Jürgen Knobloch

Evaluation of Two Nested PCR Assays for Detection of Histoplasma capsulatum DNA in Human Tissue

ABSTRACT In order to evaluate the diagnostic relevance of two nested PCR assays for diagnosis of histoplasmosis in clinical specimens, 100 paraffin-embedded biopsy specimens were examined. Upon microscopy of tissue, 50 biopsy specimens were histoplasma positive and 50 were negative. Due to destruction by formalin fixation, successful extraction of amplifiable human DNA was limited to 29 and 33 samples, respectively. A product of the Histoplasma capsulatum nested PCR assay targeting the gene encoding the unique fungal 100-kDa-like protein was detected in 20 histopathologically positive biopsy specimens but in none of the microscopically negative samples. Sequencing revealed that all 20 products of 210 bp were identical to the sequence of H. capsulatum in the GenBank database. In contrast, the nested PCR assay targeting the fungal 18S rRNA genes amplified products in 26 histopathologically positive but also in 18 microscopically negative biopsy specimens. However, sequencing revealed that only 20 of these 44 PCR products (231 bp) were identical to the sequence of H. capsulatum. The remaining 24 sequences were homologous to those of several Euascomycetes. These PCR products were detected only in tissues possibly colonized by nonpathogenic fungi, possibly causing these nonspecific amplifications. The detection limit of both H. capsulatum nested PCR assays was 1 to 5 fungal cells per sample. The two assays were similarly sensitive in identifying H. capsulatum. In this preliminary study, the novel 100-kDa-like-protein gene nested PCR revealed a specificity of 100% without requiring sequencing, which was necessary for identification of the 18S ribosomal DNA nested PCR products in order to avoid a high rate of false-positive results.

Safety and immunogenicity of GMZ2 — a MSP3–GLURP fusion protein malaria vaccine candidate

Malaria is a major public health problem in Sub-Saharan Africa. In highly endemic regions infants, children and pregnant women are mostly affected. An effective malaria vaccine would complement existing malaria control strategies because it can be integrated in existing immunization programs easily. Here we present the results of the first phase Ia clinical trial of GMZ2 adjuvanted in aluminium hydroxide. GMZ2 is a malaria vaccine candidate, designed upon the rationale to induce immune responses against asexual blood stages of Plasmodium falciparum similar to those encountered in semi-immune individuals. Ten, 30 and 100 microg of GMZ2 were well tolerated in 30 healthy malaria-naïve German volunteers when given three times in monthly intervals. Antigen-specific antibodies as well as memory B-cells were induced and detectable throughout the one year follow-up of the study. We conclude that GMZ2 is a safe and immunogenic malaria vaccine candidate suitable for further clinical development.

Comparison of fluorescence, antigen and PCR assays to detect Cryptosporidium parvum in fecal specimens

To optimize routine screening for cryptosporidiosis, 198 stool samples from patients at risk and from calves were examined by enzyme immunoassay (EIA), a direct fluorescent-antibody (DFA) and a modified immunofluorescence assay. Ninety-nine samples were positive in at least one assay, whereas 99 were negative in all three assays. Sensitivity of antigen EIA and DFA were similar (94%, 95% CI: 88-98%, and 91%, 95% CI: 84-95%). The modified immunofluorescence was significantly less sensitive (64%, 95% CI: 55-74%). 149 samples were also examined by two nested PCR assays targeting either the 18S rRNA or Cryptosporidium outer wall protein (COWP) gene. A PCR product was amplified from 86 out of 89 samples being positive in at least one other assay (sensitivity 97%, 95% CI: 91-99%). None was obtained from 60 samples negative in the three other assays. PCR assays did not increase the detection rate. Antigen EIA or DFA appear sufficient for routine Cryptosporidium screening of fecal samples.

Diagnosis and Monitoring of Murine Histoplasmosis by a Nested PCR Assay

ABSTRACT A newly developed nested PCR assay was applied to murine models of histoplasmosis. ICR and BALB/c mice were intravenously infected withHistoplasma capsulatum and sacrificed up to 29 days later. Samples of blood, spleen, and lung homogenates were cultured and examined by the PCR assay. In the ICR mouse model, 265 of 319 organ samples showed concordant results. With 7 samples, the culture was positive and the PCR assay was negative whereas a positive PCR but a negative culture were obtained with 47 samples (P < 0.0001 according to McNemars test). Organ homogenates and blood samples of either spontaneously cured or treated BALB/c mice were PCR negative. The nested PCR assay performs excellently in the monitoring of spontaneously and treatment-cured murine histoplasmosis. It limits the infection risks of the laboratory staff and might be of diagnostic value for humans.

Exchange blood transfusion in severe falciparum malaria: retrospective evaluation of 61 patients treated with, compared to 63 patients treated without, exchange transfusion.

The rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presumptive ‘toxic’ factors, and improvement of the rheological quality of the blood. We evaluated the records of 61 patients treated with ET to describe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of 61 patients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exchange transfusion is applied according to the clinician’s subjective impression rather than strict guidelines. Logistic regression analysis adjusting for the differences in clinical parameters between patients treated with or without ET did not identify treatment as a prognostic indicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4–4.9). Exchange transfusion did not significantly improve the unfavourable prognosis in cases of severe falciparum malaria. However, failure to reach statistical significance may be due to the retrospective design of the study and therefore non‐systematic approach.

Comparison of staining methods and a nested PCR assay to detect Histoplasma capsulatum in tissue sections.

To optimize diagnosis of histoplasmosis in tissue sections, 30 spleen specimens from mice, experimentally infected with Histoplasma capsulatum, were examined by H&E, Grocott stain, anti-bacille Calmette-Guerin antibody immunostain, Fungiqual A fluorochrome stain (Drs Reinehr and Rembold, Kandern, Germany), and a nested polymerase chain reaction (PCR) assay. Results were compared with the tissue burden determined by quantitative culture. By applying logistic regression, the nested PCR assay was the most sensitive method, but not significantly more sensitive than the Grocott stain. The 50% quantile to achieve a positive result was determined to be 3 colony-forming units per milligram of spleen tissue for the PCR assay, 11 for the Grocott stain, 27 for the fluorochrome stain, 190 for immunostaining, and 533 for the H&E stain. The Grocott and fluorochrome stains did not differ significantly in detecting fungal elements. The PCR assay unambiguously identified H. capsulatum in tissue sections.

Long-term malaria prophylaxis for travelers

Long-term malaria prophylaxis is hampered by a lack of standardization and compliance. Advice should be individually optimized to achieve a high degree of protection and compliance. Individual risk assessment takes into consideration the duration of stay in the endemic area, the individual exposure, the seasonal transmission rates, and the drug-resistance situation. Methods for prevention of exposure may help reduce the reliance on chemoprophylactic drugs. Exposure-prevention methods may be combined with standby treatment in lower transmission areas if the traveler has been trained to take the antimalarials appropriately. Although suitable for long-term use, chloroquine and chloroquine-proguanil cannot be used as prophylaxis owing to high resistance rates in most endemic regions. Mefloquine is suitable for most malaria-endemic regions, although its use is restricted by neuropsychiatric side effects, particularly in women. Doxycycline is also appropriate; experience with long-term malaria prophylaxis is available for up to 6 months. The use ofatovaquone-proguanil is restricted to 28 days in some countries, but clinical studies indicate that its use is suitable for at least 20 weeks. Primaquine is also effective for chemoprophylaxis; experience is limited to 1 year of protection against falciparum and vivax malaria. When giving individual recommendations to a traveler, special considerations for backpackers, expatriates, and frequent travelers may apply.

Cytopathic effects of Blastocystis hominis on Chinese hamster ovary (CHO) and adeno carcinoma HT29 cell cultures

Blastocystis hominis isolates from asymptomatic carriers and symptomatic patients were cultured in vitro, purified from the co‐cultivated bacterial flora and tested for cytopathic effects on monolayers of Chinese Hamster Ovary (CHO) cells and Adeno Carcinoma HT29 cells. In the case of the CHO cells, living B. hominis cells and B. hominis cell lysates were able to cause significant cytopathic effects, which were dependent on the concentration of cells employed. Destruction of the cell monolayers was observed to the same extent with patient isolates derived from healthy or symptomatic B. hominis carriers. HT29 cells were less susceptible: B. hominis cells and cell lysates caused only minor effects which were not statistically significant. Culture filtrates of B. hominis exhibited cytopathic potential on CHO and HT29 cells; however, the control which consisted of filtrates from Robinsons cultures in which B. hominis failed to grow showed similar effects, too. Therefore the culture supernatants could not be proven to produce a specific cytopathic effect on CHO and HT29 cells.

Isoenzyme patterns of Blastocystis hominis patient isolates derived from symptomatic and healthy carriers

Isolates of Blastocystis hominis derived from patients with intestinal symptoms and from healthy carriers were cultured in vitro and isoenzyme patterns of hexokinase (E.C. 2.7.1.1), phosphoglucomutase (E.C. 2.7.5.1) and glucose phosphate isomerase (E.C. 5.3.1.9) were investigated to find evidence for pathogenic and non‐pathogenic subspecies of B. hominis. For this purpose we examined 2000 patients of the out‐patient department of the Institute for Tropical Medicine in Tübingen. From these, we obtained 232 B. hominis patient isolates; 119 isolates could be tested for the three isoenzymes. Blastocystis hominis possesses 5 patterns for hexokinase, 11 for phosphoglucomutase and 35 for glucose phosphate isomerase, showing that B. hominis is highly polymorphic. However, there was no correlation between isoenzyme patterns and disease of patients.

Parasite‐specific lactate dehydrogenase for the diagnosis of Plasmodium falciparum infection in an endemic area in West Uganda

The measurement of parasite lactate dehydrogenase (pLDH) has been presented as an easy and rapid method for the diagnosis of malaria in humans. In order to evaluate the sensitivity and specificity of such a test we examined blood samples from 429 Ugandan patients. While pLDH activity was significantly linked to parasitaemia, sensitivity and specificity were found to be rather low at 58.8 and 62.2% respectively. The positive and negative predictive values failed to meet necessary standards. We conclude that the methods of measurement of pLDH activity in malaria infection, although potentially useful for the fast diagnosis of malaria, need to be improved to be of true value in endemic areas.