A consecutive series of 44 patients with proven leptospirosis was studied to document the radiographic pulmonary abnormalities, assess their prevalence, correlate them with the clinical signs and symptoms and determine their prognostic significance. Abnormalities were found in ten patients (23%), this prevalence being less than previously noted. The abnormalities shown were non-segmental opacification (consolidation-eight cases), basal linear opacities (collapse-five cases) and pleural effusions (four cases). The first radiographic demonstration of a large pleural effusion in leptospirosis is recorded. Non-jaundiced patients had a higher prevalence (43%) of these abnormalities than jaundiced (13%). No other correlation with clinical signs or symptoms was found. The presence of these abnormalities had no prognostic significance. It is concluded that the presence of radiographic pulmonary abnormality in in-patients with leptospirosis is common. These abnormalities are non-specific and can mimic other diseases leading to diagnostic difficulty. Such abnormalities may be extensive in the absence of clinical signs and symptoms.
A disease characterized by ascites and hepatomegaly was described in Jamaica by McFarlane and Branday in 1945, and later studied by Hill and his colleagues (Hill, Rhodes, Stafford and Aub, 1953), and by Bras, Jelliffe and Stuart (1954). Bras and his co-workers demonstrated occlusion of the small hepatic veins and accordingly named the condition 'Veno-occlusive disease of the liver' (V.O.D.). The exact nature of the occlusions has not been ascertained, although Bras and his colleagues likened some of them to an obliterating endophlebitis, and others to organized mural thrombi.The death of three children early in the disease, one three days, another five days and a third 21 days after the onset of symptoms has prompted us to reinvestigate the pathogenesis of what are believed to be early lesions. Materials and MethodsFormal-saline fixed liver tissue was available from all three cases. Paraffin sections were prepared in the usual way and stained with haematoxylin and eosin (H. and E.). Other staining methods used were Mallory's trichrome (M.T.), Mallory's phosphotungstic acid haematoxylin (M.P.A.H.), and Wilder's method for reticulin. One block from each case was sectioned serially, and initially every fifth section was stained. Other sections were stained when indicated.Fresh material was available from the case dying at 21 days permitting the use of the immuno-histochemical techniques described by Coons, Creech, Jones andBerliner (1942), andCoons and Kaplan (1950). Blocks of liver tissue were frozen in a dry-ice alcohol mixture and stored at -20°C. Sections were cut in a cryostat at temperatures between -20°C. to -10°C. and mounted in the cold on glass slides. They were washed with two changes of phosphate buffer, pH 7*2, and covered with rabbit anti-human fibrin serum conjugated with fluorescein isocyanate. After staining for 30 minutes they were washed repeatedly in the phosphate buffer and mounted in buffered glycerol (pH 8 0). The anti-human fibrin serum was prepared by immunizing rabbits with human fibrin. The fibrin was * Present address: King's College Hospital, London S.E.5. teased, cut into fine fragments, suspended in Freund's adjuvant and injected subcutaneously. Three doses of 1 g. fibrin were given at intervals of 10 days, and the rabbits were bled three days after the last injection. The globulins were precipitated from the rabbit serum by saturation with anhydrous sodium-sulphate and the precipitate redissolved in distilled water and transferred to a dialysing bag and the sodium sulphate removed. The globulin was then coupled with fluorescein isocyanate and the labelled antiserum treated with powdered rat liver to reduce non-specific staining. The specificity of the antiserum was checked by demonstrating a single precipitation band in an Ouchterlony plate; by staining obvious fibrin deposits in placental tissue; and by treating duplicate sections with fluorescein-coupled antihuman fibrin serum absorbed with washed human fibrin. The sections were examined with the fluorescent microscope, photographe...
The comparative efficacies of direct bacterial agglutination and immunofluorescent antibody for the estimation of serum Vi antibody were determined in the detection of typhoid carriers. Sera from all 12 typhoid carriers gave significant titers of 1/10 or more in the direct bacterial agglutination test; however, 26 of 119 (21.8%) sera from culture-negative individuals were also falsely positive. In the fluorescent Vi antibody test, 11 of 12 typhoid carriers showed significant serum antibody levels, while only two of 119 (1.7%) culture-negative subjects had significant antibody titers. In view of the much lower false-positive rate, the immunofluorescent Vi antibody test is considered to be superior to the direct bacterial agglutination test in the screening of typhoid carriers.
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