Immune complexes in synovial fluid and serum from patients with disseminated gonococcal infection: evidence for local immune complex formation within the joint.

Twenty one patients with acute arthritis associated with disseminated gonococcal infection (DGI) were studied. Synovial fluid (SF) from 14 and serum from 15 (matched in eight) were assayed for the presence of immune complexes (IC) by the Raji cell immunofluorescent assay (Raji IFA) and the 125I-Clq polyethylene glycol (PEG) binding assay. Higher levels and frequency of IC were detected in the SF by both IC assays and these were associated with a significant increase in complexes containing IgM over serum (p less than 0.02). Complexes containing IgG were found predominantly in serum and were infrequent in SF (p less than 0.003). These data suggest that the arthritis of DGI may result from primary immune complex formation within the synovial cavity after local antibody synthesis within the synovium in response to gonococcal seeding.

The Raji cell radioimmunoassay in patients with systemic lupus erythematosus: clinical significance and relationship to other serologic variables assessed by discriminant analysis.

Our aim was to determine the clinical usefulness of the Raji cell radioimmunoassay (RIA) in 30 patients with systemic lupus erythematosus (SLE) studied over a 30-month period. Raji RIA correlated positively (p less than 0.001) with antibodies to dsDNA, anti-Sm, erythrocyte sedimentation rate and central nervous system involvement and inversely with the white blood count, hematocrit and CH50. There was a lack of correlation (p greater than 0.05) between the Raji RIA and cryoglobulins, Clq binding assay, lymphocyte count, rheumatoid factor and anti-RNP. Raji RIA values paralleled disease activity in 50% and were predictive of flares in 17%. By discriminant analysis, the Raji RIA could not predict nephritis as well as a variety of routine laboratory tests in SLE. The Raji RIA, while helpful in SLE, does not appear to offer any advantage over standard assays in monitoring SLE disease activity.

Anticentromere antibody. Clinical Correlations and association with favorable prognosis in patients with scleroderma variants.

The presence of antibody to the chromosomal centromere appears to be associated with a subset of patients with the limited CREST form of scleroderma. To further define the prognostic value of this autoantibody, 27 patients, who were identified as having anticentromere antibody by screening antinuclear antibody tests using HEp-2 cell substrates, were followed clinically and serologically for 2 years. The presence of anticentromere antibody is common in the limited CREST forms of systemic sclerosis, and it is often the only autoantibody specificity present in the sera of patients with the CREST variant. When compared with other patients who exhibit speckled or nucleolar antinuclear antibody patterns, those with anticentromere antibody had significantly less major organ system involvement.

Defective monocyte cytotoxicity in rheumatoid arthritis: a correlation with disease activity and reversal by levamisole.

The cytotoxic activities of human blood mononuclear cells against certain established cell lines were evaluated prospectively in 17 patients with rheumatoid arthritis before and after treatment with low (150 mg per week) and moderate doses (300 mg per week) of levamisole. Spontaneous or "natural" killer activity (NK) and antibody-dependent cellular cytotoxicity (ADCC) of plastic adherent cells ("monocytes") and lymphocytes were studied. We report a selective cytotoxic defect in monocyte NK and a correlation of this defect with severely active disease. The patients with the most severe defect responded to low-dose levamisole, but others with normal values did nor respond as well to treatment. This cytotoxic defect may be an important pathogenetic factor in rheumatoid arthritis and this new assay may be helpful in selecting candidates who are most likely to respond to levamisole.

Antibodies to Sm in patients with systemic lupus erythematosus. Correlation of Sm antibody titers with disease activity and other laboratory parameters.

Thirty patients with systemic lupus erythematosus (SLE) were studied over a 2.5-year period. The group was divided into 14 patients with antibodies to Sm and a control group that failed to exhibit antibodies to Sm over the study period. The titer of antibodies to Sm fluctuated in all 14. A rising titer of antibodies to Sm 1) predicted a flare disease in 50% an 2) correlated with an exacerbation of disease in 60%. Patients with antibodies to Sm had a comparable incidence of severe disease, renal disease, and central nervous system disease. They exhibited significantly more leukopenia and antibodies to non-Sm, non-RNP extractable nuclear antigen. In only 1 patient, a rise in titer of antibodies to Sm did not correlate with or predict a disease flare in contradistinction to other serologic markers of SLE, specifically antibodies to double-stranded DNA and cryoglobulins. Though infrequently detected, antibodies to Sm can help in the management of patients with SLE.

Etiology of summer diarrhea among the Navajo.

The etiology of diarrhea in children and adults on the Navajo Indian Reservation was investigated in August 1975. Fifty-six ill individuals and 37 controls were included in the study. Shigella was most commonly associated with diarrhea, and was isolated from 32% of ill children and adults. Fifty percent of Shigella isolates tested were resistant to ampicillin. Heat-stable enterotoxin-(ST)-producing organisms were associated with noninflammatory diarrhea in adults (27% of these cases had ST-producing strains) but not in children. Heat-labile enterotoxin-producing organisms were found among controls as well as individuals with diarrhea. No children had evidence of rotavirus infection. These findings suggest that ST-producing organisms are important causes of sporadic cases of noninflammatory summer diarrhea among Navajo adults and confirm the importance of Shigella in inflammatory diarrhea among adults and children in this setting.

Sulfamethoxazole- trimethoprim versus ampicillin in treatment of acute invasive diarrhea in adults.

Twenty-seven Navajo adults with moderate to severe acute inflammatory diarrhea were hospitalized and randomly given ampicillin or sulfamethoxazole-trimethoprim. All patients had invasive diarrhea as defined by sheets of fecal leukocytes, seen on methylene blue wet-slide preparations, and significant clinical symptoms, including postural hypotension from dehydration or fever (temperature greater than 100 degrees F [or 37.8 degrees C]). Patients were followed daily for 5 days in the hospital. Responses of symptoms in all 13 patients who were given sulfamethoxazole-trimethoprim were comparable to or better than those 14 patients randomly assigned to receive ampicillin. Nineteen (73%) of the 27 patients had culture-proven shigellosis, 6 of whom had ampicillin-resistant Shigella isolates. All isolates were susceptible to sulfamethoxazole-trimethoprim in vitro. The eight patients with culture-proven shigellosis treated with sulfamethoxazole-trimethoprim responded as well as the eight patients with ampicillin-susceptible infections treated with ampicillin. Three of the eight patients successfully treated with sulfamethoxazole-trimethoprim had ampicillin-resistant organisms. The three patients with ampicillin-resistant organisms who were treated with ampicillin appeared to do less well; one was a clinical and bacteriological failure at 72 h and subsequently improved after sulfamethoxazole-trimethoprim therapy. As predicted by in vitro susceptibility studies and by studies in children, sulfamethoxazole-trimethoprim was highly effective in treating adult patients with shigellosis and appears to be the treatment of choice in areas where ampicillin resistance among Shigella is common.

Free plasma DNA in patients with pulmonary embolism.

Plasma samples from 46 patients with suspected pulmonary embolism and 25 patients with suspected acute myocardial infarction were analyzed for DNA by counterimmunoelectrophoresis (CIE). Anti-DNA serum was obtained from a patient with systemic lupus erythematosus who had a high titer of anti-DNA antibodies. Seven of eight patients (88%) with high probability of pulmonary embolism by lung scan criteria had free DNA in their plasma. Six of 21 patients (29%) with low probability scans for pulmonary embolism also had DNA in their plasma. None of the eight patients with normal scans and only one of 13 patients with myocardial infarction had DNA in their plasma. Detection of plasma DNA by CIE is a rapid and simple method of screening for pulmonary embolism.

Value of examination for fecal leukocytes in the early diagnosis of shigellosis.

Fecal specimens from 101 patients with diarrhea were cultured and also examined with methylene blue for leukocytes. Thirty-six patients had leukocytes in their stools and 29 had culture-proven shigellosis. The sensitivity of fecal leukocytes in shigellosis was 95% (19/20) when cup specimens were obtained, and 44% (4/9) when swab or diaper specimens were examined. Only 45% of the patients with shigellosis who provided cup specimens had grossly bloody dysentery. Twelve other patients had fecal leukocytes but no demonstrable invasive bacterial pathogens. Methylene blue examination was useful in identifying motile trophozoites of Giardia lamblia and eggs or larvae of other heavy intestinal paraistic infections. Among patients with naturally-acquired acute diarrhea, methylene blue examination of stools for leukocytes is much more sensitive than examination for blood in predicting a positive culture for Shigella spp. It is also of value in detecting parasites.

A prospective study of plasma DNA in the diagnosis of pulmonary embolism.

To assess the usefulness of plasma deoxyribonucleic acid (DNA) detection in the diagnosis of pulmonary embolism (PE), we prospectively studied the frequency and duration of the occurrence of free plasma DNA in 23 patients with PE and in 49 patients with pneumonia, myocardial infarction, thrombophlebitis, or normal lung scans. Plasma DNA was detected in 19 of the 23 patients (83 per cent) with PE and in none of the 49 patients with other diagnoses. Eighteen of the 19 PE patients with free DNA had persistence of DNA on all subsequent sampling for up to 5 days. In this series, plasma DNA had a sensitivity of 83 per cent in the diagnosis of PE and was extremely specific for PE. Thus, detection of free plasma DNA may be useful as a rapid, noninvasive test to aid in the diagnois of PE.