Relationship of secretion pattern and MPB70 homology with osteoblast-specific factor 2 to osteitis following Mycobacterium bovis BCG vaccination.

Significant homology was found between MPB70 and each of four repeat domains of osteoblast-specific factor 2 (OSF-2). Two internal homology regions within each repeat domain of OSF-2 presumed to be related to the active site(s) of this bone adhesion molecule showed the highest homology. A literature search concerning osteitis after Mycobacterium bovis BCG vaccination in neonates revealed that MPB70-high-producer substrains were associated with an increased incidence of osteitis following vaccination. These observations indicate that the function of MPB70 is related to the interaction between bacilli and the host following vaccination or infection with mycobacteria.

Evidence for absence of the MPB64 gene in some substrains of Mycobacterium bovis BCG.

Substrains of Mycobacterium bovis BCG have been divided in two major groups, high producers and low producers of the secreted proteins MPB64 and MPB70. Of these, Mycobacterium tuberculosis secretes only the analog MPT64 during growth on Sauton medium. It has been confirmed that high-producer and low-producer substrains of BCG as well as M. tuberculosis contain the gene for the MPB/MPT70 protein. By contrast, polymerase chain reaction and hybridization experiments are reported here which indicate that the MPB64 gene is absent in the BCG substrains Copenhagen, Pasteur, Glaxo, and Tice, in which previous methods did not permit distinction between secretion of small amounts or absence of the protein in culture fluids.

Performance of six different commercial assays to demonstrate antibodies to HIV-2 among immigrants from high-endemic areas.

Four HIV-2 and 8 HIV-1 infections were detected when serum specimens from 422 persons from high-endemic areas were examined with 6 different commercial ELISA tests. 41 specimens showed a positive result in at least one of the assays. 12 of these were confirmed as anti-HIV positive. One of the anti-HIV-2 specimens was negative in the Abbott recombinant HIV-1 test but positive in the ELAVIA II and the 4 HIV-1/HIV-2 combination tests. The 4 HIV-2 positive individuals originated from West Africa.

PIP: IN 1987 and 1988, laboratory technicians in Norway examined the sera of 422 African immigrants for HIV antibodies. They used 6 commercial ELISA assays (Abbott recombinant HIV-1 and HIV-1/HIV-2 tests, Biochrom-HIV-1/2, Elavia II, Rapid Elavia mixed, and Enzygnost anti-HIV 1+2). They confirmed any positive samples with HIV-1 and HIV-2 western blot tests. Defining conditions for anti-HIV-1 and HIV-2 positive included reaction to the transmembrane (gp41/gp36), the external glycoproteins (gp120, gp160/gp105), and/or to the core proteins p25/p26. They used the Lav Blot I+II and the Pepti-lav 1-2 tests to differentiate between HIV-1 and HIV-2. 41 of the samples tested positive with at least 1 of the ELISA tests. The western blot tests confirmed that 12 of the samples were indeed anti-HIV positive: 4 reacted as HIV-2 (all from West Africa), and 8 as HIV-1 (from West, East, and Central Africa). Of the remaining nonconfirmed samples, 27 has a positive result in 1 ELISA test and 2 in 2 tests. 11 samples that tested positive with the Abbott HIV-1 test also reacted in the other tests, except the Biochrom test. Further, 1 sample tested positive with all the ELISA tests positive with all the ELISA test except the Abbott HIV-1 test. Another sample only tested positive with the Enzygnost test, yet reacted and anti-HIV-1 positive with the Pepti-law 1-2 test. The HIV-2 specific and the combined HIV-1/-2 ELISA tests detected the 4 anti-HIV-2 positive samples, but the Abbott HIV-1 test detected only 3. All of the ELISA tests detected the 8 anti-HIV-1 positive samples. 1 immigrant tested positive for both HIV-1 and HIV-2. 1 sample reacted to the Enzygnost test and reacted as HIV-1 to the Pepti-lav test, yet the western blot test showed it to be negative. This study confirms that tests which can detect both HIV-1 and HIV-2 antibodies should be used to screen and diagnoses high risk groups.

Blood donor selection can prevent cytomegalovirus infection after open heart surgery.

Thirty-four patients without IgG antibodies against cytomegalovirus (CMV) prior to open heart surgery were studied. The patients were randomized to receive blood either from unselected donors, or from donors without detectable CMV antibodies. Fresh whole blood was mainly used. Eleven patients received CMV seronegative blood only. All had an uneventful convalescence period and remained seronegative. Ten of the 23 patients who received blood from unselected donors had typical CMV disease with the onset of symptoms in the third or fourth postoperative week, and fever lasting for two to three weeks. They all had liver enzyme release and later seroconversion against CMV. Four patients were hospitalized during this period. The incidence of symptomatic CMV infection after open heart surgery was higher than usually reported among the CMV seronegative patients. Selection of blood donors who lack antibodies against CMV may be an adequate protective measure. Avoidance of fresh blood and reduced use of blood products are presumably also of importance.

Primary cytomegalovirus infection following open heart surgery.

Among 674 patients undergoing open heart surgery in 1981-82, 86 (13%) were cytomegalovirus (CMV) antibody-negative when tested by an enzyme-linked immunosorbent assay prior to operation. At follow-up, 54 (67%) of 80 patients restudied had seroconverted after the operation, and 35 of the 54 seroconvertants had been ill with fever and elevated liver enzymes. Among the latter 35 patients, 26 demonstrated a significant rise in CMV antibody titre, most often detected in the third week following the onset of illness. The older patients were more susceptible to illness and seroconversion, and there was a positive correlation between age and the number of blood units given. Thus, at least one third of the seronegative patients developed symptomatic CMV illness after open heart surgery. This is a much higher incidence than earlier reported.

Pelvic inflammatory disease associated with Chlamydia trachomatis infection after therapeutic abortion. A prospective study.

Chlamydia trachomatis was cultured from the cervix of 70 of 557 (12.6%) patients admitted for therapeutic abortion. Postoperatively, 22 (3.9%) developed acute pelvic inflammatory disease (PID); of these women, 14 (63.6%) had harboured C trachomatis in the cervix before the abortion. Thus of 70 patients with chlamydial infection, 14 (20%) developed PID postoperatively. Of the chlamydia-positive patients, six of the 15 (40%) aged less than 20 years and eight of the 53 (15%) patients aged 20-30 years developed PID. Twelve of the 70 women with chlamydial infections showed a significant increase in serum chlamydial IgG antibody titres over a four week period; four of these women developed PID. Neisseria gonorrhoeae was recovered from only four patients, one of whom developed PID after the abortion. Treatment with a single dose of intravenous doxycycline (200 mg) was given before and during surgery to about half of the patients. In our study, this regimen had no protective effect against the development of PID associated with C trachomatis.

PIP: Chlamydia trachomatis was cultured from the cervix of 70 of 557 (12.6%) patients admitted for therapeutic abortion. Postoperatively, 22 (3.9%) developed acute pelvic inflammatory disease (PID); of these women, 14 (63.6%) had harbored C. trachomatis in the cervix prior to the abortion. Thus, of 70 patients with chlamydia infection, 14 (20%) developed PID postoperatively. Of the chlamydia-positive patients, 6 of 15 (40%) aged 20 years and 8 of 53 (15%) patients aged 20-30 developed PID. 12 of 70 women with chlamydial infections showed a significant increase in serum chlamydial IgG antibody titers over a 4-week period; 4 of these women developed PID. Neisseria gonorrheae was recovered from only 4 patients, 1 of whom developed PID after the abortion. Treatment with a single dose of intravenous doxycycline (200 mg) was given prior to and during surgery to about 1/2 of the patients. In this study, such a regimen had no protective effect against the development of PID associated with C. trachomatis.

Acute non-A, non-B hepatitis in Norway. Clinical, epidemiological, and immunological characteristics in comparsion with hepatitis A.

Serological analysis by radioimunoassay of sera from 297 patients hospitalized with acute non-toxic hepatitis was used for classification according to virus etiology. Radioimmunoassays included tests for hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to hepatitis A virus (anti-HAV), anti-HAV of IgM class, and antibody against cytomegalovirus (GMV) and Epstein-Barr virus. One patient with a significant rise in anti-CMV antibodies was classified as having CMV hepatitis. Among the 296 remaining patients serological markers indicated hepatitis A in 51 cases (17.2%) and hepatitis B in 208 cases (70.3%). The remaining 37 patients (12.5%) fulfilled criteria for acute non-A, non-B hepatitis. This type of hepatitis had symptoms and signs indistinguishable from those of hepatitis A, except for a slight tendency to milder disease on admission. A considerable proportion of patients with non-A, non-B hepatitis had a history of drug abuse (43.2%) and of recently traveling to endemic hepatitis areas (29.7%). In the remaining 27.1% no particular background was revealed. No case of post-transfusion hepatitis was seen. During the last 6 months of the study a striking change in epidemiology concerning hepatitis A was seen, apparently caused by a steep increase in the incidence of this type of hepatitis among drug addicts. No significant difference in biochemical liver tests was seen in non-a, non-B hepatitis or hepatitis A. In contrast, a marked and statistically significant difference in serum concentrations of IgM was found, with higher values (mean, 7.5 g/1; range, 3.2-13.9 g/1) in hepatitis A than in non-a, non-B hepatitis (mean, 3.3 g/1; range, 0.9-9.4 g/1). This difference may have diagnostic value.

Therapeutic abortion and Chlamydia trachomatis infection.

Chlamydia trachomatis was isolated from the cervix of 30 of 218 (13.8%) women admitted for legal termination of pregnancy. During the first two weeks after the abortion seven of the 30 (23.3%) patients developed pelvic inflammatory disease. Four of these had serological evidence of recent active chlamydial infection. Thus, routine examination of patients for genital chlamydial infection before termination of pregnancy is recommended.

PIP: The study objective was to record the incidence of Chlamydia trachomatis infections among patients admitted for legal abortion in Ullevaal Hospital (Oslo, Norway) and to follow those women harboring chlamydia, particularly those in whom it caused postoperative infections. 218 women admitted consecutively for abortion in the 1st trimester in 1980 were included in the study. The abortion procedure used was dilatation and vacuum aspiration. The diagnosis of pelvic inflammatory disease (PID) was made on the clinical basis of pelvic pain, adnexal masses, increased erythrocyte sedimentation rate, and fever. Patients who developed acute salpingitis were treated with doxycycline. Patients who harbored C trachomatis were recalled for follow up about 3 months after the abortion. Of the 218 patients, C trachomatis was isolated from the cervix in 30 (13.8%), N gonorrheae in 2 (2.8%), and both C trachomatis and N gonorrheae in 2. 7 of the 30 (23.3%) patients harboring C trachomatis developed PID. All the infections occurred in the 1st 2 weeks after the abortion. None of the patients with cervical gonorrhea developed salpingitis. 21 of the chlamydia positive patients attended for follow up 3 months after the abortion. Of the 7 patients with pelvic infection, 6 attended. 4 of these women had an appreciable rise in chlamydial IgG antibody titre while 2 had raised but unchanged titres. Another 4 patients had a 4-fold or more rise in titre but no clinical evidence of infection. Study findings indicate that patients harboring C trachomatis in the cervix at abortion are at high risk of developing postoperative infections and that C trachomatis is a major etiological agent in salpingitis occurring after abortion.

Chlamydial serum IgG antibodies in patients with acute salpingitis measured by an enzyme-linked immunosorbent assay.

An enzyme-linked immunosorbent assay (ELISA) for the detection of serum IgG antibodies to Chlamydia trachomatis has been developed. The C. trachomatis subtype LGV-2 was used as antigen. The ELISA was reproducible and its sensitivity and specificity compared well with that of the single-antigen immunofluorescence test (r = 0.83). 29 (85%) of the 34 patients with acute salpingitis had chlamydial serum IgG antibodies measured by the ELISA technique. The detection level in single blood donor specimens was 30%. Among the 34 patients with acute salpingitis, 16 paired serum specimens showed a fourfold or greater rise/fall in antibody titres, and 12 of these belonged to the 19 who harboured C. trachomatis in the lower genital tract.

A rubella epidemic in an unvaccinated pregnant population. 2. Seroepidemiology.

The study is based upon primary rubella infections detected in a collection of 7,781 serum pairs from as many pregnant women out of a total number of about 12,500 in the Oslo area of Norway in 1974. In the spring of that year, a rubella outbreak occurred. The results obtained on the serum pairs were compared and supplemented with acute serodiagnostic data obtained from the files of the virus laboratories, informations obtained from the mothers when interviewed in 1976 and from the files of application for legal abortions. From October 1973 through December 1975 a total of 118 serologically confirmed pregnancy infections were detected in the area, 94 of which took place between February and July 1974. The year following the outbreak showed scattered cases, whereas the last half of 1975 was free of cases. The pairs of the collection covered about one third of the pregnancy months occurring between February 1974 through January 1975, and the rubella infections diagnosed by seroconversion during this period indicated an attack rate for the epidemic period of 2.8% pregnancy months, and 0.35% for the post-epidemic period. 50% of the infections went unrecognised when they occurred, whereas only 17% seemed to have been subclinical. It is estimated that at least 9 children may have been born with rubella sequelae following infections during this period, when the legal abortions because of rubella in taken into consideration.

A rubella epidemic in an unvaccinated pregnant population. I. Screening methods and serological results.

During the 1974 rubella epidemic in Oslo, paired sera from 7781 pregnant women were examined for rubella-specific IgG antibodies using the single radial haemolysis (SRH) test. 12.4% of the women with seronegative in early pregnancy, with no significant variations between the different age groups. In the seropositive samples, there was a mean decrease in the rubella IgG concentration of about 30% during 22 gestational weeks. 53 seroconversions were found. In addition, 22 primary infections were detected by the demonstration of rubella specific IgM antibodies using an indirect immunofluorescence test. The persistence of the rubella IgM antibodies was examined and a large individual variation was found, from less than 1 month up to 4 months after onset of the disease. The serological techniques, particularly the SRH test, were found to be well suited for mass screening.