The first case of lymphogranuloma venereum in a woman in East-Central Europe and its multiple co-infections

We are reporting the first case of lymphogranuloma venereum in women in East-Central Europe. A 22-year-old heterosexual woman attended our department of venereology. She complained about a burning sensation in the urethra and vaginal discharge. Many tests were performed, and lymphogranuloma venereum, syphilis, gonorrhea, chlamydial urethritis and cervicitis, genital herpes, genital warts, and hepatitis C were diagnosed. Lymphogranuloma venereum was originally endemic in tropical and subtropical areas, but since 2003, outbreaks of this infection have been reported in North America, Europe, and Australia in men who have sex with men (MSM) community. To date, all cases of lymphogranuloma venereum in the Czech Republic appeared in men, predominantly in HIV-positive MSM. There are not many evidences about lymphogranuloma venereum (LGV) in women in developed countries. This report underlines the need for awareness of lymphogranuloma venereum in women among gynecologists, venereologists, and other physicians not only in Western Europe, but across all European countries.     

Comparative Evaluation of Five Serological Methods for the Diagnosis of Sporotrichosis

The diagnosis of sporotrichosis can be time consuming. Serological procedures could facilitate the rapid and accurate diagnosis of this disease. A slide latex agglutination (SLA) test for sporotrichosis was developed and compared with the tube agglutination (TA), complement fixation (CF), and immunodiffusion (ID) tests in the serological study of 80 proven human cases of sporotrichosis representing the cutaneous, subcutaneous, and extracutaneous forms of the disease. In addition, the indirect fluorescent antibody (IFA) technique was applied to 61 case sera. In the SLA test, latex particles sensitized with culture filtrate antigens from the yeast form of Sporothrix schenckii (B 959) detected 94% of the cases, as compared to 96% of the cases detected by the TA test, 68% by the CF test, and 56% by the ID test. The IFA test detected 90% of the 61 cases. The SLA and ID tests were specific, showing no reactions with sera from 86 persons with no disease or with diseases other than sporotrichosis. Because of its sensitivity, specificity, ease of performance, and ability to provide results in 5 min, the SLA test is highly recommended for routine use in the clinical laboratory.     

The use of methanol extract of Leptospira interrogans in complement fixation tests for leptospirosis

Methanol extracts were obtained from L. interrogans serovars icterohaemorrhagiae and canicola and L. biflexa serovar patoc. Human sera from 167 normal individuals and 40 patients with different infectious diseases tested by complement fixation tests showed negative reactions. Sera from 100 patients with a suspicion of leptospirosis were tested by complement fixation tests and microscopic agglutination reactions. Agreement of 84% was found for those two reactions. Positive microscopic agglutination tests at a dilution 1:20-1:400 with negative complement fixation tests were observed in 5% of patients and negative microscopic agglutination with complement fixation tests in the range of 1:20-1:1280 were observed in 11% of the cases.     

Immunofluorescence as an Aid in the Early Diagnosis of Trichinosis

The established serological tests for trichinosis are often negative during the period when laboratory investigation is most likely to be useful.Another serological test, the immunofluorescence test, appears to be more promising in this respect. The results were based on studies involving experimental animals and human patients. In two rabbits orally infected with Trichinella spiralis larvae, antibodies were demonstrable by immunofluorescence on the fourth day after infection, by complement fixation on the eighth and tenth days, and by the precipitin test on the thirteenth and twenty-eighth days, respectively. In three human cases the immunofluorescence antibody test was positive two weeks (the earliest blood samples available) after onset, while precipitin and complement fixation tests did not become positive until the end of the fourth week. The immunofluorescence test thus becomes positive at least two weeks earlier than the other two, a factor which undoubtedly increases its value in diagnosis.     

Indirect Hemagglutination Test for Chlamydial Antibodies

An indirect hemagglutination (IHA) test is described for chlamydial antibodies in psittacosis diagnostic sera; for this test tanned sheep erythrocytes sensitized with a deoxycholate extract of Chlamydia psittaci grown in Vero cell monolayers were used. Adaptation of the IHA test to the Microtiter system decreased sensitivity; nevertheless, the Microtiter-IHA test was more sensitive than the complement fixation test. Lymphogranuloma venereum antibodies also were detected by using antigen extracted from C. psittaci.     

Pathology of cat-scratch disease

A pathologic and histogenetic study of material obtained from ten cases of cat-scratch disease was carried out. The earliest lesion was of ten days' duration and the oldest of 35 days' duration. The first changes in lymph nodes consisted of proliferation of epithelioid cells followed by exudation of leukocytes in their centers and subsequent necrosis of the exudate and epithelioid cells. Proliferative changes leading to formation of epithelioid cell tubercles were seen in some cases. Homogenization of necrotic centers brought about the formation of caseous tubercles similar to those seen in tuberculosis, syphilis, lymphogranuloma venereum and tularemia. Differentiation and the final diagnosis of cat-scratch disease rests upon correlation of histopathologic observations, clinical studies and specific skin tests.     

Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts

Serologic studies are an important diagnostic tool in the clinical evaluation and follow-up of persons with coccidioidomycosis. Numerous types of serologic tests are available, including immunodiffusion, enzyme immunoassay, and complement fixation. We conducted a retrospective review of the results of 1,797 serologic tests spanning 12 months from the onset of coccidioidomycosis in 298 immunocompetent and 62 immunosuppressed persons with symptomatic infection. Using the onset of symptoms as a reference point, we plotted the positive or negative serologic results over time for both groups. Compared with the immunocompetent group, immunosuppressed persons had lower rates of seropositivity for every type of test during the first year after onset of symptoms for coccidioidomycosis, although many results did not achieve statistical significance. Combining the results of these tests increased the sensitivity of the serologic evaluation in immunocompromised patients. Immunosuppressed persons have the ability to mount a serologic response to coccidioidomycosis, but in some circumstances, multiple methods may be required to improve detection.     

North American Blastomycosis in California—Diagnosis of a Case and a Survey with 28 California Observed Cases

North American blastomycosis is not seen often in California. An exhaustive survey uncovered records of only 28 cases. It is believed that this disease does not occur naturally in California and that a careful study of the history will reveal that a residence or visit to a known endemic area can be found.A chart summarizing the results of complement fixation and skin tests for coccidioidomycosis, North American blastomycosis, and histoplasmosis in the 28 cases is included. Use of all three antigens is recommended in cases where there is a difficult diagnostic pulmonary problem, even though there is occasional occurrence of cross-reactions between the three antigens. Finally, an appeal is made to be aware of other mycotic diseases non-edemic to this state.     

Serological diagnostic tools for the major tick-borne protozoan diseases of livestock

Tick-borne protozoan diseases, babesiosis and theileriosis, are among the most important diseases affecting the productivity of livestock worldwide and resulting in high economic losses. A prerequisite for the control of these diseases is to study their epidemiology by mapping their distribution and seasonality. As clinical diagnostic and surveillance tools, serological tests such as the complement fixation test (CFT), the indirect fluorescent antibody test (IFAT) and the enzyme linked immunosorbent assay (ELISA) have been successfully used over decades. With the development in molecular biology, recombinantly expressed parasite molecules have emerged and substituted crude parasite antigen used in serology. A popular format of these tests is the antibody binding competitive inhibition and the indirect antibody detection ELISA. Under the precondition that these tests are correctly designed and validated, they provide a powerful tool for epidemiology, with greater advantages of affordability and amenability to standardization. This paper reviews the pathogenic tick-borne protozoan diseases and the respective diagnostic ELISA based serological tests currently available for serosurveillance.     

Use of the passive hemagglutination test to diagnose toxoplasmosis]

The authors describe a method of obtaining toxoplasma erythrocytic diagnostic agent by sensitization of formalinized tannin-treated SRBC with purified toxoplasma antigen isolated by fractionation of complete toxoplasma antigen on Sephadex G-100. Comparative experiments with titration of sera of persons with suspected toxoplasmosis were conducted; the passive hemagglutination test with the antigen obtained proved to be highly sensitive in comparison with immunofluorescence and complement fixation tests.     

Erythrocyte test preparations for standardizing fluorescent antibodies and the serological diagnosis of influenza

An erythrocytic diagnostic preparation, obtained by the sandwich method and intended for the standardization of antivirus fluorescent antibodies (FA) and the determination of specific IgM in the blood sera of patients with a view to the early serological diagnosis of influenza, has been proposed. The loading of immunosorbents with influenza virus, achieved in this preparation, approaches its theoretical limit, the virions being arranged in a single layer, and constitutes up to 0.4 hemagglutinating units per 1000 red blood cells. The investigation made on 9 commercial and 4 experimental lots of FA has demonstrated that the newly developed test preparations serve as a convenient model for the standardization of FA and the choice of their optimum working dilution in practical diagnostic procedures. In the study of 153 paired blood sera from patients with acute respiratory diseases and clinically healthy persons the proposed variant of the early diagnosis of influenza has proved to be not inferior to the hemagglutination inhibition test and the complement fixation test with respect to the main characteristics of their diagnostic value, while having the advantage over these tests due to the fact that exact laboratory diagnosis can be made by the study of single blood samples as early as on the fourth day of the disease.     

A comparison of euglobulin fractions and whole serum in the hemagglutination and latex fixation tests

One hundred and thirty-two sera were investigated with the Waaler-Rose and latex fixation reactions. The reactions were performed with serum, with acid-precipitated euglobulin, and with cold-precipitated euglobulin. The material consisted of 35 sera from healthy persons, 23 from patients with various diseases, 28 from patients with joint symptoms not due to rheumatoid arthritis, and 46 from patients with classical rheumatoid arthritis.In rheumatoid arthritis sera, an increase in positive reactions was obtained in the Waaler-Rose test from 70 per cent in serum to 83 per cent in acid-precipitated euglobulin. This increase was due to a greater specificity of reactions with low titers. The cold-precipitated euglobulin gave less positive Waaler-Rose reactions than the acid-precipitated euglobulin. With the latex fixation test an increase from 65 per cent positive reactions in serum to about 71 per cent with both cold- and acid-precipitated euglobulin fractions was obtained. Here, the increase consisted of reactions negative in serum but positive in the euglobulin fractions, but again with low titers. Because the increase in positive reactions consists merely of low titer values, fractionation of sera only slightly enhances the reliability of the serological tests.Negatively reacting rheumatoid arthritis sera often had low values of the _2A globulin.     

Virus infection of the bone-marrow

Summary From the bone-marrow and the blood of two children who were suffering from a chronic disease characterized by intermittent fever and swelling of the spleen and the liver, a virus pathogenic for mice after intraperitoneal inoculation has been isolated. It could be cultivated in the chick embryo after inoculation in the allantoic cavity.In infected mice a developmental cycle has been shown. According to its properties the virus might be one of the psittacosis-lymphogranuloma venereum group, though an antigenic relationship with the viruses of psittacosis and lymphogranuloma venereum could not be established.     

Multi locus sequence typing of <Emphasis Type="Italic">Chlamydiales</Emphasis>: clonal groupings within the obligate intracellular bacteria <Emphasis Type="Italic">Chlamydia trachomatis</Emphasis>

Background  

The obligate intracellular growing bacterium Chlamydia trachomatis causes diseases like trachoma, urogenital infection and lymphogranuloma venereum with severe morbidity. Several serovars and genotypes have been identified, but these could not be linked to clinical disease or outcome. The related Chlamydophila pneumoniae, of which no subtypes are recognized, causes respiratory infections worldwide. We developed a multi locus sequence typing (MLST) scheme to understand the population genetic structure and diversity of these species and to evaluate the association between genotype and disease.     

Comparison of tests for the diagnosis of spontaneous encephalitozoonosis in rabbits

The effectiveness of immunofluorescence, complement fixation, microagglutination serologic tests, intradermal skin test, and detection of histologic lesions were compared for use in diagnosis of spontaneous encephalitozoonosis in rabbits. The India ink and microbead agglutination reactions were compared with immunofluorescence and complement fixation by testing 11 single or pooled sera. Serologic tests correlated best with each other and less well with intradermal tests or presence of lesions. Immunofluorescence, India ink reaction and microbead agglutination were equally useful in detecting antibodies to Encephalitozoon cuniculi. The intradermal test correlated best with the presence of detectable lesions.     

Chlamydia trachomatis: milestones in clinical and microbiological diagnostics in the last hundred years: a review

Chlamydia trachomatis an obligate intracellular, Gram-negative bacterium is the causative agent of several acute or chronic, local and systemic human diseases such as trachoma, oculogenital and neonatal infections. It was discovered in 1907 by Halberstaedter and von Prowazek who observed it in conjunctival scrapings from an experimentally infected orangutan. In the last hundred years the detection and study of the intracellular pathogens, including chlamydiae, passed through an enormous evolution. This memorial review is dedicated to these important research and diagnostic discoveries and to the scientists who significantly contributed to this evolution starting from the application of simple light microscopy through the cell culture technique, antibiotic susceptibility, antigen and antibody detection, serotyping, to the real-time nucleic acid amplification and restriction fragment lengths polymorphism analysis. Although the majority of these old and new excellent diagnostic methods have been introduced into the rutine practice, the trachoma has remained one of the leading causes of blindness, and oculogenital chlamydial infections still are the most frequent sexually transmitted bacterial diseases, furthermore lymphogranuloma venereum is a disease emerging in the developed countries at the beginning of the 21 st century.     

Detection of Chlamydia trachomatis in clinical specimens by nucleic acid spot hybridization

A nucleic acid spot hybridization assay was used to detect Chlamydia trachomatis DNA. The hybridization probes included DNA isolated from elementary bodies of lymphogranuloma venereum (LGV) strains and cloned fragments of both chromosomal and plasmid DNA. The sensitivity of the test was in the range 10 to 100 pg homologous DNA and 10 in vitro infected cells. Cross-reactivity with bacterial DNA was avoided when purified chlamydia-specific DNA fragments were used as probes. C. trachomatis was detectable in most of the clinical specimens with large amounts of infectious particles. Also some isolation-negative specimens gave a positive signal in the test.     

Value of the Concomitant Use of Complement Fixation and Immunodiffusion Tests in the Diagnosis of Coccidioidomycosis

Complement fixation titers of 1:2 and 1:4 with coccidioidin are not always of diagnostic significance. The concurrent use of the complement fixation and immunodiffusion tests is an effective means for specific serologic diagnosis of coccidioidomycosis in patients with low levels of complement-fixing antibodies. In routine testing, it is recommended that only sera that are negative for complement-fixing antibodies at 1:8 but positive in the immunodiffusion test with coccidioidin be selected for titration at the 1:2 and 1:4 levels.     

How often is genital yeast infection sexually transmitted?

We analysed data from a computer-based bank of clinical records of patients seen in a clinic for sexually transmitted diseases over a three-year period to investigate the association between genital yeast infections and sexually transmitted diseases (STDs). We classified STDs as primary and secondary syphilis; gonorrhoea; lymphogranuloma venereum; trichomoniasis; scabies; pediculosis; genital herpes; warts; and molluscum contagiosum. Of a total of 2984 disease episodes among women, 1054 (35-3%) included yeast infections, whereas only 382 (6-9%) of 5501 episodes in heterosexual men were associated with yeast infections, We found a significant association between yeast infection and STD and non-specific genital infection (non-specific urethritis (NSU) and procitis in men, and female contacts of men with NSU), which suggested that yeast infection was sexually acquired in 414 out of 1054 disease episodes in women (39%) and 110 out of 382 episodes in heterosexual men (29%). We conclude that sexually active patients with genital yeast infections should be screened for other STDs particularly non-specific genital infection.     

Serological Diagnosis of Human Melioidosis with Indirect Hemagglutination and Complement Fixation Tests

An indirect hemagglutination (IHA) test and a complement fixation (CF) test were evaluated from test results on sera from 212 human melioidosis patients of which 119 were culturally proved cases. Significant antibody titers (IHA titers of 1:40 or greater and CF titers of 1:4 or greater) were demonstrated with either test in all except five patients. IHA and CF titers ranged as high as 1:20,480 and 1:1,024, respectively. Antibodies were usually demonstrated by both tests 1 week after onset of disease. Transient seronegative reactions during the course of disease were seen in sera of approximately 19% of the patients with either IHA and CF but rarely with both tests. High titers in either test were obtained by the third week of disease and reached maximum levels in 4 to 5 months. Titers usually were detectable for 9 or more months. Antibodies were detected by IHA and CF tests in 80 to 100% of the sera obtained at various time intervals from 9 months to 2 or more years after disease onset. Antibody persistence occurred in patients who had a short disease course, as well as in patients with prolonged, complicated infections. The IHA test had excellent specificity when evaluated with normal human sera and diverse antimicrobial sera from hyperimmunized rabbits and human patients. The CF antigen appeared to contain common antigens with some but not all types of Pseudomonas aeruginosa. The specificity of the CF antigen could be enhanced without appreciable effect on its sensitivity by use of a titer of 1:8 in lieu of 1:4 as a criterion for a significant reaction. Either test could be used advantageously for the laboratory diagnosis of melioidosis.