Robert von Essen

Yersinia Antigens in Synovial-Fluid Cells from Patients with Reactive Arthritis

We examined synovial-fluid cells from 15 patients with reactive arthritis after yersinia infection for the presence of yersinia antigens. Extensive bacterial cultures of the synovial fluid were negative. All the samples were studied by immunofluorescence with use of a rabbit antiserum to Yersinia enterocolitica O:3 and a monoclonal antibody to Y. enterocolitica O:3 lipopolysaccharide. Synovial-fluid cells from 41 patients with other rheumatic diseases served as controls. Synovial-fluid cells from 10 patients with reactive arthritis after yersinia infection stained positively on immunofluorescence; rabbit antiserum and the monoclonal antibody yielded similar results. In most patients the percentage of positive cells ranged from 1 to 10 percent, but in one patient nearly all the cells in the sample stained strongly. Most of the positively stained cells were polymorphonuclear leukocytes, but yersinia antigens were also found in mononuclear phagocytes. All the control samples were negative. Synovial-fluid cell deposits from nine patients were also studied by Western blotting with use of the same antibodies. The results were positive in six of the nine cell deposits from patients with reactive arthritis and in none of the 10 cell deposits from control patients with rheumatoid arthritis. We conclude that in patients with reactive arthritis after yersinia infection, microbial antigens can be found in synovial-fluid cells from the affected joints.

Antibody responses to the Epstein-Barr virus and cytomegaloviruses after open-heart and other surgery.

Abstract Patients undergoing heart surgery with or without extracorporeal circulation were tested for antibody responses to the Epstein-Barr virus (EBV) and cytomegalovirus (CMV) to assess the frequency of transmission of the two viruses by these procedures. Anti-EBV responses followed both extracorporeal circulation with fresh blood and transfusions of stored blood overall in 8 per cent of 229 patients. Among 18 without preoperative antibodies anti-EBV unaccompanied by overt illness developed in six. Anti-CMV responses were noted only among the 152 patients with extracorporeal circulation overall in 35 per cent and in 59 per cent of 61 patients without preoperative antibodies. Of 72 patients specially followed, 17 formed anti-CMV de novo, accompanied in four by the postperfusion syndrome. Hepatitis-associated (Australia) antigen became detectable in one of the 72 patients, the only one in whom hepatitis B developed.

Subclinical cytomegalovirus infections and cytomegalovirus mononucleosis after open heart surgery

Abstract In a series of 63 patients submitted to open heart operations in which fresh blood was used for perfusion, a significant (i.e., at least eight-fold) postoperative rise in the titer of complement-fixing antibodies to the cytomegalovirus was established in 19 cases (30 per cent). After the operation, 1 patient had a febrile syndrome with hematologic features of infectious mononucleosis but without positive findings on a heterophil agglutination test. The cytomegalovirus was isolated from the urine. The illness was considered to be a clinical manifestation of acquired cytomegalovirus infection, cytomegalovirus mononucleosis. In 18 other patients with a postoperative rise of cytomegalovirus antibody titer, no clinical disease was observed. The frequency of significant postoperative rises in the antibody titer was clearly correlated to the preoperative level of antibody titer. A significant rise was established in 10 of 17 patients (59 per cent) who had no demonstrable antibodies preoperatively, in 9 of 36 patients (25 per cent) whose preoperative titer was relatively low and in none of those with higher preoperative titers. In a control series of 60 patients submitted to other kinds of heart operations, without extra-corporeal circulation and with the use of citrated bank blood only, no significant rise of cytomegalovirus antibody titer was established in any patient. The transfer of the infection via fresh or relatively fresh blood, transfused in large quantities, offers the best explanation for the common occurrence of cytomegalovirus infection after open heart operations. Extracorporeal circulation may be of importance in the transmission of a new infection or reactivation of a latent infection.

T-lymphocyte proliferation in mononucleosis☆

Abstract Lymphocytes from patients with mononucleosis were characterized by their receptors for complement (B-cells) and for sheep red cells (T-cells). As judged by these tests, patients with mononucleosis had higher numbers of T-cells than did control subjects. Lymphocytes were fractionated according to size by 1g velocity sedimentation, and subsequently tested for rosette formation. In other tests, cells forming rosettes with sheep red cells were isolated by the same technique. In both types of experiments the circulating lymphoblasts, as quantitated by labeling of cells in DNA synthesis, were found to be predominantly T-cells.

Waterborne Campylobacter jejuni Epidemic in a Finnish Hospital for Rheumatic Diseases

A waterborne Campylobacter jejuni outbreak in the Rheumatism Foundation Hospital in Heinola, Finland, in November-December 1986 is described. 32 patients and 62 members of the staff developed gastrointestinal symptoms. C. jejuni heat-stable serotype 45 was isolated from the faeces of 32 enteritis patients and from none of the controls. No other enteropathogens were found. Positive serological responses to C. jejuni acid extract antigen were detected by enzyme immunoassay in 34% of the symptomatic hospital patients, in 40% of the symptomatic staff members, and in 10% of the controls. The clinical course of the illness was mostly mild and self-limited. No striking progress in the arthritis symptoms of the patients was found after the outbreak. The hospital has its own water supply. C. jejuni of the same serotype as the epidemic strain was isolated from the water of the pipeline system. After a careful examination some aged components of the waterworks were found to be responsible for leaks that resulted in the contamination of the water.

Alloiococcus otitidis-otitis media pathogen or normal bacterial flora?

During the last decade a new potential otitis media pathogen, Alloiococcus otitidis, has been studied. It is still not clear whether this bacterium really is a pathogen, although it has been found in a high percentage of middle ear effusions in children. The present study aimed to investigate the presence of A. otitidis in the nasopharynx and outer ear canals, and to develop a culture method that would make it possible to isolate A. otitidis from these locations. Nasopharyngeal samples (n=129) from children below 6 years were investigated by conventional culture on blood agar plates with 6% saline and rabbit antisera against A. otitidis, and by a PCR method. In the same way, we investigated 10 samples from vestibulum nasi of healthy persons, 68 samples from outer ear canals of patients with acute or chronic ear problems, and 24 samples from outer ear canals of healthy persons. In a rat model of acute otitis media, we instilled living A. otitidis into rat middle ears through the tympanic bulla and evaluated the outcome clinically by otomicroscopy at days 3, 6 and 14. Of the 129 nasopharyngeal cultures, 9 were positive for A. otitidis by PCR, but none by the culture method. Of the 68 samples from patients with running ears, 4 were positive for A. otitidis by PCR, but none by the culture method. Of the 24 healthy ear canals, 7 were positive for A. otitidis by PCR and 3 of them also by the culture method. No A. otitidis could be found from the vestibulum nasi. The rat experiment showed that the reactions in the middle ears were mild; we could not provoke a purulent acute otitis media in any of the rats. There was a 7% prevalence of A. otitidis in children below 6 years. The highest prevalence (29%) was found in outer ear canals of healthy persons, which strongly suggests that A. otitidis is part of the normal bacterial flora of the outer ear canal. The doubtful pathogenicity is also confirmed by the fact that—in the rat model—A. otitidis elicited only a mild response in the middle ear. It was possible to isolate A. otitidis using a blood agar plate with 6% saline.

Precipitating autoantibody to a ubiquitous tissue antigen: Association with rheumatoid arthritis treated with sodium aurothiomalate or d-penicillamine☆

Abstract Precipitating antibodies to a nephritis-associated ubiquitous tissue antigen (UTA) were studied by immunodiffusion in patients with rheumatoid arthritis (RA). Positive reactions were found in 3.6% ( 3 84 ) of patients with short-duration (mean: 2.2 years) RA. After treatment of these patients for 6 months with gold or penicillamine, 19 ( 9 47 ) and 13% ( 3 23 ), respectively, had antibodies. Twelve percent ( 7 58 ) of RA patients with long-duration (mean: 9.9 years) RA on well-tolerated long-term (mean: 6.7 years) gold treatment had antibodies to UTA. The highest proportion of positive reactions, 47% ( 8 17 ), were seen in patients with long-duration (mean: 6.5 years) RA who had developed proteinuria during gold or penicillamine treatment. Circulating UTA was detected only occasionally. One person in a control material of 500 individuals had antibodies to UTA. It was considered possible that gold and penicillamine therapy may have facilitated this manifestation of autoimmunity.

Acquired bisalbuminemia in staphylococcal endocarditis treated with dicloxacillin

An albumin fraction with increased anodal mobility was observed on cellulose acetate electrophoresis, isoelectric focusing, and immunoelectrophoresis of serum obtained 1 month after a 68-year-old male patient had been treated with dicloxacillin for Staphylococcus epidermidis endocarditis. The patient also suffered from rheumatoid arthritis demanding hospital treatment. Normal albumin results from several earlier runs were thus available, and follow-up showed reversion to normal albumin mobility. Treating albumin with dicloxacillin in vitro produced a corresponding mobility increase.