Biomedical subjects
Publications and source records attributed to E Sandström.
The development of gonococcal serovar determination and the different nomenclatures are presented. The current prospects for the application of typing to clinical, epidemiological and theoretical studies are reviewed. Future prospects are discussed with special reference to the need for standardization.
Serological tests for hepatitis A (HA) and B (HB), syphilis and HIV were performed on blood samples from 3 groups of homosexual men: 220 and 124 asymptomatic men being investigated in 1978 and 1980 respectively and another 98 men suffering from HA during the winter 1979-80. The two asymptomatic groups revealed similar test results with respect to HA, HB and syphilis: about 25% had markers for HA, 50% for HB and 10-16% for syphilis. The 1979-80 HA group had a comparatively high frequency of markers for HB (64%) and for syphilis (34%), indicating that these men were sexually highly active. While all of the men in the 1978 test group were free from HIV antibodies, 2% of the 1980 and 6% of the 1979-80 group had antibodies to the virus. The results indicate that HIV was introduced to the gay population of Stockholm during 1979-80.
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In a health screening project for gay men in Stockholm, delayed cutaneous hypersensitivity was tested in 710 men by a commercial kit (Multitest, Mérieux) containing seven recall antigens and related to past hepatitis B virus (HBV) infection, various life style factors, the lymphadenopathy syndrome (LAS), and antibodies to human T-lymphotropic virus type III (HTLV-III). The multiscore (MS: the sum of all positive reactions) was significantly decreased in men with the following characteristics: HBV markers, greater than 50 yearly sexual partners, regular practice of receptive rectal intercourse, regular sex in gay bathhouses, recent sexual encounters in the US, greater than 50 lifetime exposures to inhaled nitrates, LAS, and positive HTLV-III serology. Anergy to tuberculin (TU) but not to any other antigen was more common in men with greater than 20 yearly partners, regular practice of receptive rectal intercourse, exposure to inhalant nitrates, LAS as well as lesser degree of lymphadenopathy, and HTLV-III seropositivity. HTLV-III antibodies were demonstrated in 61 of 416 (14.7%) men. During the 2-year follow-up four men have developed acquired immune deficiency syndrome. All four had MS less than 10 mm and TU anergy. In a BCG-immunized population Multitest only adds marginal information as compared to intradermal testing solely with TU, but may yield prognostic information in evaluating HTLV-III positive individuals with respect to development of manifest AIDS.
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During one year 738 gonococcal isolates from 731 consecutive patients with gonorrhoea were collected and classified by co-agglutination using W I and W II/III specific monoclonal antibodies. Eight W I and 30 W II/III serovars (serovariants) were seen. In both serogroups the most frequent serovar among isolates from women and heterosexual men differed from that among isolates from homosexual men. Forty-two per cent of the serovars, were confined only to one subpopulation, i.e. women, heterosexual men or homosexual men, representing 19 (3%) of the 738 isolates. Out of these 19 isolates 42% were acquired abroad compared with 12% of the 653 isolates in the serovars shared between two or all three subpopulations (p less than 0.005). Imported W I isolates were often of the same serovar that dominated in Stockholm. W II/III isolates acquired abroad were often of unusual serovars (p less than 0.0005) and might be a source of future changes of the serovar pattern in Sweden. In this way we can follow the introduction of new serovars into our society and their circulation between the subpopulations.
Among 292 heterosexual men with gonorrhoea seen during one year, 59 (20%), had a co-existing chlamydial infection. Of the men infected with a serogroup WI strain 30% had a chlamydial infection compared with 16% of those infected with a serogroup W II/III strain (p less than 0.01). Heterosexual men infected with WI strains had less objective symptoms as judged by the number of leucocytes per high power field and by discharge, than men infected with W II/III strains (p less than 0.05 and p less than 0.01, respectively).
A total of 113 patients with recurrent genital herpes were enrolled in a multicentre cross-over study. Two consecutive recurrences were treated with either oral acyclovir 200 mg or matching placebo five times daily for five days. Acyclovir significantly reduced the time to crusting and healing and the duration of new lesions and symptoms. Acyclovir was not found to have any clinically significant effect on the haematological or biochemical parameters measured, or to have caused adverse events and was well tolerated. Early self-initiated treatment may abort a recurrent attack of genital herpes without progression to the ulcerative or crusting stage.
Thirty penicillinase-producing Neisseria gonorrhoeae (PPNG) strains, 26 representing 9 serovars of the protein IB and 4 representing 2 serovars of the protein IA serogroup, had 10 different patterns when investigated by the restriction enzyme (RE) technique with Hind III enzyme. One RE pattern dominated, representing 11 strains with 6 different serovars of both the protein IA and IB serogroup. Identical serovars and RE patterns were found among 7 patients (3, 2 and 2, respectively) with positive epidemiology. The majority of the strains (24/30) were resistant to, or showed decreased sensitivity to, doxycycline with minimum inhibitory concentrations between 1 and 8 mg/l, consistent with the Far East origin. All the 30 PPNG strains showed by agarose gel electrophoresis to harbour a 2.8 Mdalton, a 4.4 Mdalton, as well as a 24.5 Mdalton plasmid, whereas the two non-PPNG strains had only the 2.8 Mdalton plasmid.
Two hundred and three homosexual (HS) men and 114 hemophiliacs in Sweden were examined for serum antibodies to human T-lymphotropic virus type III (HTLV-III) and for alterations of T-lymphocyte subsets. Sera were screened for HTLV-III antibodies by an enzyme-linked immunosorbent assay and/or a dot immunobinding assay, and positive reactions were confirmed by Western blotting. HTLV-III antibodies were demonstrated in 13 of 13 (100%) HS men with acquired immune deficiency syndrome, in 63 of 67 (94%) HS men with persistent generalized lymphadenopathy, in 17 of 45 (38%) symptomatic HS men, and in 6 of 78 (8%) asymptomatic HS men but in none of 108 male blood donors. Seropositive HS men had significantly lower T4/T8 (helper/suppressor) cell ratios and T4 cell numbers than had seronegative HS men. Seronegative HS men had decreased T-cell ratios compared to controls but not decreased T4 cell numbers. Among hemophilia A patients, HTLV III antibodies were demonstrated in 40 of 48 (83%) cases treated with American factor VIII concentrate and in 17 of 29 (59%) cases treated with both American and Swedish concentrates but in none of 13 cases treated exclusively with Swedish factor VIII. Twenty-one hemophilia B patients treated with Swedish factor IX concentrates were all seronegative, whereas one of 3 hemophilia B cases treated with imported factor IX was seropositive. T4/T8 cell ratios were significantly lower in seropositive as compared to seronegative hemophilia A patients.
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Sonicated whole cells of one of three tested goncoccal strains stimulated neutrophil migration in the agarose gel model. The activity was retained by the material pelleted by high-speed centrifugation of the sonicate. This supports the theory that certain strains possess a cytotaxin bound to the outer membrane.
A total of 849 gonococcal strains from 659 patients in Copenhagen (Denmark), Helsinki (Finland), Oslo and Trondheim (Norway) and Stockholm (Sweden) were included in the study. Using coagglutination reagents with polyclonal and monoclonal antibodies the strains were serogrouped into the previously described gonococcal serogroups W I, W II and W III. W II strains were dominating in all five towns (60.0%-70.9% of the strains), but W III strains were rarely isolated. W I strains were more frequent among women than among men. With the monoclonal reagents, W I, W II and W III strains could be further subdivided into 12, 29 and two different serovariants (serovars), respectively. One of the W I serovars was dominating (76%-94% of W I strains) in all five towns, and apart from this serovar, only three to five other W I serovars were seen in each town. Of W II strains, on the other hand, a greater variety of serovars were seen: between six in Trondheim and 17 in Oslo, and no one was dominating as among W I strains. Different W II serovar patterns were found in the different towns. Even between the two participating laboratories in each of the towns, Oslo and Helsinki, differences were noted. The epidemiological value of this is discussed. Ten of the 11 beta-lactamase-producing gonococcal strains isolated belonged to unusual serovars. None of the monoclonal coagglutination patterns corresponded to a single polyclonal pattern. There were, however, some relations between the two systems. In earlier studies it was shown that in smaller Swedish towns W I strains dominated. A hyphothesis about protective anti-Protein I antibodies is discussed to explain the differences in distribution of W I and W II strains between smaller and larger towns and between women and men.