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In 12 years 627 patients presented to Wentworth Hospital, Natal with chronic destructive pneumonia (CDP). Common symptoms were haemoptysis, the production of foul-smelling sputum, and chest pain. The disease pursued a chronic course with acute exacerbations which may be lethal. The majority of patients were African men aged between 20 and 50 years who were free from other significant disease apart from dental infection. Radiographically and pathologically CDP had the characteristics of a necrotising pneumonia, and microbiological investigation showed mixed aerobic and anaerobic flora in the lower respiratory tract. Gram-positive aerobic cocci and Bacteroides species were the predominant organisms. In 120 patients treatment regimens were based on chloramphenicol, in 429 cephalosporins, and in 78 on combination therapy with cephalosporins, penicillin, and metronidazole. One hundred and seventy patients also required operative management in an attempt to control progress of the disease. The overall inpatient mortality rate from CDP was 7.8%. In the group of patients treated with combination therapy the mortality rate was 1.3%. [ABSTRACT FROM AUTHOR]

This survey was undertaken to determine the clinical spectrum and outcome of SLE in hospitalized African blacks in Durban, South Africa. We reviewed the hospital records of all patients with SLE who were seen during 1984 and 1990. Eighty-five patients were seen and their mean age at diagnosis was 33.3 years. The prevalence of the various diagnostic criteria was as follows: cutaneous, 68%; arthritis, 66%; renal, 65%; serositis, 29%; neuropsychiatric, 21%; haematological, 71%; immunological, 49%; anti-nuclear factor, 98%. Follow up data were not available in many patients but 25 (29%) are known to have died. The commonest causes of death were renal, infection, neurological and cardiac. This survey shows that SLE is being recognized more frequently in African Blacks and is associated with a high mortality. [ABSTRACT FROM PUBLISHER]

Objective: To confirm the association of antiphospholipid antibodies with early onset of severe pre-eclampsia before 30 weeks' gestation., Study Design: Thirty-four patients with diastolic blood pressure levels > or = 110 mmHg and at least 2+ proteinuria before the 30th week of pregnancy were randomly chosen for inclusion in the study. Blood samples were taken for assessment of anticardiolipin antibodies (ACAs), lupus anticoagulant, syphilitic serology and antinuclear antibodies. Fifteen normal antenatal patients matched for age, parity and gestational age acted as control subjects., Results: Four of the 34 women (11.7%) in the study group had elevated levels of both ACAs and lupus anticoagulant, compared with none in the control group. This was not found to be statistically different., Conclusion: Given the low incidence of positive ACAs in early-onset severe pre-eclampsia it is unlikely that they are implicated in its pathogenesis. It is possible that they represent a small subset of patients with alternative or combined pathology.

What were first called simply false-positive Wassermann reactions and then lupus anticoagulant are now known as antiphospholipid or anticardiolipin antibodies (ACA). These are known to cause a tendency to thrombosis and are frequently present in many neurological conditions and infections. The pathological significance of these antibodies in acute infections, if any, is unknown. We investigated the presence of these antibodies in Plasmodium falciparum malaria in an endemic area in Natal/KwaZulu, and attempted to correlate the presence of this antibody with cerebral manifestations. Immunoglobulin G-anticardiolipin antibodies measured by enzyme-linked immunosorbent assay occurred significantly more frequently in 62 patients with acute Plasmodium falciparum malaria (33.9%) than in 37 control subjects (2.7%) (P < 0.0001). There was no significant difference in the mean parasite loads in those patients who were positive for ACA (1.75%) and those who were negative (1.59%) (P = 0.83). No correlation was found between parasite load and ACA levels in the patient group, or between the number of cerebral manifestations in patients with and without the antibody. The frequency of splenomegaly was not significantly different in patients with and without ACA (P = 0.06). We conclude that there is a high prevalence of ACA in acute falciparum malaria. The pathological significance of this antibody and its relationship to complications, especially cerebral ones, warrant greater attention and may improve the understanding of cerebral malaria and its management.

Antinuclear antibodies were detected, using a sensitive immunofluorescence test, in 96% of 160 patients with systemic sclerosis. Analysis of the patterns of staining revealed that a speckled pattern was commonest (66%), followed by nucleolar staining (37%). In 15% these two co-existed, and in 26% the speckling was of the fine, grainy type, indicative of Scl 70 antibody. Centromere antibody was found in 12%. Black patients made up 54% of the series, and centromere antibody was notably absent from this group, which also had more Scl 70 and nucleolar antibodies than did Indian patients. These serological findings correspond with the clinical features, there being far fewer blacks than Indians with limited cutaneous involvement. The ethnic differences found suggest a genetic influence on the expression of the disease and its auto-antibodies.

Forty-seven HIV antibody-positive black blood donors presented for assessment and counselling at King Edward VIII Hospital, Durban. Thirteen were found to have generalised lymph node enlargement and 1 had a tuberculous pulmonary infiltrate. Significant reduction in helper T-cell numbers and in the helper-suppressor ratios was noted. Counselling appeared to produce disturbingly few positive effects.

Sixteen asymptomatic human immunodeficiency virus (HIV-1) antibody-positive female blood donors were examined for sexually transmitted diseases by lower genital tract microbiological tests and colposcopy. Two donors had generalised lymphadenopathy, and in 13 (81.2%) human papillomavirus was detected on histological examination. In 5 (31.2%) Neisseria gonorrhoeae was cultured. Sexually transmitted pathogens were found in all but 3 subjects and multiple agents were detected in 9. The high prevalence of sexually transmitted diseases coupled with the generally poor response to counselling has a frightening potential for spread of HIV locally.

A patient with acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma presenting with a vulval neoplasm is reported. Although more common in black than white people, Kaposi's sarcoma infrequently presents with gynaecological symptoms or lesions. In this case report the management of Kaposi's sarcoma presenting as a vulval neoplasm in a young woman with a positive antibody test to HIV is discussed and the need to screen young women with vulval neoplasms for this infection is highlighted.

Autoimmune thyroiditis was induced in two vervet monkeys by immunizing them with human thyroid extract. As expected, both animals developed cytotoxic antibodies which were active against human thyroid and other human cells in tissue culture. In addition, a second serum factor was detected. This was capable of sensitizing human thyroid (and other) cells and rendering them susceptible to killing by normal lymphocytes. This finding implicates antibody-dependent cell-mediated cytotoxicity in the pathogenesis of autoimmune thyroiditis.

Circulating immune complexes were measured by means of a modified Raji cell assay in 50 blood donors from each of three race groups - Indian, Black and White. The results ranged widely and were, on average, higher in Blacks than in others. The difference is probably related to the hypergammaglobulinaemia commonly found in Blacks. For maximum clinical usefulness, results should be expressed so as to indicate the degree of variation from the appropriate normal mean.

The leucocyte adherence inhibition (LAI) test was assessed as a means for measuring specific cell mediated immunity (CMI) in invasive amoebiasis. The LAI test and the amoebic gel diffusion (AGD) test were performed on 20 patients admitted to hospital with amoebic liver abscess (ALA) and 24 control subjects with no demonstrable clinical amoebiasis. The AGD results were acceptable for such a study in an endemic area as all the proven ALA subjects gave positive responses while all except one of the controls gave a negative reaction. A percentage adherence in the LAI test of more than 80% was considered to be negative and the mean percentage adherence of leucocytes for the control subjects was found to be 86.0 +/- 4.9 while that for the experimental group was found to be 76.1 +/- 15.4; the difference between these groups is statistically significant. It was noticed that the LAI test response was possibly linked with severity of disease in the ALA subjects. The LAI test has been found to be a relatively rapid test of specific CMI and although fastidious, it does not require the use of radio-isotopes.

Levels of circulating IgG- and IgM-containing immune complexes were studied in patients with typhoid fever. Raised levels of both were always found at the time of presentation; they fell towards normal over 3-4 weeks. In 1 patient with a less favourable clinical course the immune complexaemia lasted longer than in the others.

When T and B cell counts, using sheep cell rosettes and surface immunoglobulin as markers, are done on the lymphocytes of individuals who are receiving tetracycline, unusually high numbers of 'double marker' cells are regularly found.

The lymphocyte transformation response to phytohaemagglutinin (PHA) and the relative numbers of T, B and null lymphocytes were studied in 32 insulin-dependent diabetics and 32 healthy matched controls. The mean stimulation index (Sl) of the 18 patients with poorly controlled diabetes mellitus was significantly lower than that of controls. No difference was seen in the mean Sl values of well-controlled diabetics compared with controls. Neither the well-controlled group nor the poorly controlled group showed any significant differences in the mean counts of the various lymphocyte subpopulations when compared with controls.

Three patients are described who presented with symptoms and signs of a vasculitic illness but in whom a definite diagnosis was not made until the application of a test to detect auto-antibodies to neutrophil cytoplasmic antigens. There has long been a need for a diagnostic marker for the groups of diseases which fall into the broad classification of systemic vasculitides. Diagnosis of the patients as having either Wegener's granulomatosis or microscopic polyarteritis by the finding of this auto-antibody enabled a positive approach to treatment with combinations of immunosuppressive agents. In addition, serial measurement of the auto-antibody titres enabled monitoring of disease activity.

Seven infants and children with renal tumors underwent nephrectomy and the tumors were cultured to investigate the behavior of their cells. In four children over 1 year of age with histologically typical nephroblastoma in the tumor cells were bizarre and disorderly. In one patient 3 months of age where the histology suggested malignancy the tumor culture showed an orderly growth pattern of spindle cells akin to normal kidney and the patient has had no recurrence for 18 months. In one infant seven months of age the histology was consistent with malignancy and this was confirmed on culture showing bizarre cells similar to those of nephroblastoma. The third infant under 1 year of age had a teratoma on histology and an unusual growth pattern on culture characterised by polyhedral cells with long processes and much overlapping. It is suggested that in infants with kidney tumors, tissue culture be used to help in assessing the malignant potential of the tumor and deciding on adjuvant therapy.