Michael Meurer

Adherence of Escherichia coli to sperm: a mannose mediated phenomenon leading to agglutination of sperm and E. coli

OBJECTIVE To investigate the mechanism of adherence between Escherichia coli and sperm. DESIGN Experimental study performed with donor sperm and male genital tract-derived E. coli. SETTING Andrology unit of a university hospital. PATIENTS None. INTERVENTIONS Monitoring of sperm-E. coli agglutination; addition of sugars to block adherence; electron microscopy. MAIN OUTCOME MEASURE Sperm-E. coli agglutination. RESULTS Escherichia coli readily adhered to and agglutinated sperm. The phenomenon was observed at E. coli to sperm ratios as low as 1:20; maximum sperm agglutination involving approximately 90% of spermatozoa was seen with ratios of 1:5 or higher. By transmission electron microscopy, E. coli adherence was observed both on sperm heads and tails. Heteroagglutination could be blocked by D-mannose and alpha-methyl-mannopyranoside but not by other sugars. Preincubation of sperm or E. coli with mannose resulted in block of agglutination, indicating mannose-binding structures both on sperm and E. coli. CONCLUSIONS Adherence of E. coli to sperm is mediated by mannose and mannose-binding structures present on both cell types. Agglutination of sperm by E. coli may be relevant in male and female infertility.

Treatment of severe cutaneous lupus erythematosuswith a chimeric CD4 monoclonal antibody, cM-T412

BACKGROUND Monoclonal CD4 antibodies are among the most potent immunomodulatory agents in various experimental models of autoimmune disease, including murine lupus erythematosus. OBJECTIVE The aim of this study was to evaluate the toxicity and therapeutic efficacy of a chimeric monoclonal CD4 antibody, cM-T412, in patients with cutaneous lupus erythematosus (LE). METHODS Five patients with severe cutaneous LE lesions received intravenously a total of 275, 400, or 475 mg of cM-T412 in single doses of 20 to 50 mg during a period of 5 to 8 weeks. RESULTS CD4 antibody treatment induced a long-lasting decrease in disease activity. It resulted in healing of LE skin lesions, a reconstituted responsiveness to conventional treatment, or both. Despite a substantial depletion of circulating CD4+ T lymphocytes, no clinical signs of immunosuppression were noted. CONCLUSION Monoclonal CD4 antibodies should be considered as a novel treatment for the management of severe cutaneous LE.

HIGH-DOSE INTRAVENOUS IMMUNOGLOBULINS FOR IMMEDIATE CONTROL OF SEVERE PEMPHIGUS VULGARIS

on 2 September 1993 for colitis and took this medication intermittently until seen in January 1994. From midSeptember 199 i to January 1994, he suffered severs 1 episodes of typical FDF on the trunk and genitalia. without bullae. Histological examination showed necrotic keratinccytes and a polymorphous dermal infiltrate. Each episode healed completely with residual pigmentation. These episodes appeared to be closely related to intermittent administration df clioquinol. This drug was stopped hi January 1994 with m subsequent eruption. Other drugs were continued.

Detection of Chlamydia trachomatis in semen by antibody-enzyme immunoassay compared with polymerase chain reaction, antigenenzyme immunoassay, and urethral cell culture

OBJECTIVE To compare the results obtained by four different techniques for the detection of Chlamydia trachomatis in the male genital tract. DESIGN Prospective study. SETTING Andrology unit of a university hospital. PATIENTS Male infertility patients. INTERVENTIONS Analysis of semen samples and urethral swabs for the presence of C. trachomatis by recombinant antibody-enzyme-linked immunosorbent assay (rELISA), polymerase chain reaction (PCR), antigen-enzyme immunoassay (EIA) and McCoy cell culture. MAIN OUTCOME MEASURE Detection of C. trachomatis. RESULTS In 57 of 205 semen samples (27.8%) immunoglobulin A-antibodies against C. trachomatis were found. In contrast, only 1 of 56 semen samples (1.8%) was positive for C. trachomatis-DNA by PCR, only 1 of 139 semen samples (0.7%) was positive by antigen-EIA, and only 4 of 173 urethral swabs (2.3%) grew C. trachomatis in cell culture. CONCLUSIONS The discrepancy of positive results found by the antibody-rELISA and direct methods for the detection of C. trachomatis indicates successful eradication of the microorganism in > 90% of antibody-positive men. Therefore, detection of antibodies against C. trachomatis in seminal plasma appears to be of limited diagnostic value.

Ultrastructural immunogold studies in two cases of linear IgA dermatosis. Are there two distinct types of this disease

Summary It has been suggested that patients with homogeneous linear IgA deposits at the basement membrane zone constitute a distinct bullous disorder called linear IgA dermatosis (LAD) of adults or children. The results of the present ultrastructural immunogold study in two patients with LAD suggest that LAD is not a single disease entity. LAD in a 10‐year‐old girl was found to be ultrastructurally similar to an IgA‐type pemphigoid. IgA was detected in the uppermost lamina lucida underlying the basal cell plasma membrane. In a second patient, an 86‐year‐old man, IgA deposits were present within the lamina densa and the anchoring plaques. The distribution of IgA in this patient was ultrastructurally identical with that of IgG in epidermolysis bullosa acquisita skin and with that of the non‐collagenous globular terminus of collagen VII within the basement membrane zone of normal skin. By using the immunogold technique, we could distinguish two distinct types of LAD according to the IgA binding sites in the diseased skin. We suggest that different labelling patterns may correspond to different clinical pictures.

Comparison of three methods to detect white blood cells in semen: leukocyte esterase dipstick test, granulocyte elastase enzymeimmunoassay, and peroxidase cytochemistry

Comparison of three methods for the detection of WBC in semen revealed a low concordance of positive test results. Among 557 semen samples, most positives were observed with the leukocyte esterase dipstick test (n = 95; 17.1%) followed by the peroxidase test (n = 51; 9.2%). There was little overlap between positives in the esterase-dipstick and the peroxidase method (29/117; 24.8%). With only 4 of 557 samples (0.7%), the PMN-elastase ELISA showed a surprisingly low incidence of positives. Because of lack of a gold standard, none of the three methods could be identified as superior. Because of its simplicity, specificity, and cost-effectiveness, the peroxidase method appeared most suited for clinical application.

Plasma exchange in the treatment of pemphigus vulgaris.

SIR, AS described by Umbert & Winkelmann (1977), we have also seen the association of granuloma annulare (GA) and sarcoidosis. This prompted us to investigate Kveim reactions in some patients with GA but without evidence of sarcoidosis. Seven patients were studied; four females and three males. The average age was 39. Two of the females had generalized GA but in the other patients it was localized to the hands or feet. The diagnosis of GA had been confirmed histologically in all patients. Kveim reagent (obtained from the Central Public Health Laboratory, London) was injected in a standard manner into the forearm of each patient and the test site was biopsied after 6 weeks. There was no macroscopic or microscopic reaction in any patient and, although the number of patients is small, the results suggest a difference between GA and sarcoidosis as far as Kveim reactivity is concerned.

Antibodies to Ro/SSA detected by ELISA: correlation with clinical features in systemic scleroderma.

Anti‐Ro/SSA antibodies were determined by a newly developed enzyme‐linked immunosorbent assay in serum specimens from 114 patients with systemic scleroderma in order to examine the relationship between Ro/SSA antibodies and clinical subsets of scleroderma. Sera of 42 patients (37%) were positive for Ro/SSA antibodies. Clinical investigations, including Schirmers test and enzymatic profiles, demonstrated that 60% (16 of 27) of scleroderma patients with sicca syndrome and 63% (10 of 16) with polymyositis (PM) were Ro/SSA positive. In these patients there was a significant association between Ro/SSA antibodies and rheumatoid factor. HLA‐antigens DR2, DR3 and B8 showed an increased frequency in anti‐Ro/SSA positive patients.

T4/T8 ratio and absolute T4 cell numbers in different clinical stages of Kaposi's sarcoma in AIDS

Thirty‐seven men (36 homosexual or bisexual and one heterosexual) with epidemic Kaposis sarcoma and underlying HIV infection were followed up over a period of up to 32 months. Fourteen patients (38%) died, with a median survival time of 7.2 months after the diagnosis of AIDS. Seventeen patients (46%) presented with one or more opportunistic infections, mostly Pneumocystis carinii pneumonia. Eighteen patients (49%) had lymphadenopathy syndrome according to the definition of the CDC. Using the Laubenstein‐classification of Kaposis sarcoma, all patients either remained stable or deteriorated, improvement was never observed. Absolute T4 lymphocyte counts and the T4/T8 ratio were not related to the disease stage. With the onset of B symptoms (systemic symptoms), however, the absolute T4 numbers and the T4/T8 ratio markedly decreased. Delayed type hypersensitivity also showed no relationship to the clinical stages of Kaposis sarcoma. Thus, the clinical progression of Kaposis sarcoma lesions seems to be largely independent of the immunological parameters investigated. However, the onset of B symptoms was observed to be related to changes in immune status.

Chronic ulcerative stomatitis

Chronic ulcerative stomatitis (CUS) has recently been described as a new disease entity characterized by chronic ulceration of oral mucosa which responds to treatment with hydroxychloroquine. It has a particular type of stratified epithelium‐specific, antinuclear autoantibody as an immunological marker. Twelve cases have been reported in the literature. We present a 40‐year‐old woman with an 11‐year history of chronic oral ulcerations. Other dermatological diseases, including oral lichen planus, pemphigus vulgaris and cicatricial pemphigoid, as well as bullous lupus erythematosus, were excluded. The clinical diagnosis of CUS was confirmed on the ground of the immunological and ultrastructural findings. The lesions initially responded to high doses of systemic corticosteroids but relapsed promptly after dose reduction. Dapsone was ineffective. Hydroxychloroquine, given at a dosage of 200–400 mg/day, led to a complete and longlasting remission.