Interleukin-2, soluble interleukin-2 receptor and tumor necrosis factor in sera from patients with rheumatoid arthritis.

Interleukin-2 (IL-2), soluble interleukin-2 receptor (IL-2R) and tumor necrosis factor (TNF) have been measured in sera from 47 patients affected by classic rheumatoid arthritis (RA) using an enzyme-linked immunosorbent assay. The patients were divided into 4 groups as follows: group A, 18 patients with inactive disease; group B, 19 patients with active disease under treatment with non-steroidal antiinflammatory drugs (NSAID) and second-line drugs; group C, 5 patients with active disease under treatment with NSAID and cyclosporine A (CSA) for at least 4 months; group D, 5 patients in the same condition as patients of group C, but treated with azathioprine (AZA) instead of CSA. IL-2 was undetectable in all patients except two, both characterized by active disease. Soluble IL-2R levels were above the upper limit of the normal range in most of the patients studied, but the mean value ( +/- 1 SD) was significantly higher in patients of group B (1,288 +/- 421 U/ml) than in patients of group A (686 +/- 205 U/ml) and group C (842 +/- 414 U/ml). In two patients affected by active RA treated with pulse methylprednisolone therapy (1 g/day for 3 alternate days) the values of soluble IL-2R dropped from 948 to 662 U/ml and from 660 to 518 U/ml, respectively. No statistically significant correlation was observed between the serum level of IL-2R and the RF titre or percentage of C1q-binding activity, respectively. TNF was found within the normal range in all patients except one, who was characterized by active arthritis, high number of rheumatoid skin nodules and extremely high RF titre.(ABSTRACT TRUNCATED AT 250 WORDS)

A waterborne outbreak of leptospirosis.

During the period from July 10-26, 1984, 33 cases of serologically confirmed leptospirosis occurred in a small town in central Italy. The fatality rate, including the deaths of two unconfirmed cases, was 8.6% (3 of 35). Based on serologic evidence, the infection was caused by leptospires of the serogroup Australis. Epidemiologic study showed that the patients contracted the infection by drinking water from a fountain. The source of leptospiral contamination was probably a hedgehog trapped in a reservoir of water not in use but still connected to the water system of the fountain.

Human leptospirosis in an area of central Italy: results from a serological survey.

The results of a serosurvey for leptospiral antibodies in a random sample of healthy subjects are reported. The study was carried out in an area where a waterborne outbreak of leptospirosis, due to leptospires of serogroup Australis, had occurred a month before. Sera were tested with the microagglutination technique. Leptospiral agglutinins were found in 13.8% of tested subjects, mostly in adult females. The highest prevalence rate was observed for serovar lora belonging to serogroup Australis. The leptospires of this group have a relevant spread in the study area in keeping with other surveys carried out in Italy.

Endocarditis due to Cardiobacterium hominis.

A case of subacute bacterial endocarditis was caused by Cardiobacterium hominis in a 55-year-old man who had a history of rheumatic fever. A survey of the literature showed few reports dealing with the isolation of these organisms from human sources. Microbiologically, the chief distinguishing features of C. hominis are its characteristic colonial morphotype, a positive reaction, and its production of indole.

Childhood enteritis: a community study.

The population aged 0-12 years living in the area of an Italian Local Health Unit (about 8,800 children) was studied for one year in order to estimate the overall incidence rate of enteritis and the incidence rates of diarrheas from bacterial agents. All children complaining of acute diarrhea and seen by the pediatric practices of the study area were recorded by date, age, and sex; the microbiological study of stools was performed for a sample of patients. All hospitalized cases of childhood enteritis occurring in the same period in the study population were studied too. Campylobacter jejuni and Salmonella were cultured from 5 out of 71 examined out-patients (7.0%), with a projected annual consultation rate of 2.1 per 1000 population aged 0-12 years. Yersinia enterocolitica was cultured from 2 out-patients (2.8%), while no cases from Shigella and enterotoxigenic Escherichia coli were observed in this group. Data concerning hospitalized cases confirmed this pattern of results. Bacterial enteritis is an important public health problem in the study area and its occurrence is possibly related to animal reservoirs of infection, with particular regard to poultry and pets.

[Campylobacter pyloridis and gastritis: endoscopic, histological and microbiological correlations]. / Campylobacter pyloridis e gastrite: correlazioni endoscopiche, istologiche e microbiologiche.

Biopsy specimens from antral mucosa in 65 consecutive patients presenting for gastroscopy were assessed histologically and microbiologically for the presence of C. pyloridis. Spiral bacteria were found in 63% of cases by Warthin-Starry silver stain and in 72% by culture on blood agar plates with Skirrow's antibiotic supplement. A significant association between the occurrence of C. pyloridis and chronic gastritis was noted; the association is not influenced by the type of gastritis, superficial or atrophic, or the degree of activity of gastritis.

[Incidence and origin of Clostridium difficile in neonatology]. / Incidenza e origine di Clostridium difficile in neonatologia.

The epidemiology of Clostridium difficile was studied prospectively in 101 newborn infants by screening of fecal samples collected in the first or second day of life and in the fourth or fifth one. A vaginal swab and a stool specimen were collected from mothers before delivery. Environmental cultures were obtained from selected sites in the ward, while colonization of intestinal tract and contamination of the hands were evaluated in the personnel. C. difficile was isolated from the feces of 13 infants (13%); colonization rate was higher in infants delivered by cesarean section, but the difference was not significant. Intestinal carriage was demonstrated in two mothers (2%); the baby of one colonized mother was positive for C. difficile. All vaginal swabs were negative. Fecal samples of 2 nurses (18%) were positive; none of the environmental cultures yielded C. difficile. It was concluded that the mothers are not the sources of their infants' organisms and that the contamination of the environmental surfaces is the most likely explanation for the spread of C. difficile in the hospital setting.

[Obligatory anti-tetanus vaccination and the public health service]. / Vaccinazione antitetanica obbligatoria e servizi di sanità pubblica.

Tetanus antitoxin levels were measured in a non-random group of 281 subjects of pediatric age, using a passive haemagglutination technique. 94.7% of sera had protective antitoxin levels (titer greater than or equal to 1: 1024), while the other ones had levels usually considered as partly protective (titer of 1:256 or 1:512). Subjects who completed vaccination schedule had protective levels also 6 or more years after last dose. Subjects with partly protective antitoxin levels can be identified reviewing vaccination registers and recalling people who did not complete vaccination schedule. This procedure, if used as screening test, has sensitivity of 20%, specificity of 98% and a predictive value of positive tests of 37.5%. The quality of vaccination service of the study area, assessed using three indicators, resulted fairly good.