Serology and immunoglobulin profile in rheumatoid arthritis.

One hundred and twenty cases of clinically diagnosed rheumatoid arthritis, 80 non-rheumatoid cases suffering from various other diseases and 40 healthy individuals were investigated for the presence of rheumatoid factor, quantitation of serum immunoglobulin, demonstration of ANA and LE cell phenomenon. Microlatex agglutination test of serum for rheumatoid factor showed 56.6% positivity in rheumatoid group and 3.7% positivity in non-rheumatoid group. All three serum immunoglobulins (IgG, IgM, IgA) were raised in serum in significant titre in cases of rheumatoid arthritis, whereas only IgA lever was elevated in the group of non-rheumatoid diseases. ANA and LE cell phenomenon were observed in 11.7% and 4.4% cases of rheumatoid arthritis who had severe underlying disease. In non-rheumatoid group, only one of 6 cases of systemic lupus erythematosus showed rheumatoid factor and that too in an insignificant titre (less than 1:20). Synovium and synovial fluid contained plenty of plasma cells and lymphocytes. It has been observed that RF appears first in synovial fluid and it may take several months to a year to attain detectable level in serum.

Toxoplasmosis in women of child bearing age and infant follow up after in-utero treatment.

A total of 540 women (including 70 pregnant cases) of child bearing age with bad obstetrical history were tested serologically for anti-toxoplasma antibody using microlatex agglutination test. Forty two women including 5 cases of pregnancy were found to be seropositive in a titre of 1:32 or more. Maximum prevalence (10.2%) and highest titer of anti-toxoplasma antibodies were observed in women of 35-42 years age group. The overall prevalence of toxoplasmosis in these women was 7.7%, whereas it was 7.1% in pregnant women. Further studies are needed to estimate the exact rate of prevalence of infection. Of the 70 pregnant women, 5 were seropositive and two of them acquired infection during pregnancy which was detected by IgM immunosorbent assay. Seropositive pregnant women were treated using combined regimen of sulfadiazine and pyrimethamine. Four infected women with pregnancy were followed up and one did not turn up subsequently. There was spontaneous abortion in one case and in 3 other cases full term normal babies were delivered. Incidence of toxoplasmosis in women is low because of infrequent and uncommon practices of ingesting undercooked or uncooked food stuff specially meat by a substantial number of the population surveyed.

Neonatal candidemia.

Fifty five clinically diagnosed cases of neonatal septicaemia of the nursery ward, Medical College Hospital Calcutta were subjected to blood culture on two consecutive days in all cases. Bacterial isolates were found in 34 (61.8%) cases as pure growth and candida species from 9 (16.4%) as pure culture. Remaining 12 samples did not yield any growth. Species distribution of candida showed C. albicans 6, C. parapsilosis 2, and C. guillermondii 1. Asphyxia neonatorum was the common feature in all cases of candidaemia. All neonates with candidal infection were low-birth-weight and premature. C. albicans, the predominant species (66.6%) recovered, was responsible for a localised outbreak of infection in the nursery.

Tuberculous endometritis in hills of Darjeeling: a clinicopathological and bacteriological study.

Combined histological and bacteriological investigations of 800 specimens of nonpregnant endometrial curettings of 15 to 60 years age group of hill women of Darjeeling District were carried out for detection of tuberculous endometritis. The principal complaints were infertility (47.5 per cent), abnormal uterine bleeding (30.75 per cent), amenorrhoea (11.25 per cent), leucorrhoea (6.25 per cent), and miscellaneous conditions (pelvic pain and pyometra) (4.25 per cent) cases. By histological examination alone, only 10.9 per cent cases could be diagnosed while by combined study the incidence rate was 11.8 percent, an increase in the diagnostic acumen by more than 10.3 per cent. Bacteriological study was of greater value in doubtful cases where there was absence of tuberculous granuloma or epithelioid cell but presence of nonspecific inflammatory cells along with variable degree of necrosis of glandular epithelia. The incidence of M.tuberculosis was 97.7 percent while that of atypical mycobacteria was 2.3 per cent. Thus simultaneous use of culture and biopsy yielded better results. Our prevalence is a little higher than other reports from India. In cold weather at a high altitude, the tubercle bacilli survive longer in fomites which serve as important sources of infection in Darjeeling. Women of third decade are more frequently affected (43.2 per cent).

Outbreak of neonatal septicemia with multidrug resistant Klebsiella pneumoniae.

A nosocomial outbreak of neonatal septicemia due to K. pneumoniae occurred in nursery during June-July, 1991. Klebsiella pneumoniae (Klebocin type 314) was recovered from blood of 33 (70.2%) of 47 neonates with septicemia. Multiple drug resistance was observed in all the cases. The same strain of K. pneumoniae was recovered from the neonates and environment of nursery and labour room as well. The outbreak was attributable to environmental dissemination.