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A diabetic renal transplant recipient with cellulitis caused by Cryptococcus neoformans, serotype A, is described. The diagnosis was based on the demonstration of capsulated, budding yeast cells in the aspirated material and tissue from the cellulitic lesion and isolation of the aetiological agent in culture. The isolate formed well-developed capsules in the brain tissue of experimentally infected mice and produced cherry-brown colonies on niger seed medium. The patient's serum was positive for cryptococcal antigen (titre 1 : 4) with no other evidence of systemic infection. He was successfully treated with AmBisome, followed by fluconazole, resulting in the complete resolution of cellulitis and disappearance of the cryptococcal antigen. This report underscores the fact that patients with cutaneous cryptococcosis should be thoroughly evaluated, as it may be the first manifestation of a systemic disease. Prompt diagnosis and treatment are important to improve survival.

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Diagnosis of schistosomiasis still depends upon demonstration of eggs in excreta, by which time significant pathology may occur to the human host. This study was undertaken to identify Schistosoma mansoni antigen(s) to be exploited in serodiagnosis of prepatent and/or acute infections. Immunoglobulin G and M responses of inbred and outbed mice to Schistosoma mansoni whole adult worm antigen were monitored in immunoblots using sera obtained at sequential times from mice infected with either 600 or 100 Schistosoma mansoni cercariae each. Regardless of the initial infection dose, immunoblot reactions to two doublets, 31/32 and 34/35 kDa appeared as early as two and three weeks post infection respectively and reactions to 38 and 70 kDa antigens appeared after five weeks infection. Antigens 31/32 and 38 induced both IgG and IgM responses whereas 34/35 and 70 predominantly induced IgG response. Homologues of these four antigens equally reactive with serum of infected mice were also demonstrated in Schistosoma haematobium, worms. Examination of sera from 25 patients suffering from acute Schistosoma mansoni, two suffering from Schistosoma haematobium and 16 patients suffering from infections with other parasite species confirmed the potential of 31/32, 34/35 and 38 kDa antigens in the specific diagnosis of prepatent and acute schistosomal infections but showed cross-reactivity of the 70 kDa antigen.

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Pre- and postdeployment serum samples obtained from U.S. marines in Operations Desert Shield and Desert Storm were tested for antibodies to Shigella sonnei. High predeployment levels of immunoglobulin A (IgA) and/or IgG antibodies to S. sonnei lipopolysaccharide antigen in serum and seroconversions were accompanied by higher IgA and/or IgG antibody response to Shigella invasion plasmids (Ipa). The results suggest exposure to S. sonnei in predeployment troops and frequent exposure to this bacterial agent during deployment.

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The conservation of flagellin genes from thermophilic Campylobacter spp. strains isolated in Egypt was evaluated by a restriction fragment length polymorphism (RFLP) assay. The flaA and flaB genes were amplified from 59 independent clinical isolates and digested with EcoRI and PstI, and the resulting patterns were compared with each other and with previously described RFLP groups. The results indicate that the isolates fell into 14 groups for flaA and 11 groups for flaB, 9 of which have been described, and that considerable genetic variability exists among isolates belonging to the same LIO serogroup. In most cases, the flaB gene displayed the same RFLP pattern as that of the flaA gene of the same strain, although some variability was observed. The data suggest that more variability of flagellin genes exists within the LIO serogroups common to Campylobacter field isolates from Egypt than has previously been reported for North American isolates.

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The aim of the present work was to study the possible association of some class I, II MHC gene products with variations in the clinico-pathological outcome of human schistosomiasis mansoni as well as with the variability in immune responsiveness. The study was carried out on 47 patients with schistosomiasis mansoni and 20 healthy volunteers served as control group for the immunological parameters and 200 subjects for the genetic studies. The following were determined: class I, II HLA typing, serum IgG, IgM, C3c, immediate intradermal test and passive haemagglutination using S mansoni worm antigen, T lymphocyte subsets, delayed intradermal test and leukocyte migration inhibition using phytohaemagglutinin (PHA) and soluble egg antigen (SEA) of S mansoni. A statistically significant association was found between HLA-B5 and DR3 and with the occurrence of hepatosplenic disease; this phenotype also correlated with changes in T lymphocyte subsets and high immune reactivity, both humoral and cell mediated. HLA-DQI was also associated with failure to develop hepatosplenic disease. The present study consolidates also the view of the important role of host immune reactivity in the clinical outcome of schistosomiasis mansoni and demonstrates the contribution of the genetic impact on both clinical and immunological heterogeneity of the disease.

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Simultaneous platelet and fibrinogen survival and turnover were studied using selenomethionine (75Se) in early and late groups of schistosomal hepatic fibrosis (SHF) and in a control group. In the control group, the mean platelet survival was 11.66 +/- 1.59 days and mean platelet turnover was 20,230 +/- 5090 platelets/microliter/day. Mean fibrinogen survival was 7.3 +/- 0.60 days and fibrinogen turnover was 0.35 +/- 0.04 mg/ml/day. In the early schistosomal group, platelet survival was shortened with an increased turnover rate and normal platelet count. The presence of a structurally abnormal fibrinogen molecule in the early group may have resulted in its shortened survival, that was compensated by the liver through increasing the turnover rate. In the late group, platelet survival was shortened with no significant increase of fibrinogen turnover, while fibrinogen concentration remained normal, suggesting the presence of extrahepatic sites of fibrinogen synthesis.

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The diversity of HLA antigens frequencies associated with Insulin Dependent Diabetes Mellitus (IDDM) reported in different populations raised the importance of determining HLA-A, -B and -C specificities in patients with IDDM in the Egyptian population. The study has been carried out on thirty patients with IDDM and thirty healthy control subjects matched for age and sex as patients included in the study. The results of the present work showed that patients with IDDM showed a significant increase in frequency of HLA-A2, HLA-B8 and HLA-B15. These findings are in accordance with the genetic heterogeneity of IDDM which is in turn in harmony with the modern concept on the complex aetiology of the disease. On the other hand, HLA-A3, HLA-B5 and HLA-B7 have been found significantly decreased in patients with IDDM, thus suggesting that these alleles may confer a protective effect from acquiring the disease. When HLA specificities have been studied in relation to the age of onset of the disease, HLA-A29 have been found in higher frequency in the age group after 15 years, while HLA-B15 in that before 15 years. This variability may be related to variation in the viral agents responsible for the infectious mechanism.

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Golden hamsters were used to determine whether intraperitoneal Zn supplementation can improve the outcome of infection with Schistosoma mansoni. The animals were divided into two groups; one received an initial intraperitoneal dose of Zn chloride (0.75 mg 100 g body wt.-1) followed by booster doses (0.25 mg 100 g body wt.-1) twice weekly for four weeks, the other group received no Zn supplement. After one week, when the initial and one booster doses were given, half of the animals in each group were exposed to S. mansoni cercariae for two hours using body immersion technique. After five weeks (one week after the final Zn supplement) the animals were killed, their worm burdens determined and their livers, kidneys, spleens, hearts and sera examined. There was a significant reduction in total worm counts in the Zn supplemented group (P less than 0.05). Also, Zn supplementation of infected animals protected them against the hepatomegaly which is very often associated with schistosomiasis. Spleen weight and Zn uptake were highest in the infected Zn supplemented group, indicating that this organ requires larger amounts of Zn to perform its various Zn-dependent immunological functions. The data suggest that Zn may enhance the ability of the body organs to resist some of the harmful effects of schistosomal infection.

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Levels of vitamin A and components of its transport protein complex, retinol binding protein and prealbumin, as well as zinc and its major binding proteins albumin and alpha 2-macroglobulin were measured in plasma of ninety-one male Egyptian patients with active schistosomal infection and thirty-two healthy adult males. Patients were divided into four groups: Group I had active schistosomiasis without associated complications; Group II had schistosomiasis complicated by colonic polyposis; Group III had advanced schistosomiasis, hepatosplenomegaly and/or ascites; and Group IV had chronic salmonella septicaemia in addition to schistosomiasis. Results showed that all patient groups had subnormal levels of plasma vitamin A, retinol binding protein, prealbumin, zinc and albumin (P less than 0.005 for all parameters) but elevated alpha 2-macroglobulin (P less than 0.001) when compared to the control group. Alterations in the vitamin A transport proteins increased with schistosomal complications and were closely correlated to changes in vitamin A (P less than 0.005), but alterations of albumin and alpha 2-macroglobulin were less consistent and did not correlate with changes in zinc levels. There was a highly significant correlation, however, between plasma zinc concentrations and those of vitamin A, retinol binding protein and prealbumin (P less than 0.001 for all correlations) in all groups of patients as well as the control group. These findings indicate that the binding and transport proteins of both zinc and vitamin A were adversely affected by schistosomiasis and its various complications. Deficiencies of both zinc and vitamin A seem to be interrelated in this disease and the vitamin A transport system may be largely dependent on zinc status.

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Plasma copper, zinc, serum vitamin A and carotenoids were serially determined in three groups of patients: a group with active Schistosoma mansoni infection, a group with S. mansoni complicated by colonic polyposis and a group with S. mansoni associated with chronic salmonellosis. Results indicated a significant elevation in copper and significant depressions in zinc, vitamin A and carotenoids, the degree of which correlate with the associated complications of this disease. There was a positive correlation between zinc and vitamin A levels in all patients on admission suggesting a relationship between these two nutrients in schistosomal infection. Nutritional repletion of some patients of the first group resulted in significantly improved levels of copper, zinc, vitamin A and carotenoids before drug therapy was introduced indicating that alterations of these parameters are at least partially related to anaemia and poor nutritional status. At clinical recovery, levels of the four parameters were significantly improved in all patients from pre-treatment values but were within the normal range only in patients of the first group. This indicates that complications associated with schistosomiasis may delay normalization of copper, zinc and vitamin A levels beyond the clinical cure stage.

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Exposure of rabbits to hashish smoke every other day for a period of one month resulted in a marked increase in blood ammonia. This increase is not probably due to any hepatic damage since there was no concomitant increase in the number of serum enzymes known to be elevated during hepatic damage. It might be related to the inhibitory effect of hashish on incorporation of amino acids into proteins resulting in an increased availability of amino acids to the catabolic pathways coupled with an increase in the glutamate dehydrogenase activity. These factors could also account for the increased blood urea concentrations in these animals.

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Adult male rats were exposed to tobacco smoke from filter-tipped cigarettes twice daily for a period of four months. Some blood lipids and coagulation parameters were studied. This treatment did not change the serum cholesterol, whereas it significantly increased serum triglycerides and plasma free fatty acids; these were possibly secondary to nicotine-induced catecholamine release. Blood thromboplastic activity as well as platelet aggregation were significantly increased. On the other hand blood fibrinolytic and prothrombin activities were unaffected. These results were discussed.

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