, although failing to give positive results in 29% of cases of proved blastomycosis, proved to be as satisfactory as the yeast-phase antigens previously employed, and had the distinct advantages of solubility and ease of storage. The soluble materials from sonic-treated washed yeast-phase cells of Histoplasma capsulatum also gave positive complement fixation tests with sera from patients with proved blastomycosis. The supernatant fluid from the protein-free saline suspensions of untreated yeast-phase cells was shown to contain an antigen which fixed guinea pig complement with sera from immunized rabbits but not with sera from patients with blastomycosis. This supernatant fluid, and a polysaccharide precipitated from it, were capable of sensitizing sheep's cells, rendering them agglutinable by sera from patients with blastomycosis. There was no correlation between the titers obtained by the hemagglutination technique and those obtained by the complement fixation tests in sera of patients with blastomycosis, but there was a definite relationship between the titers obtained in both tests and the prognoses of the patients. The data obtained on a limited number of mice suggested that the injection of small amounts of carbohydrate material, precipitated from the saline extract of the untreated cells, stimulates the development of a limited degree of resistance to heavy challenge doses of living B. dermatitidis. Skin tests on guinea pigs infected with B. dermatitidis and Histoplasma capsulatum using extracts of untreated cells and treated cells of both fungi indicated that the former substances produced more specific reactions and that the latter antigens were less specific. The above findings and their implications in the interpretation of the immunologic reactions obtained in blastomycosis and other systemic fungus infections are discussed.

Coccidioidal pericarditis.

In endemic areas where coccidioidomycosis is encountered, pericarditis of an occult etiology warrants a careful search for coccidioidomycosis. A coccidioidin skin test is helpful. The established diagnosis, however, depends upon positive coccidioidal complement fixation and precipitin tests, or recovery of the organism from the sputum or the pericardial fluid.

CAT SCRATCH SYNDROME

The clinical, laboratory and pathologic findings of a series of cases of cat scratch syndrome have been reviewed. In spite of a variable clinical course, certain features associated with a selected group of laboratory tests appear to be constant enough to be of diagnostic value. A history of contact with a cat and/or scratch which is usually associated with a peripheral skin lesion, lack of lymphangitis, presence of regional lymphadenopathy with tenderness to palpation are the most constant clinical findings. Fever, so frequently emphasized as a characteristic clinical sign, may be extremely variable in type and duration or entirely absent. A skin test with cat scratch antigen has been positive in all cases. Lacking this antigen, a negative Frei skin test in conjunction with a positive complement fixation test (Lygranum C. F.) is suggestive evidence for the diagnosis. With positive evidence from the above data, biopsy of an affected gland with its relatively nonspecific pathologic picture is not considered essential for the establishment of the diagnosis of cat scratch syndrome.

Studies on opsonins in Q fever.

A method was developed for the quantitative determination of opsonins for C. burnetii. An opsonin unit for C. burnetii was defined as that quantity of opsonin which, under standardized conditions, causes phagocytosis of elementary bodies of C. burnetii by 94 to 100 per cent of polymorphonuclear neutrophils. The opsonin titer represents the number of opsonin units in 0.1 ml. of serum or heparinized plasma. A plasma opsonin titer of 1 occurred in 1 per cent of the people tested at Camp Detrick, Frederick, Maryland, with no known contact with C. burnetii; in 30 per cent of the immunized people of Camp Detrick treated by subcutaneous injection of phenol-inactivated C. burnetii in chick embryo yolk sac; and in 31 per cent of the people tested at Los Angeles, with no clinical evidence of Q fever. On a statistical basis, about 42 per cent of the vaccinated people of Camp Detrick and of "normal" Los Angeles people had evidence of increased opsonins in their blood. Vaccinated individuals of Camp Detrick showed no relation between opsonin and complement fixation titers, but individuals living in Los Angeles, an area endemic for Q fever, revealed positive complement fixation tests only in one-seventh of individuals with opsonin titers of 1. The significance of these differences is discussed. The opsonin titer of patients with Q fever may increase many million fold, and much more than the complement fixation titer. The opsonin titers of serum and heparinized plasma were identical, and both decreased with storage at 5 degrees C. The opsonin titer for elementary bodies of C. burnetii grown in chick embryo yolk sac may be used as an epidemiological and diagnostic indicator for the distribution of the agent causing Q fever.

Studies on the Prevention of Mumps

Summary The results of over 1800 skin tests and over 1500 complement fixation tests have been analyzed in terms of past mumps infection, age of the individual and geographical area. Correlation between past known infection and positive complement fixation or skin tests was of the order of 70 to 80%. With the skin test it was somewhat higher in the adult than in individuals less than 18 years of age, whereas the reverse was noted with the complement fixation test. Neither a positive complement fixation reaction nor a positive skin response affords absolute assurance of resistance to mumps but the incidence of infection among such individuals was found to be less than 2%, whereas it was many times that in those giving negative reactions. Since discrepancies between the results of the 2 tests, when performed simultaneously, were not infrequent, it is obvious that both technics should be employed to attain maximal accuracy in determining the immune status of an individual.

Schistosomiasis with spinal meningo-radicular lesions

Os autores apresentam o caso de um paciente originário de Pernambuco, com antecedentes sugestivos de contaminação por furcocercárias e portador de hepatosplenomegalia, no qual se desenvolveu déficit motor generalizado, predominando nos membros inferiores, com arreflexia e hipotonia, hipoestesia superficial nas mãos e membros inferiores, e desordens da sensibilidade profunda consciente nos segmentos distais dos membros. O diagnóstico de esquistossomose sistêmica foi confirmado pelo encontro de ovos de Schistosoma mansoni nas fezes e pela positividade das reações intradèrmica e de fixação de complemento no sangue. O diagnóstico clínico de provável esquistossomose medular foi reforçado pelas alterações meningo-parenquimatosas do liqüido cefalorraqueano, destacando-se hiperci-tose média com eosinofilorraquia e, particularmente, a alta positividade da reação de fixação de complemento para bilharziose. Antes que pudesse ser instituído tratamento antimonial o paciente faleceu. À necropsia foram verificadas lesões que costumam ocorrer na esquistossomose visceral, mantendo-se o diagnóstico clínico, apesar de não terem sido encontrados ovos nos tecidos. Encèfalo normal; na medula foi comprovada a existência de aracnoidite produtiva, radiculite, degeneração bilateral de raízes da cauda eqüina e degeneração secundária dos fascículos gráceis.

Inquérito sôbre a Doença de Chagas em candidatos a doadores de sangue

Em 576 indivíduos que se apresentaram ao Banco de Sangue do Hospital do Pronto Socorro de Belo Horizonte, para a prova de seleção de doadores de sangue, foi feita a reação de fixação do complemento (antígeno de cultura do S. cruzi) para o diagnóstico da doença de CHAGAS. Em 14 casos a reação foi positiva. Sete candidatos a doador, com reação positiva, foram estudados clìnicamente, e nêles foi praticado xenodiagnóstico, eletrocardiograma e tele-radiografia do coração e vasos da base. Em todos os 7 casos estudados apurou-se que já haviam habitado casas infestadas por triatomíneos em zonas endêmicas e 3 deles apresentaram sinais de comprometimento miocárdico, revelando o eletrocardiograma, em dois, bloqueio do ramo direito, e, em um, bloqueio A-V total. Em 3 candidatos conseguiu-se a comprovação parasitológica da infecção chagásica pela positividade do xenodiagnóstico. Foram feitas considerações sobre o problema da transmissibilidade da doença de CHAGAS pela transfusão de sangue e da necessidade de se tornar obrigatória a inclusão da reação de fixação do complemento para esquizotripanose entre as provas de rotina exigidas na seleção de doadores de sangue.

The immunology of the human mycoses.

The immunological aspect of medical mycology has tended to lag behind similar aspects of other fields. It appears, however, that immunologic proc­ esses in the fungus-infected host are essentially similar to those which occur in bacterial, viral, and other diseases of infectious etiology. The procedures and techniques for measuring immunologic reactions are, therefore, similar to those which have been established for the infectious diseases in general. Possibly because of the somewhat more highly differentiated structure of the fungi, the preparation of antigens for immunologic studies requires certain modifications. Except for this difference no really specialized knowledge ap­ pears to be necessary in the performance of immunologic tests. As in other infectious diseases, immunologic data are of diagnostic and prognostic consequence only when interpreted in the light of the limitations of the commonly used tests. In some instances negative results, such as negative tests for cutaneous sensitivity, are of greater significance in exclud­ ing a particular diagnosis than are positive tests in establishing it, as exempli­ fied by the tu berculin test and, similarly, by the coccidioidin test for coccidi­ oidomycosis. Immunologic studies, however, constitute an important part of the clinical evaluation in respect to diagnosis, prognosis, and management of many of the systemic mycoses. The systemic mycoses are insidiously developing, chronic, and often fatal diseases. They tend to simulate tuberculosis. Consequently, there are many pathologic and immunologic analogies between the mycoses and chronic bacterial diseases. The pathogenic fungi may, on the one hand, be characterized as being more allergenic than bacteria, in the sense that cutaneous sensitivity is practically a constant feature of the human mycoses. On the other hand, they may be said to be less antigenic than many bacterial pathogens in that concentrations of circulating antibodies, expressed as antibody titers, are generally low. For example, although a positive complement-fixation test with undiluted serum or serum diluted 1 : 2 might be skeptically regarded in other infections, such low titers may assume diagnostic significance in the human mycoses, as is the case in blastomycosis ( 1 ) . The reasons for this mea­ ger antigenicity are not well known. It is possible that the slow progression

Inquérito sôbre a doença de Chagas no hospital da Santa Casa de Misericórdia de Belo Horizonte (Minas Gerais, Brasil)

São relatados os resultados de um inquérito sôbre doença de Chagas realizado na Santa Casa de Misericórdia de Belo Horizonte (Minas Gerais, Brasil), com a finalidade de verificar a incidência desta moléstia e especialmente de sua forma cardíaca crônica entre os doentes ali internados. Foram examinados 181 pacientes adultos não selecionados, adotando-se os seguintes métodos: a) exame clínico geral e exame minucioso do aparelho circulatório; b) eletrocardiograma; c) reação de fixação do complemento para a doença de Chagas (antígeno de cultura do Schizotrypanum cruzi); d) reação de Wassermann; e) xenodiagnóstico e radiografia dos pacientes com reação de fixação do complemento (Guerreiro & Machado) positiva e de portadores de outras cardiopatias. Dos 181 pacientes examinados, 37 (20,44%) tinham provas de laboratório positivas para foença de Chagas. 49 (27,07%) eram portadores de cardiopatias, com as seguintes etiologias: doença de Chagas (18 casos); arteriosclerose (13 casos); hipertensão arterial (12 casos); sífilis (casos); febre reumática (3 casos); cardiopatia congênita (1 caso); cor pulmonale crônico (1 caso). De 34 pacientes com doença de Chagas, 18 (52,95%) apresentavam evidências eletrocardiográficas de comportamento miocárdico. As alterações eletrocardiográficas mais freqüentes foram: bloqueio do ramo direito, extra-sístoles ventriculares, alterações de QRS (isoladas ou associadas a alterações de T), bloqueios auriculo-ventriculares. Estes achados são semelhantes aos já descritos na cardiopatia chagásica crônica por Laranja e cols. (13,26). As alterações eletrocardiográficas mais frequentes no grupo de pacientes com provas de laboratório negativas para doença de Chagas foram: curvas de hipertrofia ventricular esquerda (strain) alteralçoes primárias de T e extra-sístoles vemtriculares. A idade de 50,0% dos pacientes com miocardite chagásica crônica não ultrapassou os 30 enquanto que 83,33% dos pacientes portafores de outras cardiopatias eram maiores de 30 anos. A reação de fixação do complemento (antígeno de cultura do Schizotrypanum cruzi), devido à sua especificidade e sensibilidade, mostrou ser muito util para o diagnóstico de laboratório da doença de Chagas em sua fase crônica. O xenodiagnóstico foi positivo em 8 casos (25,8%) de 31 pacientes com reação de Guerreiro & Machado positiva. Foi discutidoo problema da etiologia do megaesôfago e do megacolon, admitindo os Autores que adoença de Chagas possivelmente desempenhe, em determinadas zonas, papel significativo no desenvolvimento destas afecções. Foi brevemente relatada a distribuição geográfica dos triatomídeos no Estado de Minas Gerais. Os principais vetores são Panstrongylus megistus, Triatoma infestans e Triatoma sordida, se bem que outras 12 espécies ocorrem neste Estado. Estes triatomídeos existem em 204 (64,55%) dos 316 municípios do Estado de Minas. Vetores infetados foram encontrados em 143 municípios (70,09%). Foram assinaladas as áreas infetadas mais importantes. Os Autores salientaram a importância médica da doença de Chagas, acreditando ser esta infecção um dos mais importantes fatores de cardiopatia em amplas zonas rurais do Estado de Minas Gerais.

Intradermal and Complement Fixation Reactions Elicited by Various Antigens in Persons Infected with Onchocerca Volvulus 1

Summary and Conclusions In order to evaluate the two methods, a total of 658 intradermal and 161 complement fixation tests was conducted on onchocercosis patients in endemic areas and on control individuals in other areas. A single skin biopsy on 81 individuals with Onchocerca nodules disclosed microfilariae in 40 per cent of the cases, whereas O. volvulus antigen in a dilution of 1:8,000 gave a positive reaction in 78, or 96.2 per cent, of the individuals when the reading of the reaction was based on an antigen wheal greater by 3 mm. or more than the control wheal. In a dilution of 1:8,000, antigens prepared from Dirofilaria immitis, Setaria equina, and Litomosoides carinii gave a lower percentage of positives; the efficacy of these antigens was exceeded by a 1:16,000 dilution of O. volvulus material. The O. volvulus antigen was more specific than the other antigens. In a series of 50 patients (Morganton, N. C.) who had never been exposed to O. volvulus infection but who harbored other helminth parasites, false positive reactions were obtained with a 1:8,000 dilution in the following number of cases: D. immitis 10, S. equina 11, L. carinii 6, and O. volvulus 2. In a Mexico City group of 209 individuals not exposed to O. volvulus but of whom 92 were infected with intestinal helminths, twice as many false positive reactions were obtained with D. immitis and S. equina antigens than with the O. volvulus material. Complement fixation reactions with O. volvulus antigen proved positive in all of 60 individuals with Onchocerca nodules; D. immitis antigen gave positive reactions in 49 of 53 of these cases. In a control group of 43 persons infected with helminth parasites other than O. volvulus, D. immitis material gave positive complement fixation tests in 4 cases, a doubtfully positive reaction in 1 case, and a negative reaction in 39 cases. Intradermal and complement fixation tests on a series of school children at Tamazunchale, Mexico, not supposed to be within the endemic area of onchocercosis, gave a higher percentage of positive reactions than obtained in individuals in any other control group. At the present time no satisfactory explanation can be given for the significant difference in the number of positives obtained in the control individuals at Tamazunchale and Mexico City. From the results in all series, it appears that the O. volvulus antigen is more specific and sensitive than the other three antigens employed in the intradermal tests. The second best antigen appears to be that from D. immitis. The O. volvulus antigen is also superior to the D. immitis antigen when employed in the complement fixation test. Because of the lack of material, judgment on the comparative value of L. carinii antigen in complement fixation tests must await further work. Antigen prepared from S. equina invariably gave anticomplementary reactions. Quantitative complement fixation tests are suggested as a method of measuring the efficacy of drugs in studies on the chemotherapy of onchocercosis.

IMMUNITY IN MUMPS

The results of skin tests read at 48 hours on several hundred adults and children in which heat-inactivated mumps virus was the antigen have been presented and discussed. They can be summarized as follows:- Of 89 persons tested before the onset of mumps, 89 per cent exhibited erythematous reactions 10 mm. or less in diameter and 95 per cent, reactions 15 mm. or less in diameter. Of 40 persons tested during the first 5 days of mumps, 95 per cent exhibited reactions 10 mm. or less and 98 per cent reactions 15 mm. or less. Of 480 exposed persons the attack rate of mumps was 46 per cent among 340 with reactions 10 mm. or less and 10 per cent among 240 with reactions greater than 10 mm. The attack rate was only 2 per cent among 161 with reactions exceeding 15 mm. The attack rates in 13 skin-tested groups which were exposed to mumps tended to be inversely proportional to the incidence of reactions exceeding 10 mm. The incidence of reactions exceeding 10 mm. was approximately twice as high among 529 adults (persons 18 years or older) as it was among 306 children (persons under 18 years). Of 179 adults giving positive histories of mumps, 82 per cent exhibited skin reactions exceeding 10 mm. In certain groups the correlation between history and positive skin test was as high as 0.9. Of 132 adults giving negative histories, 58 per cent exhibited skin reactions of this magnitude. The proportion of reactions exceeding 10 mm. in a small number of children giving positive histories was 75 per cent. The proportion of reactions less than 10 mm. was 15 per cent. Of 167 adults with positive complement fixation tests, 87 per cent exhibited skin reactions exceeding 10 mm. Of 111 adults with negative complement fixation tests, 52 per cent exhibited reactions exceeding 10 mm. Of 43 children with positive complement fixation tests, the skin test reactions exceeded 10 mm. in 70 per cent. The skin reactions exceeded 10 mm. in 29 per cent of 105 children with negative complement fixation tests. In 69 of 72 individuals in whom skin reactions exceeded 10 mm., complement-fixing antibody either appeared in the blood or increased in amount within about 2 weeks after the tests were done. Such antibody responses likewise were observed in 34 of 76 individuals in whom skin reactions were 10 mm. or less. The data summarized up to this point were obtained with virus derived from the infected parotid gland of monkeys. The results of simultaneous tests in 82 individuals employing materials prepared from infected monkey parotid gland and amniotic membrane of chick embryos infected with mumps virus indicated in general that the same individual responded in a similar manner to both antigens. In many instances, however, the membrane material produced weaker reactions. Occasionally an individual failed to react at all to one of these materials but did respond to the other.

IMMUNITY IN MUMPS

Of 163 persons giving positive complement fixation tests who were exposed to mumps, 1 afterwards developed the disease; of 285 negative reactors similarly exposed, 56 afterwards came down with mumps. Of 78 individuals subjected to intimate exposure to mumps whose tests were originally negative and who failed to develop the disease, 41 per cent gave positive reactions when tested 1 month later. Seventy-seven per cent of complement fixation tests done on the sera of 565 normal adults who admitted a previous attack of mumps were positive. A similar correlation was recorded in tests on the sera of a small group of children with positive histories. Of 356 medical students admitting previous attacks, 80 per cent gave positive tests. Of 386 normal adults who denied previous attacks, 42 per cent gave positive tests; of 85 children giving negative histories, 38 per cent reacted positively. The results of complement fixation tests on the sera of 1665 normal adults (over 17 years) and 679 children (1 to 17 years) are recorded. It has been shown that 63 per cent of the adults and 57 per cent of the children had antibody in their blood which reacted with the virus of mumps. In groups in which exceptionally intense exposure was not known to have occurred in the past, the proportions of positive reactors were: adults, 61 per cent; children, 49 per cent. In contrast to these normal persons, the incidence of positive reactors among permanently institutionalized mental defectives was 38 per cent of 356 adults and 32 per cent of 475 children. In only 2 per cent of 320 normal adults and children did the titer of complement-fixing antibody reach 1-192. In no instance in which the endpoint was determined was a higher titer recorded. The results of complement fixation tests on the sera of mother and newborn infant were essentially the same in 5 instances.

The Estrogen Treatment of Stricture of the Rectum Due to Lymphogranuloma Venereum1

CLINICAL observations noted accidentally may lead to new and important therapeutic conceptions. The treatment of stricture of the rectum due to lymphogranuloma venereum has, until the present time, been highly unsuccessful. The observation that a stricture of this type improves tremendously during pregnancy and renders the patient free from symptom after delivery stimulated the search for the explanation of this phenomenon. This report of four cases will serve to indicate the beneficial and almost specific effect of estrogens in alleviating rectal strictures of this type. Lymphogranuloma inguinale or lymphopathia venereum (9) is a wide spread communicable disease usually acquired venereally. It affects all races but is especially common in the colored race. It occurs in both males and females and gains entrance through the skin and mucous membranes. The disease is believed to be due to a filterable agent (2) and is diagnosed by a positive Frei test (1) and a positive complement fixation test (8).

Luetic rectal stricture

A case of luetic stricture of the rectum and a review of the literature are presented. The characteristics of our case which support the diagnosis are (1) the distinctive roentgen appearance of the rectum without evidence of sinuses or fistulae, (2) negative proctoscopic examination—rectal mucosa intact, (3) positive complement fixation tests for syphilis, (4) repeatedly negative Frei tests, (5) absence of inguinal adenopathy, (6) no menstrual abnormalities, (7) absence of gram-negative diplococci, (8) improvement and healing during antiluetic treatment, and (9) course of local disease condition approximately two years.

RELATIONSHIP OF THE VIRUS OF LOUPING ILL IN SHEEP AND THE VIRUS OF RUSSIAN SPRING-SUMMER ENCEPHALITIS IN MAN

An experimental study of three strains of Russian spring-summer encephalitis virus and one of louping ill virus has yielded the following results:- 1. The sera of mice hyperimmunized to the viruses of Russian encephalitis and louping ill respectively have produced complement fixation with both antigens in almost precisely the same titer. 2. In neutralization tests hyperimmune sera against the Russian virus strains protected against louping ill virus to the same extent as against the Russian virus strains. Conversely, hyperimmune sera against the louping ill virus protected against the Russian viruses, although to a less degree than against louping ill virus. 3. In cross-resistance tests in mice, a vaccine consisting of formolized Russian virus gave strong protection against this latter and moderate protection against louping ill virus. Formolized louping ill virus gave moderate protection against infection with louping ill and considerably less against the Russian virus. 4. Serum from an individual recovered from a laboratory infection with louping ill virus contracted in 1933 gave positive complement fixation and neutralization tests with the Russian spring-summer encephalitis, as well as with louping ill virus. 5. Serum from a patient who became infected with either Russian or louping ill virus or both while working with the viruses in the laboratory in the fall of 1942, gave positive reactions on complement fixation and neutralization tests against them both. 6. No such similarities have been found with other central nervous system viruses. Hence it would appear that they are specific.

Pleurisy with effusion as a manifestation of rheumatic fever: Hansen, A. E.: Journal-Lancet 62: 158, 1942

The case of a 43-year-old white man with two gummatous lesions in the mucosa of the hard palate and a negative standard serologic test for syphilis has been presented. The diagnosis was made on the basis of the following criteria: (1) a past history of exposure and infection, (2) clinically, the appearance of painless, soft, gray ulcers with a raised erythematous periphery, (3) the exclusion of other possible etiological agents, (4) a positive Reiter's protein complement fixation test, and (5) the rapid resolution of the gummas following the institution of anti-syphilis therapy.

Complement Fixation in Human Malaria

Summary and Conclusions Analyses of our data show that the complement-fixation test in malaria is very closely correlated with the presence or recent presence of malarial parasites in the peripheral blood. In sera from individuals known to be infected with malaria a strongly positive complement-fixation test means the presence or recent presence of malarial parasites in the peripheral blood. A negative complement-fixation does not rule out the presence of malarial parasites. From the standpoint of diagnosis the complement-fixation test in malaria would appear to be especially valuable in infection with Plasmodium falciparum wherein malarial parasites appear in the peripheral blood only on alternate days during the acute clinical attack. All the analyses tend to show that the standardized antigen used in our second series of complement-fixation tests is more sensitive than the antigens prepared after the methods of other workers. Positive complement-fixation is more closely correlated with the presence or recent presence of malarial parasites in the peripheral blood than with the presence of chills or fever. In the individual patient the test tends, as a rule, to become more strongly positive as the number of parasites increase in the blood. As the parasites disappear, the antibody-titer of the serum decreases. In the second series of 18 cases of induced malaria, 17 showed, at one time or another during the course of the disease, strongly positive complement-fixation, and no strongly positive reaction was obtained in patients without malaria. We wish to thank Dr. F. L. Roberts, Professor of Preventive Medicine at the University of Tennessee, for his kindness in making a statistical analysis of these data. All this work was under a cooperative grant from the Tennessee Valley Authority, The Tennessee State Department of Public Health, the University of Tennessee and the Commissioners of Shelby County.