Salivary IgA responses to bacteria in dental plaque as related to periodontal and HIV infection status.

Levels of total IgA and specific IgA reactive with Streptococcus mutans, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Fusobacterium nucleatum were measured by ELISA in parotid saliva from HIV+ and HIV- persons with healthy gingiva (HG), chronic gingivitis, chronic marginal periodontitis (CMP), or necrotizing ulcerative periodontitis (NUP). When the HIV+ group was compared with the HIV- group regardless of periodontal status, total salivary IgA concentration was higher in HIV+ patients, but no such difference was observed for total IgA output. HIV+ CMP displayed higher total IgA concentration as compared with HIV- CMP. No significant differences in specific IgA outputs and ratios were detected between HIV+ and HIV- subgroups with similar periodontal status. HIV+ NUP displayed increased specific IgA output towards S. mutans and increased specific IgA ratio values towards S. mutans, P. gingivalis and P. nigrescens as compared with HIV+ CMP, and increased specific IgA ratio values towards S. mutans and P. nigrescens as compared with HIV+ HG. No such differences were observed between the HIV- subgroups. In sum, salivary IgA responses to bacteria in dental plaque seem not to be related to chronic periodontal disease and HIV infection, but are possibly influenced by acute periodontal infection.

Changing incidence of HIV-induced brain lesions in Oslo, 1983-1994: effects of zidovudine treatment.

OBJECTIVE: To investigate the relation between HIV-induced brain lesions, zidovudine (ZDV) treatment and survival length in a well-defined population of HIV-positive patients. METHODS AND PATIENTS: Ulleval Hospital has the responsibility for treating all AIDS patients from the city of Oslo except haemophiliac patients. The patient population in this autopsy study comprised all adult AIDS patients in Oslo who were treated at our hospital and died during 1983-1994 (n = 171). This represents 86% of all adult AIDS patients from Oslo who died during the same period. Full autopsy, including neuropathological examination of the brain and spinal cord, was performed on 128 (75%) of those who died. RESULTS: No significant differences were found between autopsy and non-autopsy cases with regard to sex, age, risk groups, survival length or ZDV treatment. In the autopsy material, multinucleated giant cells (MGC) in brain tissue were found in 29 cases and diffuse damage of white matter in 52 cases. Analysis shows that ZDV (600 mg per day) reduced the incidence of these brain lesions, but only if continued until death. A second finding was an increased incidence of HIV-induced brain lesions for those with long-term survival. Together these observations may explain a substantial part of the time-trend in the incidence of MGC in Oslo. MGC were frequent (40%) during the first years of the epidemic, although survival length was short in this period. The incidence fell markedly around the time ZDV was introduced and later remained low in those using ZDV until death. The incidence of MGC has, however, increased during the later years, the new cases mainly occurring in patients who had discontinued ZDV use. CONCLUSION: If continued until death, ZDV can reduce the incidence of HIV-induced brain lesions in AIDS patients. When ZDV treatment is terminated a rapid increase occurs in the incidence of HIV encephalitis.

[Norwegian infection control in the new Europe]. / Norsk smittevern i et nytt Europa.

Infectious diseases are still a major health problem world wide. In Europe, however, and in Norway in particular, infectious diseases have not been a threat to public health for several years. In this paper, some of the major events in the European region which could have an impact on public health are discussed. These events include the extensive migration of people in the European region, military conflicts in former Yugoslavia, serious economic and social problems in the former Soviet-Union, and the expansion of the European Union (EU). Increased passage across borders of people and food may, in the worst case, represent a threat to public health. The paper also deals with the status of the different elements of the Norwegian health care system involved with infectious disease control, and with the parts of this system that should be improved, in order to adjust to the new epidemiologic situation that may be encountered in the European region.

Expression of costimulatory molecule CD28 on T cells in human immunodeficiency virus type 1 infection: functional and clinical correlations.

To study the functional integrity of T cells from human immunodeficiency virus type 1 (HIV-1)-infected persons, CD4+ and CD8+ cells were examined for proliferation and secretion of interleukin-2 (IL-2) in response to staphylococcal superantigens and antibodies to CD3 and the alpha beta T cell receptor. A functional defect within CD8+ but not within CD4+ cells from HIV-1-infected persons was observed. Within CD8+ cells, proliferation and secretion of IL-2 was restricted to cells expressing the costimulatory molecule CD28. Such cells were proportionally reduced in HIV-1-infected persons. In patients with advanced immunodeficiency, however, evidence of functional derangement was found also within the CD28+ CD8+ cells. In a cross-sectional study of 73 HIV-infected persons and 15 controls, a significant correlation was observed between the number of CD28+ CD8+ cells and the presence of HIV-related disease. Our results suggest that regulation of expression of CD28 may play an important role in the immunopathogenesis of AIDS.

[Norwegian infection control in modern Europe]. / Norsk smittevern i et nytt Europa.

Infectious diseases are still a major health problem world wide. In Europe, however, and in Norway in particular, infectious diseases have not been a threat to public health for several years. In this paper, some of the major events in the European region which could have an impact on public health are discussed. These events include the extensive migration of people in the European region, military conflicts in former Yugoslavia, serious economic and social problems in the former Sovjet-Union, and the expansion of the European Union (EU). Increased passage across borders of people and food may, in the worst case, represent a threat to public health. The paper also deals with the status of the different elements of the Norwegian health care system involved with infectious disease control, and with the parts of this system that should be improved, in order to adjust to the new epidemiologic situation that may be encountered in the European region.

[Systemic mycoses. Epidemiology, clinical aspects, diagnosis]. / Systemiske mykoser. Epidemiologi, klinikk, diagnostikk.

Systemic mycoses are serious, often life-threatening, infections that are encountered with increasing frequency in many countries. These infections are most often seen as a result of advanced medical treatment leading to profoundly immuno-suppressed patients. In Norway, most systemic mycoses are caused by Candida, followed by Aspergillus, Cryptococci and Mucorales. This paper deals with the pathogenetic and immunologic mechanisms underlying these infections. The different agents are described, and the various clinical manifestations. A discussion of the diagnosis of systemic mycoses is followed by some general considerations regarding treatment.

[Fluconazole--a new antifungal agent]. / Flukonazol--et nytt antimykotikum.

Fluconazole (Diflucan) is a new triazole antifungal agent that is effective against a wide range of fungi and has a favourable pharmacokinetic profile. Fluconazole is absorbed well after oral intake independent of food intake. Fluconazole is given once daily, in a dose of 50-400 mg. The dosage is the same for oral and parenteral administration. Tissue penetration is good, as is the concentration in cerebrospinal fluid. Fluconazole should not be given to children under 16 years of age, nor to pregnant or breast-feeding women. In Norway, fluconazole is indicated for treatment of candida vaginitis that is resistant to other treatment, invasive candida infection, candida stomatitis in immunocompromised hosts, and cryptococcal meningitis.

[Post-splenectomy septicemia]. / Postsplenektomiseptikemi.

The spleen is a major component of the immune system and plays an important role in the defence against encapsulated bacteria. It is well recognized that splenectomized patients run increased risk of developing serious invasive bacterial infections, especially post-splenectomy septicaemia caused by pneumococci. Two case reports are used to draw attention to infections in patients without a spleen. The author discusses the indications for the use of pneumococcal vaccine, and recommends more extensive use of the vaccine in splenectomized patients in Norway.

[The risk of exposure to hepatitis B and human immunodeficiency virus among employees at Norwegian hospitals]. / Smitterisiko for hepatitt B og humant immunsviktvirus blant ansatte ved norske sykehus.

During the period from 1986 to 1989 a study was carried out to determine the risk of occupational exposure to hepatitis B virus and human immunodeficiency virus among approximately 5,500 employees at Aker hospital, Ullevål hospital and "Sentralsykehuset" in Akershus. Four hundred and fourteen injuries were reported during the study period of approximately 16,800 man-years, corresponding to an injury rate of 2.4/100 man-years. The majority of injuries occurred during direct patient contact in the wards. Of the known sources 8.2% were HBsAg positive and 16.8% HIV-antibody positive. One attendant contracted hepatitis B during the observation period. No HIV-seroconversion has been observed as yet.

The early introduction of HIV infection among Norwegians at highest risk.

Patients with acute hepatitis B and hepatitis non-A non-B-like illness seen between 1981 and 1984 were chosen for the study of the introduction of HIV among persons at highest risk for HIV infection in Norway. HIV was introduced into these risk groups in 1982, but the prevalence of HIV seropositivity increased only slightly during the following 2 years.

HIV and hepatitis B infection in an international cohort of dental hygienists.

The risk for dental hygienists to contract HIV and hepatitis B infection at work was studied in an international cohort of 167 dental hygienists from 13 countries. A significant proportion of the hygienists had taken care of HIV-positive patients or patients known to be at risk for contracting HIV infection. None of the hygienists had antibodies to HIV. Five hygienists who came from or worked in high-endemic areas for hepatitis B infection had antibodies to hepatitis B core antigen, consistent with previous infection with hepatitis B virus. The study is in agreement with previous reports on blood-borne infections among health care workers, concluding that the risk for dental hygienists of contracting HIV and hepatitis B infection is minimal.

Systemic meningococcal disease: a model infection to study acute endotoxinemia in man.

Plasma LPS were quantitated in 40 patients with bacteriological verified systemic meningococcal infection (SMD). Twenty-two patients (55%) demonstrated LPS greater than 25 pg/ml. Fourteen patients with initial plasma LPS levels greater than 700 pg/ml developed a severe septic shock, impaired renal function and extensive coagulopathy compared to 2 out of 26 patients with LPS levels below 700 pg/ml. Seven patients died due to the circulatory collapse and multiple organ failure all with initial LPS levels greater than 1,000 pg/ml. Initiation of antibiotic therapy did not result in further increase of plasma LPS concentration. LPS were cleared from the circulation with a half-life of 1.5-3 hours after initiation of antibiotic treatment with penicillin and chloramphenicol. The results suggest that plasma LPS are quantitatively related to the development of septic shock, multiple organ failure and death from these complications in SMD, making LPS measurement a direct prognostic marker.