[A case of hyperammonemia presented in a patient with multiple myeloma].

Hyperammonemia-induced encephalopathy is a rare complication of untreated multiple myeloma. This case report illustrates a 78-year-old woman with multiple myeloma who developed acute delirium due to elevated level of serum ammonia in the absence of hepatic failure. One should suspect the condition when common management is ineffective.

Similar inflammatory response in human whole blood to live Streptococcus pneumoniae of different serotypes.

Differences in inflammatory responses in human adult whole blood to live pneumococcal serotypes 3, 7F, 9V and 23F were investigated. Using flow cytometry and ELISA, oxidative burst, expression of activation markers CD11b/CD18, and in-vitro production of tumour necrosis factor-alpha, interleukin-6 (IL-6) and interleukin-8 were measured. There was no significant difference between the serotypes regarding any of the variables investigated, although there was a trend towards higher concentrations of IL-6 induced by serotypes 9V and 23F.

Correlations between serum amyloid A protein and C-reactive protein in infectious diseases.

Serum amyloid A (SAA) protein is an acute phase reactant that has recently become of increasing interest as a marker for disease and treatment monitoring. We have correlated SAA levels to those of C-reactive protein (CRP) in sera from 98 patients admitted to an infectious diseases clinic because of viral and bacterial infections, including hepatitis A and B, cytomegalovirus infection, varicellae-zoster, infectious mononucleosis, influenza A, bacterial pneumonia, streptococcal pharyngitis, bacterial sepsis and severe bacterial sepsis. The study population was chosen from the clinical setting as representatives of these frequently encountered patient groups.

Production of tumor necrosis factor-alpha and interleukin-6 in whole blood stimulated by live Gram-negative and Gram-positive bacteria.

OBJECTIVE: To investigate the production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) induced by live Gram-negative and Gram-positive bacteria in whole blood in vitro. METHODS: In all, 49 different isolates were studied. Each of the 49 different isolates was incubated for 4 h with whole blood at a ratio of one monocyte per 1--5 bacteria.

Recurrent Pneumococcal bacteraemia and meningitis in an asplenic adult with possible unusual focus.

An unusual case of a dental infection leading to osteitis of the mandible and possibly to 4 episodes of invasive pneumococcal disease in an asplenic adult is presented. The patient had 2 episodes of pneumococcal meningitis with bacteraemia and 2 episodes of bacteraemia without meningitis during a 1-y period. Investigations using bone and leukocyte scintigraphy revealed only a focal uptake in the right mandibular bone.

The effects of live Streptococcus pneumoniae and tumor necrosis factor-alpha on neutrophil oxidative burst and beta 2-integrin expression.

Objective: To study the effects of TNF-alpha and live Streptococcus pneumoniae on human neutrophil oxidative burst and beta 2-integrin expression using flow cytometry.

Methods: Six clinical isolates of S. pneumoniae (serotypes 3, 19A, 22F, 6A, 33F and 9N) from patients with bacteremic pneumonia or upper respiratory tract infections were studied.

The effects of live Neisseria meningitidis and tumour necrosis factor-alpha on neutrophil oxidative burst and beta2-integrin expression.

The effects of human recombinant tumour necrosis factor-alpha (TNF-alpha) on neutrophil (PMNL) oxidative burst and on CD11b/CD18 and CD14 expression after stimulation with pathogenic or nonpathogenic Neisseria meningitidis were studied using chemiluminescence and flow cytometry. PMNL oxidative burst increased more when stimulated with the apathogenic 29E strain than with the pathogenic B strain both when studied by chemiluminescence and by flow cytometry. When TNF-alpha was added to whole blood or PMNL together with bacteria a significant increase in the oxidative burst was seen for the B strain only.

Cytokine responses in patients with pneumonia caused by Chlamydia or Mycoplasma.

The serum concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma) were measured by enzyme immunoassays in 44 patients with Chlamydia (n = 13) or Mycoplasma (n = 14) pneumonia or influenza A infection (n = 17) and in 20 control subjects. The levels of IFN-gamma were raised in 29/44 patients. The concentrations of IL-6 were raised in 32/44 patients.

Chronic active mononucleosis.

A 16-year-old girl with 3 clinical episodes of mononucleosis during a period of more than 2 year is presented. The patient had persistently elevated VCA-IgM antibodies during follow-up for 15 months until she became EBNA-positive. This is a case of prolonged primary EBV infection and late seroconversion as clinical restitution and development of EBNA antibodies occurred 2 year after the onset of clinical illness.

Dynamics of blood cytokine concentrations in patients with bacteremic infections.

Cytokines play a major role in the pathophysiology of sepsis and septic shock. Using enzyme immunoassays the acute serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), granulocyte-colony stimulating factor (G-CSF), interleukin-8 (IL-8), and leukemia inhibitory factor (LIF) were investigated in 90 patients with positive blood cultures and clinical signs of infection. In 27 patients samples were obtained on admission, after 1, 4, 12, 18, and 24 h, and then daily.

Diagnostic value of blood cytokine concentrations in acute pneumonia.

Background: The role of cytokines in the pathogenesis of pneumonia is still poorly understood. In a previous study the diagnostic value of measuring blood concentrations of interleukin 6 and interferon gamma was established. In the present study the value of blood concentrations of interleukin 8, granulocyte-colony stimulating factor, and lactoferrin as markers of bacteraemic pneumonia is evaluated.

Deep soft-tissue infections caused by Streptococcus pneumoniae.

Three cases of deep soft-tissue infections caused by Streptococcus pneumoniae are presented. All patients were previously healthy adults. The first case was a man with a protracted illness in whom pelvic and inguinal abscesses developed at the site of a scar from a traumatic injury several years earlier.

Serum concentrations of interleukin-6, tumour necrosis factor-alpha, and C-reactive protein in patients undergoing major operations.

Objective: To investigate the kinetics of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and C-reactive protein after a surgical operation.

Design: Prospective study.

Setting: Teaching hospital, Sweden.

Detection of bacterial DNA in cerebrospinal fluid by an assay for simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and streptococci using a seminested PCR strategy.

Primers specific to conserved and variable regions in the 16S rRNA sequence were selected from the partially sequenced 16S rRNA genes of Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, S. agalactiae, and Staphylococcus epidermidis. The PCR assay was divided into two DNA amplifications.

Pneumococcal meningitis in adults.

A retrospective study was conducted to examine the clinical features and outcome of 31 adult pneumococcal meningitis patients during the years 1981-92. The incidence was 1.0/100,000 adults/year.

Tumor necrosis factor-alpha (TNF alpha) in cerebrospinal fluid from patients with meningitis of different etiologies: high levels of TNF alpha indicate bacterial meningitis.

The levels of tumor necrosis factor (TNF)-alpha in cerebrospinal fluid (CSF) were analyzed in 139 patients with meningitis and in 20 control subjects. Elevated concentrations were observed in 42 (82%) of 51 patients with purulent bacterial meningitis (18/24 Haemophilus influenzae, 13/14 Streptococcus pneumoniae, 7/7 Neisseria meningitidis, and 4/6 with other purulent bacterial etiology). In contrast, elevated levels were found in only 5 of 78 individuals with nonbacterial meningitis (2/8 with herpes simplex type 2, 3/3 with varicella-zoster virus).

Association of pneumonia and lung cancer: the value of convalescent chest radiography and follow-up.

A retrospective study of 1011 hospitalized patients with pneumonia was undertaken to assess the value of routine convalescent chest radiography for detection of underlying lung cancer. To investigate the mode of clinical onset of pulmonary carcinoma, 232 inpatients with this diagnosis were also studied. The findings may be summarized as follows: 1) 13/1011 pneumonia patients were found to have previously undiagnosed pulmonary carcinoma; 2) many of these carcinomas (8/13) were disclosed by an acute chest X-ray; 3) pulmonary carcinoma was found by convalescent chest X-ray in 2/88 patients not feeling well and in 2/524 patients feeling well at follow-up, and none of these 4 patients benefitted from the carcinoma diagnosis; 4) ESR was of no value in detecting underlying pulmonary carcinoma at follow-up in patients with pneumonia; 5) of the 232 patients with pulmonary carcinoma, 29 (12.

Deep obstetrical and gynecological infections caused by non-typeable Haemophilus influenzae.

Six patients with deep obstetrical and gynecological infections due to non-typeable Haemophilus influenzae are presented. 3 patients had tubo-ovarian abscesses, 2 septic abortions and 1 postpartum sepsis. All our patients with tubo-ovarian abscesses had used intra-uterine contraceptive devices until admission and all had a protracted course of illness.

Regional differences of Chlamydia pneumoniae as causative agent of pneumonia in Sweden.

A retrospective serological study was performed on sera from 1982-83 and 1989 to investigate the incidence of Chlamydia pneumoniae infection in hospital treated patients with pneumonia in Orebro County. Paired sera from 231 patients were available and 3 cases (1.3%) of C.