Th. Mertens

Epidemiology of HIV and Hepatitis B Virus (HBV) in Selected African and Asian Populations

Summary401 sera from patients of a rural hospital in Zimbabwe (1987), 211 South African sera (1982/83), as well as 460 sera from four Katmandu hospitals (1985) were tested for HIV-1 antibodies. The sera from Zimbabwe and Nepal were additionally tested for anti-HIV-2 using a panel of different tests, for hepatitis B markers, and partially for antibodies against other viral, bacterial, and protozoal antigens. Detailed clinical and sociodemographic data were taken from the Zimbabwe and Katmandu patients. The prevalence of HIV-1 antibodies in the Zimbabwe study population was 3.2%. All infections were found in the age group 17 to 30 years (n=254). The epidemiological situation was entirely different from that of HBV (hepatitis B virus). No serum could be confirmed to be anti-HIV-2-positive, but a definite diagnosis is still difficult to establish. Regular town contacts may be considered a possible risk factor. Antibodies against HIV-1 could not be detected in the South African and Asian sera. The seropositivity for anti-HBc in Katmandu (14%) and the prevalence of HBsAg (1.1%) was much lower than reported from other Asian countries.Zusammenfassung401 Seren von Patienten eines ländlichen Hospitals in Zimbabwe (1987), 211 Seren von Südafrikanern (1982/83) und 460 Seren aus vier Krankenhäusern in Katmandu (1985) wurden auf HIV-1-Antikörper untersucht. Die Seren aus Zimbabwe und Nepal wurden darüber hinaus vergleichend mit mehreren Tests auf HIV-2-Antikörper, Hepatitis B-Marker und zum Teil auf Antikörper gegen andere Viren, Bakterien und Protozoen untersucht. Ausführliche klinische und soziodemographische Daten wurden bei den Patienten in Zimbabwe und Katmandu erhoben. 3,2% der Seren aus Zimbabwe waren anti-HIV-1-positiv. Alle Infizierten gehörten der Altersgruppe zwischen 17 und 30 Jahren (n=254) an. Damit unterschied sich die epidemiologische Situation deutlich von der bei Hepatitis B. Antikörper gegen HIV-2 konnten in keinem Serum gefunden werden, aber eine definitive Diagnose ist z. Zt. noch schwierig. Regelmäßige Stadtkontakte stellen möglicherweise einen Risikofaktor dar. Weder in den Seren aus Südafrika noch in denen aus Nepal konnten HIV-1-Antikörper gefunden werden. Das Vorkommen von anti-HBc (14%) und vor allem HBsAg (1,1%) in Katmandu war wesentlich seltener als für andere asiatische Länder angegeben.

Neutralizing antibodies against Coxsackie B viruses in patients with recent onset of type I diabetes.

In a search for Coxsackie B virus-induced, insulin-dependent diabetes mellitus (IDDM) we examined sera from 166 selected patients (age 1–17 years) with recent onset of IDDM for specific neutralizing antibodies. All 166 patients investigated had a clinical history of recent infectious illness. Eighty per cent of the patients had antibodies against at least one Coxsackie B virus type. But even among the children studied with antibody titers higher than 256 only in about 44% could a recent Coxsackie B virus infection be serologically demonstrated by determining specific neutralizing IgM antibodies. This result again strengthens the notion that IDDM includes several different etiologic groups, among others possibly Coxsackie B virus infections.

The use of cultures of human osteoblastlike cells as an in vitro test system for dental materials

An in vitro culture of human osteoblastlike cells was established in order to perform toxicity tests with materials interacting with bone in vivo. Different dental materials were tested with osteoblastlike cells and with human gingival fibroblasts. Direct and indirect tests were performed according to the different properties of the materials. It was found that the osteoblastlike cells in test cultures were affected by materials that caused no visible cell damage in the fibroblast cultures. The results indicated that human osteoblastlike cell cultures represent a highly sensitive test system for cell-specific toxicity.

Problems of live virus vaccine-associated poliomyelitis a paralytic case with isolation of all three poliovirus types.

The case of a 4-month-old girl is described who developed a paralytic polio-like syndrome 3 weeks after oral polio vaccination (OPV). All three poliovirus types could be isolated (9 days after onset of disease polio type 2, and 33 days after onset of disease types 1 and 3, respectively).In order to classify these isolates as Sabin (vaccine)-like (SL) or non-Sabin-like (non-SL), several markers were tested in three laboratories [intratypic serodifferentiation, reproductive capacity at supraoptimal temperature (RTC), A1(OH)3 gel elution assay, and oligonucleotide mapping]. The results of the marker determinations were not uniform, but — summarizing all data — it seems plausible to associate the disease with the OPV. The significance of marker determinations in proving a vaccine-induced poliomyelitis is discussed in the light of this clinical case. Some comments are made on poliovirus vaccination policy in developed countries.

Two cases of coxsackie B2 infection in neonates: Clinical, virological, and epidemiological aspects

Two cases of neonatal coxsackie virus B2 infection are described. One infant presented with meningitis and enteritis, the other with rhinitis, meningoencephalitis, and enteritis. Both infants made good recoveries. The virus infection could also be demonstrated in all nonimmune family members, most of whom gave a history of recent mild febrile disease (pharyngitis, diarrhea). Enterovirus infections may be suspected in cases of neonatal meningitis or myocarditis associated with gastrointestinal signs, especially 1. when it is during the hot season July-October, 2. when there has been febrile illness in other family members recently. For an effective and rapid isolation of the agent, rectal swabs or stool specimens not only from the patient, but also from household contactss should be sent to the virus laboratory on several consecutive days. Meningitic infection may be proved by anearly c.s.f. sample. For serodiagnosis a first blood specimen should be drawn as soon as possible, a second one some days later. The importance of rapid virological diagnosis and of stringent hygienic measures to prevent spread of the infection is stressed.

Peripheral facial palsy and viral infections —Findings and problems

Eighty-four patients of the Cologne University ENT Clinic with a diagnosis of idiopathic peripheral facial palsy (PFP) were examined — both clinically and virologically. In addition, examinations were carried out on 33 further PFP-patients from different practising physicians (Group B) where the clinical information, however, was much less detailed. In the ENT Clinical Group (84 patients), there was a total of 12 recent virus infections (9 varicella zoster virus, 2 herpes simplex virus, 1 coxsackie B4). Proof of a recent infection depended strongly on the diagnostic prerequisites: if early and paired sera were available a virological diagnosis was possible in 32% of the cases, while in some of the other patients a recent infection could at most be suspected by the serological results. Group B with the 33 unselected patients yielded no virologically significant results. The aetiological relationship between the virological findings and PFP is discussed.

Perimyokarditis bei Influenza A Virus-Infektion

SummaryA 48-year old man was admitted with suspected acute myocardial infarction because of severe precordial pain and monophasic ST-elevations in the ECG. The patients history of an ongoing infection, the localization, extent, and course of the ECG changes as well as the development of a pericardial effusion suggested viral perimyocarditis. The diagnosis was supported by a significant rise of antibodies (seroconversion) against influenza A virus.

Re-implantation of homologous, cultivated osteoblast-like cells for improvement of bone regeneration: An animal study

The regeneration of osseous tissues after implantation of rat osteoblast-like cells cultivated in vitro was investigated. A cell line of rat osteoblast-like cells originating from explants of four inbred rats (Lewis) was established. The osteoblast-like cells were cultivated in vitro and re-implanted after 3 passages in cell culture into artificial femur defects of the same inbred Lewis rats. The cultivated osteoblast-like cells were embedded in bovine bone gelatine and implanted together with hydroxylapatite granulate (12 animals), pyrolized calf bone (12 animals) or without any additional material (12 animals). These bone replacement materials were used as a carrier for the osteoblast-like cells. After 10, 20, 40 and 80 days animals were killed and the treated femora were taken for histological examination and determination of bone growth rate. It was demonstrated that the cultivated osteoblast-like cells in this experiment had no measurable effect on quantitative bone growth, but caused a significant difference in the histological bone regeneration pattern.

Comparison of four different methods for detection of rubella IgM antibodies

Four different tests for detection of rubella-specific IgM antibodies were compared: two Ig separation methods (centrifugation and chromatography) with subsequent haemagglutination inhibition test and two commercially available ELISA tests. The 114 sera tested had been sent to the diagnostic laboratory, mostly with insufficient clinical histories. Agreement between the centrifugation method and one of the ELISA tests was good (2 divergent results with 107 sera tested), while the other ELISA test yielded more positive (partly perhaps non-specific) results. The chromatographic method did not separate the Ig classes as reliably as the centrifugation method, but because of its simplicity it may be useful, if adequate test controls are performed. The divergent results are discussed. It is postulated that in cases with pending induced abortion, two independent tests should be performed.

Demonstration of rubella-specific IgM by serum ultracentrifugation on sucrose gradients: Comparison of a vertical and a swinging bucket rotor

The performances of a vertical and a swinging bucket rotor in the diagnosis of rubella-specific IgM were compared using two sets of predominantly low titre rubella IgM positive sera. Applying a number of subtle criteria, the vertical rotor was shown to separate IgM and IgG less well than the swinging bucket rotor. If the vertical rotor was loaded with pretreated sera with IgG content decreased severalfold, its performance was similar to that of the swinging bucket rotor with native serum. The findings are discussed from the aspect of the main indication of rubella IgM testing, and it was concluded that for the majority of cases the vertical rotor would not present an alternative to the swinging bucket rotor.