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X-linked agammaglobulinemia (XLA) is an X-linked genetic defect in maturation of B lymphocytes that results in the absence of B lymphocytes in the peripheral blood and profound hypogammaglobulinemia. It is caused by a mutation in the BTKgene located on the X chromosome. There are no large series describing XLA from the developing world.

There has been an exponential rise of HIV positive patients as observed at the surveillance center of Nehru Hospital. Most patients are poor and cannot afford repeated viral load assays. Therefore, there is a need to identify cost effective and reliable surrogate markers of disease activity. In the present study absolute number of CD4 cells, β2 micro-globulin, circulating necleosomes were studied in 30 patients of AIDS, 30 seropositives and 30 healthy controls. In addition viral load, P-24 assay, and TNFR-II assays were done in seropositive and AIDS patients. The mean CD4 cells in patients with AIDS were 69.66 ± 68.25 mm3while in seropositives values was 370 ± 201.29 mm3. The mean CD4 cells in healthy controls were however 690 ± 198 mm3. The differences in all the groups were highly significant (p< 0.001). The mean CD4 values in Indians are significantly lower than reported from the west. The lower number of CD4 cells in healthy population is interpreted to be due to immune activation. The CD8 cell number in controls was 650 ± 207 mm3this figure is also higher than that observed in the west. P-24 assay failed to delineate between seropositives and patients with AIDS. Although, β2 microglobulin levels were significantly higher in AIDS than in seropositives and higher in seropositives than in controls yet with the best possible cut off, it had a sensitivity of only 70% in delineating the two conditions. The correlation between CD4 cells and viral load was more significant when the CD4 cells were below 200 mm3. Five out of 30 patients with a CD4 of 300–600 mm3had a viral load of over 1 × 105cop/ml. The difference in TNF R-II levels between seropositives and AIDS was however more impressive. With a cut off of 550 pg/ml it had a sensitivity of 95% in delineating HIV from AIDS. It is concluded that a combination of absolute number of CD4 cells and TNF R-II assay along with clinical evaluation may be used to monitor therapy in resource poor countries where frequent viral load assay is unaffordable.

Tuberculosis, a reemergent killer, is threatening to assume serious proportions all over the world, particularly in view of the AIDS pandemic. The detection of mycobacterial DNA by polymerase chain reaction (PCR) in clinical samples is a promising approach for the rapid diagnosis of tuberculous infections. The aims of this study were to evaluate PCR for detection of Mycobacterium tuberculosisin pleural fluids and to correlate the results with adenosine deaminase activity (ADA) estimation and acid-fast bacilli (AFB) screening.

Both serum studies by indirect immunofluorescence (IIF) tests and skin biopsy examination by direct immunofluorescence (DIF) were performed on 22 cases of pemphigus with clinically active lesions. Twenty cases had pemphigus vulgaris and two, pemphigus foliaceus. The majority of cases (70%) were between 21 and 60 years old; the mean age was 39.5 ± 12.7 years. There was no sex predilection. DIF showed the positive fluorescence of intercellular cement substance (ICS) of the epidermis in all 22 cases (100%). IgG was positive in 77.27%, followed sequentially by C3C (50%), IgA (45.45%), and IgM (36.36%). Six cases (27.27%) also showed granular immunoglobulin and/or complement deposits at the dermoepidermal junction. IIF detected serum antiepithelial antibodies in 18 cases (81.81%) using human esophagus as substrate. Most of these cases (88.88%) showed IgG type of antibodies; the other 11.11% exhibited IgA and IgM in low concentrations. 1+ titer positivity was observed in 15 cases. This study demonstrates the value of DIF for a definitive diagnosis of pemphigus. However, it is also important to appreciate that immunofluorescence is not a substitute for histopathology, but rather complementary to it.

Purified phenolic glycolipid (PGL‐1) from Mycobacterium leprae was used to detect IgG antibodies against PGL‐1 in leprosy patients in an enzyme‐linked immunosorbent assay (ELISA). A total of 698 sera were screened; they came from patients suffering from leprosy, autoimmune disease, myeloma, tuberculosis and sexually transmitted diseases (STDs). Cases with miscellaneous diseases and persons undergoing AIDS screening were also included. Sera from lepromatous and tuberculoid leprosy patients gave positivity rates of 60.5% and 41.7%, respectively. In non‐leprosy cases, the PGL‐1 ELISA showed an overall positivity rate of 6.9%; this was greatest in patients with tuberculosis (43.8%) followed by autoimmune diseases (40.9%) and miscellaneous cases including liver diseases (37.9%). This study emphasizes that PGL‐1 ELISA has a low predictive value for diagnosis of active infection by Mycobacterium leprae. Positive reactions in a significant percentage of patients with autoimmune disease are intriguing and need indepth study.

Reports in the literature indicate the use of animal models for testing newer anti-leishmanial drugs in vivo. However, in certain established cell lines and macrophages in vitro models have the advantage over the in vivo system of simplicity and speed with which the results can be obtained. A simple in vitro system using peritoneal exudate macrophages of BALB/c mice infected with Leishmania donovani promastigotes has been tested for its use in determining the efficacy of several new drugs. Two well-established drugs, amphotericin B and sodium stibogluconate, as expected, could kill the intracellular parasites effectively. Two relatively new drugs not routinely used against leishmania, rifampicin and metronidazole at concentrations of 20 µg/ml and 10 µg/ml, respectively, were also able to kill the intracellular leishmania parasites effectively. Critical factors for drug testing in vitro have been elucidated: the most important being the temperature of incubation after infection.

The study was conducted with the prime objective of isolating an antigen from the crude preparation of whole promastigotes (Leishmania donovani) with a view to future exploitation in serodiagnosis and production of monoclonal antibodies. Soluble antigen, prepared from promastigotes isolated from actively growing cultures, was fractionated by gel filtration chromatography over a column of Sephadex G200. Three peaks of proteins could be recovered. The antigenic reactivity of different fractions was checked against sera of kala azar patients by immunoelectrophoresis (IEP), rocket immunoelectrophoresis (RIEP) and enzyme-linked immunosorbent assay (ELISA). The first peak was found to be highly reactive in comparison with other peaks. SDS-PAGE and western blot analysis of this antigen revealed a major antigen of promastigotes in the vicinity of 65 to 66 kDa, while a weakly reactive triplet could also be detected in the low molecular weight region.

Groups of rabbits were immunized with 4 doses of porcine zona pellucida antigen along with different adjuvants. The presence of antibody after immunization was checked periodically using different assay systems. The impact of immunization on ovaries was evaluated at different time intervals up to 2 years. Results of the study showed generation of high titre antibodies which could be detected until the end of the period of observation. The antibodies specifically bound to zona pellucida in situ were demonstrated by immunoperoxidase staining, and in vitro by inhibition of enzymatic digestion of zonae. Histologically, antibodies had numerous pathological effects on ovaries including thinning of the cortex, aberrant cell clusters, stromal cell hyperplasia, perifollicular fibrosis, irregular zona formation and arrest of follicle development. These changes could be correlated with the length of exposure to antibodies. It is concluded that heat-solubilized porcine zona (HSPZ) protein is a very strong immunogen and causes infertility by arresting the maturation of developing follicles. There is a need to identify the sperm receptor so that immunization could selectively impair sperm-egg interaction.

Twenty‐one monoclonal antibodies were produced against promastigote antigens of Leishmania donovani, Five monoclonal antibodies (Hyb.17, 6, 5, 4 and 2) identifying molecules associated with various L. donovaniantigenic determinants ranging from 42–116 kDa were selected as ‘capture antibodies’ and compared with specific anti‐leishmania antisera for detection of circulating leishmania antigens in kala azar patients' sera in a competitive‐enzyme‐linked immunosorbent assay system (ELISA). The anti‐leishmania antisera could detect circulating antigen in 30% of kala azar cases while out of the five monoclonals, Hyb.17 could effectively detect circulating leishmania antigen in 85.4%. The efficacy of Hyb.6 was however low (31.7%). The antigens recognized by these monoclonal antibodies in the western blot assay could possibly represent the ones circulating in sera of patients suffering from kala azar. A cocktail of these monoclonal antibodies may be more useful than the conventional polyclonal antisera in detection of circulating antigen for clinical diagnosis of kala azar.

We described the course of a young man with SLE who developed hepatitis B virus and human immunodeficiency virus infections through contaminated blood tranfusion. He presented with severe SLE, improved on treatment and then developed hepatic failure which responded to conservative treatment. He now has AIDS and the SLE and HBV infection are quiescent.

Kala azar was diagnosed in 45 clinically suspected cases following bone marrow smear examination and in vitro culture of the aspirate. Bone marrow aspiration smear examination revealed amastigotes in 27 cases (60%). In vitro culture of the aspirate demonstrated leishmania parasites in 44 cases (97.8%). A total of 18 cases (40%) were negative for amastigotes in smear examinations but parasites could be demonstrated by culturing the same aspirates. The in vitro culture of bone marrow is necessary to diagnose Kala azar and is strongly recommended to be performed along with the bone marrow smear examination.