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Raoul Follereau Hospital, Bissau, Guinea-Bissau.To study the long-term outcome of patients with bacteriologically verified tuberculosis (TB), with or without human immunodeficiency virus (HIV) co-infection.Sputum samples were collected from all patients referred to the hospital with clinical symptoms of pulmonary tuberculosis. Direct microscopy and culture was performed at the Health Laboratory. Patients with a culture positive for Mycobacterium tuberculosis were followed for 3 years, and underlying factors were analysed regarding the outcome of treatment. A group of sex and age-matched HIV-negative individuals was used as controls.Of 206 bacteriologically verified pulmonary TB patients, 168 were followed up. Antibodies to HIV-2 were found in 33 patients (19.6%); eight patients (4.8%) had antibodies to HIV-1 or showed dual reactivity. Of 149 patients discharged to follow ambulatory treatment, the survival rate of HIV-2-positive patients was 42.3% (11/26) and for HIV-negative patients it was 81.9% (95/116). The difference in survival between HIV-2-positive and HIV-negative patients was highly significant (P0.00001). HIV-negative TB patients had a significantly higher mortality than their controls (mortality ratio 3.75, 95% confidence interval 1.58-8.90). Most patients who survived, regardless of HIV status, also became free from symptoms compatible wtih pulmonary TB.Although the mortality rate among HIV-positive TB patients was very much higher than among HIV-negative patients, there are weighty arguments for active contact tracing and effective treatment of all TB patients.

Bestatin, a chemically well-defined immunomodulator, was tested for its capacity to interfere with PWM-induced Ig synthesis of peripheral lymphocytes from healthy donors. It was observed that secretion of IgA, IgG and IgM was impaired when Bestatin was present in the cultures. Serum Ig concentrations and antibody activities of IgG class to cytomegalovirus, herpes simplex and morbilli virus were examined in cancer patients who were treated with 30 mg of Bestatin daily for 1–21 weeks. These values remained constant during Bestatin treatment indicating that antibody secretion in vivo was not affected.

In sera from 4 of 25,000 individuals tested for antibodies against streptococci, extremely high antideoxyribonuclease B titers ( > 10(6) U/ml) were found. Two of the cases were diagnosed as monoclonal gammopathies. The M-components were shown to possess the anti-deoxyribonuclease B activity. The other two cases were diagnosed as relapsing erysipelas. The high serum titers of deoxyribonuclease B antibodies were accompanied by a very inflammatory reactivity in the patients' sera and by an oligopolyclonal pattern of immunoglobulin G. In routine diagnoses of streptococcal infections with the anti-deoxyribonuclease B test, patients with extremely high serum titers should be examined for the possible occurrence of gammopathies.

Anticardiolipin antibodies which seldom occur in healthy persons are frequently found in systemic lupus erythematosus (SLE). Their presence, especially at high levels (greater than 10 units) are often accompanied by thromboembolic manifestations as well as thrombocytopenia and recurrent abortions. The incidence of cardiolipin antibodies was as great in SLE as in women with clinically unexplained recurrent abortions. The anticardiolipin levels remained unchanged in most patients for long periods and were remarkably unaffected by disease activity and therapy. On the other hand, in several cases the activated partial thromboplastin time which was prolonged in most patients with persistently high cardiolipin antibody levels, approached normal during treatment with prednisolone and salicylic acid. This seemed to facilitate a successful outcome of pregnancy. Absorption of sera with cardiolipin and other negatively charged phospholipids but not with uncharged phospholipids abolished the anticardiolipin activity in enzyme linked immunosorbent assay. In most sera with cardiolipin antibody levels greater than 10 units complement activation by the classical pathway could be demonstrated. Whether the anticardiolipin antibodies contributed to complement activation could not be determined.

The digital skin microcirculation was studied by vital capillaroscopy in 32 consecutive patients with Raynaud's phenomenon. A detailed classification (stages 0-6) of the capillary abnormalities based upon observations of the capillaries in many different sites of the fingers was used. Associated diseases were searched for by an extensive clinical and immunological investigation. Seventeen (53%) of the patients had distinct structural changes in the capillaries but only 6 of them showed a restricted total digital circulation. Fifteen (88%) of these 17 patients displayed an underlying disease and/or immunological abnormalities. The corresponding figure for patients with mild or no capillary changes was 40% (p less than 0.01). Thus, the presence of marked (greater than or equal to stage 3) skin capillary abnormalities seems to be a good indicator of an associated systemic disease. The majority of patients in this category improved their capillary status during successful treatment of the underlying disease. We conclude that the form of capillaroscopy used in this study is a sensitive method for evaluating disturbances of the skin microcirculation in patients with Raynaud's phenomenon. The method may also contribute to the clinical evaluation of patients with this syndrome by identifying those with an underlying systemic disease.

Six girls and one boy with chronic active hepatitis (CAH) of unknown etiology were between 9 and 15 years at the clinical onset of their illness. After beginning immunosuppressive therapy the course of their disease was followed from one to ten years. All had markedly increased IgG, high titres of smooth muscle antibodies (SMA) and antinuclear antibodies of IgG class in the earliest serum specimens tested. Therapy resulted in an improved sense of well-being and a decrease in SGOT, IgG and titres of SMA. Very high titres of measles antibodies were observed in all cases. In one of the cases CAH manifested itself after measles and in another after rubella infection. The first case in our series of patients died of liver failure after 5 years of illness. The other patients have survived and are able to live a normal life. The possibility of CAH should be considered when children develop symptoms of hepatitis. Long-term immunosuppressive treatment with regular clinical and laboratory evaluation is important. Estimation of titres of SMA is an additional parameter of value in following of the activity of CAH in these young patients.

All of 15 sera containing anti-mitochondrial antibodies (AMA), type M 5, reacted in ELISA with ssDNA, whereas only four had anti-nuclear antibodies as demonstrated by immunofluorescence technique. Twelve of 15 had biological false-positive seroreaction for syphilis and seven of 11 cases investigated had a positive lupus anti-coagulant test. Cold agglutinins were present in 11 sera. Hyper-gamma-globulinaemia was not a prominent finding, but C4 values below the lower limit were common in spite of C3 within the normal range. Absorption of IgG fractions from three different sera with cardiolipin eliminated the reaction with ssDNA and mitochondria, supporting a certain degree of cross-reactivity among the antibodies. The presence of AMA, type M 5, seemed to discriminate a group of patients with symptoms often consistent with SLE although some of the most prominent findings were often absent.

Immunologic investigations were performed on 337 healthy women with unexplained habitual abortion. Their sera were investigated for antinuclear antibodies (ANA), antibodies against DNA, and anti-cardiolipin antibodies, and the activated partial thromboplastin time (APTT) and complement levels of their plasma were determined. Cellular reactivity and blocking antibody were studied in one-way mixed lymphocyte culture (MLC). None of the women had any signs of autoimmune disease. However, in 77 of the 337 women (22%) increased anti-cardiolipin antibody levels were found, in 19 (7%) above 10 units. Most patients with high anti-cardiolipin antibody levels had lowered values of complement factor C4. We consider the mere occurrence of anti-cardiolipin antibody in women with habitual abortion to be no absolute cause for treatment with prednisolone, and this is true even in cases with very elevated anti-cardiolipin values. Treatment with prednisolone and acetylsalicylic acid (ASA) during pregnancy should be given to only those women who have high levels of anti-cardiolipin antibodies concomitant with high APTT values, and low values of complement C4. Anti-cardiolipin antibody was also investigated during pregnancy in 136 normal pregnant women. Eleven of them (8%) were positive at any of four sampling occasions, but only one (1%) had high levels. These data differ significantly from those of the habitual aborters. Thus the development of anti-cardiolipin antibody is no normal feature of pregnancy in Swedish women and so the high frequency found among healthy Swedish women with habitual abortion remains unexplained. We have introduced an immunization programme of third party leukocyte transfusions in habitual abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Extraocular muscle biopsies from normal individuals and five patients with Graves' ophthalmopathy were analyzed by immunohistochemical staining. Fibroblasts in normal extraocular muscle as well as Graves' extraocular muscles expressed HLA-class II antigens, but the muscle cells did not. There was an increase of interstitial tissue in Graves' extraocular muscles but no visible damage to the muscle cells. In four of the biopsies from Graves' patients the cellular reaction was very weak. In the fifth patient the reaction was more pronounced with macrophages predominating, but with few lymphocytes and almost equal amounts of B and T cells. We could not confirm the earlier described specific extraocular muscle antibodies in sera from Graves' patients and conclude that there seems to be an activation of orbital fibroblasts in Graves' ophthalmopathy. This may contribute to the pathogenesis of the disease.

Antibodies to cardiolipin were measured in 62 survivors of myocardial infarction under age 45 at 3, 12, and 36 months after the acute event. 13 patients (21%) had raised anticardiolipin antibody levels on at least two of the three sampling occasions. Risk-factor profiles and coronary angiographic findings did not differ between the anticardiolipin-positive group and the rest of the patients. No correlation was found between cardiolipin and anti-DNA antibody levels. 8 of the 13 patients with raised anticardiolipin antibody levels experienced additional cardiovascular events during a follow-up of 36-64 months after the first myocardial infarction: cerebral infarction developed in 2, arterial occlusion of the lower limb in 2, new myocardial infarction in 3, pulmonary emboli in 1, and deepvein thrombosis in 1. These 8 patients had cardiolipin antibody titres of 5 times the mean for voluntary blood donors. Antibodies to cardiolipin are common in young post-infarction patients and should be interpreted as markers of high risk for recurrent cardiovascular events.