Mixed cryoglobulinemia secondary to visceral Leishmaniasis.

We describe a case of type II mixed cryoglobulinemia, with monoclonal IgMkappa rheumatoid factor, associated with visceral leishmaniasis caused by Leishmania infantum. Involvement of Leishmania antigen(s) in the formation of cryoprecipitable immune complexes was suggested by the fact that cryoglobulinemic vasculitis subsided after antiparasite therapy and that anti-Leishmania antibodies, as well as rheumatoid factor, were enriched in the cryoprecipitate. We observed 2 additional patients with visceral leishmaniasis and cryoglobulinemic vasculitis. All 3 patients had seemingly contracted leishmaniasis in Italy, were hepatitis C virus negative, and were initially diagnosed as having autoimmune disorders. These findings indicate that Leishmania can be an etiologic agent of type II mixed cryoglobulinemia. This parasitosis should be taken into consideration in the differential diagnosis of vasculitides in endemic areas.

Toxoplasmosis in pregnancy: research on 2295 women in Rome and its province.

The authors report the data concerning 2295 women tested for toxoplasmosis immunodiagnosis, in the Department of Infectious and Tropical Diseases of "La Sapienza" University of Rome in the years 1993-1994. Four hundred eleven cases (17.9%) were positive for IgG only; 2 cases (0.1%) for IgM only; 15 cases (0.6%) for both IgG and IgM while 1867 cases (81.4%) were negative. 1668 women were pregnant. In this group 260 (15.6%) were positive for IgG only, 2 (0.1%) for IgM only, and 10 (10.6%) for both IgG and IgM; in one case there was a spontaneous absorption in the 10th week of pregnancy, in another case a still-birth in the 20th week with brain lesions; a child was born with phocomelia of the right arm and one with a clubfoot. While it is possible to explain the absorption and the still-birth with the toxoplasma infection, it is difficult to understand the causes of the abnormality of the limbs.

Prevalence of anti-HCV in two Tanzanian villages.

The presence of anti-HCV antibodies was investigated in sera from a total of 123 inhabitants of two Tanzanian villages. In one of the villages, 72.2% of the sera and in the other village, 82.6% of the sera were found to be anti-HCV positive. These values are dramatically higher than other reported prevalences, whereby cross-reactivity between HCV and Flaviviruses as well as possible transmission by arthropod vectors cannot be ruled out.

An epidemic of Neisseria gonorrhoeae in a Somali orphanage.

Neisseria gonorrhoeae was isolated from 53 young females (6-14 years old) in a Somali orphanage. A male guardian was found to be the effective transmitter having sexually abused the children. All the bacterial isolates were of the same serogroup WI and the same serovar Aedih. This presents an unusual example of a tight geographic cluster of infected people which is often characteristic of gonorrhoea epidemics.

PIP: The physician of an orphanage in Afgoye, 30 km from Mogadishu, Somalia, noticed vaginal discharge in 95 of the 500 girls at the orphanage in September 1987. A Somali-Italian investigative team took vaginal specimens from the 95 girls. Laboratory personnel isolated Neisseria gonorrhoea in 56% of the 95 6-14 year old females (53) who all lived in 2 adjacent dormitories. They found that all the bacterial isolates were of the N. gonorrhoea WI serogroup and Aedih serovar. The physician prescribed penicillin treatment for all the girls. Contact tracing revealed that a male guardian was the source of gonorrhea. Some children had already accused him of sexually abusing them. Orphanage officials had transferred him 1 week before the arrival of the investigative team. His room had been very near to the 2 dormitories for only a few weeks before the investigative team arrived. In this short time, his sexual abuse effected this cluster of infections. This supports the present theory of gonorrhea epidemiology that a core group of infectious people are most likely responsible for most, if not all, of the continuing endemicity of gonorrhea. The infection rate was in range of the estimated probability of transmission (50-70%) during sexual intercourse from an infectious male to a female. The results showed that high resolution typing of gonococci has in addition to its scientific value a more practical value; forensic medicine and illustration that gonorrhea consists of smaller microepidemics.

Reinfection of Somali children with Trichuris trichiura after chemotherapy: relevance of immunostimulation.

The intestinal helminth status of an age-stratified sample (6 to 20 years old) from a Somalian community has been assessed and the typical pattern of highly aggregated parasite distribution found. A reinfection study on a sample of 40 children (treated and untreated with a pentapeptide identical to the active site of the thymic hormone thymopoietin) seemed to indicate that immunological factors play a significant role in modulating the population dynamics of infection in endemic communities.

[Technics for identifying Cryptosporidium spp. in feces: synthetic review and personal experience on anti-HIV seropositive, AIDS-related complex and AIDS subjects]. / Tecniche per l'identificazione di Cryptosporidium spp. nelle feci: rassegna sintetica ed esperienze personali su soggetti anti-HIV sieropositivi, con ARC e con AIDS.

The authors describe the most common techniques used for the detection of Cryptosporidium spp. in the faeces. Coproparasitological investigations have been carried out on 216 patients anti-HIV seropositives, 192 of them with no symptoms, 5 with ARC and 19 with AIDS. The techniques that have been used are: the FPC concentration, the colouring of Henriksen and Pohlenz and modified Koster, the indirect immunofluorescent assay with monoclonal antibodies. Oocystis of Cryptosporidium spp. have been recovered in three patients, two ARC and one AIDS. On the ground of the authors' experiences the used techniques must be considered particularly suitable for the diagnosis of cryptosporidiosis.

[Determination of specific IgM using column chromatography in immunologic diagnosis of toxoplasmosis]. / La determinazione delle IgM specifiche mediante l'uso di colonnine cromatografiche nella diagnosi immunologica della toxoplasmosi.

The usefulness of detecting specific IgM antibodies in the immunodiagnosis of toxoplasmosis is fraught with false positive and false negative results. For instance false positivity can be obtained when rheumatoid factor is present in the serum while false negativity can occur because competing levels of IgG antibodies. We report the results obtained by the use of a simplified chromatographic method, commercially available in kits, for the separation of IgM from IgG in the immunodiagnosis of toxoplasmosis. The 1564 sera tested by indirect immunofluorescent technique (IFA) showed that 119 (7.6%) were positive if the whole serum was tested and only 7 (0.4%) after the chromatographic separation. This suggests that the use of this method can notably reduce the number of false results in sera with high IFA titer of IgM to toxoplasma.

The prevalence and intensity of intestinal parasites in two Somalian communities.

About 85% of the population of two Somali communities harboured soil-transmitted intestinal nematodes and/or protozoa. The commonest parasite (75% in the Lafoole institution and 59% in the Afgoye institution) was Trichuris trichiura. Mixed infections were common. The source of infection is contaminated fields around dwelling quarters, because of indiscriminate defaecation. One of the factors responsible for the higher incidence of hookworm in Lafoole (45%) compared with Afgoye (1.5%) may be the different soil character of the surrounding fields.

Epidemiological study of parasitic infections in Somali nomads.

In Somali nomads the incidence of intestinal helminths is very low compared with that observed in Somalian closed institutions and practically no Entamoeba infection occurs. Schistosoma haematobium eggs are observed in urine of 50% of adults nomads. Immunological tests reveal that the relative prevalences of leishmaniasis (the lowest), malaria, and toxoplasmosis (the highest) in nomads are similar to those shown by the same techniques in settled communities.

Hepatitis B virus circulation in three different villages of Somalia.

Hepatitis B virus (HBV) circulation was surveyed in three Somalian villages (Buur-Fuul, Mooda-Moode and Bajuni Islands) in different districts and 52 children living in a closed community, aged under one year, were studied. Of the 331 village subjects aged one to 83 years, 12.08% were HBs positive, 29.9% anti-HBs positive, 43.8% anti-HBc positive and 21.4 anti-HBe positive. Among the HBs-positive subjects, 34.7% had HBeAg and 21.7% had anti-HBcAg-IgM. No statistically significant differences were found for HBs, anti-HBs, anti-HBc and anti-HBe among the three villages. HBeAg prevalence was higher in Buur-Fuul than in Mooda-Moode and in Bajuni Islands. HBsAg prevalence was about the same for each age group studied, whereas the prevalence of anti-HBc showed a continuous rise and reached its maximum level of 43.8% in those aged 39 years and older. The proportion of HBs-positive subjects who also carried HBeAg was high in the youngest children but fell with age. HBs-positive children aged under one year had a high anti-HBc-IgM prevalence. Our finding suggests that perinatal infection may play an important role among the Somalian population in determining the reservoir of virus carriers.

Low prevalence of thyroid antibodies in a Somalian population.

Prevalence rates of serum thyroid antibodies in a Somalian population have been compared with those of an Italian population. Thyroid antibodies have been evaluated by passive haemagglutination (microsomal antigen) and by 125I-thyroglobulin binding. In the Italian survey 13% of all subjects were positive for thyroid antibodies. A significantly lower prevalence of thyroid antibody positive subjects was found in the Somalian group (2,07%, P less than 0.001). It is suggested that the observed difference between Somalian and Italian populations could reflect nutritional or genetic causes which influence the antithyroid autoimmune response.

[Epidemiological studies, with the direct and immunodiagnostic method, of parasitic diseases in residents of a Somalia village located in the irrigated zones]. / Indagine epidemiologica, con methodo diretto e immunodiagnostico, delle malattie parassitarie nei residenti di un villaggio somalo situato in zona irrigata.

The authors carried out an epidemiological survey for the evaluation of the incidence of the parasitoses in a Somali village localized in proximity to a watercourse. They found parasites in the 72,53% of the examined population: Schistosoma haematobium 42.5%, Ascaris lumbricoides 32%, Ancylostoma duodenale 14%, Entamoeba histolytica 7,5%. The immunofluorescence, nevertheless, showed the presence of antiparasite antibodies in a much higher percentages of cases; it could meant that the real incidence of the various parasitoses is greater than it appears with direct examination.

[Evaluation of the gel diffusion technique in the diagnosis of the amoebiasis (author's transl)]. / Valutazione della tecnica di immunodiffusione su gel nella diagnosi dell'amebiasi.

Amoebic gel diffusion precipitin test has tried in comparison with fluorescent antibody test on sera from clinical amoebiasis cases and on 50 normal control sera. Ultimately the use of both tests is recommended as the latter resulted more specific while the positivity of the gel diffusion test appeared strictly correlated with acute infections.

[Indirect immunoperoxidase technic in the biological diagnosis of human parasitic disease]. / L'immunoperossidasi indiretta nella diagnosi biologica delle parassitosi umane.

Two serological techniques, immunoperoxidase (IP) and immunofluorescence (IFI), were used for the detection of specific antibodies in 60 sera from patients with schistosomiasis, in 44 sera from patients with hydatidosis, and 28 sera from patients with intestinal amebiasis or liver amebic abscess. The IP test correlated well with IFI. The advantage of IP technique compared to IFI are that it is more rapid, less laborious and is performed without technical equipment.