[Non-tubercular mycobacterial infection of the lungs due to Mycobacterium smegmatis]. / Nichttuberkulöse Mykobakteriose der Lungen durch Mycobacterium smegmatis.

Nontuberculous mycobacteriosis due to M. smegmatis is a rarity. We report on the case of a 51 year old male HIV-seronegative patient without predisposing bronchopulmonary disease, but with a state after gastrectomy and splenectomy who developed unproductive cough, night sweat and weight loss. The chest radiograph and thoracic CT showed wide-spread bilateral patchy infiltrations. Histological examination of transbronchial biopsies revealed chronic carnificating pneumonia. A perhoracic fine-needle biopsy showed caseating epitheloid cell granulomas with acid fast bacilli. These were identified as M. smegmatis by PCR with subsequent sequencing. Acid fast bacilli could not be detected microscopically neither in sputum nor in bronchial secretions, however M. smegmatis has been repeatedly detected by culture in these materials. In neither material tubercle bacilli have been detected by nucleic acid amplification (NAT) or culture. Immunologic investigations revealed a reduced number of CD4+ lymphocytes and a reduction of interferon alpha- and -gamma-synthesis by peripheral blood mononuclear cells. Treatment with Rifabutin, Ethambutol, Clarithromycin and Ofloxacin resulted in complete clinical and roentgenological resolution.

[Primary pulmonary manifestation of extramedullary acute myelocytic leukemia]. / Primär pulmonale Manifestation einer extramedullären akuten myeloischen Leukämie.

We report on a 49 year old female with primary extra-medullary manifestation of a acute myeloid leukemia in the lungs without leukemic signs. The disease was diagnosed by detection of leukemic blast cells in bronchoalveolar lavage. Chemotherapy with the TAD-VP-scheme resulted in partial remission. The patient died in systemic early relapse. To our knowledge this is the first description of primary isolated extra-medullary manifestation of a acute myeloid leukemia in the lungs.

[Determination of thyroglobulin autoantibodies using enzyme immunoassay, radioimmunoassay and passive hemagglutination]. / Untersuchungen zum Nachweis von Thyreoglobulin-autoantikörpern mit Enzymimmuntest, Radioimmuntest und passiver Hämagglutination.

A solid-phase enzyme immunoassay, a radioimmunoassay and the passive hemagglutination were tested for the determination of antithyroglobulin autoantibodies. The antibody-titres detected with these methods showed a good correlation. The sensitivities of the solid-phase immunoassays are four times higher than the sensitivity of the passive hemagglutination. For the diagnosis of thyroid autoimmune diseases the enzyme immunoassay.

[Incidence of goiter and thyroiditis in chronic inflammatory rheumatism]. / Strumahäufigkeit und Thyreoiditis bei chronisch entzündlichem Rheumatismus.

In our investigations 201 patients with rheumatoid arthritis show in 127 cases according 63.2% (123 women = 71.1%; 4 women = 14.3%) and 32 patients with collagen diseases in 11 cases according 34.4% (11 women = 43.3%) a goiter. In comparison to a control group with a goiter incidence of 29.5% in women (168 out of 570 women), we found in female patients with rheumatoid arthritis or collagen diseases a clearly higher prevalence of goiter. But there was no difference of goiter frequency between the small groups of men. A second aim of our study was to investigate, whether an increased occurrence of the hypertrophic kind of Hashimoto's thyroiditis is to find in patients with rheumatic diseases, because of a possible association of two immunological induced affections. The results of sonographical, immunological and cytological examinations of the thyroid gland suggested no high responsibility of Hashimoto's thyroiditis for the goiter frequency in rheumatism. Only in three out of 201 investigated patients with rheumatoid arthritis (1.5%) we were able to diagnose this disease. In comparison to a rheumatologically healthy population out of the same catchment area (HT-frequency less than 0.5%), indeed the morbidity rate in rheumatic patients seems to be 3 times higher. But for a goiter frequency of altogether 63.2% in this disease the Hashimoto's thyroiditis is only of very small importance. Other causes such as pharmacotherapy with goitrogenic antirheumatic drugs, conditions of iodine deficiency, disposition and probably also an increase of thyroid growth stimulating immunoglobulins may be alone or in combination or a much higher degree responsible for goiter development in patients with rheumatoid arthritis or collagen diseases.

Multireactive human monoclonal antibodies.

Human monoclonal antibodies were tested using different immunochemical procedures for their reactivity with various antigens. The great majority of human monoclonal IgM antibodies (15 out of 24) turned out to bind to a whole series of recognized antigens (DNA, keratin, tetanus toxin, ricin etc.). The specificity of these reactions was detected by competitive assays. For some antibodies a simultaneous reaction with two antigens could be demonstrated by capture bridge technique. IgG antibodies also turned out to be multireactive, but not to the same extent (range of antigens much smaller, only 5-6 out of 53).

[Axial filament antigen enzyme immunoassay (AF-ELISA) in syphilis serology]. / Der Axialfilamentantigen-Enzymimmunassay (AF-ELISA) in der Syphilisserologie.

179 sera from patients with various stages of syphilis were investigated in the axial filament enzyme linked immunosorbent assay (AF-ELISA), the Treponema pallidum haemagglutination assay (TPHA), the fluorescence treponemal antibody absorption (FTA-ABS) test and the cardiolipin micro precipitation test (CMT). For the control of specificity 30 problem sera from non Treponema pallidum infected patients with a high quantity of Treponema genus specific antibodies and 40 sera from people without syphilis were also investigated. The sensitivity of the AF-ELISA (98.3%) was comparable with the TPHA (99.4%) and the FTA-ABS-test (98.9%). It was a high unspecificity in the group of problem sera.

[Characterization of treponemal axial filament antigens using the Western blot]. / Charakterisierung der Treponemen-Axialfilamentantigene im Westernblot.

Analysis by SDS-PAGE of axial filaments of cultivable treponemes showed 3 major bands: a 33/34 kD doublet and a 37 kD polypeptide. In sera from patients with various stages of syphilis, from biological false positive reactors, and from negative controls the most consistent reaction was detected against the doublet, but only sera from patients with primary or secondary syphilis reacted with the 37 kD axial filament polypeptides. About 6 weeks after antibiotic treatment sera had lost their reactivity with 37 kD antigens in agreement with decreasing antibodies in VDRL-test. Because of their recognition early in infection 37 kD-proteins are postulated to use in serodiagnostic assays, but our data emphasize also the need for use further antigens in tests for diagnosis in later stages of syphilis.

[Detection of circulating immune complexes in patients with EPH gestosis or intrauterine fetal growth retardation]. / Nachweis von zirkulierenden Immunkomplexen bei Patientinnen mit EPH-Gestose oder intrauteriner fetaler Retardierung.

Sera from 19 patients with EPH gestosis, 22 patients with hypotrophic newborns, and a control group of ten women with normal pregnancy and fetuses were studied for the presence of circulating immune complexes. Both the C1q solid-phase radioimmunoassay and the polyethylene glycol precipitation test revealed significantly higher levels of circulating immune complexes in both groups of patients.

Reticulin antibodies in coeliac disease.

The diagnostic value of demonstrating reticulin antibodies in children affected by coeliac disease is discussed. The antibodies were shown by immunofluorescence in 201 serum samples of 82 patients during the initial phase, during gluten provocation after several months of gluten-free diet. Demonstration of reticulin antibodies is not useful in screening for coeliac disease in patients suspect of the condition since both false positive and negative results occur in spite of the high sensitivity of the test. Determination of the antibodies is, however, a useful guide in dietary control. The antibodies discriminate coeliac disease from cow's milk protein intolerance.

[Problem of the early diagnosis of Goodpasture syndrome]. / Zum Problem der Frühdiagnostik des Goodpasture-Syndroms.

It is reported on a 16-year-old patient with Goodpasture's syndrome in whom in a period of two years recurrent respiratory infection with haemoptyses appeared. Shortly after admission to hospital he died of respiratory insufficiency. Immunohistologically post mortem on pulmonary and renal tissue could be proved diffuse linear deposits of IgG and C3 on the basement membrane of the renal glomeruli and the alveoli. Histologically prevailed pulmonary haemorrhages and pulmonary haemosiderosis, whereas on the kidneys only a focal segmental mesangioproliferative glomerulonephritis was present. References are given to the possibility of early diagnosis by means of immunohistological examinations on the lungs and/or biopsies of the kidney and the determination of circulating glomerular antibodies of the basement membrane, since despite general knowledge also in adequate anamnesis with relapsing pulmonary haemorrhages at juvenile age it is not always thought of this fact and hopeful courses under early therapy with corticoids, immunosuppressive drugs and perhaps plasmapheresis are described in literature.

[The significance of "slight proteinuria"]. / Zur Wertigkeit der "geringen Proteinurie".

It is reported on renal biopsies in 67 patients with "slight proteinuria", 39 of whom were at an age of younger than 20 years. In 53 patients the cause of the "slight proteinuria" is a mesangio-proliferative glomerulonephritis, where in 2 cases severe changes with sclerosis were proved. Thus by way of addition the necessity of a renal biopsy is emphasized for the clarification of the cause also of a "slight proteinuria".

[Idiopathic adrenal cortex dystrophy with the clinical picture of Addison's disease]. / Zur Kenntnis der idiopathischen Nebennierenrindendystrophie mit dem klinischen Bild des Morbus Addison

Clinical and autopsy findings are reported of three cases of Addisons disease due to idiopathic dystrophy of the adrenal cortex as seen in two women, 20 and 37 years of age respectively as well as a boy of 14 years. Idiopathic dystrophy of the adrenal cortex as a cause of Addisons disease has become aware of more and more frequently for some years. Its classification as an auto-aggression disease has been made a subject for discussion. Morphological findings and immunological investigations with three own cases confirm this conception. This disease should be reminded of with regard to the problem of clinically diagnosing it and the fatal prognosis of untreated cases.

[Humoral immune reaction in chronic liver diseases]. / Humorale Immunreaktionen bei chronischen Lebererkrankungen

In 60 patients with a morphologically ascertained chronic liver disease and 40 hepatologically examined patients with a healthy liver of a control group the quantitative determination of the immunoglobulin and the immunofluorescence-serological determination of antibodies against nuclei, smooth musculature and mitochondria were carried out. Only in one female patient with a chronic active hepatitis out of 51 patients with morphologically ascertained liver cirrhosis or chronic active hepatitis antibodies against nuclei and smooth musculature in a level of the titre of more than 1 : 40 and only in 2 female patients with a primary biliary cirrhosis antibodies against mitochondria could be proved in a level of the titre of more than 160. Titres of antibodies lying below were found in the group of patients with liver diseases and the control group in the same frequency, so that an autoimmune form of the cryptogenic cirrhosis could not be differentiated. The proof of antibodies against nuclei and smooth musculature of a high titre in connection with an isolated increase of the IgG is of special diagnostic importance for the autoimmune form of the chronic active hepatitis; the same is the case in the proof of antibodies against mitochondria of a high titre in connection with an isolated increase of IgM.

[Immunopathological phenomenona in liver diseases]. / Immunpathologische Phlänomene bei Leberkrankheiten

More than 400 patients with acute and chronic liver diseases as well as non-hepatic diseases (control group) were examined for the existence of antibodies against mitochondria, smooth musculature and cytoblasts with the help of the immunofluorescence-serological method. The proof of the hepatitis-B antigen was carried out by means of the transmigration-electrophoresis. Auto-antibodytitres larger than 1 : 160 (limiting titres) could be established only in the chronically aggressive hepatitides and the chronically destructing non-purulent cholangitides. Whilst in the chronically destructing non-purulent cholangitides dominate high mitochondrial antibody-titres, in the chronically aggressive hepatitides the antibodies against smooth musculature and/or cytoblasts are dominating. When the hepatitis-B-antigen was present in all groups of diagnosis auto-antibody titres of 1 : 160 were not transgressed. The kind of the antibody-spectrum and the size of the antibody-titres seem to be suitable for the differential diagnosis. High mitochondrial antibody-titres in women are suspicious of a chronically destructing non-purulent cholangitis. High titres of antinuclear antibodies or such ones against smooth musculature might be a reference to the so-called auto-immune form of the chronically aggressive hepatitis. For a still better differentiation of the chronic liver diseases the determination of these antibodies seems to be valuable.