Utility of scintigraphic methods in patients with fever of unknown origin

BACKGROUND: We assessed the utility of scintigraphy with indium 111-labeled polyclonal human IgG scintigraphy in patients with fever of unknown origin that fulfilled the criteria of temperature of 38.3 degrees C or more for at least 3 weeks and no diagnosis during 1 week of hospital admission. We compared the utility of this technique with results of scintigraphic techniques reported in the literature. METHODS: Data for all patients seen at our university hospital in whom 111In-IgG scanning was performed were analyzed and checked for the criteria for fever of unknown origin. The literature on the utility of scintigraphic techniques in patients with fever of unknown origin was reviewed. RESULTS: We studied 24 patients with fever of unknown origin. In 13 patients, focal 111In-IgG accumulation was observed. In nine (38%) of those, the positive 111In-IgG scintigram led to the final diagnosis; in the other four patients (17%), the scintigraphic findings were not helpful. In the 11 patients with negative 111In-IgG scans, extensive diagnostic workup produced no infection as the final diagnosis in nine patients (38%), one had an abscess in a renal cyst that was detected several months later, and in the other the cause of fever was an infected intravenous line. The overall sensitivity and specificity of 111In-IgG scintigraphy were 81% and 69%, respectively. The positive predictive value was 69% and the negative predictive value was 82%. CONCLUSIONS: Our results show that 111In-IgG scintigraphy significantly contributed to the diagnostic process in patients with fever of unknown origin. A positive scan increased the likelihood of finding the cause of the fever, and a negative scan ruled out an inflammatory component with a high degree of certainty. These data compare favorably with data in the literature concerning other radiopharmaceuticals; a larger prospective evaluation of this technique is indicated.     

HIV-1 and HIV-2 antibodies in pregnant women in the City of Maputo, Mozambique. A comparative study between 1982/1983 and 1990

The seroprevalence of HIV-1 and HIV-2 among pregnant women in Maputo, the capital of Mozambique, was compared between the years 1982/83, 1988 and 1990. None of the 432 serum samples collected in 1982/83 was positive for HIV antibodies whereas in 1988 the HIV-1 and HIV-2 seroprevalence was 0.4% (2/500) and 0.6% (3/500), respectively, and in 1990 0.6% (12/2014) and 0.2% (4/2014), respectively. These results indicate that HIV infection has been introduced recently in Maputo and is spreading at a slow rate among women.     

A new eicosapentaenoic acid formed from arachidonic acid in the coralline red algaeBossiella orbigniana

Aqueous extracts of the coralline red algaeBossiella orbigniana have been shown to catalyze the enzymatic oxidation of arachidonic acid to a previously unreported ω6 eicosapentaenoic acid product. This unique fatty acid contains a conjugated tetraene with absorption maxima at 293, 306, and 321 nm, and was identified by spectral methods as 5(Z),8(Z),10(E),12(E),14(Z)-eicosapentaenoic acid. The compound was given the trivial name bosseopentaenoic acid. Under experimental conditions, production of bosseopentaenoic acid was linear up to 2 hr and dioxygen was consumed. Bosseopentaenoic acid, along with several other conjugated tetraenes, was also present in the algae endogenously as revealed by a comparison of the ultraviolet (UV) spectra and the high-performance liquid chromatographic (HPLC) pattern of the purified product and the organic extract ofBossiella.     

Porphyromonas (Bacteroides) endodontalis: its role in endodontal infections

Porphyromonas endodontalis (formerly Bacteroides endodontalis) is a black-pigmented anaerobic Gram-negative rod which is associated with endodontal infections. It has been isolated from infected dental root canals and submucous abscesses of endodontal origin. The presence of P. endodontalis in infected dental root canals has been correlated with symptoms of an acute infection. It is occasionally found on oral mucous membranes and periodontal pockets. P. endodontalis has shown relatively low virulence in experimental monoinfections. In anaerobic mixed infections it can play an essential role. Differences in virulence between strains have been related to capsular material. On the basis of different types of capsules, three serotypes have been described. P. endodontalis is sensitive to a wide range of antibiotics, including the penicillins, the tetracyclines, and metronidazole.