Italian experience with yersiniosis (1978-1985).
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Biomedical subjects
Publications and source records attributed to M Midulla.
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A fatal case of Coxsackievirus B-6 (CBV-6) infection in a 4 1/2-year-old girl is reported. The disease was initially characterized by a severe meningoencephalitis and, successively, by the appearance of hyperglycaemia and glycosuria, concomitantly with complement-fixing-islet cell antibodies (CF-ICA) and ICA, diarrhoea, electrolyte disorders, arrhythmia and decrease of the IgG levels, suggesting a multi-system involvement. CBV-6 was identified by isolation from stool and cerebrospinal fluid and by detection of specific IgM antibodies.
Paired sera from 46 vaccinees and 22 patients with clinically typical or atypical parotitis were tested for class-specific mumps antibodies by two different indirect enzyme-linked immunosorbent assay (ELISA) procedures. Both ELISAs appeared suitable, specific and more sensitive than neutralization (NT) and complement-fixation (CF). However, the macro-ELISA (M-ELISA) method, using beads as antigen-coated solid phase, showed a higher sensitivity than micro-ELISA (m-ELISA), performed on microplates. Diagnostic rises in mumps IgG antibodies and mumps IgA antibodies were detected more frequently by M-ELISA, mostly in post-vaccination sera. In addition, higher mean OD values of mumps IgG, IgA and IgM antibodies were generally found by M-ELISA. Nevertheless, m-ELISA appeared more convenient for evaluating class-specific mumps antibodies in large-scale studies, since the procedure is simpler, more rapid and less expensive than that of M-ELISA. Conversely, M-ELISA may be considered the test of choice for detecting low class-specific antibody levels. However, the determination of class-specific mumps antibodies appeared as an essential tool for evaluating vaccine-induced or naturally acquired mumps immunity.
The possibility that L. pneumophila causes cardiac disorders without respiratory or pulmonary symptoms in childhood was investigated. Out of 20 children with cardiac troubles of unknown aetiology, three showed a four-fold antibody increase or fall in titre against L. pneumophila antigens by the IFA test. Two children, aged 7 months and 2.5 years, had self-limiting arrhythmia and a third, 10-year-old, was suffering from a severe myocarditis. There was no serologic evidence of concurrent infection by respiratory or coxsackie B viruses nor by M. pneumoniae. It is suggested that Legionella infection should be considered in cardiac diseases in childhood, even if pneumonia is lacking.
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A fast-growing strain of human hepatitis A virus was selected and characterized. The virus has the unusual property of developing a strong cytopathic effect in tissue culture in 7 to 10 days. Sequences of the viral genome were cloned into recombinant plasmids with the double-stranded replicative form as a template for the reverse transcription of cDNA. Restriction analysis and direct sequencing indicate that this strain is different from that described by Ticehurst et al. (Proc. Natl. Acad. Sci. USA 80:5885-5889, 1983) in the region that presumptively codes for the major capsid protein VP1, but both isolates have conserved large areas of homology in the untranslated 5'-terminal sequences of the genome.
Between December 1982 and November 1983, stool specimens from 15 children with acute lymphoblastic leukemia, who were on maintenance cancer chemotherapy, were examined weekly for the presence of Clostridium difficile and its toxin. Four out of 15 patients were positive for C. difficile: three patients had stool specimens that did not contain toxin, but cultures yielded growth of toxigenic C. difficile on only one occasion. The fourth patient, who had a recent history of hospitalization, particularly aggressive cancer chemotherapy, neutropenia, and antibiotic therapy, excreted both C. difficile and its toxin for at least 1 month. All children were asymptomatic at the time of positive cultures. This preliminary study reveals a low rate of C. difficile colonization in leukemic children on maintenance cancer chemotherapy.
The increased occurrence of genital infections from Chlamydia trachomatis (Ct) suggested the need for a simple, rapid, sensitive method for detection of Ct. The purpose of the present study was to select symptomatic or asymptomatic women through two fast screenings: Pap-test and direct immunofluorescence (IF) test with monoclonal antibody. From 1,816 cervical cytology samples, 32 (1.76%) were selected for intracytoplasmic inclusions pathognomonic of Ct infection. Only 19 women underwent a check-up. The direct IF gave positive results in ten cases out of 19 (52.63%), and culture in eleven (57.89%). A correlation was made between the direct IF test and culture and also between cytologic and colposcipc findings. We thus conclude that direct IF, for its specificity, sensitivity, easy execution and low cost, could be currently utilized when clinical signs or Pap smears are suggestive of Ct infections.
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The efficiency of viral isolation in microplates was assayed during an epidemic outbreak of bronchiolitis and compared with the standard tube method. The agreement between the two methods was noteworthy. Although mainly dealing with isolation of RS virus, the data seem to indicate that due to its simplicity virus isolation in microplates is preferable to the standard tube method.
Acute-and convalescent-phase sera from 22 children were examined by ELISA in comparison with a routine complement fixation (CF) test for detection of anti-CMV antibodies. All these subjects were excreting CMV from urine and/or saliva. The results showed that ELISA is more sensitive than CF test. Particularly ten children showed, by ELISA, anti-CMV antibody titers more agreeing with clinical-virological features. Generally, in other subjects the results of the two serological tests were similar. Three cases showed discordances both between the two methods and between serological data and clinical virological findings.
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Acute-phase and convalescent-phase sera of 66 children, aged 3 months to 12 years, with neurologic disorders of unknown etiology were tested against Legionella pneumophila polyvalent and monovalent antigens (groups 1 to 4). Three significant antibody titer increases were obtained, all in children with acute cerebellar ataxia. This neurologic syndrome was characterized by sudden onset of muscle hypotonia and inability to sit or walk, with no other specific neurologic or systemic symptoms. Persisting pharyngitis always preceded ataxia. Fever of short duration was still present. Gastrointestinal disturbance occurred in two of the three children. Abnormal laboratory findings were, not always simultaneously, high ESR and leukocytosis with lymphocytosis. CSF levels and electromyographic findings were normal in two of the children. Two children received oral betamethasone. Recovery was complete within seven to ten days without antibiotic treatment. These studies indicate the possible etiologic role of L pneumophila in acute cerebellar ataxia.