Positive Wassermann Reaction Research Articles

Anti phospholipid syndrome

Arterial and venous thromboses occurring in young women and, less commonl3~ men without an obvious cause, e.g. presence of risk factors for premature atherosclerosis or blood dyscrasias, have long been known to vascular surgeons. The recognition of autoimmune disorders such as systemic lupus erythematosus (SLE), seemed to explain many of these occurrences on the basis of vasculitis causing thrombosis. However not all such patients had SLE and, even in those that did, there seemed to be a subset in whom the disease predominantly caused thrombosis, rather than the more usual clinical features of arthropathy and nephropathy. The first clue to the existence of the anti phospholipid syndrome as the cause of these thromboses was the discovery of the lupus anticoagulant (LAC) in 1952. 2 This was an in vitro coagulation inhibitor found in the plasma of patients with SLE, hence the name lupus anticoagulant. Paradoxically, however, later these patients with lupus anticoagulant were shown to be at a high risk of thrombosis rather than haemorrhage. 2 Patients with LAC also often had a positive Wassermann reaction the so called biological false positive Wassermann 3 suggesting, as the Wassermann reaction depends on binding of syphilis antibody to phospholipid, an abnormality of phospholipid in these patients. In 1983 direct measurement of an anti phospholipid antibody (APL) was described by Harris et al. 4 It seemed that the lupus anticoagulant and APL antibody were similar, though not identical antibodies to phospholipid and the anti phospholipid syndrome (APLS) was recognised, s The presence of APL antibody in young patients with arterial and venous thrombosis was confirmed in many studies over the next decade. 6 It soon became apparent that not all patients with APLS had SLE and that there appeared to be a primary form of the syndrome. 7 Also the antibody was found, often transiently, in many other disease states such as streptococcal infection, malignancy, other autoimmune disorders and use of certain drugs. The association of presence of antibody and thrombosis is less clear in these situations. 6 The main features of the APLS are venous and arterial thrombosis, particularly cerebral, recurrent foetal loss, thrombocytopenia and skin lesions such as livedo reticularis. Many other clinical features such as cardiac disease and other neurological disorders have also been described. Diagnostic criteria are not completely established but the occurrence of two or more thrombotic events in association with levels of APL antibody several times the normal, on two or more occasions over several weeks, may be taken as diagnostic s The two laboratory tests used in the diagnosis of the condition are the demonstration of LAC in the plasma and of raised levels of APL. Presence of LAC depends on first showing an abnormality, i.e. prolongation, of an in vitro phospholipid dependent test of the intrinsic coagulation pathwa~ second that the abnormality is due to the presence of an inhibitor and third that the inhibitor is directed at phospholipid. The activated partial thromboplastin time (APTT), kaolin clotting time (KCT) or dilute Russell viper venom test (DRVVT) can be used first. 68 Presence of an inhibitor is shown by mixing studies using normal platelet free plasma and confirmation that the inhibitor is directed against phospholipid can be shown by use of an exogenous phospholipid source, e.g. freeze thawed platelets, to reverse the abnormality. If the patient is on oral anticoagulants, as is often the case when the syndrome is first suspected, testing for lupus anticoagulant is difficult, needing complex laboratory manoeuvres. s Direct demonstration of raised levels of the

AN AUTOPSY CASE OF RUPTURED AORTIC ANEURYSM BY SYPHILITIC AORTITIS CONTAINING MILIARY GUMMAS

Nowadays, it is very rare to find cases of “gumma” in the syphilitic aorta. We describe here a case of perforated aortic aneurysm with syphilitic lesions (“gumma”). The patient, a 44-year-old male school teacher, collapsed during the gymnastic lesson at his school, and was sent to our hospital, where he died three hours later. Postmortem examination revealed a ruptured aortic aneurysm. This saccular thoracic aortic aneurysm (10 × 10 × 8 cm) originated just above the diaphragm. Perforation of the aneurysm was also found. The postmortem blood revealed no positive Wassermann's reaction. Microscopically, a number of “miliary gummas” were found in the aortic wall, accompanied by obliterative endarteritis with narrowing of the vasa vasorum lumen and lympho-plasmacytic infiltration. Treponema pallidum was found by the Levaditi method.

Principles and Practice of Treatment of Vertiginous Patients based on Analysis of Possible Etiologic and Conditioning Factors

Pathological factors contributing to the development of vertigo and dizziness, according to the authors' clinical survey, have proven to include abnomalities in Schellong's test, disturbed vertebral blood flow in Doppler's test, high serum cholesterol values, positive Wassermann's reaction, irregular menstruation, glycosuria, hyper- and hypo-tension, psychogenic stress, and anemia. Any one of factors may trigger the functional or organic impairment of circulation to the brain stem and inner ear.We have also experimentally confirmed the existence of critical levels of blood supply to the brain stem and inner ear, which are affected mainly by disturbance of baroreceptor reflexes and by impaired blood flow in the vertebral arteries. Finally, we are convinced that the treatment of choice for vertigo and dizziness consists of causative therapy for correcting pathological factors, symptomatic therapy for suppressing vertigo itself. essential therapy for improving impaired circulation, and physical therapy.

False positive Wassermann reaction associated with evidence of enterovirus infection.

A large proportion of high titre Coxsackie B5 complement-fixation tests was detected among sera giving false positive Wassermann reactions during 1969. Echo virus type 9 proved to be the prevailing enterovirus and is one of those which induces the formation of antibody to Coxsackie B5. One case of Echo virus type 9 meningitis is presented which produced a false positive Wassermann reaction and a high titre Coxsackie B5 complement-fixation test. The relationship between Echo virus type 9 infection, Coxsackie complement-fixation test results, and false positive Wassermann reactions is considered significant.

A Case of Autoimmune Hemolytic Anemia with Circulating Cold Agglutinins Presenting for Many Years as “Hypersplenism” and Terminating in Leukemia

Abstract A case of splenomegaly of unknown origin with autoimmune hemolytic anemia, leukopenia and thrombocytopenia (clinically classified as "hypersplenism") has been observed for 18 years. The blood showed a high sedimentation rate, hyperglobulinemia, cold agglutinins, cryofibrinogen, a false positive Wassermann reaction, a positive Coombs test and contained leukoagglutinins in high titer. The patient died of acute leukemia for which it is suggested that the preceding hematologic condition may have prepared the soil, possibly by a process of autoimmunization.

Hypergammaglobulinemia, circulating anticoagulant, and biologic false positive Wassermann reaction; a study in two cases.

Abstract 1.1. An anticoagulant with antithromboplastin effect was found in 2 patients who had hypergammaglobulinemia and hemorrhagic diathesis and whose sera gave false biologic reactions for syphilis. 2.2. After electrophoretic separation of the sera both Wassermann reagins and antithromboplastin were localized to the same region in the γ-globulins. 3.3. On absorption with lipid antigen it was possible to remove both the Wassermann reagins and the antithromboplastin from the active, separated fractions, but neither the Wassermann reagins nor the antithromboplastin from unfractionated sera. 4.4. On absorption of the sera with thromboplastin, the antithromboplastin effect decreased by about 50 per cent while the titer of the Wassermann reagins persisted unchanged. 5.5. The relationship between the 2 abnormal components in these sera causing the antithromboplastin effect and the false positive reaction for syphilis is discussed.

The Differentiation of Mediastinal Tumour and Aneurysm: Value of Angiocardiography

Angiocardiography is advocated as a simple and effective method for differentiating aneurysms from other spaceoccupying lesions of the thorax. The authors have employed a stereo cassette changer and have routinely used only two exposures per injection. Difficulties of diagnosis resulting from the fact that aneurysms may not show pulsation owing to clotting, while tumours may show transmitted pulsation, are readily resolved by angiocardiography. Four cases are presented, all of whom have a positive Wassermann reaction. The first was shown to be a tumour, and the other three aneurysms. One case had an aneurysm of the left subclavian artery in addition to an aneurysm of the aortic arch. The former did not opacify owing to the small size of the orifice communicating with the aorta.

SEROLOGICAL STUDIES IN RHEUMATIC FEVER

1. An attempt was made to repeat and extend various tests which have been presumed to demonstrate specific antigens and antibodies in rheumatic fever. 2. The "phase reaction" appears to be an inconstant phenomenon probably related to a colloidal abnormality of the serum, rather than to a specific antigen-antibody system. 3. No specific autoantibodies to human tissue extracts were demonstrable by complement fixation or by the collodion particle technique. Variable results were noted with the same test sera on different occasions, and positive reactions with control tissues and control sera were observed. 4. The possibility should be considered that autoantibodies are not necessarily specific for rheumatic fever but may be manifestations of the occurrence of a type of reaction similar to a biologically false positive Wassermann reaction.

Traumatic saccular aneurysm of the thoracic aorta: Stryker, W. A.: Am. J. Clin. Path. 18:152 (Feb.), 1948

Five cases of proved syphilitic endocarditis or aortitis, with superimposed bacterial vegetations, have been presented. In none of the cases were both diagnoses made clinically. In all five cases the blood Wassermann and Kahn reactions were positive. In four cases blood cultures were positive, and in the fifth case Streptococcus viridans was grown from the vegetation on the heart valve.Streptococcus viridans was recovered in four of the cases and Streptococcus hemolyticus in the remaining case. In three of the cases embolic phenomena were prominent, and in two the mesenteric vessels were involved. In one case there were multiple saccular mycotic aneurysms of the membranous septum and aortic cusps. In another case a fairly characteristic syphilitic aortic valvulitis and aortitis were associated with a typical rheumatic involvement of the mitral valve.The diagnosis of syphilitic aortitis and valvulitis does not exclude the possibility of superimposed bacterial involvement, as shown by the above cases, although the lesion undoubtedly is rare. This diagnosis should be considered clinically whenever there is a combination of sepsis of undetermined origin, a positive Wassermann reaction, and evidence of aortic insufficiency or aortitis, without evidence of previous rheumatic infection.

Calcification of the Ascending Aorta as a Sign of Syphilitic Aortitis

in 1945 Jackman and Lubert (1) reported that they had noted a frequent association between syphilitic aortitis and calcification of the ascending aorta. Their series of cases appeared to demonstrate that, while calcification of the ascending aorta appears on routine roentgenograms of the chest in only about 25 per cent of the cases of syphilitic aortitis, it is a valuable diagnostic sign when present. The only previous mention of this finding which they (or the present writer) were able to find in the literature were the casual statements of Snellen (3) and Schatzki (4). These authors merely reported figures and impressions and made no effort at statistical analysis. The article of Jackman and Lubert led the present writer to investigate the serology and clinical cardiac findings in several cases showing calcification in the ascending aorta on routine admission chest roentgenograms. These patients were found to have positive Wassermann reactions and in one case a definite aortic insufficiency. The suggestion of syphilitic aortitis on the basis of this sign was skeptically received and consequently the present study was undertaken. The material is divided into three groups. Group I consists of all of the cases of syphilitic aortitis, proved at autopsy, which could, be found locally, in which chest roentgenograms were available. Group II consists of all cases of clinically diagnosed syphilitis aortitis with chest roentgenograms. Group III is made up of consecutive cases in which calcification of the ascending aorta was demonstrated on routine chest examination. Pertinent information on each patient was carefully tabulated. The individual case data are omitted because of space limitations. Analysis of Findings For the purposes of control, 400 roentgenograms of the chest were examined. These were consecutive cases drawn from a routine file, unselected except for age and sex. Distribution by age and sex was made to correspond to that of the combined clinical and autopsy groups in which syphilis was present. Calcification of the ascending aorta was found in 2 cases in this control group, an incidence of 0.5 per cent. Twenty autopsy protocols of cases with a definite diagnosis of syphilitic aortitis and with chest roentgenograms were available. Of these, 11 showed calcification of the type under consideration. In 2 of the 11, aneurysm was present. Two other cases showed aneurysm without calcification. Therefore, 9 of 18 cases, or 50 per cent of cases of aortitis without aneurysm, proved at autopsy, showed calcification in the ascending aorta. There were 39 cases in which the diagnosis of syphilitic aortitis had been made at the University Hospital or the Minneapolis General Hospital. Of these, 21 showed the calcification in question. Four of the 21 were felt to have aneurysms of the aorta. Omitting these, 17 cases, or 43 per cent of the total number, showed calcification. Of the total number 66 per cent had positive Wassermann reactions.

SPOT TEST FOR SYPHILIS

THE MEINICKE Klaerung (clarification) test for syphilis is better known in the hospitals for mental diseases than in the general hospitals in England. Geographically, it is better known and more widely used on the European continent than in North and South America, where the precipitation tests of the Kahn type and their numerous modifications have received greater attention. For some time after its inception, the Meinicke test was treated with suspicion, on the grounds of nonspecificity. It was claimed that reaction took place with some tropical diseases, notably malaria, and with some febrile conditions, especially tuberculosis. But the Wassermann test is not entirely specific, and positive results are sometimes elicited in the absence of syphilis in such conditions as pregnancy, malaria and infectious mononucleosis, while common experience shows that 1 to 2 per cent of serums give a positive Wassermann reaction (although perhaps only weakly), which may be due to

CONGENITAL DIAPHRAGMATIC HERNIA ON THE RIGHT INVOLVING THE ASCENDING PART OF THE COLON

WHILE not unheard of, congenital diaphragmatic hernia on the right diagnosed in infancy is believed rare enough to warrant the report of a single case. This child was observed by me at regular intervals from birth until the seventh month, at which time symptoms referable to the abnormality first developed. <h3>HISTORY OF THE CASE</h3> J. L. H. III was born Oct. 10, 1946, being the first child of a 17 year old mother. During the second month of gestation a positive Wassermann reaction had been obtained, and intensive antisyphilitic treatment was carried out during the entire pregnancy. At the time of delivery both the mother's Wassermann reaction and the Wassermann reaction of the cord were negative. The infant breathed spontaneously at birth, and his color was good at all times. Breast feeding was supplemented with a Dryco formula. At four weeks the infant's gain was insufficient and he seemed hungry.

Recenti Progressi in Medicina

THE appearance of the first issue (dated October 1946) of Recenti Progressi in Medidna, a monthly review of international medical and surgical literature, published in Rome under the directorship of Giuseppe Lazzaro, supported by some twenty-eight collaborators, is an interesting development of post-war medical activity in Italy. This first issue, which owes much to the advice and experience of Prof. Giuseppe Bastianelli, to whom the editor pays a warm tribute, is mainly devoted to a review of recent progress in our knowledge of the various types of inflammation of the lungs. It deals not only with the types of pneumonia caused by bacteria, but also with in fluenzal pneumonia, coccidiomycosis, Q -fever and psittacosis. An especially long and detailed section, illustrated by X-ray photographs, deals with primary atypical pneumonia. Another article is devoted to the condition known to some as infiltration of Hegglen or pneumonia associated with a positive Wassermann reaction. Treatment of the pneumonias with penicillin and sulphonamides is the subject of another article, and there are abstracts from literature dealing with other aspects of the study of inflammation of the lungs. A short section records two immunological laboratory procedures. A bibliographical section consists entirely of the contents of the British Medical Journal during the months January to April 1946.

PERMEABILITY OF BLOOD-SPINAL FLUID BARRIER IN INFANTS AND IN NORMAL AND SYPHILITIC ADULTS

POSITIVE Wassermann reactions rarely occur in the spinal fluid in the absence of syphilitic involvement of the central nervous system. False reactions of the spinal fluid have been observed 1 in patients with meningitis of bacterial or virus origin, especially in persons with a positive Wassermann reaction of the serum, and it has been assumed that the normal barrier between the blood and the central nervous system may be impaired by the meningeal inflammation, permitting the passage of reagin from the serum into the spinal fluid. The positive Wassermann reactions of the spinal fluid of these patients reversed after the symptoms of meningitis subsided. Lately, we examined the spinal fluid of 16 newborn infants with syphilis. In 4 infants the results were completely normal; in 4 a positive Wassermann reaction with a high cell count, a high protein value and an abnormal colloidal gold curve were found and a

SYPHILITIC UVEITIS

SYPHILIS AS ETIOLOGIC AGENT S YPHILITIC uveitis 1 characteristically occurs in the secondary or late secondary stage of syphilis. When there is clinical evidence of early syphilis, a positive Wassermann reaction and prompt retrogression of the ocular inflammation after antisyphilitic treatment, the diagnosis offers no difficulty. How valid is the diagnosis of syphilitic uveitis based solely on a positive Wassermann reaction? Or how sound is such a diagnosis in the late stage of syphilis or when the duration of the infection is unknown? What are the criteria of efficacy of antisyphilitic treatment to justify the conclusion that uveitis was caused by syphilis ? Antisyphilitic treatment exerts a nonspecific effect on uveitis. Judgment at times is difficult, since local treatment and nonsyphilitic therapy also exert a favorable action on uveitis. The purpose of this paper is to discuss these considerations, as well as the Herxheimer reaction 2 of the ocular lesion as

Arteriosclerotic peripheral vascular disease in diabetes: Herztein, J., and Weinroth, L. A.: Arch. Int. Med. 76: 34, 1945

Rheumatic fever occurs in certain predisposed individuals but the incidence in some epidemics, and of subclinical cases, appears to exceed estimates based on genetic studies. There is a definite relationship to a preceding infection with the group A hemolytic streptococcus in the great majority of cases of rheumatic fever adequately studied. However, for many reasons summarized the infection does not appear to play more than an initial role in the rheumatic process; rather, a host reaction or allergy to the infection, as has frequently been suggested, is probably the basis for the development of the disease.Various kinds of necrotizing allergic reactions are reviewed with reference to the mechanisms initiating them. The Arthus type of reaction is related to a circulating antibody and has its clinical counterpart in serum sickness. It has been used extensively as a pattern for attempts at the experimental production of rheumatic-like lesions. The bacterial allergic reactions are distinguished by having fixed tissue antibodies. They have also been used as patterns for animal experimentation. Other experimental approaches involve the use of isoantibodies (cytotoxic antibodies) and autoantibodies. In the absence of other than morphologic criteria, the specificity of the experimentally induced lesions is not adequately established. They cannot, therefore, be unequivocally identified with the lesions of the rheumatic state although they suggest by analogy that lesions similar to those seen in rheumatic fever may be induced by various allergens.Clinical studies are reviewed which attempt to define an allergic process in rheumatic patients. Technics involving the detection of isoprecipitins and autoantibodies do not appear constant or specific in this respect and may reflect the occurrence of biologically false positive Wassermann reactions. In the study of serum complement in rheumatic fever various technics have given variable results. A predominantly high complement level in rheumatic fever was found in a recent study. This does not exclude the occurrence of an allergic reaction of the fixed tissue type because several cases of drug allergy also presented high complement levels. There is, as yet, no clinical test for the detection of an allergic reaction in rheumatic individuals that does not occur in patients recovering from a streptococcal infection or certain other diseases.Finally certain measures employed in rheumatic fever are reviewed with respect to their effect on antigen-antibody reactions. Specific desensitization with the hemolytic streptococcus has been of doubtful value. Salicylates are usually effective in producing a remission of rheumatic activity. However, they apparently do not act on antibody producing mechanisms or by altering the severity of known allergic reactions. The dramatic effectiveness of cortisone or ACTH in the rheumatic diseases should prove extremely valuable in the future study of the pathogenesis of these diseases. The role of these hormones in immune mechanisms, as well as other processes, has yet to be fully studied.

INTERSTITIAL KERATITIS TREATED WITH SUBCONJUNCTIVAL INJECTIONS OF PENICILLIN

The following case of interstitial keratitis is of interest because the progress of the disease was apparently checked by the use of subconjunctival injections of penicillin. No report has been found in the literature of the treatment of interstitial keratitis with subconjunctival injections of penicillin. General antisyphilitic therapy did not seem indicated because the patient had received adequate general treatment for syphilis prior to the beginning of the keratitis. The corneal infiltration and vascularization progressed rapidly until subconjunctival injections of penicillin were used. <h3>REPORT OF A CASE</h3> Mr. A. F., aged 27, was first seen on Nov. 22, 1944, at which time he stated that his left eye had felt irritated for the past several days. Later, he admitted that he had had a positive Wassermann reaction in 1935 and that his mother's Wassermann reaction was also positive. At that time he had received antisyphilitic treatment, and in 1941 he

PNEUMOPERICARDIUM IN A FORTY-TWO DAY OLD INFANT

On Aug. 13, 1942 Maria Terezinha, a Negro infant 1 month and 12 days old, daughter of a youthful mother, was admitted to my ward of the hospital. The father was apparently healthy, but the mother during the pregnancy had had a positive Wassermann reaction. She had received antisyphilitic treatment, consisting of injections of a bismuth compound and a total of 8.55 Gm. of neoarsphenamine, in the antepartum clinic. Gestation was normal, and the birth occurred at term, but it was delayed and difficult. The child was delivered in white asphyxia and was resuscitated by showed rigidity of the right arm, refused breast feeding and had difficulty in swallowing. The next day, July 2, there was pronounced paresis of the right leg with talipes equinus, and the plantar reflex was abolished. Roentgen examination of the arm revealed no abnormality, and a lumbar puncture showed that the spinal fluid was clear.

HEALTH OF SHARECROPPERS

<h3>To the Editor:—</h3> The two serious diseases which were found prevalent in the -histories of the Negro sharecroppers were gonorrhea and malaria. All these subjects had been under medical care and, as far as one could determine, had been cured. That they had been adequately treated and had recovered is not deplorable. Two subjects showed positive Wassermann reactions, and 1 of these was not a sharecropper. However, accepting the figure of 8 per cent, Roberts and Williams (<i>South. M. J.</i><b>30</b>:458 [May] 1937) report an incidence of 11.7 per cent in the white population of Gibson County in Tennessee, and Usilton (<i>Ven. Dis. Inform.</i><b>16</b>:147 [May] 1935) estimates that 8 per cent of males from 20 to 30 years of age contract syphilis. I cannot regret the fact that the figure for the Negroes is, if anything, lower than that for the white population. That the cardiac and respiratory signs found on clinical

BLOOD TRANSFUSION SYPHILIS

The transmission of syphilis by blood transfusion is extremely rare. In 1935 Jones, Rathmell and Wagner 1 reviewed 21 cases of blood transfusion syphilis and added 4 of their own. Eichenlaub and Stolar, 2 in a more recent survey, reported a total of 41 cases, discussed this clinical accident at length and suggested a method for sterilization of blood from syphilitic donors. In considering proof of transfusion syphilis the following criteria should be met: First, the recipient should have a negative Wassermann reaction before transfusion and a positive serologic reaction after transfusion, with or without a rash or other evidences of syphilis. Second, the donor before transfusion should be a syphilitic person with or without a positive Wassermann reaction or other signs of syphilis as detected by the physical examination or history. One cannot approach this problem without appreciating the danger of blood transfusion. In many large hospitals blood transfusions