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The production of nitric oxide (NO) by macrophages is important for the killing of intracellular pathogens, such as Toxoplasma gondii. Gamma interferon (IFN-gamma) and lipopolysaccharide stimulate NO production. The aim of this study was to investigate the importance of NO, IFN-gamma and interleukin-12 (IL-12) in the host immune response in AIDS patients suffering from toxoplasmic encephalitis (TE). It was demonstrated that the production of NO, detected as nitrite/nitrate in the sera and in the cerebrospinal fluid (CSF) of 32 AIDS patients with TE, was normal. In addition, levels of IFN-gamma in the sera and in the CSF of patients with TE were not increased. In contrast, serum levels of IL-12 in these patients were significantly increased (6.5 +/- 7.1 pg/ml; P = 0.0368), compared to the control patients (1.7 +/- 3.5 pg/ml). Furthermore, increased but not significant levels of IL-12 were also observed in the CSF of patients with TE (2.2 +/- 4.7 pg/ml; controls: 0.5 +/- 1.9 pg/ml). The results of this study indicate that reactivation or recurrence of T. gondii infection in HIV-1-infected patients is probably due to a down-regulation of IFN-gamma along with a resulting non-optimal NO activity.

To evaluate the efficacy and safety of Amphotericin B dissolved in dextrose (Amb) or in a lipid emulsion (Intralipid, Amb-IL) in AIDS patients with cryptococcal meningitis, we conducted a retrospective study in 30 AIDS patients with cryptococcal meningitis. A clinical complete resolution was obtained in 11 patients (55%) treated with Amb, and in six patients (60%) treated with Amb-IL. Intralipid did not decrease the infusion-related adverse effects, in particular nephrotoxicity and anaemia. Our results indicate that Amb-IL formulation is useful in the treatment of cryptococcal meningitis in AIDS patients, but it does not reduce the infusion-related adverse events.

Meningeal involvement in leptospiral infection is quite common, usually mild and often overlooked. In contrast, cases of isolated involvement of the central nervous system, including aseptic meningitis, have been reported only rarely. A case of a patient with acute aseptic meningitis caused by Leptospira australis serovar bratislava is reported. This is believed to be the first report of aseptic meningitis due to Leptospira australis. This case indicates the need to consider human leptospirosis in the differential diagnosis of aseptic meningitis.

24 AIDS patients, both males and females, aged from 3 to 52 years, received high-dose i.v. 7S immunoglobulin (220-400 mg/kg, range 7.5-20 g/die). These patients were affected by HIV-related thrombocytopenia and antibiotic-resistant severe hyperpyrexia; three HIV-positive asymptomatic children with severe immunodeficiency were treated to prevent opportunistic infections. I.V. 7S immunoglobulins were well tolerated, and were found to be very effective in the therapy of thrombocytopenia and in the prevention of opportunistic infections in the asymptomatic children.

AIMS--To evaluate the fibronectin concentrations in the cerebrospinal fluid of HIV-1 infected patients with central nervous system disorders. METHODS--Fibronectin was determined by an immunoturbidimetric assay in 41 HIV-1 infected patients with AIDS dementia complex, progressive multifocal leucoencephalopathy, and opportunistic infections. RESULTS--A significant decrease in fibronectin concentrations in the cerebrospinal fluid of patients with AIDS and dementia complex and progressive multifocal leucoencephalopathy was observed, as well as in those with opportunistic infections of the central nervous system (p < 0.0001). In particular, a significant decrease in fibronectin concentration in cerebrospinal fluid was observed in patients with cerebral toxoplasmosis and cryptococcal meningitis (p < 0.0001). CONCLUSIONS--Because fibronectin can bind to several viruses, fungi, and protozoa, it is conceivable to suppose that the consumption of fibronectin in the cerebrospinal fluid of patients with neurological disorders may be related to the binding of fibronectin to HIV itself, or to viral proteins, or to organisms responsible for opportunistic infections.

A wide variety of clinical expressions of the acquired immunodeficiency syndrome (AIDS) has been apparent from the earliest case reports in adult patients and pediatric patients. Both human immunodeficiency virus (HIV) infection and AIDS in children are associated with an increased prevalence of several dermatologic manifestations. In this article we present a review of the recent literature describing the cutaneous manifestations of pediatric AIDS. The cutaneous manifestations of AIDS in children can be divided into three categories: (1) neoplastic manifestations; (2) viral, bacterial and fungal manifestations, and (3) vascular lesions and other manifestations. Pediatricians as well as dermatologists may be the first physicians to recognize and to treat the clinical manifestations of AIDS.

Plasma fibronectin (PFN) concentrations were assessed in 21 patients with AIDS, in seven with AIDS-related complex (ARC), in 17 asymptomatic seropositive patients, and in 36 age and sex matched healthy control subjects. A single radial immunodiffusion technique was used to determine PFN concentration. A significant decrease in PFN concentrations was observed in patients with ARC and AIDS (especially in those patients with Pneumocystis carinii pneumonitis). On the other hand, normal PFN concentrations were observed in asymptomatic seropositive patients. The determination of PFN concentration in patients with AIDS and ARC may contribute to the diagnosis of such patients.

Fibronectin concentrations in the cerebrospinal fluid were assessed in 20 patients with acute meningitis using a turbidimetric immunoassay. A significant increase in fibronectin concentrations was observed in patients with bacterial meningitis; decreased concentrations were observed in patients with viral meningitis. The determination of fibronectin concentration in patients with bacterial meningitis may represent a useful marker in differentiating bacterial from viral meningitis.

An epidemiological and clinical investigation upon ten cases of acute viral neuraxitis observed in the country of Alessandria between January 1978 - January 1979, is reported. Four cases of neuraxitis were due to coxsackie B4 virus, two to coxsackie B3, two to influenza type A and one to influenza type B virus, one to rubella and one to varicella-zooster virus. In all the cases blood chemistry, clinical and instrumental examinations (EEgraphy, cerebral scintigraphy and angiography) were coupled with determination of serum levels of complement fixing, haemagglutination inhibiting and neutralizing antibodies on two successive specimens, isolation of virus from cerebrospinal fluid, faeces and pharingeal secretions. Some particularly interesting epidemiological, immunological and clinical features of these neuraxitis are more fully discussed.

In a double blind study carried out under standard conditions at two treatment centers silymarin, 2 sugar-coated tablets 70 mg three times daily, showed a definite therapeutic influence on the characteristic increased serum levels of bilirubin, GOT and GPT associated with acute viral hepatitis. The above mentioned values in 28 patients treated with silymarin were compared with those in 29 patients treated with placebo. The laboratory parameters in the silymarin group regressed more than in the placebo group after the 5th day of treatment. The number of patients having attained normal values after 3 weeks' treatment was higher in the silymarin group than in the placebo group. A statistical comparison revealed a difference between bilirubin and GOT values in the placebo and silymarin groups and a definite trend in the regression of GPT values in favour of silymarin. The course of the immune reaction in HBS Ag patients was not influenced by silymarin. As already proved by other investigators, the use of silymarin in acute viral hepatitis can lead to an accelerated regression in pathological values, thus indicating its use in the treatment of this liver disease.

The tolerance of a new pivampicillin and dicloxacillin association, especially at high doses and during prolonged treatment, was assessed by administering two 600 mg tablets (350 mg pivampicillin + 250 mg dicloxacillin) every 6 or 8 hr (according to the seriousness of the diseases) to 53 patients with acute infection of varying site and aetiology. Microbiological, radiological and blood chemistry data were collected with reference to the disease involved, along with clinical and laboratory data capable of demonstrating the eventual appearance of unwanted side-effects referable to the association. The results showed that the association was therapeutically effective and well tolerated at high doses given over long periods.

Three patients with severe liver and renal failure admitted to the Infectious Diseases Department of the Alessandria for suspected leptospirosis in the second half of 1979 are presented. In one case, the agent responsible was Leptospira icterohaemorrhagiae AB Wjnberg strain, in another Gram-negative sepsis, and in the third acute pancreatitis associated with serious Escherichia coli infection. An account is given of the peritoneal dialysis technique that led to successful resolution of the serious liver and renal failure.

Twenty-three patients (mean age: 47 years; range: 4 months to 79 years) admitted to Varese Regional Hospital over the period from October 1983 to March 1984 and suffering from severe infections of a septicemic nature were treated with ceftazidime. All patients had previously received other broad-spectrum antibacterial agents. Isolation of causative pathogens and evaluation of their susceptibility to ceftazidime justified use of the drug as monotherapy. Ceftazidime was administered intravenously at the mean dose of 60-120 mg/kg/day. In some cases, it was injected directly into the renal parenchyma (2 g/day) or into the cerebral ventricles (1 mg/kg/day). Local and systemic tolerance were optimal in all cases, no significant side effects being observed. Eradication of pathogens was excellent and clinical outcome satisfactory in all patients.

An epidemiological and clinical research on 48 cases of nonA-nonB hepatitis hospitalized in Alessandria, Infectious Diseases Department, from 1-1-1983 to 1-3-1984 is reported. NonA-nonB hepatitis formed 25% of full cases of viral hepatitis in the same period (192 cases); it was mainly related to hemotransfusion (33,3%) and drug addiction (29,2%); its chronic evolution was observed in the 37,5% of the cases.

82 HBsAg from acute hepatitis B patients living in Northern Italy were subtyped. HBsAg has been detected by immunodiffusion (ID), electrosyneresis (ES), complement fixation (CF) and radioimmunoassay (RIA, Kit Ausria I and II, Abbott). Subtyping was performed by ES in 50 and by ID in 30 of the 82 assayed sera. An higher frequency of ayw subtype (83,1%) in comparison with adw subtype (16,9%) has been observed. No difference was found between adw and ayw subtypes analyzed as far as geographic-ethnic characters, incubation time, course and prognosis of the disease or the biohumoral indices. No patient was found to have both y and d specificities and so r determinant was never found.

The effect of orally administered Lysozyme (2 g per diem for 6-15 days) on serum immunoglobulins, C3 complement component, its C3A properdine activator and intestinal flora was studied in 45 subjects with acute viral hepatitis. Comparison of the data before and after treatment revealed a significant decrease in IgA, IgM and C3A and an equally significant increase in C3. Coproculture tests revealed important changes in many case in which one or more pathogenetic species (Enterobacter, Proteus, Citrobacter) had completely disappeared. The mechanisms used by Lysozyme in the modulation of immunological responses during viral hepatitis are discussed. These include reduction of the enteric antigen stimulus by inhibiting the growth of bacterial flora, the blocking of anti-complement factors and the modification of antibody response.

Experimentation of two i.v. doses of a uridine-5-diphosphoglucose (UDPG) in 30 cases of acute viral hepatitis is reported. The therapeutic efficacy of the drug was assessed on qualitative and quantitative parameters indicative of liver distress. Statistically significant evidence was obtained of the efficacy of UDPG in acute and serious liver disease, and of the greater effectiveness of one of the two doses used. Excellent local and general tolerance was noted.

Seven cases of acute neuraxitis due to Coxsackie B3, 2 to mumps, 1 to measles, and 1 to influenza B observed in the province of Alessandria between Jan. 1975 and July 1977 are described. In the coxsackie cases, blood chemistry and clinical examinations were coupled with determination of serum levels of complement fixing, haemagglutin-inhibiting and neutralising antibodies on two successive specimens, isolation of virus from cerebrospinal fluid and faeces, and, in one case, from a cerebral biopsy specimen, and determination of cerebrospinal fluid IgA, IgG, and IgM. Some particularly interesting epidemiological, immunological and clinical features of teh series are discussed more fully.

The prevalence of toxoplasmosis as results by serologic tests (agglutination test = Fulton test and indirect emoagglutination test) of 904 subjects of North Italy was determined. Serologic signs of toxoplasmosis were present by only one or by both two tests in 66.4% and respectively in 64.1% of these subjects. The prevalence increased highly from the first 5 years of life, reach c.a. 40% at 20th year and 60% in the group of subjects of 20-24 years. The results of Fulton test and indirect hemoagglutination test correlate very well. 96.6% of the levels of Fulton test were from 1:16 to 1:128 and 76.9% of those of passive hemoagglutination test were from 1:64 to 1:512.

A group of patients was treated with stanozolol. A modified version of Roebuck's skin window technique was used to obtain macrophages. These were then fixed in vitro with a suspension of Paracolonbacter aerogenoides. Comparison with a group of control subjects showed that the macrophages from the treated patients appeared to take up and destroy germs more effectively and that this could be potentiated by prior opsonisation with serum from the treated subjects. These results are seen as an expression of functional activation of the macrophages and an increase in serum opsonin content.

We found a significant increase in fibronectin receptor (FNR) levels in the sera of adult human immunodeficiency virus type 1 (HIV-1)-infected patients, especially in those with AIDS (1,026.9 +/- 583.9 ng/ml; P < 0.0001). In contrast, AIDS patients with neurologic disorders and HIV-1-seropositive patients showed normal levels of FNR in serum. In addition, HIV-1-infected children showed increased levels of FNR in serum (824.4 +/- 333.5 ng/ml; P = 0.03). We suggest that an increase of FNR levels in AIDS patients is related to enhanced expression of FNR on HIV-1-infected cells.

The purpose of this study was to evaluate nitric oxide (NO) activity in patients with uncomplicated malaria. Lipopolysaccharide and gamma interferon (IFN-gamma) are potent inducers of NO by inducing production of NO synthase. NO activity was determined by measuring serum levels of nitrite/nitrate (metabolic end products of NO), and IFN-gamma in patients with uncomplicated malaria, mostly caused by Plasmodium falciparum. Neither serum levels of nitrite/nitrate nor of IFN-gamma were significantly increased in patients with uncomplicated malaria, especially in patients with P. falciparum infection, and in those with high parasitaemia. These results show that NO cannot play a role in uncomplicated malaria, and it is still debatable if NO production in this infection has beneficial or detrimental effects.

Human herpesvirus-6 (HHV-6) is the etiologic agent of roseola infantum, and has been implicated as a possible cause of encephalitis in pediatric and adult patients. A case of meningoencephalitis in an otherwise healthy, immunocompetent 59-year-old woman is described. The diagnosis of HHV-6 meningoencephalitis was confirmed by detecting viral DNA in cerebrospinal fluid collected in the acute stage of the disease by polymerase chain reaction. The patient was treated with acyclovir and recovered without any sequelae. The current knowledge of the pathophysiology, clinical course and outcome of HHV-6 meningoencephalitis in immunocompetent adult patients is also reviewed.