Antibodies to antigens associated with human T cell leukaemia virus type I (HTLV I) in Swedish adult leukaemia patients and blood donors were sought with a sensitive screening test using membrane antigen prepared from virus producing cells (MA-ELISA). Four persons (one ALL, one AML and two healthy blood donors) out of 483 persons tested reacted in the test. However, they were negative in the more specific anti-p19 and anti-whole virion ELISA tests. The prevalence of sera with definite anti-HTLV I activity seems to be very low in Sweden. The finding of four MA-ELISA positive persons needs further investigation.
Among 385 sera from Nigerian hospital personnel aged 15-39 years, 289 (75%) had an antibody titer corresponding to immunity against rubella, compared with 346 (90%) of the sera from Swedish women of the same age group. The frequency of high immune level against rubella did not change with age among Nigerians compared with a decrease in immunity with increasing age in the Swedish individuals. This probably is due to the differences between the dynamics of the development of natural immunity and immunity acquired through vaccination. In Nigeria, socio-economic factors were related with the degree of immune responses while sex was not. The results highlight the importance of immunization among hospital personnel and eventual vaccination of the whole population in Nigeria and the continuous surveillance of rubella immunity and periodic re-evaluation of immunization policies.
Blood transfusions involve the transfer of relatively large volumes of body fluids and cellular material between individuals. A variety of pathogens like viruses, some of which are associated with development of certain tumours, are known to be transmitted by this route. Blood recipients were identified during 1981-1982 in the register of the hospital blood centre, and in-patients by the in-patient and discharge register of the hospital. Tumour occurrence and vital status were determined by means of the population-based regional tumour register. Age, gender and calendar-year specific rates from the general population were used to calculate expected values. In a cohort study of 3177 blood recipients, increased numbers of malignant lymphomas [13 vs. 4.8 expected, standard morbidity ratio (SMR) 2.70 95% confidence interval (CI) 1.44-4.62] and skin cancers [12 vs. 5.2 expected, SMR 2.29, 95% CI 1.19-4.01] were seen 3 to 9 years after transfusion. In a second cohort study of 29,910 hospitalised patients, a total of 37 (29.8 expected) malignant lymphomas was found in 28,338 patients with no transfusion and 10 (2.73 expected) in 1572 patients with a transfusion, 3 to 9 years after the hospitalisation. The incidence rate ratio between these groups was 3.11 (95% CI 1.56-6.20) using a Mantel-Haenszel estimator with age stratification. Non-melanomatous skin cancers had an incidence ratio of 2.74 (95% CI 1.25-6.00). We conclude that, in the cohorts discussed here, malignant lymphomas and skin cancer occur more often in blood recipients than in controls. It remains to be established whether this is due to factors covariating with transfusion or by the transfusion itself. Further studies on these putative associations are warranted, as are analytical studies of the epidemiology of malignant lymphomas, especially non-Hodgkin's lymphoma, whose aetiology is still poorly understood.
The principal neutralization domain (PND) of the V3 region of human immunodeficiency virus type 1 (HIV-1) gp120 is central to HIV pathogenesis. The IgG antibody response to PND was followed in 15 HIV-1-infected persons from southern Sweden over 2-5 years using 32 synthetic V3 peptides. Five peptides had amino acid sequences derived from isolates from each of 5 patients. Sera obtained simultaneously with isolate almost always reacted strongly with these cognate peptides; however, reactivity was undetectable in 1 patient's serum and short lived in the sera of another, indicating inducible holes in the antibody repertoire, which would facilitate dissemination of the corresponding virus strains. Reactivity to other V3 peptides correlated with sequence similarity to the cognate peptide. Strong, stable reactivity to peptides with sequences similar to a south Swedish V3-consensus was accompanied by transient activity to less similar ones. The latter may reflect viral variation, B lymphocyte clonal depletion, or both. Certain IgG responses appeared to preclude others, suggesting clonal dominance.
IgG antibodies reactive with simian immunodeficiency virus isolated from a rhesus monkey suffering from simian acquired immunodeficiency syndrome (SIVmac, strain 239, a virus which is very closely related to human immunodeficiency virus type 2-HIV-2) were found in 18 of 120 Swedish and 8 of 11 east African confirmed HIV-1 antibody positive (HIV-1 ab+) sera, both by enzyme immunoassay and electrophoretic immunoblotting (p = 1 x 10(-6). In electrophoretic immunoblotting most of the cross-reactivity of SIVmac-reactive sera occurred on p27, the major gag protein of SIVmac. The possibility that SIVmac antibody reactivity could be due to double infection with HIV-1 and a SIVmac-related virus was eliminated by the results of absorptions between sera of Swedish and west and east African origin and viral antigens (SIVmac and North American or African/Haitian strains of HIV-1) coupled to agarose beads. HIV-2 ab+ and SIVmac reactive west African sera recognized SIVmac epitopes unrelated to HIV-1, whereas HIV-1 ab+, SIVmac reactive east African, and Swedish sera recognized SIVmac epitopes cross-reactive with epitopes present in both African and North American HIV-1 strains. No unique SIVmac-reactive African HIV-1 epitopes could thus be defined. Neither did absorption of Swedish and African HIV-1-positive sera with different HIV-1 strains (1 Haitian, 2 Zairian, and 1 North American) give evidence for unique epitopes.
The etiology of community-acquired pneumonia was studied in 127 patients with roentgenologically verified pneumonia who needed hospitalization. Etiology was determined on the basis of a positive blood culture and/or a significant antibody titer increase. Streptococcus pneumoniae was the probable etiological agent in 69 patients, nontypeable Haemophilus influenzae in five patients, Streptococcus pyogenes in two patients, and Legionella pneumophila and Staphylococcus aureus in one patient each. Evidence of Mycoplasma pneumoniae infection was found in 18 patients and of Chlamydia psittaci infection in three patients. Influenza virus type A was the cause of infection in 15 patients. One patient had infection with influenza virus type B, one patient with parainfluenza virus type 1, and three patients with respiratory syncytial virus. In 20 patients there was evidence of infection with more than one microorganism. No etiological agent was found in 27 patients. Since Streptococcus pneumoniae was the predominant etiological agent penicillin should be drug of first choice in patients with pneumonia who need treatment in hospital. In young adults, however, the high frequency of Mycoplasma pneumoniae infection would justify the use of erythromycin or doxycycline as drug of first choice.
The association between hospital teaching status and mortality after pancreatic resection is not well explored. Although hospital volume is related to short-term mortality, the effect on long-term survival needs investigation, taking into account hospital teaching status and selective referral patterns.
This was a nationwide retrospective register-based cohort study of patients undergoing pancreatic resection between 1990 and 2010. Follow-up for survival was carried out until 31 December 2011. The associations between hospital teaching status and annual hospital volume and short-, intermediate- and long-term mortality were determined by use of multivariable Cox regression models, which provided hazard ratios (HRs) with 95 per cent c.i. The analyses were mutually adjusted for hospital teaching status and volume, as well as for patients' sex, age, education, co-morbidity, type of resection, tumour site and histology, time interval, referral and hospital clustering.
A total of 3298 patients were identified during the study interval. Hospital teaching status was associated with a decrease in overall mortality during the latest interval (years 2005-2010) (university versus non-university hospitals: HR 0·72, 95 per cent c.i. 0·56 to 0·91; P?=?0·007). During all time periods, hospital teaching status was associated with decreased mortality more than 2?years after surgery (university versus non-university hospitals: HR 0·86, 0·75 to 0·98; P?=?0·026). Lower annual hospital volume increased the risk of short-term mortality (HR for 3 or fewer compared with 4-6 pancreatic cancer resections annually: 1·60, 1·04 to 2·48; P?=?0·034), but not long-term mortality. Sensitivity analyses with adjustment for tumour stage did not change the results.
Hospital teaching status was strongly related to decreased mortality in both the short and long term. This may relate to processes of care rather than volume per se. Very low-volume hospitals had the highest short-term mortality risk.