B. Sarov

Chlamydia specific IgG and IgA antibodies in women with obstructive infertility as determined by immunoblotting and assays

The prevalence rate of IgG and IgA antibodies to Chlamydia was analyzed in 50 women with laparoscopy-verified tubal infertility and in 50 age-matched control women by single serovar (L2) inclusion immunoperoxidase assay (IPA) and by immunoblotting technique (IB) Women with tubal infertility had significantly (p < 0.001) elevated IPA Chlamydia IgG antibody titer ≥ 128 and ≥ 256 than controls (64% vs 16%. Odds ratio = 9.3 and 50% vs 10%, Odds ratio = 9 respectively). The prevalence rate of IPA IgA antibody titer (≥ 16) to Chlamydia was also significantly higher (p < 0.001) in women with tubal infertility than controls (48% vs 8%, Odds ratio = 10:6).Antibodies to at least 19 chlamydial structural polypeptides ranging in molecular weight from 30 kD to 204 kD, were detected by the IB technique in the IPA seropositive sera. Antibodies to 57-60 kD were detectable in almost all the IPA IgG and IgA seropositive sera. The prevalence rate of IgG antibody to 57 kD-60 kD was significantly higher in women with obstructive infertility than healthy woman (84% vs. 56% p < 0.01; Odds ratio = 3.8). More significantly, higher differences to 57–60 kD polypeptide were found in the case of IgA between the infertile women and controls (52% vs. 10%, p < 0.001;; Odds ratio = 9.7). The significance of IPA and IB technique for screening of infertile women is discussed.

Serum IgG and IgA antibodies to Chlamydia in ectopic pregnancies.

The possible association of Chlamydia trachomatis with ectopic pregnancies was evaluated in a case-control study, comprising 35 women with ectopic pregnancy and 294 apparently healthy women who served as controls. Chlamydia-specific IgG and IgA antibodies were determined by single serovar (L2) inclusion immunoperoxidase assay (IPA). Socio-demographic characteristics, gynecological history and contraceptive methods were also evaluated. An inverse relationship was found between the educational levels and the prevalence of IgG and IgA antibodies to chlamydia. The prevalence rate of elevated IPA IgG (titer greater than or equal to 128) and IPA IgA (titer greater than or equal to 16) specific to chlamydia was significantly higher in women with ectopic pregnancy versus controls (32% vs 8%, respectively, for IgG: odds ratio = 4.9; and 26% vs 4% for IgA: odds ratio = 7.5). Chlamydia trachomatis was not isolated in cell cultures in 10 specimens available from fallopian tubes of women with ectopic pregnancy. Only 9% of the women recall having pelvic inflammatory disease (PID) indicating that most of the infections were asymptomatic. Women who did not use IUD had a higher proportion of chlamydia-specific IgG and IgA seropositives, though not statistically significant, as compared to IUD users. This study further supports the hypothesis that subclinical infection of the tube with C. trachomatis may underlie ectopic pregnancies.

Sequential serological studies of homosexual men with and without HIV infection. Epstein-Barr virus activation preceding and following HIV seroconversion.

Viral cofactors may be important in the pathogenesis of HIV infection and the development of AIDS, but their role is still imperfectly understood. Sequential serological studies were performed in a cohort of 100 homosexual men and 70 matched healthy controls over a mean period of 4 years. Of the patients, 18 were found to be HIV+ on admission to the study and 15 seroconverted to HIV+ during the follow up (seroconversion group). Serum antibodies of both IgG and IgA isotypes against Epstein‐Barr virus (EBV) and cytomegalovirus (CMV) were determined. IgG antibodies indicate past infection, while a marked increase in IgG titre or a positive IgA titre were taken to indicate active infection or reactivated latent infection. EBV and CMV infections were about two to four times more prevalent in the homosexual men both HIV– and HIV+, compared with controls. Active infections were increased in the homosexual men and particularly in the HIV+ patients. The seroconversion group revealed activation of both EBV and CMV following HIV infection. When the antibody profile of seroconverting patients at the time preceding seroconversion was compared with a matched group of 39 homosexual men who remained HIV–, no change was found in CMV antibodies, but four out of 15 (26.6%) of the patients had high titres of anti‐EBV IgA preceding seroconversion, as compared with only one out of 39 (2.6%) of HIV– homosexual men (/<0.05). This suggests a role for EBV reactivation in the pathogenesis of HIV infection in some patients.

Epidemiological aspects of idiopathic peripheral facial palsy

Four hundred and twenty seven idiopathic peripheral facial palsy (IPFP) patients admitted to the Otolaryngology Department of the Soroka Medical Center in southern Israel between 1978 and 1982 were characterized and analyzed by age, sex and season of illness. An average annual incidence rate of 33.6 patients per 100,000 inhabitans was calculated which is considered to be the highest incidence reported so far, and may be explained by the very high coverage of the ≪Sick Fund≫ insurance in the region and by the warm arid climate that prevails in the area. Knowledge of the demographic characteristics of the patients and the population in the catchment area, allowed the calculation of age-specific incidence rates and it was found that this rate increases with age, reaching a peak of 68.2/100;00 in the older age group (>65 years of age). Peak morbidity in young patients (<30 years of age) occurs in the winter while elderly patients lack seasonal variability.

Prevalence of Vectors of the Spotted Fever Group Rickettsiae and Murine Typhus in a Bedouin Town in Israel

Abstract A survey of the vectors of spotted fever group Rickettsiae and of murine typhus was carried out in Rahat, a Bedouin town in the Negev Desert, where the diseases are endemic. Houses with known cases of spotted fever group Rickettsiae or murine typhus were compared with those without reported clinical cases. A neighboring Jewish community, Lehavim, where no cases of spotted fever group Rickettsiae and murine typhus were reported in recent years, was used as a control. In the houses of patients with spotted fever group Rickettsiae in Rahat, an average of 7.4 times more ticks were found than in control houses. Out of 190 ticks isolated from sheep and goats or caught by flagging in Rahat, 90% were Rhipicephalus sanguineus (Latreille), 7.9% Rhipicephalus turanicus Pomerantzev, and 2.1% were Hyalomma sp. In the houses of patients with murine typhus, three times more rats were caught and, on the average, each rat was infested with 2.2 times more fleas than rats in the control houses. Out of 323 fleas collected from 35 Norwegian rats (Rattus norvegicus Berkenhout), 191 were Xenopsylla cheopis Rothschild and 132 Echidnophaga murina Tiraboschi. Thus, there was a six to seven times higher probability of encountering a tick or flea vector where infections had occurred than in control houses in Rahat. The percentage of rats seropositive to Rickettsia typhi was similar in study and control households (78.3 and 76.2, respectively). In the control settlement, Lehavim, only three Mus musculus L. were caught, which were not infested with ectoparasites and their sera were negative for murine typhus. Out of 10 dogs examined in this settlement, 15 R. sanguineus and eight specimens of the cat flea (Ctenocephalides felis felis Bouché) were isolated. No rats were caught in this settlement. These data indicate that there is a correlation among the density of domestic animals, their ectoparasites, and the incidence of spotted fever group Rickettsiae and murine typhus in Rahat.

THE LONG TERM FOLLOW-UP OF ASYMPTOMATIC WOMEN WITH CHLAMYDIA TRACHOMATIS

SummaryA community oriented intervention program was initiated in 1985 in 12 rural communities in southern Israel to identify and treat women of reproductive age with markers of Chlamydia trachomatis (CT) infection. Among 860 women tested, 21 (2.4%) had CT IgG antibody titers ≥128, or CT IgA antibody titers ≥16, and 9 of these women had positive cultures for CT. The 21 women, as well as their male partners, received specific anti-CT treatment, and were followed up for 5 years to assess obstetric complications, and to evaluate the effectiveness of treatment. In 9 women positive cultures became negative. In 13 out of the 17 cases with sequential follow-up a four fold decrease in IgG specific antibody titers was observed. Yet, in all but two of the cases, IgA specific antibody titers remained ≥16.

Chlamydia trachomatis and HIV infection

To study the interactions between Chlamydia trachomatis (CT) and human immunodeficiency virus (HIV) infections, we examined CT serologies in sequential serum samples of male homosexuals (MHS), followed over a mean period of 4 years. Of the MHS studied, 77 were HIV(-), 18 were HIV(+) and 10 patients seroconverted during the study period. Seventy matched heterosexual controls were tested concomitantly. CT-specific antibodies of both IgG and IgA isotypes were determined by an immunoperoxidase assay, indicating past and active infection respectively. Anti-CT IgG was frequently observed in both HIV(-) and HIV(+) MHS (40-50% vs. 23% of controls) and IgA antibodies were also common in both MHS groups (15-20% vs. 1.5% of controls). After HIV infection, no increase in CT antibodies occurred. We found serological data suggestive of active CT infection preceding seroconversion in 3 of 10 seroconverters vs. 5% of matched MHS controls who remained HIV(-) (P < 0.025), indicating a possible effect of CT infection on the acquisition of HIV should be further studied.

Chlamydial IgG and IgA in serum and follicular fluid among patients undergoing in vitro fertilisation

The point prevalence of IgG and IgA antibodies to Chlamydia was analyzed in serum and follicular fluid in 63 patients undergoing in vitro fertilisation (IVF) in comparison to sera of 298 healthy women by the single serovar (L2) inclusion immunoperoxidase assay (IPA). The presence of specific IgG and IgA to Chlamydia in follicular fluid was demonstrated. No statistical association was found between the presence of specific Chlamydia IgG and IgA in serum and follicular fluid to oocyte fertilization. The positive predictive value for mechanical infertility of Chlamydia IgG at titers of greater than or equal to 128 and IgA titers at greater than or equal to 16 was 91 and 92%, respectively, in this high-risk group for mechanical infertility. Multiple regression analysis singled out Chlamydia IgG levels as a major contributor to the variance between the groups of infertile patients.