Positive IgM Titers Research Articles

Anaplasma phagocytophilum Infektion bei einer Katze in der Schweiz

The following case report describes the diagnosis and therapy of a cat with an Anaplasma phagocytophilum infection. The cat from the canton of St. Gallen was presented because of lethargy and lack of appetite. The clinical symptoms established were fever and minor exsiccosis. The diagnosis of granulocytic anaplasmosis was established through microscopic evidence of inclusion bodies in neutrophil granulocytes, the detection of pathogen DNA in the blood by PCR and positive IgM and IgG antibody titers by serological testing. Following this diagnosis the cat was treated for 20 days with doxycycline. As the body temperature normalised, the activity of the cat improved while normalisation of food intake was delayed. After therapy Anaplasma phagocytophilum DNA could not be detected by PCR and a complete remission of abnormal serum chemistry and hematological parameters could be shown.

Mycoplasma pneumoniaepneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ)

BackgroundCurrently, broad empiric antimicrobial treatment including atypical coverage is recommended for patients with mild to moderate community-acquired pneumonia (CAP). Therefore, the relative impact of each atypical pathogen, particularly Mycoplasma pneumoniae deserves renewed attention.MethodsBased on prospective data from 4532 patients with CAP included in the German CAP-Competence Network (CAPNETZ), we studied the incidence, clinical characteristics, and outcome of patients with Mycoplasma pneumoniae pneumonia (MPP). The diagnosis of MPP was based on a positive PCR from respiratory samples and/or a positive IgM-titer from an acute phase serum sample.Results307 patients (6.8%) had definite MPP (148 with positive PCR, 204 with positive IgM, 46 with positive PCR and IgM). Compared to patients with other definite and unknown etiologies, patients with MPP were significantly younger (41 ± 16 versus 62 ± 17 and 61 ± 18 years), had fewer co-morbidities, presented with a less severe disease, showed a lower inflammatory response in terms of leukocyte counts (median 8850 versus 13200 and 11000 μL) and CRP values (60 versus 173 and 73 mg/L), and had better outcomes, including a shorter length of hospitalization (9 ± 5 versus 14 ± 11 and 12 ± 9 days), fewer patients requiring mechanical ventilation (0.3 versus 4.5 and 2.1%), and a minimal mortality (0.7 versus 8.7 and 6.5%).ConclusionIn this large series of patients with definite MPP according to very strict criteria, MPP appears as a condition with a high incidence, quite specific clinical presentation, and a largely benign course. In view of a widely favorable clinical outcome, recent recommendations including regular coverage of atypical pathogens in patients with mild to moderate CAP might be reconsidered for patients in Germany as well as in other countries with comparable epidemiological settings.

Neurological signs in juvenile harbour seals (Phoca vitulina) with fatal phocine distemper

In 2002, the northern European harbour seal (Phoca vitulina) population experienced an epidemic of phocine distemper virus (PDV) in which 22,000 seals died. Clinical signs were recorded in 20 harbour...

A Hospital-Based Serological Survey of Cryptosporidiosis in the Republic of Korea

The seroprevalence of cryptosporidiosis was examined using patients' sera collected from hospitals located in 4 different areas of the Republic of Korea. ELISA was used to measure antibody titers against Cryptosporidium parvum antigens from a total of 2,394 serum samples, which were collected randomly from patients in local hospitals; 1) Chungbuk National University Hospital, 2) Konkuk University Hospital, 3) local hospitals in Chuncheon, Gangwon-do (province), 4) Jeonnam National University Hospital, from 2002 through 2003. Of the 2,394 samples assayed, 34%, 26%, and 56% were positive for C. parvum-specific IgG, IgM, and IgA antibodies, respectively. Positive IgG titers were most common in sera from Jeonnam National University Hospital, Gwangju, Jeollanam-do, and positive IgM titers were most common in sera from Chungbuk National University Hospital, Cheongju, Chuncheongbuk-do. The seropositivity was positively correlated with age for both the IgG and IgA antibodies but was negatively correlated with age for the IgM antibodies. Western blotting revealed that 92%, 83%, and 77% of sera positive for IgG, IgM, and IgA ELISA reacted with 27-kDa antigens, respectively. These results suggested that infection with Cryptosporidium in hospital patients occurs more commonly than previously reported in the Republic of Korea.

Mycoplasma Pneumonia Infection - a Possible unrecognized Cause for Immune Thrombocytopenic Purpura

Mycoplasma pneumonia (M. pneumonia) is usually not considered among the several pathogens that induce immune thrombocytopenic purpura (ITP). We report a case of a child with a clinical diagnosis of severe ITP (as defined by the American Society of Hematology panel guidelines of 1994), that was associated with M. pneumonia pneumonia, and reviewed the few cases described in the English literature. A 7-year-old girl was admitted to the pediatric department with 1 day history of fever, purpura and petechiae on her legs, buttocks, arms, face, hard palate, oral mucous membranes and lips. Crepitations were heard over both lungs' lower fields. Complete blood count revealed WBC of 22.3×103/ μL, Hemoglobin of 11.1 gr/dL, and platelet count of 2×103/μL. Red cells appeared normal on blood film with no features of microangiopathy. A chest X-ray demonstrated right middle lobe infiltrate. Presumptive diagnoses of ITP and RML pneumonia were made and treatment was initiated with one dose of IVIG 0.8 g/kg and daily IV Ceftriaxon at 50 mg/kg. Twelve hours after the IVIG administration, platelet count was 1.2×103/μL. Bone marrow examination revealed normal cellularity with young megakaryocytes, compatible with the diagnosis of ITP. Since there was no response to IVIG, Methylprednisolone 4 mg/ kg for 4 days was started. An extensive search of the literature for ITP or thrombocytopenia and pneumonia retrieved only 7 case reports. In all cases M. pneumonia was the only identified pathogen. Therefore, clarithromycin 15 mg/kg/d was added to the treatment regimen, prior to obtaining the serology results. Thereafter severe hemoptysis developed; the patient was admitted to the PICU and received 4 units of platelets and a second dose of IVIG. Hemoptysis resolved after another day, when the platelet count started to increase gradually, only to drop after the cessation of steroids. A second course of steroids at the same dose was begun and tapered off gradually over 21 days, while the platelet count steadily increased, exceeding 150×103/μL at 4 weeks from presentation. A positive Mycoplasma IgM titer at diagnosis and a 1:160 titer at 2 months confirmed the clinical diagnosis. The child is by now 20 months after the event with normal CBC. Several features of the 8 cases described (including our case) distinguish them from “classic” ITP:Thrombocytopenia occurred concomitantly with the infection as opposed to a few days to a few weeks interval between infection and ITP.Severe bleeding in 4 out of 8 patients including 2 with fatal intracranial hemorrhage in contrast to around 3% severe bleeding and around 1‰ fatal intracranial hemorrhage in “classic” ITP.Three of the authors who looked for specific anti-platelet antibodies were unable to demonstrate it, whereas such antibodies are found in many patients with ITP.Several mechanisms are suggested to explain these differences; though it remains unclear whether Mycoplasma associated thrombocytopenia represents a subset of ITP or constitutes a separate entity. We conclude that M. pneumonia should be looked for in any case of pneumonia and thrombocytopenia or ITP, and early specific anti-Mycoplasma therapy should be initiated to rapidly eliminate the causative agent. This may enhance recovery of the platelet count and decrease the rate of complications.

FDG PET/CT findings in acute adult mononucleosis mimicking malignant lymphoma

We report a case of acute Epstein-Barr virus (EBV) infection in which the clinical syndrome and pattern of F-18-2-fluoro-2-deoxy-D-glucose (FDG) uptake mimicked malignant lymphoma. A 53-yr-old man presented with 2 wk of high fevers, night sweats, sinus congestion and severe fatigue. The patient was treated for 1 wk with broad-spectrum antibiotics for acute sinusitis without any improvement. Persistence of fevers and presence of abnormal lymphadenopathy seen on the abdominal computed tomography (CT) were concerning lymphoma with B symptoms. FDG positron emission tomography (PET) showed avid FDG uptake in numerous abdominal/pelvic nodes, liver, spleen and bone marrow. These findings were highly suspicious for lymphoma. Patient underwent a pelvic lymph node biopsy which showed large granular lymphocytes that were predominantly T cells. Bone marrow biopsy showed diffuse infiltration with plasmocytoid cells that were not kappa lambda restricted. Additional diagnostic workup became available showing positive EBV IgM titers and negative IgG levels indicating acute infectious mononucleosis. Lymph node biopsy stained positively with EBV-encoded RNA. We concluded that patient's abnormal FDG PET was most likely secondary to acute EBV infection. After 2 months, follow-up FDG PET/CT showed marked improvement in lymphadenopathy and decreased hypermetabolic activity in the liver and spleen. Other than EBV, there are many other FDG-avid non-malignant conditions that may lead to false-positive PET scans. FDG accumulates in inflamed and infected lesions with increased glucose metabolism. This case underscores the importance of maintaining a broad differential and restricting use of PET scans for staging.

Acute Cytomegalovirus Infection Superimposed on Corticosteroid-Naieve Ulcerative Colitis

Most cases of cytomegalovirus (CMV) colitis that develop in patients with inflammatory bowel disease (IBD) are caused by a reactivation of a latent virus; acute CMV infections are rare. Treatment with immunosuppressive agents further increases the infection risk. Here, we present a 32-year-old man with acute CMV-mononucleosis and colitis, superimposed on corticosteroid-naïve ulcerative colitis (UC). The diagnosis was confirmed by a viral-like prodrome, positive CMV antigenemia (C7-HRP), a positive CMV IgM titer, the presence of atypical lymphocytes, mild transaminase elevation, and immunohistological detection of CMV positive cells in his colonic mucosa. Gancyclovir was intravenously administered, and all symptoms were improved.

Serial diffusion-weighted MR imaging findings in a patient with Epstein-Barr virus encephalitis

Sirs: Acute encephalitis is a serious neurological complication associated with Epstein-Barr virus (EBV) infection and its neuroimaging abnormalities have been infrequently reported [1]. We describe a patient with EBV encephalitis in whom serial diffusion-weighted MR imagings (DWI) showed reversible vasogenic edema in the bilateral basal ganglia along with a complete clinical recovery within a few weeks. To our knowledge, no study has used serial DWI and calculation of apparent diffusion coefficient (ADC) values in cases of EBV encephalitis with basal ganglia involvement. Our patient was a previously healthy, 17-year-old male student who developed several seizures and subsequent mental deterioration after 3 days’ history of mild fever and throbbing headache. On admission, he was drowsy but did not show any focal neurological deficits. Vital signs were normal except for a mild fever (37.9 °C). Neither hepatosplenomegaly nor lymphadenopathy could be demonstrated. Initial brain CT was unrevealing and the first DWI showed symmetrical hyperintensities in the bilateral basal ganglia and left insular cortex with increased ADC values (Fig. 1A, B). Conventional MRI showed hyperintensities in the same regions on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images (Fig. 1C). No contrast enhancement was found and the vascular morphology was normal on MR angiography. Laboratory studies were significant for marginal leukocytosis (lymphocyte 65 %) and elevated creatine kinase. The CSF contained 150 white cells/mm3 (60 % lymphocytes), elevated protein (80 mg/dL), and normal glucose. The serum and CSF concentrations of lactate and pyruvate were normal. Antibiotic treatment was started with ceftriaxon and ampicillin. The antiviral agent acyclovir was given as well. On day 2, he regained alertness but was confused and occasionally agitated. The CSF was found to be positive for EBV DNA, as detected by polymerase chain reaction (PCR). Serologic studies revealed positive IgM titers for both the EBV viral capsid antigen (> 1:12) and EBV nuclear antigen (> 1:12), confirming the diagnosis of acute EBV encephalitis. Serologic or CSF studies for Japanese encephalitis, tick-borne encephalitis, Lyme borreliosis, tuberculosis, herpes simplex virus, bacteria, parasites, and fungi were all negative, as was the screening for autoimmune serology. The antibiotics were discontinued and methylprednisolone 1 g/d was added for 5 days. He gradually improved over the next 2 weeks to normal without any cognitive impairment. Repeat CSF examination on day 12 showed 60 white cells/mm3 (95 % lymphocytes), normal protein, and positive PCR for EBV DNA. The second DWI performed on day 15 revealed a decreased extent of hyperintensities as compared to the first DWI with attenuated increases in the ADC values (Fig. 1D–F). He showed no more neurological symptoms and was subsequently discharged. The third DWI performed 30 days after the second revealed a complete resolution of the hyperintensities with normalized ADC values (Fig. 1G–I). Since neuroimaging studies are normal in the majority of patients with EBV encephalitis, available reports of MRI abnormalities are limited but describe lesions that involve the basal ganglia [1–3], brainstem [4, 5], thalamus [1, 6], splenium of the corpus callosum [7], and cerebral cortex [1]. The distribution of signal abnormalities in our patient was primarily confined to the bilateral basal ganglia, consistent with the characteristic MRI findings of EBV encephalitis [1–3]. Differential diagnoses of the disorders that preferentially affect bilateral basal ganglia are extensive and include Japanese encephalitis, tick-borne encephalitis, anoxic encephalopathy, hypoglycemic encephalopathy, mitochondrial encephalopathy, carbon monoxide poisoning, Lyme encephalitis, Creutzfeldt-Jakob disease, Wilson disease, Huntington disease, and acute demyelinating encephalomyelitis (ADEM). All of these disorders were excluded in our patient on clinical grounds and based on the results of detailed serologic and CSF tests. A prognosis of EBV encephalitis is generally favorable; however, severe cases may be lethal or result in permanent disability [1, 5]. Reliable indices for predicting the prognosis in individual cases have not yet been established. Sener [8] described DWI findings in herpes simplex encephalitis and found that increased ADC values, representative of vasogenic edema, were LETTER TO THE EDITORS

Seroepidemiología de la infección por Coxiella burnetii en donantes de sangre en Albacete

The objectives of this study were to determine the prevalence of antibodies to Coxiella burnetii among blood donors and to examine the epidemiological characteristics of C. burnetii infection in Albacete, Spain. A total of 863 serum samples were collected from blood donors aged 18-65 years. Donor samples were stratified by age, sex, and residence (rural or urban). IgG and IgM titers to the C. burnetii phase II antigen were determined by an indirect immunofluorescence assay. The prevalence of anti-phase II IgG was 23.1%, and three (0.3%) donors had positive IgM titers. Men were more frequently seropositive than women (29% vs. 18%; OR: 1.85; 95% CI: 1.34-2.56), and this difference was not related to differential occupational exposure to animals. Pet ownership had no impact on seroprevalence. In contrast, occupations involving contact with domestic ungulates were associated with a higher seroprevalence (OR: 2.39; 95% CI: 1.04-5.48). Nevertheless, 90% of seropositive donors reported no contact with farm animals. Our results show that C. burnetii infection is highly endemic in Albacete and that most infections are not linked to specific occupational exposure in this area. The high prevalence of antibodies to C. burnetii among blood donors indicates the advisability of studies to determine the risk of transfusion-transmitted Q fever in endemic areas.

A nosocomial parvovirus B19 infection-induced transient aplastic crisis in a patient with chronic renal failure

A male patient aged 67 years with chronic renal failure (CRF), who had undergone hemodialysis since June 3, complained of dyspnea while walking on June 23, 1998. Rapidly progressive anemia and severe reticulocytopenia were noted. Serological tests showed that parvovirus B19- (B19) specific IgM antibody, but not IgG antibody, was present in the patient's serum. B19 DNA was detected in the patient's serum by the polymerase chain reaction (PCR). Therefore, a definite diagnosis of transient aplastic crisis induced by B19 was made. On June 10, prior to the appearance of this case, a female nurse aged 27 years working in our hemodialysis center, complained of cough, fever and arthralgia. Another female nurse, aged 35 years, developed similar symptoms on July 3. Both nurses had a positive IgM titer against B19, but were negative for IgG, indicating an acute B19 infection. These findings led us to suspect that this series of B19 infection was spread by nosocomial transmission. Although some cases of B19 infection have been reported to occur in laboratory staffs, the B19 nosocomial infection has not been described in the literature. We also suggest that a transient aplastic crisis due to B19 infection could lead to severe anemia in cases of CRF whose erythropoiesis is maintained by a recombinant human erythropoietin.

Outbreak of Dengue in Mumbai and Predictive Markers for Dengue Shock Syndrome

An alarming rise of dengue has been seen in Mumbai during the post-monsoon season. We undertook this prospective study in the pediatric wards and pediatric intensive care unit of B. J. Wadia Hospital for Children between 27 August 2003 and 10 October 2003 to determine the clinical features, laboratory abnormalities, and outcome of children affected with dengue and to determine the predictive markers for dengue shock syndrome. Fifty-one suspected dengue cases were tested for positivity of dengue by determination of dengue IgM antibodies by ELISA test. These positive cases were analysed for common clinical features, laboratory derangements, and outcome. Patients were subdivided into three subgroups: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) as per WHO classification. Predictive markers for DSS were also determined. Thirty-nine patients had a positive dengue IgM titre, 20 patients had DHF, 18 patients had DSS, and one patient had DF The mean age of presentation was 4.9 years. Fever, hepatomegaly, vomiting, bleeding tendencies, erythematous rash, thrombocytopenia, elevated liver enzymes, and deranged PT and PTT were the predominant clinical and laboratory features. Predictive markers for DSS were younger age at onset, altered sensorium, paralytic ileus, and significantly deranged PT. Patients with DSS also had a longer recovery period and required more supportive management in the form of component therapy and ionotropic support. All three patients who died belonged to the DSS subgroup with case fatality rate for DSS being 16.6 per cent. None of the patients in the DHF or DF subgroup died. Endemicity of dengue fever is on the rise in Mumbai with increased incidence among children. Appropriate investigations, strict monitoring and prompt supportive management can reduce mortality in dengue. Predictive markers of DSS can reduce the mortality if promptly treated. Also prevention of transmission by mosquito control and maintaining water sanitation is required to effectively control this epidemic.

Do Antiborrelial Antibodies Suggest Lyme Disease in Cuba?

Do Antiborrelial Antibodies Suggest Lyme Disease in Cuba?

Virology of infantile chronic recurrent parotitis in Santiago de Chile

Infantile chronic recurrent parotitis (ICRP) has been attributed to multiple causes, including viral infections, and therefore its treatment remains empirical. Our aim was to evaluate the involvement of respiratory and oropharyngeal viruses in acute episodes of ICRP. Seventy children were studied, 50 patients and 20 age‐matched controls, in a 2‐year follow‐up study. Saliva samples were taken from the parotid duct and analyzed by viral isolation and immunofluorescence for adenovirus (Ad), respiratory sincitial virus (RSV), parainfluenza virus (PI), influenza virus (Flu), Cytomegalovirus (CMV), and herpes simplex virus (HSV). Paired sera samples were tested by ELISA for anti‐Epstein‐Barr virus (EBV) IgG and anti‐mumps IgM and IgG. Viral infections were detected in 7/50 (14%) cases of the ICRP group: one CMV; 2 Enteroviruses isolated in human embryonic lung fibroblast cells; 1 Flu A; and 3 mumps virus. No EBV seroconversions were detected. In the control group, 2 out of the 20 children had an asymptomatic mumps positive IgM titer. Our data indicate that the main respiratory and oropharyngeal viruses are not the cause of acute episodes of ICRP in Chilean children. J. Med. Virol. 70:459–462, 2003. © 2003 Wiley‐Liss, Inc.

Yield and costs of screening growth-retarded infants for torch infections.

Many infants with intrauterine growth retardation (IUGR) are screened for TORCH infections. The yield and costs of such a practice may not be justifiable. Medical charts of infants with IUGR who had a workup for toxoplasmosis, other (infections), rubella, cytomegalovirus (infection), and herpes (simplex) (titer) (TORCH) infections were reviewed for the presence of clinical findings, laboratory and head ultrasound abnormalities associated with intrauterine infections. Maternal charts and reports of placental pathology were reviewed for identifying maternal illnesses and placental causes associated with IUGR. Seventy-five out of 182 infants (41%) with IUGR had a workup for TORCH infection. Maternal conditions associated with IUGR included: pregnancy-induced hypertension (19%), tobacco use (43%), alcohol abuse (21%), illicit drug use (24%), chronic hypertension, diabetic vasculopathy or collagen vascular disease (12%), and multiple gestation (3%). Placental pathology was available in 53/75 cases. Thirty-six of fifty-three (67%) placentae had abnormalities associated with IUGR: placental infarcts (22 of 36), vasculitis/villitis (15 of 36), placenta previa (1 of 36), abruptio placenta (2 of 36), and velamentous insertion of umbilical cord (1 of 36). Clinical findings among infants included hepatosplenomegaly, cataract or rash (1 of 75), thrombocytopenia and/or neutropenia and/or direct hyperbilirubinemia (11 of 75). Seven out of 75 infants had dysmorphic features. None of the infants (0 of 75) had positive IgM titers for toxoplasma, rubella, cytomegalovirus (CMV), or herpes simplex virus (HSV). No infants (0 of 43) had elevated total IgM titers; one infant (1 of 57) had a positive urine culture for CMV. One infant had evidence of calcifications on head ultrasound and a second infant had hydrocephalus (2 of 43). The costs associated with workup for TORCH infections among 75 infants included: TORCH titers determination: $17,816, total IgM titers: $1318, urine culture for CMV: $5734, and head ultrasound: $28,165. The yield of workup for TORCH infection among infants with IUGR is poor and does not justify the incurred costs.

Bartonella henselae associated uveitis and HLA-B27

AIMTo investigate the frequency of HLA-B27 in patients with presumedBartonella henselae associated uveitis and to describe the clinical characteristics of HLA-B27 positive patients with uveitis and presumed ocular bartonellosis (POB).METHODSThe...

Acute deterioration of Charcot-Marie-Tooth disease IA (CMTIA) following 2 mg of vincristine chemotherapy

Severe up to life-threatening neuropathy has been observed in patients with hereditary neuropathies receiving vincristine. A 52-year-old female painter suffering from high-grade non-Hodgkin's lymphoma (stage IVB) was treated with a total of 4 mg of vincristine during two courses of CHOP chemotherapy (cyclophosphamide, vincristine, adriamycin, prednisone). At onset of treatment no neurological problems were reported. There was good lymphoma response to chemotherapy. At the same time, however, the patient gradually developed dysphagia, dysarthria, muscular weakness of both lower and upper extremities, areflexia, paraesthesia of the fingertips and bilateral sensory impairment of feet and lower legs. These symptoms continually worsened over a period of seven weeks until she was unable to walk or to perform her work. Electrophysiological studies showed peripheral axonal and demyelinative sensorimotor neuropathy in correlation to histological findings. Molecular analysis revealed 17p11.2 duplication typical for Charcot-Marie-Tooth disease IA. While continuing chemotherapy without the use of vincristine the patient's neurologic symptoms slowly recovered within six months. Prior to administration of vincristine family and patient history as well as physical examination should be performed carefully to look for underlying hereditary neuropathy. For those patients with a clinical history or symptoms suggestive for CMT nerve conduction velocity studies and on an individual base even molecular genetic analysis are necessary to prevent serious neurologic complications. worsened significantly resulting in dependency on a wheelchair and inability to perform her work as a painter. Finally she consulted a neurologist and was admitted to hospital for further diagnostic studies and continuation of treatment for her lymphoma in March 1998 with a provisional diagnosis of severe vincristine-induced neuropathy. Medical history at time of admission included hyperthyroidism, that was currently treated with propylthiouracil, a MALT lymphoma 1983, that was treated surgically only, and a meningoencephalitis in 1968. No further medication was taken. In addition she had a history of Lyme disease since 1993 with positive IgM-titer until December 1997, when antibiotic therapy with doxycycline and ceftriaxone was administered successfully. Family history obtained on admission revealed that her mother had non-specific neuropathic symptoms as well as a poorly defined foot deformities of the mother's father. The patient's brother does not show any neurologic impairment and is in good physical health.

Evaluación de métodos diagnósticos para sífilis congénita

EVALUATION OF DIAGNOSTIC METHODS FOR CONGENITAL SYPHILIS Congenital syphilis is a relevant problem in our country. At the present, no routine method is available to verify the diagnostic. This multicenter prospective study recruited serum samples reactive for VDRL of sixty mothers with their respective infant (n = 120). In addition to the routinely used screening assay (RPR, VDRL) the following tests were performed: serological detection of specific antibodies to Treponema pallidum for IgM ( Pathozyme , Captia IgM), for IgG (Captia IgG) and for IgG/IgM ( MHA-TP; Pathozyme competition , ICE Syphilis , Determine ). A good agreement was observed between the immunoassays for IgG alone or IgG/IgM (90%) and for IgM alone or IgG/IgM (87.5%). Every mother who had syphilis in the moment of the study or had had syphilis before, and her newborn child, were positive for IgG. Only 64% of the mothers with adequate treatment during their pregnancy had a positive titer for IgM and all of their newborn were not reactive for IgM. The mothers whose treatment was inadequate had IgM titers positive in 82.3% and their children had IgM positive in 11.8%. No correlation was found between a positive maternal IgM titer and the risk of the infant to present the disease. The newborn IgM titer is a useful parameter for an early diagnosis but a negative result cannot discard this pathology.

Punctate outer retinal toxoplasmosis in an HIV-positive child

PURPOSE: To discover whether the outer layer of the retina can be the site for toxoplasmosis in AIDS patients. METHODS: An HIV-positive child, who previously had a normal ocular examination, was reexamined three months later. This examination showed outer retinal lesions compatible with toxoplasmosis and positive IgM and IgG titers specific for that organism, despite the small drop in the CD4 count. RESULTS: During the first examination, the antibodies for toxoplasmosis were negative. At the three-months follow-up, the anti-toxoplasmosis antibodies were positive and the rest of the workup was negative, suggesting a strong correlation with the patient's fundus pattern. CONCLUSION: We describe a case of punctate outer retinal toxoplasmosis uveitis, which has been previously associated with immunocompetent hosts. We, however, believe that it can be seen in immunocompromised patients as well.

Effects of moxibustion on the enhancement of serum antibody in rabbit against Staphylococcus aureus.

The titer and activity of antibody in rabbits immunized with heat-killed vaccine were assessed with and without moxibustion treatment. Enzyme-linked immunosorbent assay (ELISA) was applied for the detection of immunoglobulins to Smith strain of Staphylococcus aureus. Positive IgM titer of more than 0.4 were observed with this assay against the moxibustion group (P < 0.05). The titer of IgG antibody also increased; however, there was no significant difference between the moxibustion group and the control group. The ELISA inhibition test showed significantly higher protective activity of the sera in the moxibustion group at the 9th week after the first immunization (P < 0.05).

Longevity of antibody responses to a Salmonella typhi-specific outer membrane protein: interpretation of a dot enzyme immunosorbent assay in an area of high typhoid fever endemicity.

The objective of this study was to investigate the longevity of positive dot enzyme immunosorbent assay (dot EIA) results for IgM and IgG to a Salmonella typhi outer membrane protein in Malaysian children with enteric fever. The patients were children one month to 12 years of age with clinical evidence of typhoid fever, positive blood or stool cultures for S. typhi, and/or a positive Widal test result who were admitted over a two-year period to General Hospital (Kota Bharu, Malaysia). These patients received standard inpatient treatment for enteric fever including chloramphenicol therapy for 14 days. Dot EIA tests were performed as part of clinical and laboratory assessments on admission, at two weeks, and then at 3, 6, 9, 12, 15, 18, and 21 months postdischarge. Assessment of the longevity of positive dot EIA IgM and IgG titers was done by Kaplan-Meier analysis. In 94 evaluable patients, 28% were dot EIA IgM positive but IgG negative on admission, 50% were both IgM and IgG positive, and 22% were IgM negative and IgG positive. Mean persistence of IgM dot EIA positivity was 2.6 months (95% confidence interval = 2.0-3.1 months) and that of IgG was 5.4 months (4.5-6.3 months). There were no significant differences between the three subgroups. Thus, positive IgM and IgG results determined by dot EIA within four and seven months, respectively, following documented or suspected enteric fever in a child from an endemic area should be interpreted with caution. In other clinical situations, the dot EIA remains a rapid and reliable aid to diagnosis.