Polyclonal Epstein-Barr virus-associated lymphoproliferative disorder following autografting for chronic myeloid leukemia.

Epstein-Barr-associated lymphoproliferative disorders have been described as complications of immunodeficiency states including allogeneic BMT. There is, however, only one report in the English language literature of such a disorder after autografting. We report a 56-year-old man undergoing autologous BMT for CML in whom a rapidly progressive lymphoproliferative disorder showing the histology of typical post-transplant lymphoproliferative disorder with latent EBV presence developed at approximately 30 days after BMT. Therapy with corticosteroids, acyclovir and alpha-interferon was instituted and led to prompt resolution of symptoms and signs. There was no evidence of lymphoproliferative disease at 7 months after BMT. It is concluded that EBV-associated lymphoproliferative disorders may be a complication, albeit a rare one, of intensive therapy with autologous stem cell support.

A new serovar mogdeni of serogroup Tarassovi of Leptospira interrogans isolated from a sewage plant in England.

Among 30 strains of leptospires isolated from samples of sewage taken before and during treatment at two sewage plants in England, only one appeared to belong to Leptospira interrogans, the species that comprises the leptospires that are pathogenic to man and animals. That strain, Compton 746, was isolated from settled sewage, before treatment at a treatment plant that deals mainly with human sewage. It was shown serologically to belong to serogroup Tarassovi and appears to represent a new serovar that has been named mogdeni after the name of the sewage plant, Mogden, from which it was isolated.

The risk of leptospirosis in United Kingdom fish farm workers. Results from a 1981 serological survey.

Less than one per cent of serum samples taken from 257 fish farmers in 1981 had agglutinating antibodies to strains of Leptospira interrogans of serogroup Icterohaemorrhagiae at a titre of 30 or greater. Compared with the results from other serological surveys, this agglutinating antibody prevalence suggests that fish farming does not have a high occupational risk for leptospirosis. Between 1961 and 1981 the incidence in fish farmers was about 33 per 100000 person years at risk. During the same period the incidence in the general adult male population was 0.137 per 100000 person years at risk, so that fish farming had a moderately increased risk of Icterohaemorrhagiae serogroup infection (relative risk = 243). No one particular risk factor within fish farming could be reliably identified and therefore recommendations to reduce the risk can only be general.

Acute renal failure due to leptospirosis: clinical features and outcome in six cases.

Six cases of severe leptospiral infection with renal failure are described. Five of the six patients had acute oliguric renal failure requiring dialysis. Renal function recovered over three weeks and by two months all patients had plasma creatinine levels less than 200 mumol/litre. The initial diagnosis of leptospirosis depended on clinical and epidemiological features because serological confirmation was not possible during the first week of the illness. All the patients had either high risk occupations or a history of exposure to external sources of infection. All had fever, myalgia, jaundice and muscle tenderness. Although bilirubin levels were high (greater than 350 mumol/litre in five) the elevations of aspartate transaminase and alkaline phosphatase levels, and prolongations of prothrombin times were relatively slight. Thrombocytopenia occurred in five of the six cases. Leptospira complement fixation tests were weakly positive or negative on admission in five cases but rose to significant levels subsequently. Penicillin treatment resulted in Jarisch-Herxheimer reactions in three cases. The important complications were: upper gastro-intestinal haemorrhage (five cases), thrombocytopenia less than 30 000 platelets/mm3 (four cases), atrial fibrillation (three cases), drowsiness with asterixis (four cases). All six patients were seriously ill and required intensive supportive therapy. All survived.

Leptospirosis in trout farmers.

A worker on a trout farm died from serologically confirmed leptospirosis. Four other workers at the trout farm had recently had an influenza-like illness; one had had jaundice. The man with jaundice had high leptospiral antibody titres, and two others had titres of 1/30. The remaining serum sample was negative. Family members and neighbours not associated with the farm had no detectable leptospiral antibodies. There was evidence of rat infestation around the ponds and in a shed used for storing trout food. Pond water or trout food contaminated with rat urine is believed to have been responsible for the outbreak. Another case occurred in a fish farmer elsewhere and it is thought he was infected through wading in rat polluted water with defective rubber boots. A survey to determine the incidence of leptospirosis in fish farm workers is under way.

Detection of leptospiral antibodies in animal sera by means of fractionated antigenic extracts.

Sodium dodecyl sulphate extracts of the reference strains Mus 127, Castellón 3 and Arborea of the Ballum agglutinogenic serogroup of Leptospira interrogans (the species of pathogenic leptospira), of strain Patoc 1 of the saprophytic species of L. biflexa, and of strain 3055 of illini serotype, the sole representative of L. illini, were each fractionated by ultracentrifugation in a sucrose density gradient into 10 fractions. The fractions were tested by complement fixation and immunodiffusion against the sera of animals during the process of immunisation and during the course of naturally occurring infections. The fractions could be divided into three main pools of serological activity: pool I (fractions 1, 2 and 3), pool II (fractions 4, 5 and 6), pool III (fractions 7, 8 and 9). Pool I was species/genus specific; fraction 1 tended to be species specific while fraction 2 reacted with antisera to all strains whether pathogenic or saprophytic. Pool II was serogroup specific and reacted only with antisera to members of the same serogroup. Pool III was serotype (serovar) specific and revealed the identity of the infecting strain at an early stage of infection.

Isolation and classification of sixteen strains of saprophytic leptospires.

Sixteen strains of leptospires were isolated from surface water (14 in England and 2 in Italy) and were classified. They were all saprophytic, and nine of them belonged to known serovars: the others were found to represent new serovars within already known serogroups.

Leptospirosis in human pregnancy followed by death of the foetus.

An attack of leptospirosis due to serotype canicola in a pregnant woman was followed in the convalescent period by death of the foetus. Previous cases of this nature are reviewed. In certain areas where leptospirosis is known to exist among the animal population early recognition and treatment of human cases is advised, especially when they occur during pregnancy.