Eur J Epidemiol, 1989 Dec, 5(4), 414 - 9 Approaches to the molecular epidemiology of rickettsioses; Balayeva N; This review deals with the developments of molecular approaches to the investigation of rickettsial disease epidemiology . The data presented include changes in the incidence and geographic distribution of endemic rickettsioses . Use of the DNA restriction enzyme technique, in combination with DNA probe analysis, for the molecular genetic differentiation of tick spotted fever--and typhus fever--group rickettsiae and correlation between with the analysis of polypeptide composition of the above group of rickettsiae are discussed . The data are presented on progress in the identification of various Coxiella burnetii strains as a result of restriction analysis of plasmid DNA as well as chromosomal DNA in combination with DNA probe . New and detailed characteristics of classified and newly isolated strains of rickettsiae and Coxiella burnetii revealed by molecular genetic differentiation techniques are discussed . New identification techniques using DNA probes in combination with restriction analysis of chromosomal from rickettsiae and both plasmid and chromosomal DNA from Coxiella burnetii are considered to have good prospects for future use in epidemiological assessment . The establishment of reference file banks containing restriction endonuclease data on the available typical and atypical strains of rickettsiae and Coxiella burnetii is suggested. J Trop Med Hyg, 1989 Dec, 92(6), 373 - 8 Seroprevalence of murine typhus and fièvre boutonneuse in certain human populations in Egypt; Botros BA et al.; A study was conducted between 1984 and 1987 to determine the prevalence of Rickettsia typhi and Rickettsia conorii infections among humans residing in the Nile Delta, Suez Canal area and Nile Valley of Egypt . Serum specimens were obtained from garbage and rodent control workers, other unclassified occupational workers, and from patients with fever of undetermined aetiology . All sera were assayed for IgA + IgM + IgG (IgAMG) antibody mixture and if positive, reassayed for specific IgM antibody to rickettsia by the indirect fluorescent antibody technique . R . typhi antibody was found in 19% (33/178) of the garbage collectors, whereas only 1% (2/178) had demonstrable antibody to R . conorii . Among those with other occupations, R . typhi antibody was detected in 0.7% (2/295) and none had R . conorii antibody . The antibody prevalence rate for R . typhi among patients with febrile illness ranged from 25 to 41%, and from 2 to 15% for R . conorii, at three different locations in Egypt . In addition, IgM antibody to R . typhi was demonstrated in some patients showing symptoms compatible with rickettsial disease and in some patients who seroconverted, indicating that R . typhi was the cause of illness among some of these patients . These findings support previous observations that R . typhi and R . conorii are the causes of human rickettsial disease in Egypt, and that humans are commonly infected with R . typhi. Med Vet Entomol, 1989 Oct, 3(4), 429 - 33 Experimental transmission of murine typhus by Xenopsylla cheopis flea bites; Azad AF et al.; Transmission of Rickettsia typhi to rats by the bites of Xenopsylla cheopis (Rothschild) fleas was investigated . Procedures rigorously excluded the possibility of contamination of the host skin by flea faeces . Fleas with R . typhi infection (21-25 days post-infection) which fed through bolting cloth (45 min exposure to ten fleas) transmitted rickettsiae with a success rate of 20% . Infective fleas allowed free access to their host for 8 h (10-15 fleas/rat) gave transmission rates of 45-68% . They were also capable of inoculating R . typhi through a membrane of rat skin on a feeder . Only fleas which had been infected for 21 days or longer transmitted R . typhi orally . Oral transmission appeared to be the result of regurgitation of rickettsiae present in the foregut lumen rather than through salivary secretions. Kansenshogaku Zasshi, 1989 Oct, 63(10), 1149 - 59 {A study on immunity in tsutsugamushi disease}; Yokota T et al.; The immune response in human tsutsugamushi disease (scrub typhus) was studied . Anti-rickettsial activity of sera, peripheral mononuclear cells and their culture supernatants from patients on in vitro growth of Rickettsia tsutsugamushi proliferating in normal human peripheral macrophages was examined . The results obtained were as follows . 1) Sera from patients at the early convalescent stage, which exhibited high antibody titers against R . tsutsugamushi, effectively inhibited their growth in macrophages . 2) Sera from patients after a long period from the onset showed low antibody titers and did not inhibit rickettsial growth . 3) Mononuclear cells and T cell enriched fractions suppressed rickettsial growth when they were obtained from the patients at the early convalescent stage and even after as long as 3.5 years from the onset . 4) The culture supernatants of the T cell-enriched fractions which were collected from the patients mentioned above, exhibited a similar antirickettsial activity . These findings indicate that sensitized T lymphocytes and macrophages might play a fundamental role in immunological defense mechanism in tsutsugamushi disease . And the results obtained in our experiments are compatible with those previously reported in experimental scrub typhus in laboratory animals such as mice and monkeys. Infect Immun, 1989 Oct, 57(10), 3116 - 22 Antigenic and genetic relatedness of eight Rickettsia tsutsugamushi antigens; Oaks EV et al.; The genetic and antigenic relatedness of eight antigens in three strains of Rickettsia tsutsugamushi has been studied by using recombinant organisms expressing epitopes of the 150-, 110-, 72-, 58-, 56-, 49-, 47-, and 20-kilodalton (kDa) polypeptide antigens of the Karp strain . Southern blot analysis of Karp, Kato, and Gilliam strain genomic DNA by using probes specific for each antigen class indicated that while strong homology exists between each of the corresponding antigen genes in these three strains, some restriction fragment length polymorphism exists . Antibodies affinity purified against each recombinant antigen class reacted with a comparably sized polypeptide in the Karp, Kato, and Gilliam strains in Western blots (immunoblots) . Against more recent human isolates of R . tsutsugamushi, the affinity-purified antibodies against the 58-kDa recombinant antigen (anti-58-kDa) reacted with all nine isolates, anti-56-kDa reacted with eight of nine isolates, anti-47-kDa reacted with eight of nine isolates, anti-72-kDa reacted with eight of nine isolates, and anti-110-kDa reacted with four of nine isolates . Additional analysis indicated that the 110-kDa antigen may contain strain-specific epitopes similar to those previously reported for the 56-kDa polypeptide . Evidently, the strain heterogeneity among scrub typhus rickettsiae is a result of multiple components that exhibit variability in a background of strong homology. J Clin Microbiol, 1989 Sep, 27(9), 2073 - 9 Line blot and western blot immunoassays for diagnosis of Mediterranean spotted fever; Raoult D et al.; The line blot, a new immunoassay in which antigens are placed on nitrocellulose as narrow lines, was evaluated for its sensitivity and specificity relative to the microimmunofluorescence assay for the diagnosis of Mediterranean spotted fever (MSF) . The line blot assay was only slightly less sensitive and less specific than the microimmunofluorescence assay for detection of immunoglobulin M (IgM) or IgG in 100 serum specimens from 42 patients with MSF . No line blot reactions were observed among 50 control serum specimens from febrile patients with other illnesses . The line blot assay was largely group reactive for spotted fever rickettsiae, but 26% of the positive serum specimens also cross-reacted by IgM with Rickettsia typhi . Western immunoblotting was used to characterize the antigenic components recognized by 19 MSF serum specimens . For both IgM and IgG, lipopolysaccharide was the cross-reactive group antigen, whereas the high-molecular-weight species-specific protein antigens (SPAs) were the only reactive proteins . Relative to the other nine rickettsiae, Rickettsia bellii was unique both in exhibiting no SPA reactions and in having a lipopolysaccharide with a predominantly high-molecular-weight distribution . Although most of the 19 MSF serum specimens examined by Western blotting exhibited preferential reactivity to SPAs of two strains of R . conorii and weaker reactions to the other rickettsiae, 2 serum specimens exhibited SPA reactions consistent with typhus infections . In comparison with other assays, the line blot and Western blot immunoassays have advantages which may permit an improvement in the general availability and commercialization of assays for the serodiagnosis of rickettsial infections. Rev Med Chil, 1989 Aug, 117(8), 948 - 54 {Revista Médica de Chile . 100 years ago}; Costa-Casaretto C; France celebrated the first centennial of the French Revolution . Sixty nine international meetings took place, 24 of them dealing with medical or public health problems . The Chilean Commission for the Paris Universal Exhibit asked Dr Adolfo Murillo to write an account (460 pages) of public health conditions in Chile . Main epidemics at that time (smallpox, tuberculosis, dysentery, venereal diseases, typhoid fever and typhus are described. Zh Mikrobiol Epidemiol Immunobiol, 1989 Aug, (8), 57 - 60 {Effect of interferon and its inducers on the immunogenicity of typhus vaccines}; Pshenichnov VA et al.; The acceleration of antibody formation in animals immunized with chemical typhus vaccine has been shown to occur under the influence of interferonogens (poly I--poly C, tyloron) and leukocytic interferon in experiments on guinea pigs and monkeys. J Clin Microbiol, 1989 Aug, 27(8), 1841 - 6 Serodiagnosis of scrub typhus with antigens immobilized on nitrocellulose sheet; Urakami H et al.; This study was designed to develop a simple method for serodiagnosis of scrub typhus . The basis of the method is detection of anti-Rickettsia tsutsugamushi antibody in patient serum by reaction with antigens dot blotted on a nitrocellulose sheet (NCS) . The final evaluation of the reaction is performed by observing the color intensity which develops as a result of sequential treatments of the NCS with peroxidase-conjugated anti-human immunoglobulin G or immunoglobulin M antibody and with the substrate of the enzyme . After various trials, we found that the best results were obtained by using a purified antigen which adhered to an NCS at 0.2 to 2 micrograms of protein per dot and a test serum diluted 1,000- to 4,000-fold . Under these conditions, almost all antibody-positive sera showed a distinct color at the dot on the NCS, so that a positive reaction could be distinguished by the naked eye from a negative reaction with antibody-negative sera, which developed only a faint color . A comparison of the results of screening of antibody-positive and -negative sera by this method and the immunofluorescence test showed that both methods produced similar results . From these results, it is concluded that this dot immunoassay can be useful for the serodiagnosis of scrub typhus. Microbiologica, 1989 Jul, 12(3), 189 - 94 Epidemiology of boutonneuse fever in western Sicily: demonstration of multiple spotted fever group-Rickettsiae subtypes; Tringali G et al.; Electrophoretic analysis of the proteins and genomic DNA of spotted fever-group Rickettsiae isolated from ticks and a human in Western Sicily show that at least two distinct subtypes other than R . conorii are present in this region . All of the spotted fever-group isolates share common features with other, well-defined spotted fever-group rickettsial species, e.g . R . sibirica, Thai Tick Typhus, and R . rickettsii . Based on these data, caution is recommended when identifying species by the more traditional and less specific tests . Studies of the ecology and epidemiology of spotted fever-group Rickettsiae in regions where R . conorii infections occur would benefit and be challenged by intensive antigenic analyses of the proteins and genomic DNA of the various strains of the spotted fever-group Rickettsiae present in those areas. Ann Ophthalmol, 1989 Jul, 21(7), 253 - 4 Acquired toxoplasmic retinochoroiditis after platelet transfusions; Nelson JC et al.; We present a rare well-documented case of acquired toxoplasmic retinochoroiditis transmitted by platelet transfusion . A 52-year-old woman developed severe thrombocytopenia shortly after receiving a sulfamethoxazole-containing antibiotic . This episode was treated with platelet transfusions and a three-day course of corticosteroids . Thirteen days later, she developed an acute febrile illness typical of the typhus-like form of toxoplasmosis . Fifty-six days later, while still taking corticosteroids for recurrent immune thrombocytopenia, she developed an acute macular retinochoroiditis OD . Serology showed recently acquired toxoplasmosis . Epidemiologic investigation revealed no possible source for the toxoplasmosis other than the platelet transfusion. J Dermatol, 1989 Jun, 16(3), 169 - 77 Rickettsioses of the spotted fever group around the world; Walker DH; Spotted fever group rickettsioses comprise Rocky Mountain spotted fever (Rickettsia rickettsii), boutonneuse fever (R . conorii), North Asian tick typhus (R . sibirica), Queensland tick typhus (R . australis), rickettsialpox (R . akari), and Oriental spotted fever (R . japonica) . Ticks or mites serve as the vector and reservoir hosts of the rickettsiae . These obligate intracellular bacteria invade vascular endothelial cells, which are damaged directly, causing increased vascular permeability . The rash usually appears in Rocky Mountain spotted fever on the third day of illness and later evolves to become petechial maculopapules in 50% of cases with involvement of the palms and soles in a similar proportion of patients . Eschar occurs in some SFG rickettsioses at the site of tick bite, but rarely in Rocky Mountain spotted fever . Diagnosis often proves difficult, and laboratory assays for antibodies to SFG rickettsiae are generally useful only in convalescence . Rickettsiae are demonstrable by diagnostic immunohistology in biopsies of rash or eschar . Empiric treatment with doxycycline, tetracycline, or chloramphenicol should be given early in the course on the basis of clinical suspicion of the diagnosis of a SFG rickettsiosis. Zh Mikrobiol Epidemiol Immunobiol, 1989 Jun, (6), 43 - 7 {Typhus infection (Brill's disease) in the environment of a large city}; Daiter AB et al.; The data on the epidemiological analysis of 675 cases of infection of the typhus nature, detected in Leningrad in 1974-1986, are presented . The seasonal morbidity curve, the age structure of patients, the character of the clinical course of the disease and other data gave a reason for the diagnosis of Brill's disease . The comparison of the relative data on morbidity rates in typhus at different periods of the current century was made. J Autoimmun, 1989 Jun, 2 Suppl, 81 - 91 The importance of the crystalline surface layer protein antigens of rickettsiae in T-cell immunity; Carl M et al.; Studies in animal models have demonstrated that solid immunity to typhus rickettsiae is dependent on immune T cells . In addition, the surface protein antigen (SPA) of typhus rickettsiae has been shown to be an effective immunogen, protecting vaccinated animals against subsequent challenge with virulent organisms . In the present studies we describe three classes of human lymphocytes which are capable of lysing cells infected with typhus rickettsiae . The first class is CD3,8-positive and is capable of specially lysing both HLA-matched and mismatched targets infected with typhus rickettsiae . Since this cytotoxic effector can be generated with IL-2 as well as with SPA it appears to be a lymphokine-activated killer (LAK) . The second class of lymphocytes is CD3,4-positive and is capable of producing gamma interferon in response to the SPA of typhus rickettsiae . Gamma interferon in turn can cause the lysis of cells infected with typhus rickettsiae as well as inhibit intracellular rickettsial growth . A third cytotoxic effector which is CD3,4-positive and which is capable of lysing only HLA-matched targets infected with typhus rickettsiae was generated with a sonicated antigen, and its fine antigenic specificity is not known at present . We conclude that the SPA is an immunologically important protein for the human host and represents an outstanding candidate for a subunit vaccine against typhus. Rev Infect Dis, 1989 May-Jun, 11 Suppl 4, S864 - 76 Hemorrhagic fever with renal syndrome in Korea; Lee HW; Several clinical variants of hemorrhagic fever with renal syndrome (HFRS) are caused by Hantaan and related viruses . Since 1951, 500-900 patients with HFRS have been hospitalized annually in Korea . Although HFRS is associated primarily with rural areas, it is now being recognized as an urban problem and a particular hazard to laboratory staff using rodents for research . Recently, epidemic outbreaks of leptospirosis and scrub typhus have occurred during the HFRS season, leading to confusion in diagnosis . Serologic diagnosis of HFRS is based on the demonstration of IgM antibodies to Hantaviruses by the indirect fluorescent antibody technique or enzyme-linked immunosorbent assay . The specific Hantavirus causing infection can be identified on the basis of titers of plaque-reduction neutralizing antibody . Results of studies with monoclonal antibodies suggest that viral subtypes exist for each Hantaviral serotype presently recognized . While infection with Hantaviruses is known to be a problem of worldwide dimensions, present evidence indicates that it occurs over a wider area than previously recognized . Vertical transmission of Hantaan virus in a pregnant woman has been documented. Zh Mikrobiol Epidemiol Immunobiol, 1989 May, (5), 73 - 7 {Monoclonal autoantibodies to the epithelial basement membrane cells of human skin and thymus obtained through immunization with Rickettsia prowazekii antigens}; Drobyshevskaia EI et al.; As the result of immunization of BALB/c mice with the commercial preparation of typhus vaccine and R . prowazekii corpuscular antigen, in 29.2% and 40.3% of cases (respectively) the appearance of hybridomas synthesizing monoclonal antibodies (McAb) to different autologous structures (skin and thymic epithelium, cell nuclei, conjunctive tissue structures and vascular endothelium) has been revealed . The McAb under test have proved to be IgM-autoantibodies . McAb M-6, active against the basal membrane of human skin and thymic epithelium, produce quite a definite picture of disturbances in the differentiation of epithelium and can be used for the diagnosis of dyskeratosis. Am J Trop Med Hyg, 1989 May, 40(5), 521 - 8 Detection of murine typhus infected fleas with an enzyme-linked immunosorbent assay; Dobson ME et al.; An enzyme-linked immunosorbent assay (ELISA) for the detection of Rickettsia typhi antigen in homogenates of pooled or individual laboratory infected fleas is described . The assay uses a double sandwich technique, employing a pool of monoclonal antibodies to capture the antigen and a hyperimmune rabbit serum for antigen detection . Using pools of R . typhi infected Xenopsylla cheopis, Ctenocephalides felis, and Leptopsylla segnis, the sensitivity of the ELISA was compared with direct fluorescent antibody examination of individual fleas for rickettsiae and with rickettsial titers determined by plaque enumeration on primary chicken embryo fibroblasts (PFU) . Pooled samples with less than 4 PFU of viable rickettsiae gave ELISA results which were not significantly above background . Both ELISA OD and ELISA titer (last dilution giving an OD that was 2 SD above the control) of a 1:10 dilution of homogenate (4 fleas/ml) were linearly related to rickettsial titer up to 10(6.8) PFU/sample . Multiple freeze-thaws of pools of infected fleas led to a rapid loss of ELISA sensitivity . ELISA assays on single fleas demonstrated large individual variability in rickettsial content . This was independent of the number of days postinfectious feeding or the mean number of PFU/flea (10(1.7-6.9) found for pooled fleas in the same cohort . The sensitivity and ease of performance of ELISA should make it usable under field conditions. Arch Intern Med, 1989 Apr, 149(4), 949 - 51 Delayed neurologic display in murine typhus . Report of two cases; Samra Y et al.; Two cases of murine typhus with prolonged neurologic manifestations appearing after the febrile stage of the illness are described . One patient had behavioral and memory disturbances for almost 18 months after defervescence, which terminated gradually without specific therapy . The second patient had similar manifestations over a period of weeks that rapidly resolved after tetracycline therapy . Such phenomena were not previously described in the literature, as far as we know, although similar manifestations were noted in Rocky Mountain spotted fever. Infect Immun, 1989 Apr, 57(4), 1276 - 80 Heterogeneity of CD4-positive human T-cell clones which recognize the surface protein antigen of Rickettsia typhi; Carl M et al.; Immunity to the typhus group of rickettsiae is largely dependent on the effector function of several classes of T lymphocytes, including those which produce gamma interferon . Since the surface protein antigen (SPA) derived from typhus group rickettsiae has been shown to be an effective immunogen in animal models, human T-cell clones specific for the SPA of Rickettsia typhi were isolated and tested for their antigenic specificity, as well as for their ability to produce gamma interferon . Eighteen CD4-positive clones specific for the SPA of R . typhi exhibited considerable diversity in their response to the SPAs derived from two strains of Rickettsia prowazekii and from Rickettsia canada . The vast majority of clones also recognized the SPAs from R . prowazekii but not from R . canada . Two heteroclitic clones demonstrated significantly higher proliferative responses to the SPAs derived from one or both of the R . prowazekii strains than to the SPA of R . typhi, and one clone demonstrated a significantly higher response to the SPA of R . typhi than to the other SPAs . All 18 clones produced gamma interferon in response to SPA stimulation . We conclude that the SPAs from typhus group rickettsiae can elicit both a diverse T-cell response in humans and the efficient stimulation of gamma interferon-mediated immunity. Zhonghua Yu Fang Yi Xue Za Zhi, 1989 Mar, 23(2), 96 - 8 {Detection of typhi antibodies by latex agglutination}; Geng Y; A latex test for immunodiagnosis of murine typhus, using erythrocyte-sensitizing substance from Rickettsia prowazekii absorbed to latex particles, has been developed . The test was evaluated with a total of 234 healthy person and non-typhus patient sera, 89 single and 63 paired typhus patient sera . The positive rate was 92.1% for paired and 80.9% for single sera from patients with typhus . The test gave results consistent with those given by the microimmunofluorescence (Micro-IF) and microagglutination (MA) tests . The sensitivity of the test was higher than Weil-Felix (P less than 0.05) test . This test was simple, rapid, sensitive and specific. J Infect, 1989 Jan, 18(1), 35 - 7 Relapse of rickettsial Mediterranean spotted fever and murine typhus after treatment with chloramphenicol; Shaked Y et al.; In the years 1975-1984, 132 patients with rickettsial Mediterranean spotted fever and murine typhus were treated with chloramphenicol or tetracycline . Among the 24 patients who received chloramphenicol ten relapsed and one failed to respond at all . None of the 108 recipients of tetracycline suffered a relapse . It appears that tetracycline should serve as first-line therapy in several rickettsial diseases. Trop Geogr Med, 1989 Jan, 41(1), 76 - 9 Cardiovascular and pulmonary complications of epidemic typhus; Diab SM et al.; A case of typhus fever associated with cardiac and pulmonary complications is reported . The patient was a 24-year-old Egyptian female with characteristic clinical presentation of rickettsial infection, though no rash was present throughout the course of the disease . We could not find a report of such complications in the English medical literature. Prog Med Virol, 1989, 36, 62 - 102 Hemorrhagic fever with renal syndrome; Lee HW et al.; Hantaviruses, the causative agents of HFRS, have become more widely recognized . Epidemiologic evidence indicates that these pathogens are distributed worldwide . People who come into close contact with infected rodents in urban, rural and laboratory environments are at particular risk . Transmission to man occurs mainly via the respiratory tract . The epidemiology of the hantaviruses is intimately linked to the ecology of their principal vertebrate hosts . Four distinct viruses are now recognized within the hantavirus genus and that number is likely to increase to six very soon; however, further investigations are necessary . Much more work is still needed before we fully understand the wide spectrum of clinical signs and symptoms of HFRS as well as the pathogenicity of the different viruses in the hantavirus genus of the Bunyaviridae family . HFRS is difficult to diagnose on clinical grounds alone and serological evidence is often needed . A fourfold rise in IgG antibody titer in a 1-week interval, and the presence of the IgM type of antibodies against hantaviruses are good evidence for an acute hantavirus infection . Physicians should be alert for HFRS each time they deal with patients with acute febrile flu-like illness, renal failure of unknown origin and sometimes hepatic dysfunction . Especially the mild form of HFRS is difficult to diagnose . Acute onset, headache, fever, increased serum creatinine, proteinuria and polyuria are signs and symptoms compatible with a mild form of HFRS . Differential diagnosis should be considered for the following diseases in the endemic areas of HFRS: acute renal failure, hemorrhagic scarlet fever, acute abdomen, leptospirosis, scrub typhus, murine typhus, spotted fevers, non-A, non-B hepatitis, Colorado tick fever, septicemia, dengue, heartstroke and DIC . Treatment of HFRS is mainly supportive . Recently, however, treatment of HFRS patients with ribavirin in China and Korea, within 7 days after onset of fever, resulted in a reduced mortality as well as shortened course of illness. Boll Ist Sieroter Milan, 1989, 68(1), 1 - 4 {Scrub typhus: an imported case seen in Milan}; Bianchi GB et al.; The Authors describe a scrub typhus case imported from Indo-China and observed in Milan, which is probably the first case reported in Italy . The patient, on holiday journey, exposed herself unwisely to the danger of catching the infection . The diagnosis was based on clinical grounds and Weil-Felix reaction . The problems of the diagnosis reliability and of the imported diseases are briefly discussed as well. Tr Inst Im Pastera, 1989, 66, 160 - 5, 175 {Characteristics of monoclonal antibodies directed to species specific and group specific antigens of Rickettsia prowazekii}; Drobyshevskaia EI et al.; A number of hybridomas against different determinants of R . prowazekii were obtained by hybridization of splenocytes from BALB/c mice immunized with whole cells or soluble antigens of the organism . Some of the monoclonal antibodies bound to thermolabile species specific protein of R . prowazekii and did not react with R . mooseri antigens (monoclonal antibodies series B4/4 and A3) . Monoclonal antibodies C5/2 and A3/2 reacted with group specific thermostabile antigen which is common for both R . prowazekii and R . mooseri . Monoclonal antibodies against species specific antigen were found to be of Ig G2a subclass . The monoclonal antibodies can be used to identify R . prowazekii and R . mooseri and solve the problem of differentiating Rickettsiae of typhus group. Lab Delo, 1989, (2), 58 - 61 {Detection of antibodies to Rickettsia prowazekii using 3 serologic tests}; Kuznetsova AV et al.; Commercial antigens of R . prowazekii may be used for the diagnosis of the typhus group rickettsiosis by the new solid-phase indirect enzyme immunoassay (SPI EIA) . High sensitivity of the test makes the diagnosis of rickettsioses more effective and ensures an earlier detection of typhus patients . The authors have employed SPI EIA modification with polyethylene glycol, permitting a change in the incubation regimen (20 degrees C instead of 37 degrees C) and more rapid reaction; this recommends the method for laboratory and field practice . The possibility of a visual assessment of the test results also recommends it for wide practice. Am J Med, 1988 Dec, 85(6), 799 - 805 Imported rickettsial disease: clinical and epidemiologic features; McDonald JC et al.; PURPOSE AND METHODS: The rickettsioses continue to constitute major health problems in many parts of the world . With increasing international travel, recognition of rickettsial diseases by physicians is becoming more important . The clinical features of four cases of rickettsial disease imported into Canada over a five-year period are presented; two patients with tick typhus (Rickettsia conorii), one patient with scrub typhus (R . tsutsugamushi), and one patient with murine typhus (R . typhi) . We also present the North American data over the past 10 years from the Centers for Disease Control (CDC) (Atlanta) . RESULTS: Since 1983 in the United States, three cases of imported scrub typhus, all after travel to India, were confirmed, as well as six cases of murine typhus after travel to southeast Asia . At the CDC, 67 imported cases of tick typhus have been confirmed by indirect fluorescent antibody test since 1976; most illnesses occurred after travel to Africa . CONCLUSION: Rickettsial diseases are underrecognized by physicians, who should consider these diagnoses in travelers returning from endemic areas . Since effective treatment is available, prompt diagnosis and treatment are important . In all cases, specific serologic confirmation should be obtained. Am J Trop Med Hyg, 1988 Nov, 39(5), 421 - 6 The ELISA-U: an enzyme-linked immunosorbent assay using urease as the enzyme marker for rapid detection of Plasmodium falciparum antibody in human serum; Lee M et al.; A visual, enzyme-linked immunosorbent assay using urease (ELISA-U) as the enzyme marker was adapted for rapid detection of antibody against Plasmodium falciparum . Flat-bottom, 96-well microtiter plates were coated with P . falciparum soluble antigen obtained by saponin and NP-40 treatment of parasite cultures . Antibody was detected by successive incubations with test sera, urease-conjugated rabbit-human antibody, and urease substrate . Reactive sera developed a definite and easily visualized purple color . Sera from patients with single infections of P . vivax or P . ovale were unreactive . No cross-reactivity was noted with sera from patients with rheumatoid arthritis, filariasis, amebiasis, schistosomiasis, dengue, scrub typhus, leptospirosis, or toxoplasmosis . The procedure can be performed at room temperature and completed within 1 hr . The sensitivity of the assay is comparable to that of the indirect fluorescent antibody test at all but the lowest dilutions tested. Ann Acad Med Singapore, 1988 Oct, 17(4), 595 - 9 Murine typhus infection complicated by dengue haemorrhagic fever; Kueh YK et al.; Murine typhus is endemic in many South East Asian countries but it has not been reported from the island of Borneo . Recently we attended to an English lady who contracted the disease in Brunei . Her clinical course unexpectedly turned stormy in the third week of the illness accompanied by severe thrombocytopenia . She made a complete recovery . Serological studies here and subsequently in England confirmed that she suffered from recent murine typhus infection complicated by dengue haemorrhagic fever. J Clin Microbiol, 1988 Oct, 26(10), 2221 - 3 Addition of monoclonal antibodies specific for Rickettsia akari to the rickettsial diagnostic panel; McDade JE et al.; Monoclonal antibodies were produced from mice infected with Rickettsia akari (the etiologic agent of rickettsialpox) and evaluated for specificity in indirect fluorescent-antibody tests with 23 different rickettsial antigens . Of the nine antibodies that were evaluated, two were specific for R . akari and four reacted with R . akari and all other spotted fever group rickettsiae . The remaining three antibodies reacted with some, but not all, members of the spotted fever group . None of the antibodies reacted with typhus, scrub typhus, trench fever, or Q fever rickettsiae . Adding these antibodies to the list of available diagnostic reagents will facilitate identification of rickettsial diseases, particularly those caused by members of the spotted fever group, where the clinical presentations are similar and the etiologic agents are closely related antigenically. Am J Trop Med Hyg, 1988 Oct, 39(4), 391 - 7 Newborn rats in the murine typhus enzootic infection cycle: studies on transplacental infection and passively acquired maternal antirickettsial antibodies; Arango-Jaramillo S et al.; This study focused attention on the newborn rat as a possible significant participant in the highly successful enzootic cycle of murine typhus . We examined the influence of maternal Rickettsia typhi (R . mooseri) infection in rats on the offspring with respect to the possible vertical transmission of R . typhi and the passive transfer of maternal antirickettsial antibodies . Transmission of R . typhi by rickettsemic pregnant rats did not occur either transplacentally during gestation to their fetuses or postnatally through colostrum and milk to their newborn . The rickettsial burden of the placenta was sometimes greater than 10(6) plaque forming units per g tissue and undetectable in colostrum or milk . However, newborn rats were highly susceptible to infection per os . Transplacental passage of antirickettsial antibody to offspring was detectable only when the mother's antibody titer was high . Passive postpartum acquisition of antirickettsial antibodies by newborn rats from colostrum and milk of immune mothers occurred regardless of the height of the maternal antibody titer, rose to a maximum at about 3 weeks of age, and then declined rapidly, becoming undetectable 4 weeks after birth. Infection, 1988 Sep-Oct, 16(5), 283 - 7 Murine typhus and spotted fever in Israel in the eighties: retrospective analysis; Shaked Y et al.; One hundred and twenty-one cases of murine typhus and spotted fever in Israel between 1976 and 1985 in the Chaim Sheba Medical Center are reviewed . Clinical manifestations of murine typhus were similar to those described previously, but those of spotted fever were different from classical Mediterranean spotted fever: rash was present in 87% but eschar was noted in only two out of 38 patients . The occurrence of relapse in eight of the 16 patients treated with chloramphenicol (seven cases of murine typhus and one case of spotted fever) was striking, particularly since none occurred in 86 patients treated with tetracycline hydrochloride (p less than 0.01) . Relapses were milder than the primary illness, except for one which did not receive specific therapy and was fatal. Zh Mikrobiol Epidemiol Immunobiol, 1988 Sep, (9), 79 - 82 {Immunoenzyme analysis in a system of serologic evaluation of louse-borne typhus vaccines}; Pshenichnov VA et al.; The blood sera of persons immunized with different typhus vaccines have been studied in the complement fixation test, the indirect hemagglutination test and the enzyme immunoassay . The data thus obtained indicate that the enzyme immunoassay is highly sensitive and can be universally used for the determination of antibodies to Rickettsia prowazekii after primary and booster immunization with different typhus vaccines . This method detects specific antibodies both at an early period and, which is of particular importance, at a remote period after immunization (3 years later) when complement-binding and hemagglutinating antibodies are absent . This is seemingly indicative of the two-phase character of postvaccinal immunity induced by live typhus vaccine. Infect Immun, 1988 Sep, 56(9), 2526 - 9 Recognition of typhus group rickettsia-infected targets by human lymphokine-activated killer cells; Carl M et al.; Lymphokine-activated killer cells caused significant lysis of target cells infected with typhus group rickettsiae (TGR) but not cells infected with Rickettsia tsutsugamushi . Monoclonal and polyclonal antibodies against TGR or TGR-infected cells failed to bind specifically to infected targets, as determined by flow cytometry or by immunoprecipitation of radiolabeled cell surface proteins . Major unaltered antigenic determinants of TGR therefore cannot be detected on the surface of infected targets. Postgrad Med J, 1988 Aug, 64(754), 614 - 6 Rickettsial infection presenting as culture-negative meningitis; Woo ML et al.; Meningitis is an unusual presentation of rickettsial infection . We report a patient who was confirmed by serology to have typhus fever (not scrub), but who presented with the typical findings of culture-negative bacterial meningitis . Neurological manifestations of different types of rickettsial infection are discussed. Jpn J Exp Med, 1988 Aug, 58(4), 169 - 84 Rickettsiosis in Japan; Kawamura A Jr et al.; The rickettsial diseases of man in Japan include Tsutsugamushi disease (scrub typhus), murine typhus, which occurs sporadically, and one of spotted fever group diseases, recognized as a new entity since 1984 . Starting from 1976, there has been a remarkable resurgence in the number of reported cases of Tsutsugamushi disease in Japan after several years of virtual absence, and endemics are still continuing after reaching a prominent outbreak in 1984 . Its yearly incidences from 1982 to 1986 were 538, 749, 971, 890 and 738, respectively . This resurgence is most likely related to an increase of vector mite colonies that carry Rickettsia tsutsugamushi . However, it cannot be explained as to how these foci of vector mites developed . The existence of spotted fever group disease had not been recognized until quite recently . This rickettsiosis was first identified in Tokushima and Kochi Prefectures in 1984 . To date, the estimated total number of sero-positive cases is over 45 cases . The causative rickettsiae were isolated from the blood of 5 patients using cell culture methods and the identification of these rickettsiae is now being carried out. Q J Med, 1988 Aug, 68(256), 595 - 602 Scrub typhus pneumonitis: an entity which is frequently missed; Chayakul P et al.; Four cases of scrub typhus pneumonitis are reported . Diagnosis was confirmed by positive Weil-Felix OX-K reaction and immunofluorescent antibody test for Rickettsia tsutsugamushi . Two patients presented with atypical pneumonia and two had overwhelming pneumonia resembling adult respiratory distress syndrome . All patients made a full recovery after appropriate treatment. Am J Trop Med Hyg, 1988 Aug, 39(2), 145 - 9 Use of avidin-biotin-glucose oxidase complex to detect antimalarial antibody in serum by light microscopy; Lee M et al.; An immunohistochemical assay was developed combining an avidin-biotin-glucose oxidase complex procedure (ABC-GO) with light microscopy to detect specific antibody against Plasmodium falciparum . Thin blood films were prepared from culture material of P . falciparum and fixed with acetone . Antibody was detected by successive incubations with test serum, biotinylated goat antihuman antibody, avidin-biotin-glucose oxidase complex, and glucose oxidase substrate . In the presence of reactive serum, a blue precipitate formed on the parasites and could be visually observed with a 40x objective . Sera from patients with single infections for P . vivax or P . ovale were unreactive . No cross-reactivity was observed with sera from patients with rheumatoid arthritis, filariasis, amebiasis, schistosomiasis, dengue, scrub typhus, leptospirosis, or toxoplasmosis . The sensitivity of ABC-GO is comparable to that of the indirect fluorescent antibody test. Jpn J Med Sci Biol, 1988 Apr, 41(2), 57 - 68 Evaluation of the whole blood lymphocyte transformation assay for scrub typhus exposure: adaptability to field sample collection; Lim TS et al.; The optimal conditions for the determination of exposure to scrub typhus by the whole blood lymphocyte transformation assay was 7 days culture of 10% blood in RPMI 1640 medium supplemented with 10% human AB-negative serum and L-glutamine with 50-200 micrograms protein/ml of Karp, Kato, or Gilliam strain membrane antigen . A simple exponentially decaying linear model shows the decrease in lymphocyte viability, the ability of sensitized cells to be stimulated with PHA mitogen, and the corresponding decrease in stimulation by scrub typhus antigens with increasing time of preincubation on ice . The lower limit of stimulation index for the detection of scrub typhus by whole blood lymphocyte transformation assay was 4.0 with a type I error of 1%. Am J Trop Med Hyg, 1988 Mar, 38(2), 400 - 6 Comparative evaluation of the indirect immunoperoxidase test for the serodiagnosis of rickettsial disease; Kelly DJ et al.; An indirect immunoperoxidase test was compared with an indirect fluorescent antibody test and the Weil-Felix OXK test for serodiagnosis of scrub typhus by measuring the rickettsial antigen specific activity of IgG, IgM, and whole globulin . Acute and convalescent sera from 50 Rickettsia tsutsugamushi isolate-positive scrub typhus patients and from 45 febrile patients diagnosed as having diseases other than scrub typhus were tested . The receiver operating characteristic for each test showed that the indirect immunoperoxidase and indirect fluorescent antibody tests were more sensitive and specific than the Weil-Felix test using convalescent and acute as well as paired sera . The indirect immunoperoxidase test showed no cross-reactivity when R . tsutsugamushi antigen was tested against sera collected from patients living outside the scrub typhus-endemic area with diseases other than scrub typhus . The indirect immunoperoxidase and indirect fluorescent antibody tests were comparable in measured response to R . tsutsugamushi, R . typhi, and TT-118 (spotted fever group) antigen . Thus the indirect immunoperoxidase test represents a sensitive, specific, reproducible, and practical semiquantitative test for rickettsial disease diagnosis. Antimicrob Agents Chemother, 1988 Feb, 32(2), 285 - 6 Chloramphenicol, gentamicin, and ciprofloxacin against murine scrub typhus; McClain JB et al.; Ciprofloxacin (120 mg/kg of body weight per day), chloramphenicol (300 mg/kg per day), and gentamicin (30 mg/kg per day) were compared with placebo in a BALB/cj mouse model of scrub typhus . All animals treated with ciprofloxacin and chloramphenicol survived . All animals treated with gentamicin or placebo died . All surviving animals showed evidence of seroconversion . Ciprofloxacin and chloramphenicol were statistically more effective in preventing death than gentamicin or placebo. World Health Stat Q, 1988, 41(1), 37 - 45 {International health regulations--evaluation and trends}; Vessereau A; The current International Health Regulations (IHR) were adopted by the Twenty-second World Health Assembly in 1969 and amended in 1973 and 1981 . They are a revised and consolidated version of the International Sanitary Regulations which were adopted by the Fourth World Health Assembly in 1951, themselves based on the previous International Sanitary Conventions . The purpose of the IHR is to ensure maximum security against the international spread of diseases with a minimum interference to world traffic . Over the years the IHR included cholera, yellow fever, plague, smallpox, typhus and relapsing fever, and then dropped the last three as a result of the global eradication of smallpox and the decline of typhus and relapsing fever as international threats . The IHR have played and still play an important part with respect to the diseases for which they were drawn up . The international spread of yellow fever has been contained by the application of a highly effective vaccine to travellers, and of plague by the inspection of ships and aircrafts for rats, and improvements in the design of air and sea cargo carriers to make them increasingly uninhabitable for rats . The role of the IHR was questioned as far as smallpox and cholera are concerned by arguing that smallpox was eradicated by rigorous national local vaccination programmes and cholera must be defeated by improved environmental sanitation . However, one must not lose sight of the fact that an important element of the IHR is the obligation to notify cases of the diseases listed, together with as much epidemiological information as possible, in order to permit other countries to take appropriate action.(ABSTRACT TRUNCATED AT 250 WORDS) Microbiol Immunol, 1988, 32(11), 1085 - 92 Immunoblotting analysis of anti-rickettsial antibodies produced in patients of Tsutsugamushi disease; Ohashi N et al.; The reactivity of sera from patients of Tsutsugamushi disease (scrub typhus) with the antigenic polypeptides of Rickettsia tsutsugamushi was analyzed by the immunoblotting method . The reactivity varied greatly among the sera of individual patients tested . IgG and IgM antibodies of most patients reacted with the 54-56 kilodalton (54-56K) polypeptide located on the rickettsial surface, suggesting that this polypeptide is a predominant antigen in the infection . Other polypeptides of 60K, 50-52K, 46-47K, 35K, and 21-25K were reactive with some but not all sera . From the reactivity of these polypeptides, it was suggested that the 54-56K polypeptide is both strain-specific and group-specific, the 60K polypeptide is group-specific, and the 35K and 21-25K polypeptides are subgroup-specific . IgG antibodies seem to be more cross-reactive with polypeptides of multiple strains than IgM antibodies and have a tendency of increased cross-reactivity that was observed in the sera obtained at the later stage of illness. Am J Trop Med Hyg, 1988 Jan, 38(1), 168 - 71 Murine typhus among Khmers living at an evacuation site on the Thai-Kampuchean border; Brown AE et al.; An outbreak of febrile disease involving 170 Khmer adults at an evacuation site in Thailand occurred during the dry season of 1986, only 8 months after the camp was constructed . The illnesses were characterized by persistent fever, retro-orbital headache, myalgias, and clinical response to tetracycline within 2-3 days . The symptoms, effectiveness of tetracycline, and presence of a large rat population raised the suspicion of murine typhus . Fourteen (74%) of 19 patients had elevated or rising antibody titers against Rickettsia typhi, confirming the clinical diagnosis . Rats were caught, and they and their fleas were identified . In agreement with the known Thai host and vector, 80 (93%) of 86 rats were Rattus exulans, and all of 32 fleas were Xenopsylla cheopis . This first reported outbreak of murine typhus in Thailand is notable for its occurrence in a new human settlement only 8 months after construction. Trans R Soc Trop Med Hyg, 1988, 82(5), 761 - 6 A study of viral and rickettsial exposure and causes of fever in Juba, southern Sudan; Woodruff PW et al.; Patients presenting at the Juba Teaching Hospital, either with fever of undetermined origin or with a clinical cause of fever, gave evidence of exposure to a wide range of viral and rickettsial agents . Serological tests showed high antibody levels to flaviviruses (56.9%) and alphaviruses (29.2%), with lesser levels of bunyamweraviruses (3.8%), Rift Valley fever (2.3%), and sandfly fever (0.75%) . Flavivirus exposure was significantly associated with clinical evidence of liver disease; repeated exposure to flaviviruses was particularly prevalent in those with poor sanitation and who had received previous injections . A significant focus of Ebola and Marburg exposure in Juba has been identified . Clinical evidence of liver disease was evident in 37% of patients studied, and 24.6% were HBsAg positive . The first 2 HIV-positive individuals from the southern Sudan are reported, including one with clinical AIDS . A high prevalence of positive antibodies to Rickettsia typhi in the population indicated that murine typhus was common locally . This study indicates the need for further public health measures in the southern Sudan to control the spread of these infections. Geburtshilfe Frauenheilkd, 1987 Nov, 47(11), 821 - 2 {Ulcerating vulvitis--a rare complication in abdominal typhus}; Schmidt R et al.; This article describes the clinical pattern and course of an ulcerating vulvovaginitis occurring within the overall clinical picture of a case of typhus abdominalis as a now rare complication of that severe infectious disease. Am J Trop Med Hyg, 1987 Nov, 37(3), 629 - 35 Suppression of Rickettsia typhi transmission in fleas maintained on murine typhus-immune rats; Azad AF et al.; The presence of host antibodies against Rickettsia typhi in the hemolymph of Xenopsylla cheopis fed on immune rats was studied using an indirect immunofluorescent antibody (IFA) test and enzyme-linked immunosorbent assay (ELISA) . The time course experiment revealed that antibody to R . typhi appears in the flea hemolymph after 18 hr exposure to host and persists for 24 hr . IFA tests utilizing specific antisera to rat IgG (Fc) and rat IgG (Fab) fragments, indicate that some unaltered rat IgG to R . typhi were present in the hemolymph of immune fed fleas . Host antibody to R . typhi was detected on the surface of the rickettsiae in the flea hemolymph and gut contents by IFA . Maintenance of infected fleas on immune host had no significant effect on the establishment and subsequent growth of rickettsiae within the fleas . However, 19-22 day infected fleas maintained on immune hosts failed to transmit R . typhi to baby rats. Vestn Khir Im I I Grek, 1987 Oct, 139(10), 46 - 9 {Results of surgical treatment of patients with intestinal perforation caused by abdominal typhus}; Sukharev VF; The clinical picture of typhoid peritonitis in 67 patients is described . All the patients were operated upon . General roentgenography of the abdominal cavity and Widal's reaction are thought to be an important help in diagnostics of typhoid peritonitis . An analysis of postoperative complications and lethality in this group of patients is presented. Ann Ophthalmol, 1987 Aug, 19(8), 301 - 3, 306 The ocular manifestations of Rocky Mountain spotted fever; Duffey RJ et al.; To our knowledge, this is the first report of an iris nodule in a case of Rocky Mountain spotted fever (RMSF) . The iris nodule may be similar to the "typhus nodule" of the central nervous system reported at autopsy in patients with typhus rickettsial disease . Previous case reports of RMSF have emphasized either anterior uveitis or retinal vasculitis . In the case reported here, both occurred in our patient as a result of RMSF . Also, we review the ophthalmic literature on rickettsial disease. Rev Infect Dis, 1987 Jul-Aug, 9(4), 823 - 40 Epidemiology and ecology of rickettsial diseases in the People's Republic of China; Fan MY et al.; Since 1949, information on rickettsial diseases in the People's Republic of China has been virtually nonexistent in the West . This is the first comprehensive review of the ecology and epidemiology of Chinese rickettsial diseases to be published outside the People's Republic . At least five rickettsioses exist in China: scrub typhus, murine typhus, epidemic typhus, Q fever, and one or more spotted fever-group (SFG) rickettsioses . Although epidemic typhus has been controlled and scrub typhus has abated in many areas, murine typhus, Q fever, and SFG rickettsiosis are important public health problems . Serologic surveys indicate high prevalences of antibodies to Coxiella burnetii, Rickettsia tsutsugamushi, and SFG rickettsiae in some regions; these rickettsiae have been isolated from humans, arthropods, and animals . Doxycycline has emerged as the best treatment for murine typhus, epidemic typhus, and scrub typhus . China offers both opportunities and challenges for the investigation and alleviation of the problems of rickettsial diseases. Fam Pract, 1987 Jun, 4(2), 138 - 42 Pilot study of the prevalence of head lice infestation in a population of Saudi Arabian children; Boyle P; The prevalence of infestation with the head louse, Pediculus capitis, was assessed among the child population, from birth to 10 years old inclusive, of the rapidly expanding Saudi Arabian city of Jeddah . Over a period of two months, 300 consecutive children attending the general practitioner for any reason were examined specifically to identify those infested with head lice: 37 cases of active infestation were found, which is an overall prevalence of 12% . An interesting distribution, however, was noted in respect of age, ranging from less than 2% in the first year of life, rising rapidly to around 30% in ages six to eight years, thereafter declining steadily to about 16% by age 10 years . The distribution of infestation among males and females was broadly similar . These results show a high head lice infestation, particularly in the early school years, where presumably interpersonal contacts are most frequent, facilitating contagious spread . As the head lice is known to spread several viral and rickettsial diseases, such as relapsing fever and typhus, greater efforts should be made towards patient education in hygiene, and towards identifying and treating the disease when found. Am J Med Sci, 1987 May, 293(5), 320 - 3 Serologic evidence of acute murine typhus infection in a patient with culture-negative endocarditis; Austin SM et al.; A patient with culture-negative infective endocarditis is presented in whom detailed serological studies were indicative of acute infection with murine typhus . The patient had aortic and mitral regurgitation with congestive heart failure and typical peripheral manifestations of subacute endocarditis, but no documented fever . Aortic and mitral valve replacement surgery and a 6-week course of doxycycline therapy produced a clinical cure in this patient, as well as a diagnostic fall in markedly elevated preoperative typhus indirect fluorescent antibody (IFA) and complement fixation (CF) titers . Serological studies were consistently negative for Q fever. Am J Trop Med Hyg, 1987 May, 36(3), 621 - 30 Factors influencing Rickettsia tsutsugamushi infection of cultured cells; Hanson B; Several factors which influence Rickettsia tsutsugamushi infectivity of, and replication in, cultured cells have been investigated in order to establish standard laboratory conditions for reliable quantitation and maximization of rickettsial yield and to begin to explore the nature of the relationship between the rickettsia and its host cell . The extent of scrub typhus rickettsial association with host cells was dependent on the rickettsial and target cell concentrations and on the medium in which the infection took place . Brain heart infusion broth, a standard rickettsial diluent for infectivity, was markedly inhibitory . Both rickettsial and host cell replication were dependent on a component(s) supplied by serum to the tissue culture medium; rickettsial multiplication was less affected by small temperature variation (optimum 34 to 37 degrees C) than was host cell growth (optimum 37 degrees C) . The antibiotic daunomycin was very useful in selectively inhibiting host cell replication and permitting attainment of somewhat greater rickettsial yields than in uninhibited cells . These findings have underscored the close relationship between parasite and infected cell and have led to more predictable, higher yields of rickettsiae in vitro. Pediatr Med Chir, 1987 May-Jun, 9(3), 291 - 9 {The pediatrician faced with the child with a valvular prosthesis}; Paci A et al.; Among the acquired or congenital valvular dysfunctions that require conservative valvuloplastic surgical intervention or valvular replacement, the rheumatic valve disease is reported in a limited number of cases among the developed countries, while it is frequent in those with precarious socio-economic conditions . In these countries there are many cases of rheumatic valve diseases during childhood, quickly leading to serious health conditions to require valve replacement during second and third childhood . On the contrary, in the more developed countries, congenital valvular disease prevail by far . The child who underwent valve replacement, once dismissed from cardio-surgical centre, must be nursed domiciliary by his family pediatrician . This assistance consists in a strict supervision for a precocious identification of valvular prosthesis dysfunctions and possible embolic and hemorrhagic complications and in supplying anticoagulant therapy . For this purpose it is important to refer to a well equipped cardiological centre . Besides these fundamental tasks there are others - equally important - directed to preserve health: curing each pathological extracardiac event, intercurrent or recurrent; preventing, with or without compulsory vaccinations, infectious childhood's diseases; preventing especially bacterial endocarditis as the most frequent cause of prosthesis pathology . This work pays particular attention to bacterial endocarditis (prophylaxis and cure) . Thromboembolism and anticoagulant therapy (with the list of coumarin drug interventions) have also been dealt . Moreover we have reported brief indications on the prevention and/or cure of diseases for which vaccination is not compulsory, such as: measles, chicken-pox, whooping-cough, typhus, influenza . Our script ends with good suggestions on nourishment and physical activity. Zh Mikrobiol Epidemiol Immunobiol, 1987 Feb, (2), 12 - 5 {Biological properties of antibiotic-resistant mutants of the mildly pathogenic Rickettsia prowazekii E strain}; Frolova OM et al.; The use of R . prowazekii strain E with low pathogenicity as live vaccine against exanthematous typhus is limited by its high specific reactogenicity, which is probably due to the reversion of the virulence of the strain . One of the approaches to the stabilization of the avirulent properties of strain E is obtaining its mutants with stable decreased pathogenic properties . The article presents the data on the infectious properties of R . prowazekii antibiotic-resistant strain E mutants obtained in earlier experiments, in respect of chick embryos and laboratory animals, as well as the capacity of this strain for producing immunity to challenge with R . prowazekii virulent strain in guinea pigs . The study has revealed that the erythromycin-resistant mutant of R . prowazekii strain E, induced by nitrosoguanidine (NG), has lower infective capacity for chick embryos, guinea pigs, cotton rats and white mice . The infective capacity of the NG-induced rifampicin-resistant and spontaneous erythromycin-resistant mutants of R . prowazekii strain E is similar to the infective capacity of the initial strain . The rifampicin-resistant and spontaneous erythromycin-resistant mutants of R . prowazekii strain E possess immunogenicity similar to that of the initial strain E, and the NG-induced erythromycin-resistant mutant possesses lower, but sufficiently pronounced immunogenicity despite its decreased infective capacity for guinea pigs. J Clin Microbiol, 1987 Jan, 25(1), 167 - 71 Reactivity of monoclonal antibodies to Rickettsia rickettsii with spotted fever and typhus group rickettsiae; Anacker RL et al.; Analysis of 15 spotted fever group (SFG) and 2 typhus group strains of rickettsiae with a panel of monoclonal antibodies revealed a number of shared and unique epitopes of the 120- and 155-kilodalton surface proteins . All of the SFG strains but neither of the typhus group strains reacted with antibody to the lipopolysaccharidelike antigen of Rickettsia rickettsii; possibly the lipopolysaccharidelike antigen is the common antigen which defines the SFG . North Carolina and Montana strains of R . rickettsii known to differ slightly in virulence for guinea pigs differed in at least one epitope of the 120-kilodalton protein. Southeast Asian J Trop Med Public Health, 1986 Dec, 17(4), 613 - 9 A serological survey of scrub, tick, and endemic typhus in Sabah, East Malaysia; Taylor AC et al.; A seroepidemiological survey of 837 people and 383 febrile patients was performed in rural areas of Sabah . We determined that the rickettsial diseases scrub typhus and endemic typhus were uncommon causes of febrile illness, as was tick typhus, except in forest dwelling peoples . The rate of occurrence of SFGR specific antibody was 16.5% among 412 forest dwellers, indicating that tick typhus may be a frequent cause of illness in this population. Clin Exp Immunol, 1986 Nov, 66(2), 279 - 84 Antigens of virulent and attenuated Rickettsia tsutsugamushi; Pang HL et al.; We studied the antigens present in L929 mouse fibroblast or rabbit testicular cells, which had been infected or not with a prototype strain of Rickettsia tsutsugamushi, the causal agent of scrub typhus, and its attenuated variant . Immunoblotting revealed four antigens, designated 1, 1a, 2 and 3, which appeared to be specifically associated with infection with this organism . Antigens 1 and 1a had similar mol . wt of about 60 kD and antigen 2 and 3 had mol . wts of 45 kD and 28 kD respectively . Whereas antigen 1a, 2 and 3 were common to infection with either the virulent or the attenuated strains of the organism, antigen 1 was only detected in cells infected with the virulent strain and was reactive only with the antiserum raised against cells infected with that strain . In addition, two antigens were also detected by crossed immunoelectrophoresis, one of which was similarly associated with infection with the virulent strain as antigen 1, while the other was common to infection with either of the strains . It seems that the antigenic cross reaction between the two strains may account, in part at least, for the protection of mice against infection with the virulent strain afforded by the attenuated strain, while the loss or modification of antigen 1 might be associated with attenuation of the organism with respect to its virulence to mice. Infect Immun, 1986 Nov, 54(2), 297 - 302 Human T helper cells specific for antigens of typhus group rickettsiae enhance natural killer cell activity in vitro; Carl M et al.; The peripheral blood mononuclear cells (PBMC) from 5 individuals immune to typhus group rickettsiae and from 13 nonimmune individuals were stimulated in vitro for 7 days with typhus group rickettsial antigen (TGRA) . At the end of day 7, lysis of the natural killer (NK)-susceptible target K562 by these PBMC was determined . As controls, PBMC from both groups of donors were cultured in vitro for 7 days without antigen or were freshly isolated, and lysis of the K562 target was determined . There was no significant difference between the level of NK activity in freshly isolated PBMC from immune and nonimmune donors . PBMC from immune donors which were stimulated with antigen for 7 days exhibited significantly greater NK activity than did the control population, which was cultured for 7 days without antigen . PBMC from immune donors which were stimulated with TGRA demonstrated significantly higher NK activity than the same PBMC stimulated with antigen derived from an antigenically unrelated rickettsia, Coxiella burnetii . There was no significant difference, however, in the level of NK activity of nonimmune antigen-stimulated PBMC compared with that of the same PBMC population cultured without antigen . Most of the antigen-stimulated NK activity was mediated by Leu-11-positive cells as determined by electronic cell sorting . The ability of TGRA to sustain the NK activity of PBMC from immune donors was abolished when the T4/Leu-3-positive population of lymphocytes was eliminated by positive or negative selection prior to antigen stimulation . The ability of TGRA to sustain the NK activity of PBMC from immune donors was also significantly decreased in the presence of antibodies against human interleukin-2 . The results suggest that the activity of human NK cells can be sustained in vitro by antigen-specific T helper cells and that the effect of the T helper cell is mediated, at least in part, by interleukin-2. Lab Anim Sci, 1986 Oct, 36(5), 481 - 5 Laboratory animal models for human scrub typhus; Ridgway RL et al.; A wide variety of animals have been utilized in an attempt to provide the information necessary to bring scrub typhus to the point where it is no longer a threat to man . The laboratory mouse is usually the animal of choice for the study of this disease . The discovery that certain strains of inbred mice are genetically resistant to Rickettsia tsutsugamushi, the agent of scrub typhus, has opened new avenues in the study of the immune response to the disease . The cynomolgus monkey, Macaca fascicularis, appears to be the best animal model for the study of scrub typhus as it occurs in humans and should be useful in the development of an efficacious vaccine. Zh Mikrobiol Epidemiol Immunobiol, 1986 Sep, (9), 66 - 9 {Cellular immunity factors of tick-borne typhus patients in northern Asia}; Tomilka GS et al.; In patients with North Asian tick-borne typhus fever the deficiency of the T-system of immunity, most pronounced in the acute period of the disease, is observed, which is manifested by low values of lymphocyte blast-transformation and rosette-formation . A decrease in the number of active E-rosette-forming cells depends on the severity of the disease . The shifts in the T-system of immunity, appearing in patients with North Asian tick-borne typhus fever, are compensated for comparatively quickly, the normalization of the functional activity of T-lymphocytes occurring sooner than the restoration of their number . The specific dynamics of the characteristics of cell-mediated immunity in patients with North Asian tick-borne typhus fever is accompanied by a comparatively mild course of the disease and its favorable outcome. Am J Epidemiol, 1986 Aug, 124(2), 306 - 16 Kawasaki syndrome: a controlled study of an outbreak in Wisconsin; Klein BS et al.; The etiology of Kawasaki syndrome remains unestablished, although a possible role has been suggested for exposure to the application of carpet shampoo, house dust mites, and rickettsial infection . During an outbreak of 20 cases of Kawasaki syndrome that occurred in southeastern Wisconsin from November 1982 through March 1983, a case-control study was done of 15 cases and 30 matched controls . The study included questionnaire administration, dust collection from homes, and serum specimen collection . Only one patient had been exposed to a shampooed carpet within 30 days before onset of illness . No differences were noted between cases and controls in the degree of exposure to house dust mite-associated factors in the home, nor in the occurrence, density and species-specific prevalence of house dust mites in the home . Meadow voles exposed to house dust mites from the homes of patients did not develop serologic or pathologic evidence of infection due to rickettsiae in the spotted fever and typhus groups or Coxiella burnetii . Anti-mite-specific immunoglobulin E was not detected in serum specimens from cases or controls . Results from this study do not support hypotheses suggesting that the development of Kawasaki syndrome is associated with exposure to application of carpet shampoo, house dust mites, or rickettsial infection. Infect Immun, 1986 Jul, 53(1), 226 - 8 Lymphokine-activated-killer-mediated lysis of cells infected with typhus group rickettsiae can be inhibited by OKT3 monoclonal antibody; Carl M et al.; We examined the ability of monoclonal antibodies directed against lymphocyte surface antigens to block the lysis of typhus group rickettsia-infected cells by lymphokine-activated killer effectors . Lysis was significantly inhibited by OKT3 monoclonal antibody but not by OKT4 or OKT8 monoclonal antibody. Zh Mikrobiol Epidemiol Immunobiol, 1986 Jun, (6), 74 - 8 {Importance of T-lymphocytes in antibody production in experimental typhus infection}; Ignatovich VF et al.; The study of antibody production in cotton rats infected with Rickettsia prowazekii B and TB has revealed that R . prowazekii antigens, inducing the production of antibodies determined in the complement fixation, indirect hemolysis, and passive hemagglutination tests, are T-independent . The study of the nonspecific reactivity of T-lymphocytes in cotton rats infected with R . prowazekii TB has indicated that in case of the prolonged persistence of the infective agent in the animals no secondary immune deficiency develops. Int J Zoonoses, 1986 Jun, 13(2), 104 - 11 Prevalence and distribution of spotted fever and typhus infections in Sierra Leone and Ivory Coast; Redus MA et al.; A serosurvey for evidence of rickettsial infections was conducted in the rural populations of several tropical rain forest areas in Sierra Leone and Ivory Coast . Seropositivity rates were surprisingly high in both countries, with more than 7% of the individuals in some districts having antibodies to spotted fever-group rickettsiae . No significant difference was found in the overall prevalence of diagnostic antibody titers to spotted fever-group rickettsiae in Sierra Leone (5.3%) and Ivory Coast (6.2%) . However, there was a significant difference (p less than 0.001) in the prevalence of diagnostic antibody titers to typhus rickettsiae in the two countries . There were no marked geographic differences within either country in overall prevalence of rickettsial infections, but there were possible area differences in specific seropositivity rates to typhus- and spotted fever-group rickettsiae in Sierra Leone . In both countries, age and sex differences were important in determining seropositivity, but there was no indication of an age-sex interaction . In Sierra Leone, 59 of the 80 positive sera (73.8%) were from persons age 15 or above (p less than 0.001), and 50 of the 80 (62.5%) were from males (p = 0.05) . In Ivory Coast, 33 of the 37 positive sera (89.2%) were from the greater than or equal to 15-age group, and 28 of the 37 (75.7%) were from males (p less than 0.001 for both age and sex) . The identification of specific areas endemic for these rickettsial diseases should facilitate the diagnosis and treatment of patients with rickettsial illnesses in West Africa. Infect Immun, 1986 Jun, 52(3), 718 - 24 Effect of sublethal gamma radiation on host defenses in experimental scrub typhus; Kelly DJ et al.; The effect of sublethal gamma radiation on inbred mice chronically infected with scrub typhus rickettsiae was examined . Inbred mice which were inoculated with the Gilliam or Karp strain of Rickettsia tsutsugamushi by the subcutaneous route harbored the infection for at least 1 year . Irradiation of these animals at 12 or 52 weeks postinoculation with normally sublethal levels induced a significantly higher percentage of rickettsemic mice (recrudescence) than was seen in the unirradiated, similarly infected control animals . In addition, sublethal irradiation at 12 weeks induced a quantitative increase in total rickettsiae . Homologous antibody titers to the rickettsiae were examined for 5 weeks after irradiation to determine the role of the humoral response in radiation-induced recrudescence . Unirradiated, infected mice showed consistent titers of about 320 throughout the 5-week observation period, and the titer was not affected by exposure of up to 500 rads of gamma radiation . Drug dose-dependent radioprotection and modification of recrudescence was noted in infected, irradiated mice treated with the antiradiation compound S-2-(3-aminopropylamino)ethyl phosphorothioic acid . The results of this investigation supported the conclusion that the recrudescence of a chronic rickettsial infection in the appropriate host after immunological impairment due to gamma radiation can result in an acute, possibly lethal rickettsemia. Ann Intern Med, 1986 May, 104(5), 606 - 15 Acute febrile cerebrovasculitis: a syndrome of unknown, perhaps rickettsial, cause; Wenzel RP et al.; In late 1983, five patients living near Charlottesville, Virginia, were treated for an unusual syndrome of fever, headache, altered mentation, multifocal neurologic signs, and cerebrospinal fluid pleocytosis . Clinical signs of brainstem disease developed in four patients . All five had had recent exposure to forests or wood and contact with flea-infested dogs . Two patients died; one survivor has had recurrent seizures . Brain biopsy samples in two patients and autopsy findings in another showed cerebral vasculitis and perivasculitis involving mostly venules and capillaries . In the autopsy, the severest vascular lesions involved the brainstem and thalami, where they were accompanied by acute fibrinoid necrosis, but discrete vascular lesions of lesser intensity were randomly distributed in the white matter and cortex . Serologic studies on paired specimens in four patients showed significant cross-reacting antibody responses to rickettsial (typhus-group) antigens in the indirect hemagglutination, latex agglutination, and IgM microimmunofluorescence tests, but no agent was visualized or isolated . The cause of this serious inflammatory disorder is unknown. Acta Virol, 1986 May, 30(3), 256 - 60 Thymus-independent antibody production to the antigen of Rickettsia prowazekii; Kabanova EA et al.; Antibody production has been studied in cotton B-rats and in CBA B-mice during immunization with chemical typhus vaccine (CTV) and during infection with Rickettsia prowazekii . Studies of the immune response to rickettsial antigen in T-deficient animals have shown a high immunogenicity of CTV and independence of antibody production on T-lymphocytes . Active antibody synthesis was also observed in B-rats and B-mice during Rickettsia prowazekii infection . The absence of T-lymphocyte dependence in experimental animals was tested by administration of sheep red blood cells (SRBC). JAMA, 1986 Apr 25, 255(16), 2173 - 6 Epidemiology of murine typhus in Texas . 1980 through 1984; Taylor JP et al.; From 1980 through 1984, a total of 200 cases of murine typhus were reported in Texas . All cases were confirmed by the indirect fluorescent antibody assay or latex agglutination test . Patients ranged in age from 1 to 90 years (median, 35 years) . Fifty-one percent were female . Seventy-four percent of the patients resided in south Texas . Illness occurred in all months of the year, but 40% of the cases had onset in April, May, or June . Annual incidence increased with age and was higher in Hispanics . Murine typhus continues to be an important public health problem in Texas. J Immunol, 1986 Apr 1, 136(7), 2654 - 61 Characterization of human cytotoxic lymphocytes directed against cells infected with typhus group rickettsiae: evidence for lymphokine activation of effectors; Carl M et al.; An in vitro culture and assay system was used to determine whether cytotoxic lymphocytes are generated in humans after rickettsial infection . Peripheral blood mononuclear cells (PBMC) were obtained from six individuals with serologic evidence of prior infection with typhus group rickettsiae and from six nonimmune individuals . After PBMC from immune individuals were stimulated in vitro for 7 days with rickettsial antigen, they were capable of lysing typhus group rickettsia-infected, autologous phytohemagglutinin (PHA)-induced blasts, but not uninfected PHA-blasts . No cytotoxic effector cells were generated when either PBMC from immune individuals were placed in culture for 7 days without antigenic stimulation, or when PBMC from nonimmune individuals were stimulated in vitro with antigen for 7 days . Freshly isolated PBMC from immune donors were also unable to lyse typhus group rickettsia-infected autologous PHA-blasts or an autologous rickettsia-infected lymphoblastoid cell line (LCL) . Neither supernatants from antigen-stimulated cultures of PBMC from immune donors nor recombinant human interferon-gamma were capable of significantly lysing typhus group rickettsia-infected PHA blasts by this assay . Populations of cytotoxic effector cells depleted of OKT3, OKT4, or OKT8-positive cells by treatment with the respective monoclonal antibodies and complement were assayed for their cytotoxic capacity . The results suggest that the cytotoxic effector cell population is predominantly OKT3 and OKT8-positive, but OKT4-negative . Positive selection with the use of a fluorescence-activated cell sorter also suggested that most of the cytotoxic effector cells are OKT8-positive . PBMC from immune donors after in vitro stimulation with rickettsial antigen were capable of significantly lysing infected autologous LCL or infected HLA-mismatched LCL as compared with the respective uninfected controls . In addition, PBMC from either immune donors or nonimmune donors after stimulation in vitro for 7 days with media containing purified lymphokines were capable of significantly lysing autologous infected LCL as compared with the uninfected autologous control . We conclude that lysis of cells infected with typhus group rickettsiae is mediated by a lymphokine-activated killer. Otolaryngol Head Neck Surg, 1986 Mar, 94(3), 390 - 3 Typhus-induced facial necrosis; Wolfman DE et al.; A patient with open wounds on his hands developed a severe case of typhus following exposure to a wild rabbit . Typhus resulted in extensive necrosis of the mid-face, including the nasal alae, pinna, and lips . The patient also sustained extensive extremity necrosis . A brief review of the epidemiology, pathophysiology, and treatment of this cause of facial necrosis is presented, as well as a discussion of dopamine gangrene . While this uncommon entity probably played a large part in the necrosis of this patient's extremities, these peripheral lesions are also compatible with typhus. Microbiol Immunol, 1986, 30(7), 611 - 20 Immunological properties of Rickettsia tsutsugamushi, Kawasaki strain, isolated from a patient in Kyushu; Yamamoto S et al.; Nine isolates of Rickettsia tsutsugamushi were obtained from patients with Tsutsugamushi disease (scrub typhus) in Miyazaki Prefecture in Kyushu . Immunological analyses of these patients' sera and the isolates were performed by indirect immunofluorescence, indirect immunoperoxidase or immunoblotting techniques . In the analysis of reactions of the patients' sera with the prototype strains Gilliam, Karp, and Kato and with the isolates, sera from two patients, including Kawasaki, showed similar profiles and cross-reaction with the two isolates recovered from the corresponding patients, but reacted only weakly with the prototype strains . With guinea pig polyclonal antibodies against the isolate and prototype strains, Kawasaki strain showed some degree of cross-reaction with Gilliam strain but not with either Karp or Kato strain, nor with Shimokoshi strain which is known to be different antigenically from the prototype strains . Additionally, strain-specific murine monoclonal antibodies against Gilliam, Karp, and Kato strains did not react at all with Kawasaki strain . These results suggest that the Kawasaki strain may be different antigenically from the prototype strains and Shimokoshi strain . The finding two strains of the same antigenic type (Kawasaki) among only nine isolates suggests the presence of Kawasaki-type rickettsiae in Miyazaki Prefecture . Shimokoshi strain also did not react with these strain-specific monoclonal antibodies, suggesting that strains of R . tsutsugamushi antigenically distinct from the prototype strains, such as Kawasaki and Shimokoshi strains, may easily be recognized by their nonreactivity with these monoclonal antibodies. Microbiol Immunol, 1986, 30(7), 599 - 610 Production and characterization of monoclonal strain-specific antibodies against prototype strains of Rickettsia tsutsugamushi; Murata M et al.; We have developed 18 hybridoma cell lines which secrete murine monoclonal strain-specific antibodies to prototype strains of Rickettsia tsutsugamushi: nine anti-Gilliam, four anti-Karp and five anti-Kato antibodies . All the monoclonal antibodies reacted only with their homologous strains in direct and indirect immunofluorescence (IF), or indirect immunoperoxidase (IP) test . By IF and IP tests with the monoclonal antibodies, 22 strains of R . tsutsugamushi, which were newly isolated from mites, field rodents and patients with Tsutsugamushi disease (scrub typhus) in Japan, were all clearly identified as either Gilliam or Karp type . Analysis by polyacrylamide gel electrophoresis and immunoblotting techniques revealed that the monoclonal antibodies recognized primarily the polypeptides of an apparent molecular weight of 54 to 56 kilodaltons of the homologous rickettsial surface . The monoclonal antibodies produced in the present study should enhance the serotyping and further analytical investigation of the rickettsial antigens since they recognize the strain- or type-specific polypeptides and do not show any cross-reaction among strains. Zh Mikrobiol Epidemiol Immunobiol, 1986 Jan, (1), 73 - 6 {Immunogenicity of a chemical typhus vaccine and of a corpuscular radioantigen obtained from Rickettsia prowazekii}; Pushkareva VI et al.; The protective activity of chemical typhus vaccine and R . prowazekii corpuscular radioantigen (CRA) was studied . Guinea pigs were immunized with doses of 32 and 48 antigenic units . Antibody production was assayed in the complement fixation test . On days 7, 15, 21, 30 and 60 after immunization the animals were challenged with R . prowazekii introduced in an amount of 10(5) minimum embryonal infective doses (MEID) . On day 30 some of the animals were challenged with 10(3) MEID of R . typhi . The results demonstrated that both preparations were highly immunogenic and capable of protecting most of the animals from 10(5) MEID of R . prowazekii . Immunity developed earlier after immunization with CRA . The guinea pigs immunized with CRA, purified in percoll density gradient, and challenged with 10(3) MEID of R . typhi on day 30 showed a high level of cross immunity . In all control animals high fever and periorchitis were observed. Ter Arkh, 1986, 58(10), 35 - 8 {Functional activity of neutrophils in patients with abdominal typhus}; Nagoev BS; Cytochemistry and cytofluorometry were employed to study the main components of the intraleukocyte microbicide system of neutrophils in 52 patients with typhoid fever . During the disease there was a consistent decrease in the content of cationic protein and in the activity of leukocyte myeloperoxidase depending on the stage and severity of the pathological process . At the same time an increase in the glycogen content and activation of acid and alkaline phosphatases of leukocytes with a maximum at the disease height were detected . Addition of the complications aggravated cytochemical alterations in the cell and led to the delay in their elimination . Profound qualitative and quantitative changes in the activity of intracellular components with a visible clinical recovery of the patients pointed to an unfavourable prognosis. J Clin Microbiol, 1986 Jan, 23(1), 189 - 91 Flying squirrel-associated Rickettsia prowazekii (epidemic typhus rickettsiae) characterized by a specific DNA fragment produced by restriction endonuclease digestion; Regnery RL et al.; The DNA from flying squirrel-associated Rickettsia prowazekii was characterized by using a specific DNA fragment produced by digestion with the enzyme BamHI . The DNA fragment was cloned into a plasmid vector and used to readily distinguish between available human- and flying squirrel-associated R . prowazekii DNAs derived from crude cytoplasmic extracts. Infect Immun, 1985 Dec, 50(3), 911 - 6 Mechanisms of immunity to infection with typhus rickettsiae: infected fibroblasts bear rickettsial antigens on their surfaces; Rollwagen FM et al.; As with any immune response to infectious organisms, both antibody and T cell-mediated immune responses to infection with Rickettsia typhi require the appropriate presentation of rickettsial antigens to immunocompetent cells . Considering the obligate intracellular nature of rickettsiae, the exact mechanisms by which lymphocytes and macrophages encounter and respond to rickettsial antigens may depend on certain aspects of pathogenesis and on the availability of organisms or their antigens to cells of the immune system . One potential mode of rickettsial antigen presentation, not previously identified, is the appearance in vitro of rickettsial antigens on the cell membrane of R . typhi-infected L-929 fibroblasts . Polyvalent fluoresceinated rabbit antisera directed against whole R . typhi cells used in flow cytometric analysis of infected fibroblasts showed an increasing presence of R . typhi antigen on the host cell membrane 1 to 3 days postinfection . The significance of this finding in the pathophysiology of rickettsia-host interactions and the generation of cytotoxic T cell-mediated immunity and antibody immunity is discussed. Schweiz Med Wochenschr, 1985 Nov 30, 115(48), 1714 - 20 {Typhus epidemiology in Switzerland 1980-1983 . Slight or lack of effectiveness of the live vaccine Vivotif in tropical travel}; Wuthrich RP et al.; 214 cases of typhoid fever (TF) occurring in Switzerland between January 1980 and December 1984 were analyzed for travel history, vaccine status and nationality . A subgroup of Swiss tourists who acquired TF in India was compared to a sample of healthy Swiss tourists who travelled to India in 1983 to determine the factors predisposing to TF . Eighty cases of TF occurred in Swiss tourists to the Third World, of whom 26 had travelled in India . Among the latter, the length of stay was longer than in the control sample of 258 healthy tourists, and "trekking" (travelling off the usual tourist routes with backpacking) was more frequent . 20 of the 80 patients had been vaccinated with the live oral typhoid vaccine Vivotif (strain S . typhi Ty 21a, contained in gelatine capsules, to be taken with bicarbonate capsules), marketed in Switzerland in 1981-1984 . Comparison of the vaccination rates in case and control groups indicated that the vaccine efficacy was not significantly different from 0% during the time of observation . This lack of efficacy may be related to inadequate dosage and to the lack of stability of the vaccine . Forty cases of TF occurred in Swiss who had travelled in European countries, of whom 8 had not travelled outside Switzerland . The remaining 94 cases occurred in non-Swiss travellers, a majority of whom were from Mediterranean countries . TF in Switzerland was associated with a history of travel in 96% of cases . The live oral typhoid vaccine Vivotif was ineffective between 1981 and 1983.(ABSTRACT TRUNCATED AT 250 WORDS) Zh Mikrobiol Epidemiol Immunobiol, 1985 Nov, (11), 78 - 82 {Use of the immunofluorescence reaction for evaluating the immunological transformation in those inoculated with a chemical typhus vaccine}; Rydkina EB et al.; The results of the serological examination of persons immunized with chemical typhus vaccine (CTV) are presented . The examination was carried out by means of the complement fixation test (CFT), the passive hemagglutination test (PHAT), the toxin neutralization test (TNT) and the immunofluorescence test (IFT) . The acetone-fixed live culture of Rickettsia prowazekii, strain Breinl, served as antigen in IFT . If persons immunized with CTV showed positive titers in CFT, TNT and PHAT, the results of IFT were highly correlated with the CFT titers . In 6-12 months after immunization with CTV the titers of CFT, TNT and PHAT became negative, while the IFT titers remained positive for several subsequent years. Am J Trop Med Hyg, 1985 Nov, 34(6), 1173 - 8 Identification of strain-specific and group-reactive antigenic determinants on the Karp, Gilliam and Kato strains of Rickettsia tsutsugamushi; Eisemann CS et al.; Hybridoma antibodies (Hab) were prepared against the Karp, Gilliam and Kato strains of Rickettsia tsutsugamushi and were examined for homologous and heterologous reactivity using an indirect immunofluorescence assay . Strain-specific Hab demonstrated homologous IFA titers ranging from 1/320 to 1/1,280 and did not react (less than 1/10) with the heterologous strains . The cross-reactive Hab generally reacted equally with all three strains in the scrub typhus group; however, there were some Hab that reacted with only one of the two heterologous strains tested . The Hab also were examined in enzyme-linked immunosorbent assays with scrub typhus antigens eluted from SDS-polyacrylamide gels . Most Hab reacted with either one or several of the six eluted antigens detected with a polyclonal immune serum . It was also observed that strain-specific and cross-reactive Hab sometimes reacted with the same antigen, suggesting the existence of multiple antigenic determinants in one electrophoretic peak . The data suggest that strain-specific Hab can be used in the indirect immunofluorescence assay to identify isolates of R . tsutsugamushi without the cross-reactions usually observed with polyclonal antisera, and that they are useful probes for detection and analysis of rickettsial antigens. Am J Med, 1985 Sep, 79(3), 370 - 2 The "typhoid state" revisited; Verghese A; The "typhoid state" occurs classically with typhoid and typhus fevers but is also seen in other infectious diseases . Clinical descriptions of this state as "muttering delirium" or "coma vigil" refer to the peculiar preoccupied nature of the stupor . Picking at the bedclothes and at imaginary objects (carphology and floccillation) are characteristic, as is muscular twitching (subsultus tendinum) . There is strong evidence that the death of Falstaff in Shakespeare's Henry V is a vivid description of the typhoid state. Jpn J Med Sci Biol, 1985 Jun, 38(3), 125 - 39 A scanning and transmission electron microscopic examination of Rickettsia tsutsugamushi-infected human endothelial, MRC-5, and L-929 cells; Ng FK et al.; Monolayers of primary human endothelial cells were infected with the Karp strain of Rickettsia tsutsugamushi and examined by scanning and transmission electron microscopy . The results were compared with those obtained with similarly infected L-929 and MRC-5 cells and with uninfected cells of all three types . The rickettsiae grew to slightly higher titers in the human endothelial cells . Transmission electron microscopy revealed significant changes in the host cell organelles; a reduction in ribosome-coated endoplasmic reticulum and in Golgi activity, swelling of mitochondria, and an increase in vacuolation within the cytoplasm . Since human endothelial cells are known to retain their in vivo structural and functional qualities when cultured in vitro, it is likely that these effects are similar to those which occur during the infectious process in human scrub typhus. Biull Eksp Biol Med, 1985 May, 99(5), 595 - 6 {Reaction of the biologically active points of the skin to immunization with typhus vaccine}; Pshenichnov VA et al.; Electroacupuncture diagnosis was used to demonstrate the reaction of biologically active points of the skin (BAPS) to immunization with typhus vaccine . In 7 persons immunized with chemical and live (strain E) typhus vaccines, the reaction differed significantly from the initial parameters and other measurement data obtained in a group of unvaccinated subjects . The reaction of the BAPS was noticeable starting from the first day after vaccination and was far ahead of seroimmune shifts detectable in the host . The best correlation was established between the seroimmune response and the activity of the acupuncture points on meridians X and I (a positive correlation) and on meridians III, VIII and XI (a negative correlation). Am J Trop Med Hyg, 1985 May, 34(3), 555 - 63 Transmission of murine typhus rickettsiae by Xenopsylla cheopis, with notes on experimental infection and effects of temperature; Farhang Azad A et al.; In studies on experimental infection of Rickettsia mooseri (= R . typhi) in Xenopsylla cheopis and laboratory rats, it was found that 10 days after the infectious feeding, the fleas were voiding feces that were infective to rats upon inoculation . The feces remained infective for at least the duration of the experiment, and a quantity as small as 0.2 micrograms of feces would result in seroconversion of 67% of the rats upon inoculation . Fleas were capable of transmitting the infection to rats as early as seven days after feeding on rickettsemic rats, but the rate of transmission was much higher late in the course of rickettsial development in the flea, e.g., virtually 100% by day 17 . Fleas transmitted R . mooseri infection even when they fed on the host for a maximum of 30 min and were removed from the rats at least 25 min before they could be expected to deposit any feces . These and other data suggest that R . mooseri may be transmitted by X . cheopis by the feeding process, and not merely through contact with infective feces or crushed fleas . The ambient temperature had a profound effect upon rickettsial growth in the fleas . At 18 degrees C, the rickettsial content of the fleas was below detectable levels for at least ten days and remained low throughout, whereas at 24 degrees C and 30 degrees C the rickettsial titer was consistently two or three times greater . However, if, after six days, the fleas were transferred from an environment of 18 degrees C to one at 24 degrees C or 30 degrees C, the rickettsial growth increased by two or three logs within one week. J Immunol, 1985 Apr, 134(4), 2689 - 94 In vitro antigen-specific antibody response to the species-specific surface protein antigens of typhus group rickettsiae by human peripheral blood mononuclear cells: generation of an antigen-dependent suppressor T cell; Misiti J et al.; We defined conditions suitable for in vitro synthesis of rickettsia-specific antibody by human PBMC cultured with the SPA of Rickettsia typhi or R . prowazekii and without addition of mitogens or polyclonal stimulators . Antibody synthesis, as measured by an enzyme-linked immunosorbent assay, was cycloheximide-inhibitable and antigen-specific . PBMC from individuals with prior rickettsial infection made antibody, whereas PBMC from those receiving vaccine or with undetectable levels of serum anti-SPA antibody did not . Antibody production was T helper cell-dependent because isolated B cells did not generate antigen-specific antibody in the absence of autologous T cells . Furthermore, prior exposure of T cells to high concentrations of SPA led to the generation of an antigen-dependent population of cells capable of suppressing the anti-SPA response when co-cultured with autologous PBMC and optimal SPA concentrations . This system should serve as an effective tool for analyzing the cellular interactions involved in the in vitro regulation of antigen-specific antibody synthesis by human PBMC. Am J Trop Med Hyg, 1985 Mar, 34(2), 372 - 9 Fleas on roof rats in six areas of Los Angeles County, California: their potential role in the transmission of plague and murine typhus to humans; Schwan TG et al.; Roof rats (Rattus rattus) in southern California are rarely involved with plague epizootics and murine typhus . Little evidence exists implicating these rodents as sources of human infection . This might be explained by the absence of fleas capable of transmitting these 2 diseases . From February 1981 through January 1982, roof rats were live-trapped and examined for fleas each month in 4 areas of Los Angeles County . Two other areas were trapped for 9 and 3 months respectively . Areas sampled were in or near the suburban-wilderness fringe where plague and murine typhus occur, and where roof rats coexist with a variety of wild and domestic mammals and humans . From 1,206 roof rats, 827 fleas belonging to eight species were collected . Leptopsylla segnis (54%) and Nosopsyllus fasciatus (39%) were the most abundant and together comprised 93% of all fleas . Xenopsylla cheopis was not found . The relative abundance and diversity of fleas on roof rats varied considerably between areas, making it difficult to predict flea diversity and abundance in unsurveyed areas where similar conditions exist . However, the overall low flea indices and the absence of X . cheopis help to explain why roof rats in Los Angeles County are rarely involved with plague and murine typhus. J Clin Microbiol, 1985 Mar, 21(3), 470 - 1 Comparison of a latex agglutination procedure with the microimmunofluorescence test for Rickettsia typhi; Rawlings JA et al.; Sera submitted to the Texas Department of Health for the serodiagnosis of Rickettsia typhi were tested by the microimmunofluorescent antibody technique and a new latex agglutination procedure . Results indicated that the latex agglutination test was sensitive and specific and would serve well as a first-line screening test for murine typhus. Science, 1985 Feb 1, 227(4686), 543 - 5 Transovarial transmission of murine typhus rickettsiae in Xenopsylla cheopis fleas; Farhang-Azad A et al.; It has been generally accepted that infected fleas do not pass on Rickettsia mooseri, or indeed any other known pathogen, to their progeny . It is reported here that such transovarial transmission does occur in laboratory-infected Xenopsylla cheopis fleas . By means of the direct fluorescent antibody test, Rickettsia mooseri was observed in cells of the hemolymph of infected fleas . As many as 11 percent of the adults and 2.9 percent of the larvae of the generation reared therefrom, had demonstrable rickettsiae . Moreover, batches of the F1 fleas were capable of transmitting the infection to more than 18 percent of the rats they infested . The data support the contention that Xenopsylla cheopis fleas play an important role in the maintenance of murine typhus in rats in nature. Int J Health Serv, 1985, 15(4), 547 - 59 Medicine as social science: Rudolf Virchow on the typhus epidemic in Upper Silesia; Taylor R et al.; Rudolf Virchow's Report on the 1848 typhus epidemic is one of the neglected classics of "social medicine"--a term he did much to popularize . His analysis of the epidemic emphasized the economic, social, and cultural factors involved in its etiology, and clearly identified the contradictory social forces that prevented any simple solution . Instead of recommending medical changes (i.e., more doctors or hospitals), he outlined a revolutionary program of social reconstruction; including full employment, higher wages, the establishment of agricultural cooperatives, universal education, and the disestablishment of the Catholic Church . This article includes the first English translation of these long-term recommendations . It also locates Virchow's Report within the context of the Medical Reform Movement of 1848 and traces his influence on the subsequent development of social medicine . Parallels are drawn between Virchow's attempts to reform health care and current developments in the political economy of health. Med Pr, 1985, 36(2), 123 - 30 {Ototoxic factors requiring consideration in the diagnosis of occupational hearing loss}; Grzesik J et al.; In the practice of diagnosing occupational deafness resulting from noise effects of factors determining workers' hearing, such as living conditions, working conditions, nutritional and other habits, diseases and their therapy, are often neglected . Discussed in the paper are the significance and ototoxic effects of such factors as: aminoglycoside antibiotics, diuretics, salicylic acid derivatives, fenacetin, quinine, fluorine compounds, cytotoxic drugs, chemical compounds other than drugs (carbon monoxide, carbon disulphide, lead, organic solvents), ethyl alcohol, diseases (abdominal typhus, bacillary dysentery, diphtheria, brucellosis, epidemic parotiditis, poliomyelitis, rubella, aural shingles, syphilis, diabetes mellitus, chronic renopathies, hypothyroidism, serologic conflict, pigmentary retinitis) . Exposure to intense noise is more and more frequently juxtaposed with the impact of the mentioned factors . If industrial physicians get aware of this association the prevention of deafness and reliability of treatment may be largely promoted. Bull Soc Pathol Exot Filiales, 1985, 78(2), 153 - 6 {Serological approach to the occurrence of rickettsioses in the Central African Republic}; Gonzalez JP et al.; A serosurvey for evidence of human rickettsial infections was carried out in the Republic of Central Africa on 144 sera by indirect immunofluorescence (IIF) and microagglutination tests (MA) . There was no serological evidence of epidemic typhus and only two sera were positive for murine typhus . Approximately 15% of the surveyed population was serologically positive by MA for R . conorii antibodies . However, 48% of this population had spotted fever group antibodies as detected by IIF but were negative in MA for R . conorii, R . rickettsii and R . akari antibodies . These sera with high titers in IIF and negative in MA lead us to believe that in Central Africa there are rickettsiae pathogenic for man that are related to the Spotted Fever group and are yet to be identified. Rev Infect Dis, 1985 Jan-Feb, 7(1), 119 - 22 "Contribution to the Question of Pneumotyphus": a discussion of the original article by J . Ritter in 1880; Harris RL et al.; In 1880, Dr . J . Ritter wrote a classic infectious disease article (originally in German) on psittacosis entitled, "Contribution to the Question of Pneumotyphus." In this article, Ritter meticulously describes a mini-epidemic--in which three individuals died--of seven cases of psittacosis caused by parrots and finches caged in the study of his brother's house in Uster, Switzerland . Ritter accurately identified the study as the site of the source of infection, considered the birds as vectors, and determined both the incubation period and the nontransmissability of the disease from human to human . His main differential diagnosis was a choice between typhoid and typhus; with pneumonitis being the main pathologic finding, he coined the term pneumotyphus . Ritter's article elegantly describes the clinical presentation, epidemiology, pathologic findings, and natural history of infection due to Chlamydia psittaci . Ritter's astute observations and their significance are discussed in this paper. Arch Inst Pasteur Tunis, 1984 Dec, 61(4), 427 - 33 {Current data on rickettsial diseases in Tunisia}; Kennou MF et al.; The indirect immunofluorescent technic, recommended by WHO, allows us to consider again, the problem of rickettsial diseases in Tunisia . This pathology, always actual, presents, also in epidemiological as in clinical aspect, a predominance for Mediterranean spotted fever by R . conori . Murin typhus by R . mooseri is still remained, but its incidence seems to be slight . The frequency of Q Fever must to be determined. S Afr Med J, 1984 Nov 3, 66(18), 694 - 7 Treatment of tick-bite fever with erythromycin; Miller GB et al.; Because of the occasional need for an alternative drug for the treatment of tick-bite fever, a study of the value of erythromycin for the variety of tick-borne typhus fever occurring in southern Africa was undertaken . In guinea-pigs erythromycin 125 mg/kg for 5 days largely prevented the fever and other signs of the infection, but did not prevent the serological reaction as determined by the rickettsial complement fixation test . A series of 17 human patients were treated for 4 days with erythromycin 500 mg 6-hourly for adults and 30-50 mg/kg/d in 4 divided doses for children . Eleven patients appeared to respond favourably . It was concluded that erythromycin does not have as specific a value as tetracycline in the treatment of tick-bite fever, but that when tetracycline is contraindicated erythromycin is a useful alternative drug. Southeast Asian J Trop Med Public Health, 1984 Sep, 15(3), 402 - 6 Scrub typhus and chiggers in northern Thailand; Takada N et al.; It was reconfirmed that L . deliense was the most dominant chigger during the rainy season in northern Thailand . Overall prevalence of IgG antibody against R . tsutsugamushi among the rural villagers in the northern most part of Thailand was nearly 60% at the level over 1 : 10 by an indirect immunofluorescent test . The level of IgG and IgM antibody titers was considerably high as greater than or equal to 1 : 2560 in some sera, but did not markedly vary by age groups or sexes . Based on detection of IgM antibody, the probability of new or reinfections were considered. Int J Zoonoses, 1984 Jun, 11(1), 45 - 52 Tick-borne rickettsioses in Pune district, Maharashtra, India; Padbidri VS et al.; An extensive study on tick-borne rickettsioses in the Pune district of Maharashtra revealed that Indian tick typhus exists as a zoonosis, which only occasionally causes disease in man . By sero-conversion in guinea pigs, presumptive isolates of Rickettsia conori and Coxiella burnetii were recovered from 4 of the 11 species of ticks examined . Boophilus microplus and Rhipicephalus haemaphysalis were found to be harbouring R . conori whereas C . burnetii was isolated from Haemaphysalis intermedia and Hyalomma hussaini in addition to the above mentioned 2 tick species . Complement fixation tests carried out on sera from various species of rodents and gerbils revealed the presence of antibodies against the R . conori antigen in the sera of Rattus blanfordi, R.r . rufescens and Suncus murinus . In the case of large mammals, similar antibodies were detected in the sera from dog, cow, horse and sheep . C . burnetii infection was found to exist in both the sylvan and domestic cycle, as evidenced from the involvement of ticks, large and small mammals and man in its natural history. Nurse Pract, 1984 May, 9(5), 39, 42 - 4, 46 Health care in China; Brown MS et al.; PIP: Reporting on a professional exchange tour of American nurses in China, this discussion recounts what was learned about the Chinese health care system, nursing system, and maternal-child health, and focuses on some insights gained into the US health care system . Before 1949, the infant mortality rate was 20% during the 1st year of life; 30-40% of children died before age 5; vernereal disease, tuberculosis, schistosomiasis, typhus, cholera, and the plague were rampant; and traditional medicine had been outlawed . When the communists came to power, efforts were made at preventive health care but the results were not impressive until the Cultural Revolution of 1965 . 4 main health objectives were stressed at that time: improving access to health care for the rural areas; emphasizing prevention; emphazing Chinese traditional medicine; and making health an individual and collective responsibility . Peasants were brought in to become the nurses or physicians with minimal or no preparation or education . Since then Western-trained physicians and nurses have been reintroduced into the health care system . Since 1965 the Chinese life expectancy has increased from 40 to 70 years . Infant mortality is now 1 of the lowest in the world . Veneral disease, drug addiction, and several other epidemic diseases have been almost totally eradicted, as has malnutrition . There is at least 1 barefoot doctor in each of these "production teams" of 30-50 families, often supported by traditional medical assistants, health aides, midwives, nurses, and public health workers . Patients can be referred to the commune hospital and can be further referred to county hospitals for more complicated problems . Free care is provided for many people . It is within this highly organized, prevention oriented, socially conscious context of health care that maternal-child health care is deelivered . Prenatal and postpartum care begins with home visits by traditional birth attendants or ffemale barefoot doctors . At the well baby clinics the walls are hung with colorful health education posters . Family planning is probably the number 1 health concern in China, and the government stresses late marriages, free use of contraceptives, and the 1 child family . Another insight gained was the idea of harnessing manpower rather than technological power for the purpose of health . Infect Immun, 1984 May, 44(2), 205 - 10 Rickettsial interactions with human endothelial cells in vitro: adherence and entry; Wa