Raising livestock in resource-poor communities of the North West Province of South Africa--a participatory rural appraisal study.

A participatory research model was used in six village communities in the Central Region of the North West Province of South Africa in order to achieve the following broad objectives: to obtain information on the challenges owners face in raising livestock in these areas and to evaluate the livestock owners' level of knowledge of internal parasites in their animals. Information obtained at participatory workshops clearly indicated a need for improvements in water supply, schools, job creation, and health services. Lack of pasture for grazing livestock was also cited as being important. Other most frequently mentioned livestock problems included 'gall sickness' (a vaguely defined condition not necessarily referring to anaplasmosis), parasites (both external and internal), chicken diseases and ingestion of plastic bags discarded in the environment. When livestock owners were questioned during individual interviews, most were able to identify the presence of parasites in either the live or dead animal. However, it seems likely that this is limited to the identification of tapeworms. It was found that most livestock owners use a combination of treatments, ranging from traditional to folklore to commercial. There were some difficulties in using the participatory methods since it was the first time that the facilitators and the communities had been exposed to them. Many communities had difficulty in dealing with the concept of finding solutions within the community, which is such an integral part of participatory methods.

Insertion element IS3-based PCR method for subtyping Escherichia coli O157:H7.

An Escherichia coli O157:H7 subtyping method based on PCR amplification of variable DNA sequences between the repetitive element IS3 was developed. Template DNA was prepared by boiling cells in Chelex. Two separate IS3 PCR amplifications were performed for each isolate: one with a single primer (primer IS3A) and one with two primers (primers IS3A and IS3B). The IS3 PCR subtyping method was applied to 35 epidemiologically related and unrelated E. coli O157:H7 isolates that had been previously characterized by pulsed-field gel electrophoresis (PFGE). PFGE identified 25 different subtypes (difference of one or more bands). PCR with single primer IS3A and primer pair IS3A-IS3B identified 6 and 14 different subtypes, respectively. By combining the results of the two PCR amplifications, 15 different IS3 PCR subtypes were identified. While not as sensitive as PFGE, IS3 PCR subtyping grouped all outbreak-related isolates. IS3 PCR banding patterns were reproducible between amplifications and between subcultures. IS3 PCR could serve as a simple, rapid screening method for the identification of unrelated E. coli O157:H7 isolates.

Nitrate in baby foods. Adding to the nitrate mosaic.

OBJECTIVE: To identify commercial baby food varieties high in nitrate content using ion chromatography and compare the health risk associated with the consumption of high-nitrate water and high-nitrate commercial baby food. DESIGN: Ion chromatographic determination of nitrate concentration in a variety of commercial baby foods. SETTING: University Hygienic Laboratory, University of Iowa College of Medicine, Iowa City. PATIENTS: None. RESULTS: Commercial baby foods with nitrate levels higher than 45 ppm include mixed vegetables, bananas, carrots, garden vegetables, spinach, green beans, and beets. The amount of nitrate in one 113-g (4 oz) jar of beets, for example, is equivalent to the amount of nitrate in nearly 5.5 L of water at 45 ppm nitrate. CONCLUSIONS: A controlled clinical trial is needed to clarify how consuming high-nitrate foods correlates with methemoglobin levels in infants younger than 6 months.

Evaluation of multiple-marker screening for Down syndrome in a statewide population.

OBJECTIVE: Our purpose was to evaluate our experience with a statewide, multiple-marker Down syndrome screening program. STUDY DESIGN: The results of 18,712 screening tests performed from July 1, 1991, to Oct. 31, 1992, were reviewed. Amniocentesis and aneuploidy detection rates were compared with the experience of a previous year (1989-1990) in which material serum alpha-fetoprotein was used for detection of Down syndrome. RESULTS: Positive screening tests (Down syndrome risk > or = 1/190) occurred in 665 of 18,712 (3.5%) patients; 516 of 665 (78%) patients accepted amniocentesis. Fifteen aneuploidies were identified: 12 trisomy 21, one trisomy 18, one trisomy 13, and one 48,XXXY. The overall detection rate was one in 34 amniocenteses performed; for trisomy 21 it was one in 43. In a previous year in which maternal serum alpha-fetoprotein alone was used, 3.6% had positive screening tests (Down syndrome risk > or = 270); the detection rate for all aneuploidies was one in 57 amniocenteses, and for trisomy 21 it was one in 114. The expanded maternal serum alpha-fetoprotein test was well accepted by clinicians, with 36% of gravid state residents undergoing screening. CONCLUSION: The multiple marker test is a good screening tool and is superior to material serum alpha-fetoprotein alone.

HIV screening of newborns.

Iowa has participated in the national survey for the prevalence of HIV infection in childbearing women since July of 1989. As of February 1992, blinded testing for antibodies to HIV has been performed on blood spot specimens from 100,717 newborns. Of this number, 14 were confirmed as positive by Western blot. In the Iowa survey the prevalence of HIV infection in childbearing women was 0.14/1000 or 1/7000. This is similar to the prevalence that was observed for PKU in newborns during this time period. However, assuming only 30% of mothers transmit HIV to their babies, the predicted prevalence of HIV infection in Iowa newborns is 1/23,000. Certainly HIV disease is a public health concern with a frequency in Iowa mothers similar to that of other diseases screened for in the Iowa program. HIV meets the remaining WHO criteria for newborn screening, as well: the HIV screening test is simple and reliable and has a low incidence of false-positive and false-negative results; confirmatory testing, counseling, and medical care are available; the quality and length of life of affected individuals are improved by treatment; and data show that early diagnosis and treatment result in a cost advantage to society. The major obstacle to the addition of HIV testing to a newborn screening program is obtaining informed consent without jeopardizing program effectiveness.

HIV infection in childbearing women.

A blinded survey of HIV infection in childbearing women is being conducted in 43 states and territories. After one year of participation in the survey, 6 of 37,846 women bearing live children in Iowa were found to be infected with HIV.

Molecular characterization of HIV-1 isolated from a serum collected in 1976: nucleotide sequence comparison to recent isolates and generation of hybrid HIV.

Human immunodeficiency virus type 1 (Z321 designate, HIV-1Z321), the oldest known HIV, was isolated from a serum sample collected in Zaire in 1976 and was molecularly cloned. Restriction enzyme analysis of unintegrated viral DNA revealed the presence of conserved restriction enzyme cleavage sites in the long terminal repeat sequences. Nucleotide sequence analysis of the 3' end of the viral DNA revealed a pattern similar to other HIV-1 isolates described. However, some of the common restriction sites present in other isolates were absent in HIV-1Z321. The extent of differences between HIV-1Z321 and recent isolates from North America and Zaire was 17.86-18.36% on the nucleotide sequence level and 26.5-33.2% difference in the predicted amino acid sequence in the envelope gene. Differences were also noted in 3'-orf (nef: according to HIV gene nomenclature; see Ref. 42) gene and U3 region of the long terminal repeat sequences of HIV-1Z321 and other isolates. Nucleotide sequence of a HIV-1 isolate, 12 years apart from the present isolates, will provide an important time calibration point for the evolutionary divergence of HIV isolates. Hybrid HIV was also generated by transfecting HIV-1Z321 and HIV-1HTLV-III viral DNAs into cells.

Right ventricular tardokinesis in cardiac contusion: a new observation on phase images.

The usefulness of gated blood pool (GBP) scintigraphy in evaluating cardiac contusion among trauma patients was examined. In ten of 62 patients who sustained blunt chest trauma, phase images of GBP studies demonstrated delayed onset of right ventricular (RV) contractions (RV tardokinesis). Clinical charts of these ten patients were reviewed to determine the significance of this finding. Only one had no supportive evidence of cardiac injury. Four patients were determined to have clinically significant cardiac contusion on the basis of the occurrence of arrhythmias of cardiac failure during their hospital course. These patients had ventricular histogram widths greater than 30 degrees of the entire cardiac cycle at half maximum height and had a bifid peak in their ventricular contraction histograms. Of the 52 patients who did not have RV tardokinesis, only one had a clinically significant cardiac contusion, resulting in a false-negative rate of 2% for the test. This new observation of RV tardokinesis may be clinically useful in establishing the difficult diagnosis of cardiac contusion.

The prevalence of infection with human immunodeficiency virus over a 10-year period in rural Zaire.

In 1985 we tested 659 human serum samples, collected in the remote Equateur province of Zaire in 1976, for antibody to human immunodeficiency virus (HIV). Five (0.8 percent) were positive, and HIV was isolated from one of these. Follow-up investigations in 1985 revealed that three of the five seropositive persons had died of illnesses suggestive of acquired immunodeficiency syndrome (AIDS), and two remained healthy but seropositive. In 1986, a serosurvey we conducted using a cluster-sampling technique in the same region showed a seroprevalence of 0.8 percent in 389 randomly selected residents. The seroprevalence in 283 prostitutes was 11 percent. Patients with AIDS were identified in various hospitals in the province. Risk factors for AIDS included a greater than average number of sexual partners and residence outside the area. We believe that the long-term stability of HIV infection in residents of rural Zaire suggests that social change may have promoted the spread of AIDS in Africa.

PIP: In 1985, 659 human serum samples, collected in rural Zaire in 1976 were tested for antibody to human immunodeficiency virus (HIV). 5 (0.8%) were positive, and HIV was isolated from 1 of these. Follow-up questions in 1985 revealed that 3 of the 5 seropositive persons had died of illnesses suggestive of acquired immunodeficiency syndrome (AIDS), and 2 remained healthy but seropositive. In 1986, a serosurvey conducted using a cluster-sampling technique in the same region showed a seroprevalence of 0.8% in 389 randomly selected residents. The seroprevalence in 283 prostitutes was 11%. Patients with AIDS were identified in various hospitals. Risk factors for AIDS included a greater than average number of sexual partners and residence outside the area. Long-term stability of HIV infection in residents of rural Zaire suggests that social change may have promoted the spread of AIDS in Africa.

Rotational artifact in phase imaging of cardiac scans: potential pitfalls in diagnosis.

In the past few years, we have occasionally observed linear bands in the phase images of gated cardiac blood-pool scans along the interventricular septum region among patients with normal septal motions. Our retrospective study investigated the cause of out-of-phase bands of 12 patients. We documented through review of cines, computer analysis of gated cardiac blood-pool scintigraphy data, and correlation with echocardiograms that this phenomenon was artifact introduced by rotational movements of the heart. It is important for nuclear physicians to recognize this rotational artifact on the phase analysis image in order to avoid the erroneous misdiagnosis of wall motion abnormalities of the septum.

Detection of human T cell leukemia virus type I and human immunodeficiency virus in cultured lymphocytes of a Zairian man with AIDS.

We report the detection of human T cell leukemia virus type I (HTLV-I) and human immunodeficiency virus (HIV) in the cultured lymphocytes of a 45-year-old Zairian man with AIDS. HIV was successfully isolated and analyzed by SDS-PAGE and competition radioimmunoassay. However, by the culture techniques used, HTLV-I could not be separated from the HIV. Western blot analysis of the patient's serum showed the presence of both HTLV-I- and HIV-specific antibodies. The finding of this dual infection may explain reports that greater than or equal to 30% of patients with AIDS are positive for antibodies to HTLV-I.

Risk factors for human immunodeficiency virus (HIV) infections in homosexual men.

To clarify risk factors for infection with the human immunodeficiency virus (HIV) we selected at random 785 homosexual men who had participated in studies of hepatitis B in San Francisco in 1978-80 for a follow-up study of the acquired immunodeficiency syndrome. Although most had not been contacted in over five years, 492 (63 per cent) were located and enrolled. The 240 (67 per cent) who had developed antibodies to HIV, as measured by an enzyme-linked immunosorbent assay (ELISA), were compared with 119 who had remained seronegative. In multivariate analyses, receptive anal intercourse with ejaculation by nonsteady sexual partners, many sexual partners per month, and other indicators of high levels of sexual activity were highly associated with seroconversions. None of the sexual practices that we studied appeared to offer protection against HIV infection.

Cohort comparison study of children whose mothers have acquired immunodeficiency syndrome and children of well inner city mothers.

The virus or viruses (human immunodeficiency virus) associated with the acquired immunodeficiency syndrome may be transmitted in utero or perinatally from an infected mother to her baby. Infected adults may remain asymptomatic for months to years, during which time a mother could transmit the virus. It is not known to what degree a mother may transmit the virus perinatally or whether postnatal transmission is possible. We studied a cohort of children whose mothers had been reported to have acquired immunodeficiency syndrome, comparing human immunodeficiency virus-seropositive with seronegative children as well as a cohort of inner city children with similar socioeconomic characteristics whose mothers are well. Three (12%) of 25 children whose mothers have acquired immunodeficiency syndrome were seropositive compared with none of 44 children whose mothers were well. The seropositive children had lower T4A:T8 lymphocyte ratios than children in the other groups. Nine children of affected mothers were young enough to have been born within their mother's incubation period and were seronegative and well. When compared with seronegative children the seropositive children did not have greater contact with their ill mothers, either in types of physical interaction or in length of time lived together. Although this study cannot preclude the possibility of postnatal nonsexual transmission, it does present evidence against it.

Relationship between antibody to LAV/HTLV-III and the natural course of subclinical cellular immune dysfunction in homosexual men.

To assess the epidemiology and natural history of persistent generalized lymphadenopathy (PGL) and subclinical immunodeficiency in relation to serologic evidence of lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) infection, 109 homosexual men with PGL, 47 homosexual men without lymphadenopathy who attended a sexually transmitted disease (STD) clinic, 25 homosexual male university students, and 26 heterosexual men who attended the STD clinic were studied. In 1982-1983 antibody to LAV/HTLV-III was present in 97%, 35%, 21%, and 4% of the four groups, respectively (P less than .001). Subclinical immunodeficiency was more closely associated with LAV/HTLV-III seropositivity than with lymphadenopathy. Cohorts of 78 homosexual subjects with PGL, 35 homosexual subjects from STD clinic, and 15 homosexual university students were followed for median periods of 13.5, 20, and 14.5 months, respectively. The seroconversion rate was 23% per year among seronegative subjects, and 4% of seropositive subjects developed overt acquired immunodeficiency syndrome (AIDS). Among seronegative subjects, there was significant improvement in T4:T8 ratios (P = .001), whereas most seropositive subjects continued to have subnormal total counts of T4 lymphocytes and low T4:T8 ratios. Some cases of subclinical cellular immunodeficiency apparently are unrelated to LAV/HTLV-III infection, and the presence of antibody to this virus is associated with an unfavorable immunologic prognosis.

Isolation of human immune deficiency virus from African AIDS patients and from persons without AIDS or IgG antibody to human immune deficiency virus.

We previously reported a high incidence of acquired immune deficiency syndrome (AIDS) in Kinshasa, Zaire, as well as a high frequency of antibody to human immunodeficiency virus (HIV), which includes HTLV-III and LAV viruses, in persons without AIDS. In this report we assessed the frequency of HIV virus infection in persons with and without clinical AIDS and the association of virus isolation to presence of antibody. We isolated HIV from 27 (77%) of 35 patients with AIDS, and 5 of 9 patients with AIDS-related complex (ARC). Virus was also isolated from plasma and cerebrospinal fluid of patients in the study. The presence of antibody was a reliable marker for virus infection in African patients with AIDS. HIV was isolated from 5 of 27 control patients without AIDS, 3 of whom had normal T helper to T suppressor ratios and normal numbers of T helper cells. Two of these patients had no detectable antibody to HIV by ELISA or Western blot methods. In a population, such as the general heterosexual population of Kinshasa, with frequent infection by HIV and with few clearly definable risk groups, screening for antibodies to HIV may not be sufficient to identify some virus infected persons.

PIP: This study represented the 1st attempt to isolate human immunodeficiency virus (HIV) from African acquired immunodeficiency syndrome (AIDS) patients and controls. HIV was isolated from 27 (77%) of 35 Zairians with AIDS and from 5 (55%) of 9 patients with AIDS-related complex (ARC). In addition, 5 (19%) of 27 controls admitted to Zaire's Mama Yemo Hospital for causes unrelated to AIDS were found to be positive for antibodies to HIV. Next, an effort was made to isolate the virus from 42 AIDS or ARC patients on whom data were already available on the results of an enzyme-linked immunosorbent assay (ELISA). HIV was isolated from 30 (81%) of 37 patients with positive ELISA tests and from none of the 5 patients with a negative assay. Among controls, antibodies were found in a higher proportion of patients with abnormal helper: suppressor ratios or a low absolute T helper cell count. On the other hand, these abnormalities were not found in 3 of the 5 control patients from whom HIV was isolated, including 2 without HIV antibody. This suggests that neither of these criterion are good indicators of virus infection. The isolation of HIV infection from 5 hospital controls with no clinical signs of infection suggests that either the rate of asymptomatic HIV virus infection is high in Zaire or that common tropical diseases such as malaria or tuberculosis may be associated with HIV infection. The frequency of HIV isolation from AIDS and ARC patients in this study is higher than that in earlier reports from non-Africans, but is comparable to current statistics from the US.

Human T-cell leukemia virus I provirus and antibodies in a captive gorilla with non-Hodgkin's lymphoma.

Antibodies reactive against human T-cell leukemia virus I (HTLV-I) were detected by indirect immunofluorescence assay using MT-2 as target cells, enzyme linked immunosorbent assay screen and competition assay, and Western blot analysis in three sera (one collected in 1979) from a captive gorilla which developed diffuse histiocytic lymphoma in 1983. The sera from four other healthy gorillas housed separately were HTLV-I antibody negative. All sera were negative for HTLV-III antibodies by enzyme linked immunosorbent assay. Southern blot analysis of DNA from lymphoma tissue after digestion with BamHI and using complete HTLV-I genome probe gave one 10-kilobase fragment and a characteristic 1.05-kilobase internal fragment detected in all known HTLV-I isolates. These results indicate that the gorilla was infected with HTLV-I or a closely related simian virus several years before the development of lymphoma.