Lymphocyte characterization of decidua basalis spiral arteries with acute atherosis in preeclamptic and normotensive pregnancies.

Uteroplacental acute atherosis (AA) is a common spiral arterial lesion in preeclampsia, characterized by intramural foam cells, fibrinoid necrosis, and a perivascular immune cell infiltrate. A clear definition of this infiltrate is lacking. Therefore, our aim was to characterize lymphocytes in pre-defined zones regarding spiral arteries with or without AA, from preeclamptic and normotensive pregnancies. Lymphocytes were characterized in decidua basalis samples (n = 91), previously evaluated for AA, around spiral arteries in three pre-defined zones; 1) intramural, 2) perivascular and 3) interstitial. Adjacent serial sections were immunostained to identify different T-cell populations (CD3+, CD8+, FOXP3+), and NK-cells (CD56+). CD3+CD8- T-cells were also identified. These were presumed to be largely CD4+ T-cells. AA was associated with significantly higher intramural CD3+ cell concentrations in Zone 1, in both normotensives and preeclamptics. In preeclamptics only, this difference extended into Zone 2. Similar results were observed for CD3+CD8- cells. AA was also associated with increased intramural CD8+ concentration; however, the number of cells was low. Regulatory T-cells (FOXP3+) were generally scarce or absent in all pre-defined zones. Although intramural NK-cells (CD56+) were scarce, the intramural concentration was significantly lower in spiral arteries with AA compared to without AA in preeclamptics. Our main finding was that CD3+CD8-FoxP3- T-cells were associated with AA. We therefore suggest that T-cells, of a non-regulatory CD4+ subtype, could be involved in the formation of spiral artery AA in the decidua basalis. Whether AA gives rise to, or is partly mediated by increased T-cell concentration around the lesions, remains to be determined.

Herpes simplex virus type 2 DNA detected in cerebrospinal fluid of 9 patients with Mollaret's meningitis.

We present clinical and virological data on 9 patients, 7 women and 2 men aged 31-56 years, with recurrent aseptic meningitis (Mollaret's meningitis). Polymerase chain reaction detected Herpes simplex virus type 2 DNA in cerebrospinal fluid samples from all patients collected during their latest attacks of meningitis. Six patients had no history of genital herpes. Only 1 patient was offered prophylactic antiviral treatment during the study period (45 months).

False-negative results of a ligase chain reaction assay to detect Chlamydia trachomatis due to inhibitors in urine.

The aim of this study was to assess the presence of inhibitors in urine specimens causing false-negative results in a commercial Chlamydia trachomatis gap-filling ligase chain reaction (Gap-LCR) assay. On testing of urine samples by the Gap-LCR assay and urethral swab specimens by cell culture, 73 (19%) Chlamydia trachomatis positive subjects were detected among 382 men attending a clinic for sexually transmitted diseases. In 56 subjects, the agent was detected in both the urine and the urethral samples, while 309 subjects were negative in both tests. In seven subjects urine samples were Gap-LCR positive (confirmed by a different Gap-LCR assay), but the corresponding urethral swab samples were cell culture-negative. In another ten subjects the urethral swab samples were cell culture positive, but their urine samples were Gap-LCR negative. Subsequent re-analysis of the urine samples including the addition of external Chlamydia trachomatis DNA indicated full or partial inhibition in nine of the cell culture-positive Gap-LCR negative subjects. When urine preparations were freeze-thawed and diluted prior to testing, Chlamydia trachomatis was detected in six of the ten initially Gap-LCR-negative samples. Gap-LCR inhibitors were present in at least nine (12%) of the 73 urine preparations from the Chlamydia trachomatis positive individuals. Identification of samples containing Gap-LCR inhibitors and subsequent processing to reduce the inhibition increased the sensitivity of the test from 86% to 95%.

[Serous meningitis associated with primary genital herpes infection]. / Serøs meningitt assosiert til primaer genital herpesinfeksjon.

Aseptic meningitis is not an uncommon complication to primary genital herpes infection caused by herpes simplex virus type 2 (HSV-2). Compared with other types of viral meningitis, HSV-2-meningitis is associated with a significant rate of neurological complications in the acute stage. In addition, some patients will suffer from recurrent aseptic meningitis (Mollaret's meningitis) later. We describe six patients, five women and one man, age 26-35 years, with aseptic meningitis caused by HSV-2. All the patients showed serological evidence of primary herpes infection (negative HSV-IgG and/or positive HSV-IgM in serum samples). Polymerase chain reaction detected HSV-2 in cerebrospinal fluid in all five of five cases, while virus cultures were positive in two of the six cases. Only three patients showed clinical signs of simultaneous genital herpes infection. One patient, a 28-year-old female, developed transient autonomic nervous system dysfunction with urinary retention, constipation, and neuralgic pain in the buttocks, perineum and lower limbs. 13 months later she was hospitalised for a genital herpes infection with headache, parestesia and fever, but spinal fluid examination showed no abnormality.

[Mollaret meningitis. Is the riddle finally solved?]. / Mollarets meningitt. Er gåten endelig løst?

Mollaret's meningitis is characterised by recurrent aseptic meningitis in otherwise healthy persons. It has recently been shown that most cases are caused by herpes simplex virus type 2 (HSV-2). In this article we describe five women, age 33-57 years, with altogether 12 episodes of virus-culture negative aseptic meningitis, where polymerase chain reaction detected HSV-2 in samples of cerebrospinal fluid. Only three patients had a medical history of previous genital herpes infection. None of our patients has been offered prophylactic antiviral treatment.

Restriction endonuclease analysis of adenovirus type 3 isolated in Norway from 1970 to 1991.

Forty-three strains of adenovirus type 3 isolated from patients in Norway between 1970 and 1991 were analyzed with four restriction endonucleases. Bg1 II was the most discriminative enzyme. Five genotypes were identified and one of these has not been described before (Ad3a12). During both the epidemics in this period, new genotypes were introduced into the population. The same genotypes were identified in Norway as have previously been found in the northern parts of Europe, America and the Soviet Union.

[Prevalence of Chlamydia trachomatis in women applying for abortion in Oslo 1985-91]. / Prevalens av Chlamydia trachomatis hos abortsøkende kvinner i Oslo 1985-91.

The prevalence of Chlamydia trachomatis was investigated in a retrospective study of 17,215 women who requested termination of pregnancy at Ullevål and Aker hospitals in Oslo during the years 1985-89 and 1991. The overall prevalence of C trachomatis decreased from 11.3% (267/2,354) in 1985 to 3.8% (112/2,958) in 1991. The reduction was considerable from 1985 to 1989 but only slight at the end of the period. The prevalence was higher in younger women during the whole period. In women < 25 years old the prevalence decreased from 16.7% in 1985 to 6.3% in 1991, and in women > or = 25 years old from 5.9% in 1985 to 1.8% in 1991.

A double blind study of single dose azithromycin and doxycycline in the treatment of chlamydial urethritis in males.

OBJECTIVE: To compare the efficacy and safety of azithromycin and doxycycline in the treatment of males with uncomplicated urethritis caused by chlamydia trachomatis. DESIGN: A multicentre, double-blind, randomised treatment study. SUBJECTS: 130 male outpatients with clinical signs and symptoms of urethritis. SETTING: STD clinics at four Norwegian University Hospitals. METHODS: Patients were randomly allocated to 1000 mg azithromycin as single dose or doxycycline 100 mg twice daily for 7 days. Clinical, bacteriological and safety assessments were made at entry and after 1 and 2 weeks. Safety data were also repeated after 4 weeks. RESULTS: Demographic data were similar in both groups. At the week 1 assessment bacteriological eradication was achieved in 44 of 44 evaluable azithromycintreated patients and in 42 of 42 in the doxycycline group. At the week 2 assessment the corresponding figures were 35 of 35 and 34 of 34 respectively. CONCLUSION: Azithromycin 1000 mg single dose was as effective as doxycycline 100 mg twice daily for 7 days in male patients with chlamydial urethritis.

[Chronic hepatitis C. Experience with 50 patients]. / Kronisk hepatitt C. Erfaring med 50 pasienter.

We studied 50 patients (36 males and 14 females) with chronic hepatitis C who were admitted consecutively to our medical department during the period 1987-91. Eight patients (16%) had had a blood transfusion, 17 (34%) had used intravenous drugs and 25 (50%) were "sporadic cases" with no identifiable risk factor except that at least five had been tattooed. Most of the patients had moderate symptoms, including tiredness and asthenia. Few were jaundiced. A percutaneous liver biopsy was performed in 27 patients and showed chronic persistent hepatitis in 12 of them, chronic active hepatitis in six and cirrhosis in nine. Three patients with cirrhosis died; one from hepatoma, one from an endstage cirrhosis with bleeding and coma hepaticum, and one from septicaemia.

Respiratory tract viruses in otosclerotic lesions. An immunohistochemical study.

A series of viral antigens, including adenovirus, influenza A and B, parainfluenza types 1 and 3, measles, mumps, respiratory syncytial (RSV) and Epstein Barr (EBV) viruses was studied in a prospective series of stapes specimens from 24 consecutive patients operated on for otosclerosis. The stapes specimens were processed for light microscopy and immunohistochemistry. With the exception of one case of positive specific reactivity for anti-RSV antibody in one multinuclear osteoclastic cell, no specific reactivity was seen in the specimens. This was the case both in active (n = 8) and inactive (n = 16) otosclerotic lesions. The possibility of unspecific staining reactions is discussed.

The use of flow cytometry to detect the biosynthesis of complement components.

Agarose beads, an activator of complement, were incubated with MRC-5 or He 9 fibroblast cell lines under serum-free conditions. The beads were tested for binding of anti-complement antibodies by flow cytometry with a FACS 440 using FITC-labelled anti-Ig detection antibodies. Controls consisted of co-cultured beads incubated with irrelevant antibody or albumin, beads maintained in cell cultures containing cycloheximide, and beads which were not exposed to cells. The histograms demonstrated positive staining with anti-C3c, -C5, -C7 and -C9, but not with anti-C6 and -C8. Flow cytometry with multiple histogram analysis confirmed that the differences between the positive curves and the controls were statistically significant. The results show that cell-derived complement components (C3, C5, C7 and C9) were deposited on the beads and could be detected by flow cytometry.

[Recurrent herpes labialis and secondary bacterial infection. A study among the employees at the Ulleval hospital]. / Residiverende herpes labialis og bakteriell sekundaerinfeksjon. En undersøkelse blant ansatte ved Ullevål sykehus.

Recurrent herpes labialis is a prevalent infection. We have investigated the annual incidence and some clinical aspects of the condition, and the frequency of probable superinfection among the staff at the largest hospital in Norway. Over a period of 12 months a total of 83 (67 females and 16 males) out of 3,565 persons with a mean age of 34.3 years experienced clinical recurrence of herpes labialis, giving an annual incidence of 23 persons with one or more eruptions per 1,000 employed. The mean recurrence rate was 4.8 episodes per year. UV-light was reported as a precipitating factor by 60% and psychological stress by 30%. Seven persons reported sick leave of one to three days' duration because of the most recent eruption. In 6/83 patients the probable pathogenic bacteriae (i.e. beta-hemolytic streptococci group A in one and Staphylococcus aureus in five cases) were isolated within the first 48 h after the skin lesions occurred. After 7-9 days S aureus was found in eight persons. The mean duration in days until all skin lesions had healed was the same in patients with or without probable superinfection. Recurrent herpes labialis does not seem to be a significant health problem among the staff of Ullevål Hospital. Probable superinfections appear to occur rarely and without significantly increasing morbidity.

Prevalence of anti-HCV in Norwegian blood donors with anti-HBc or increased ALT levels.

Testing for hepatitis B core antibodies (anti-HBc) was performed in 12,104 consecutive blood donors, 139 (1.15%) of whom were found to be positive. The first 6036 donors were also screened for ALT; 91 (1.51%) had repeatedly elevated values. ALT screening was of no help in detecting anti-HBc-positive donors. Those with anti-HBc or repeatedly raised ALT levels were further tested for hepatitis C virus antibodies (anti-HCV), and 3 (2.16%) and 1 (1.10%) anti-HCV-positive donors were detected, respectively. This prevalence of anti-HCV (0.5%) is not significantly different from that found in 1000 unselected donors at our blood bank. Testing for ALT and anti-HBc as surrogate markers for hepatitis C is therefore not recommended in Norwegian blood donors and should be replaced by anti-HCV screening.

Chlamydia trachomatis: in vitro susceptibility of genital and ocular isolates to some quinolones, amoxicillin and azithromycin.

The minimum inhibitory concentration (MIC) of ofloxacin, ciprofloxacin, norfloxacin, amoxicillin and a new erythromycin analogue (azithromycin or CP 62993) against Chlamydia trachomatis was determined. There was a large difference between the MICs (microgram/ml) of different quinolones (median of 3 independent measurements; range): ofloxacin (0.5; 0.5-1) less than ciprofloxacin (1; 1-2) less than norfloxacin (16; 16-32). The MIC of amoxicillin varied from 0.25 to 1 (median 0.5) in different experiments. The MIC of azithromycin (0.125; 0.063-0.25) was lower than that of erythromycin (0.25; 0.125-0.5). The minimum lethal concentration (MLC) of ofloxacin and azithromycin was determined with and without passage of the McCoy cells. Both methods gave the same results. Ofloxacin seemed to have a lethal effect on C. trachomatis, as the MIC and MLC were equal. In contrast, the effect of the MIC of azithromycin on C. trachomatis was bacteriostatic. The MLC of azithromycin was 2-4 times higher than the MIC (p less than 0.001).

Serum levels of ampicillin and gentamycin in neonates of varying gestational age.

Serum concentrations of gentamycin and ampicillin were investigated at loading and in steady state in two groups of neonates, of 26-33 weeks and 34-40 weeks gestation. At loading the usual intravenous dose of gentamycin (2.5 mg/kg) was increased by 50%, the usual intravenous dose of ampicillin (50 mg/kg) by 100%. Gentamycin and ampicillin were administered subsequently at the same intervals, 12 h in the 34-40 weeks group, and 18 h in the 26-33 weeks group. Adequate serum levels were achieved from the first day of treatment. For practical reasons ampicillin and gentamycin can be administered subsequently at identical intervals also when the intervals exceed 12 h. The ideal dosing interval for gentamycin in very preterm neonates is 24 h. When treating small preterm and term neonates with an aminoglycoside, rapid serum concentration analyses should be available, and the treatment modified accordingly.

A microbiological study of conjunctivitis with emphasis on Chlamydia trachomatis, in northern Norway.

To determine the microbiological agents in conjunctivitis in children and young adults, physicians outside hospitals were asked to obtain samples from the conjunctiva in patients presenting with conjunctivitis. Specimens from 194 patients and 177 healthy controls were cultivated for Chlamydia trachomatis. In 12 cases Chlamydia trachomatis was isolated (i.e. 4 neonates, 1 three-year-old child and 7 adults, aged 17 to 39 years), but in none of the controls. Of the specimens from patients 168 and all of the healthy controls were cultivated for both bacteria (including Chlamydia trachomatis) and viruses. The main micro-organisms, regarded as infectious, were Haemophilus influenzae (20), Streptococcus pneumoniae (18), Staphylococcus aureus (14) and Chlamydia trachomatis (9). Haemophilus influenzae (non-typable strains) were isolated more frequently in the age group below 5 years of age than in the age group 5-50 years. Herpes simplex virus (type II) was isolated in one neonate. Chlamydia trachomatis is among the most important infectious agents in conjunctivitis treated outside hospitals. As chlamydial infections need special attention regarding treatment and follow-up, physicians should be encouraged to obtain specimens for microbiological examination, including chlamydia, from the population at risk.