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We report the case of a young man who was hospitalized at the Department of Cardiology for palpitations and dyspnea. Standard ECG revealed the presence of Q waves and T negative waves in the inferior leads, suggestive of myocardial necrosis. Chest X-ray test detected a round mass in the lung. Two-dimensional echocardiography revealed three cardiac cystic masses. The biggest cyst was located in the left atrium and simulated a mitral stenosis; the second cyst was located in the posterosuperior right atrial wall and the third in the posterior wall of the left ventricle. The finding was confirmed by nuclear magnetic resonance imaging. Echinococcosis was suspected based on the patient's origin (Morocco) and the echocardiographic and MR imaging, and was confirmed by a positive hemagglutination test. This case is of particular interest because of the number of cysts and their unusual localization.

Unlabelled: MYCOPLASMA PNEUMONIAE: Delayed diagnosis and empiric therapy., Background: To evaluate the consistency of IHA test to the initial diagnosis and therapy in suspected cases of Mycoplasma pneumoniae pneumonia (MP)., Design: retrospective-descriptive., Environment: Division of Pneumology, IRCCS Policlinico S. Matteo, Pavia from November 1991 to October 1993., Patients: 235 pts inpatients., Variables: age, sex, clinical diagnosis, microbiology, serological investigations for MP by indirect hemagglutination test (IHA); therapy, monitoring and evaluation; considered as positive IHA titres > or = 1:40., Results: Clinical presentation not different from other "atypical" pneumonia. Macrolides, aminoglycosides, quinolones or cephalosporins were the usual treatment; patients recovered within 1 to 2 weeks consistently to the severity of disease. Sixty-five cases were IHA-positive (28%). Serological outcomes were usually known after 7 to 10 days or more, when most of patients resulted discharged. Mean age in IHA-positive pts was younger than in IHA-negative (31.3 vs 51.6 yrs; p < 0.0001). IHA test was repeated after 3 weeks in 23/235: 2 (9%) remained negative and 15 (65%) positive; 5 (22%) turned from positive to negative; 1 (4%) from negative to positive., Conclusions: Clinical and roentgenological presentation similar to other "atypical" pneumonia; late etiological diagnosis and only in 28%, including those monitored distally; significantly young age among IHA-positives; empiric therapy, effective even on the remaining 72% IHA-negative. IHA, commonly used test with good specificity and sensitivity, is of late support to the clinician in short course and uncomplicated disease.

The effectiveness of mebendazole as adjuvant treatment in hydatidosis was evaluated in 19 patients; 12 were treated both before and after surgery, 6 were not treated, one had primary treatment only, owing to the refuse of surgery. Mebendazole was administrated at the dosage of 30-50 mg/kg/day po for 30 days followed by a washout of 15 days, for a mean of 4 cycles (range 1-7) and 12 cycles (range 1-24) before and after surgery, respectively. Patients were monitored by total IgE, specific anti-echinococcus IgE and IgG, at diagnosis, just before surgery and thereafter every six months. Antibody titer decrease was observed soon after the first cycles of medical treatment before surgery, as well as a clear-cut drop after surgery, followed by a continuing decrease after the following cycles of mebendazole. Relapse of disease was observed in two patients only at one and two years after surgery respectively. These preliminary results seem to point out that mebendazole might play a role in the treatment of hydatidosis as adjuvant of surgical therapy.

This paper reports data concerning the immune status of 252 pregnant women with regard to rubella infection. The inverse haemagglutination was used to titrate rubella virus-antibodies and it was carried out for each pregnant woman on two blood samples, collected at three weeks' interval. Thirty-nine of the 252 pregnant women (15.50%) contracted the infection in the first trimester of pregnancy. Fifty-seven women (22.60%) showed a low degree of protection against the infection while only forty-five women had a protective rubella virus-antibody titre. Finally, 111 of the 252 (44.60%) pregnant women were rubella virus seronegative and therefore susceptible to the infection.

The Authors studied three techniques for the determination of HBsAg in 740 sera from blood donors and in 60 sera from patients with viral hepatitis with three different commercial tests based on the radioimmunoassay, on the micro-ELISA method and on the passive haemoagglutination. The micro-ELISA method showed a high sensibility comparable to that of the radioimmunoassay.

Specific serum IgG and IgM directed against blood culture isolated bacteria have been determined in patients with positive blood culture by the indirect immunofluorescence and passive hemagglutination methods in order to distinguish the true positive blood cultures due to bacteremia from those due to contamination. 45 (16%) out of 280 blood cultures examined during the period 1/1/1980-30/1/1981 gave positive isolations: 25 cases (55.5%) were due to gram-negative bacteria and the remaining 20 cases (44.5) to gram-positive bacteria: among these there were 9 cases (20% of the total positive blood cultures) with isolation of micrococci. No positive blood culture for anaerobic bacteria were observed during that time interval. 96% of patients from whose blood cultures gram-negative bacteria had been isolated showed high titres of serum specific antibodies with both the indirect immunofluorescence and the passive hemagglutination methods. Only 40% of the cases whose blood cultures gave isolation of gram-positive bacteria showed high titres of serum specific IgG. The remaining 60% that did not show presence of serum specific antibodies included 9 cases of positive blood culture for micrococci (well known as contaminants) and 2 cases for streptococcus (in two of these there had been a mixed flora isolation). Specific IgM antibodies at significant level were also present in 76% of patients with positive blood culture for gram-negative bacteria and in 40% of patients with positive blood culture for gram-positive bacteria. All patients whose cultures gave isolation of micrococci showed absence of specific IgM. The observed good correspondence between isolation of contaminant bacteria on one hand and the absence of serum specific antibodies on the other, and vice versa between isolation of pathogenic bacteria (either obligate or opportunistic) an one hand and the presence of high level of specific antibodies on the other suggests that the search of specific immune response in patients with positive blood culture might constitute a good criterion (in addition to the classical criteria) for distinguishing true positive blood cultures from contaminated blood cultures.

By means of the passive hemagglutination test the antitetanus immunity in a group of 380 children, aged between 0 and 14 years, of various Italian regions, was ascertained. On the whole, 62.9% of the subjects showed a titer equal to, or higher than 1024, equivalent to 0.1 I.U./ml of antitoxin. In subjects younger than 2 years, this ratio is only 42.2%, thus showing a scanty protection in this age period. As far as the origin of the subjects is concerned, it turns out that, for the group of the Center-South the percentage of the children immunized in the younger ages is higher, unlike what occurs subsequently beyond 10 years when the highest ratio of unprotected subjects can be detected. The opportunity to immunize the mothers and to anticipate the age of the primovaccination for tetanus is set forth.

We weighed the situation of tetanus immunity in a population sample of the province of Pavia in which both sexes and all age groups were represented. We carried out the survey performing the indirect haemagglutination test with turkey red cells. In each age groups the checked subjects have been classified in three different tetanus antibodies concentration levels: under 0.01 U/ml, between 0.01 and 0.1 U/ml, above 0.1 U/ml. The method we used is easy to perform and has a good reproducibility. The survey points out the good protection against tetanus in age classes under twenty years and the possibility of discovering districts where ineffective immunization methods are performed.

The main, recently proposed, techniques for the identification of Australia antigen are reported (immuno-diffusion, complement fixation, latex agglutination, counterelectrophoresis, radioimmunological assay, inverse haemoagglutination). Following personal observations, the AA. indicate the more suitable methods in various practical circumstances.

The AA. relate the results of a serological study on the spreading of listeria infection over the pediatric population of Liguria. The research of agglutinating antibodies for types 1 and 4b of L. monocytogenes in 367 sera gave the following results: -- 195 sera (53,13%) resulted positive, although at low titer (1/40) as a general rule; -- on the whole, agglutinins toward type 1 had considerably higher incidence than toward type 4b ones (57,43% and 5,12% respectively); -- O - antibodies had higher incidence (44,95%) than H - antibodies (22,34%).

The Authors present the actual knowledge about the hepatitis B associated antigen (HBsAg) and the now more used methodics for detection of its surface component (HBsAg); consequently they present the results of a screening executed between january 1976 and december 1979, directed to research the HBsAg into sera of 655 patients affected by various diseases, particularly liver diseases, using the reverse haemoagglutination test. With this technique, that is of very easy and rapid performance, together with a good sensibility (even though it gives a rather important deal of feigned positivity, yet these can be voidable by means of an adsorption test) the Authors have totally acquired a 8.7% of positive cases for HBsAg (with a majority of patients affected by liver diseases) and a 1.2% chronic carriers for this antigen.

The tests for tetanus aetiological diagnosis are briefly surveyed: with particular attention to Passive Haemagglutination on Turkey Red Blood Cells (P.H./T.R.B.C.), for the assessment of antitoxin serum level. The P.H./T.R.B.C. proves a valuable tool in different occasions: -in patients, to control the immunotherapy; -in subjects at risk, to apply a correct prophylaxis; -in the whole population, to verify the outcome of compulsory vaccination.

Boutonneuse fever has become endemic in some parts of Sicily and the Italian mainland over the last five years. An account is given of the features assisting its clinical recognition and serological verification. The main nosographical aspects of the disease are described. The conditions required for certain, probable and presumed diagnosis are stated, stress being laid on the prime importance of timely clinical assessment, and the possibility of serological ascertainment when the disease is waning, or even later. Serum diagnosis via complement fixation or microagglutination will be positive in the second half of the second seven-day period of fever. It is specific with Rickettsia conorii antigens, though these have not been easy to find so far. The Weil-Felix reaction with Proteus OX19 and OX2 is significantly positive in advanced coalescence. While this is always a practical possibility, it is of indicative, and usually retrospective, value only.

A statical investigation conducted by the authors in a random population demonstrated the utility of the determination of antitetanic antibodies by means of Tetan test in order to establish the immunological defence level against infection.

Previous studies on the serological diagnosis of the lower respiratory tract infections caused by bacteria have been reviewed. The most significant results have been up to today obtained with the double immunodiffusion technique (Ouchterlony) for detecting different, specific and aspecific, bacterial precipitins in the serum of the patients, and with the immunoelectrophoresis which allows to distinguish specific precipitine lines from the aspecific ones. Among the other immunological methods, bacterial agglutination, passive haemagglutination, cross-over-immunoelectrophoresis, complement fixation, and immunofluorescence have been only occasionally used, but further comparative studies are needed and suggested to establish their diagnostic value. Other technical problems, as purity of antigens or cross-reactivity of antibody or antibodies level evaluation, are raised and discussed. Further improving of the serological methods would allow their routine use in clinical bacteriology as a useful tool in the assessment of pathogenicity of the bacterial species in the sputum and in the ethiological diagnosis of broncho pulmonary infections, at least of those cases in which exclusive relaying on sputum cultures could be fallacious.

The evaluation of the antitetanus immunity in human sera is of primary importance for the carrying out of an adequate prophylaxis and treatment of tetanus. Tetan Test is a diagnostic kit for the titration of the antitetanus antibodies, by means of the passive hemagglutination technique. Tetan Test is examined under the point of view of the preparation techniques and the process and final controls which warrant the quality and the standardization of the product itself. The stability of Tetan Test, after storage at the temperatures: 67 degrees C, 52 degrees C, 37 degrees C, 22 degrees C is evaluated. The excellent results obtained allow the use of the product also in hot climates, in developing countries, where the storage at the advised temperatures is not possible.

There have been some results of the antitoxotoxin investigation into antibodies in cases variously positive to the Dye test for the toxoplasmic infectious disease. The results point to various etiological considerations, therapeutic and therapeutic-prophylactic, on which the AA dwell briefly. They touch upon the possibility of a timely recourse to desensitization which, however, is sometimes not excluded even in cases which show a negative result to the toxotoxin.

The problem of the relationship between the surface B antigen and the parasitosis characterized by active penetration of the larvae through the skin has not yet been resolved. Conflicting results have been reported lately on this problem even though it is currently believed that HBsAg is found more often among patients infected by parasites than among healthy subjects. Serum samples from 67 Somalian patients infected by S. haematobium were tested for the presence of the surface B antigen by ELISA method. The HBsAg was found in 19.4 per cent of these patients, while among controls (90 cases) the frequency of HBsAg was of 10 per cent. A comparative analysis of the results obtained with various methods in Somalia shows that the frequency of HBsAg among subjects with urinary schistosomiasis is of 25.9 per cent with indirect haemoagglutination (IHA), of 19.4 per cent with ELISA method and of 14.8 per cent with radioimmunoassay (RIA). These observations seem to indicate that the problem of an increased frequency of HBsAg among patients with urinary schistosomiasis needs further investigation.

The prevalence of toxoplasmosis as results by serologic tests (agglutination test = Fulton test and indirect emoagglutination test) of 904 subjects of North Italy was determined. Serologic signs of toxoplasmosis were present by only one or by both two tests in 66.4% and respectively in 64.1% of these subjects. The prevalence increased highly from the first 5 years of life, reach c.a. 40% at 20th year and 60% in the group of subjects of 20-24 years. The results of Fulton test and indirect hemoagglutination test correlate very well. 96.6% of the levels of Fulton test were from 1:16 to 1:128 and 76.9% of those of passive hemoagglutination test were from 1:64 to 1:512.

The trend of antibodies tested with indirect hemagglutination, of total IgE and complement fraction was examined in patients with liver hydatid disease, treated with surgery and benzoimidazoles.

The main methods for the detection of the Australia antigen (HBAg) are reported and discussed by the AA. according to their true availability.

A group of 800 human sera, obtained from syphilitic and nonsyphilitic individuals were tested in the counterimmunoelectrophoresis (CIE) technique with Reiter protein antigen. The sera were assayed for comparison in the following treponemal and nontreponemal tests: standard serologic tests for syphilis with cardiolipin; complement fixation (Kolmer 1/5 vol) with Reiter protein antigen (RPCF); T. pallidium immobilization (TPI) test; haemoagglutination test for T. pallidum antibodies (TPHA). The sensitivity and specificity of CIE test, its simplicity, the low cost, the possibility of practical application as a routine test for syphilis serology were discussed.

Haemagglutinating antibodies have been assessed in rabbits undergoing active- passive immunization against tetanus. The animals received 6 injections of horse immune serum, 400 UI/kg, and A1PO4 adsorbed toxoid, 0.35 Lf/kg, every 30th day. One the 5th day, after the first injection, E.A. antibodies appeared, at low levels, as a result of a passive immunization. Thereafter the tests became negative, up to the 70th day, when an active immunization emerged, with a 25 days delay in comparison with controls. Neutralization test in vivo behaved in the same way. The results stress once more the need to give up the use of heterologous immune sera in tetanus prophylaxis, in active-passive immunization as well. Arguments adding force to this point of view are: the sensibilization against heterologous proteins, the very low (if any) passive protective action, and, last not least, the delay in the emergence of active immunization: the only reliable shield against tetanus.

The data revealed on the same subject by the indirect agglutination test and the immunoenzyme test for IgG and IgM anti-toxoplasma antibodies were compared. The analysis shows that neither the indirect agglutination test nor the antibody count is sufficient for the diagnosis of the disease and that both are more appropriately employed in statistical epidemiological surveys.

The passive haemagglutination assay is at present the most common method available for evaluating tetanus antibody levels. We recently developed a modification of the technique of HA by Mai and Rosin using turkey red blood cells (TRBC-HA) instead of sheep red blood cells (SRBC-HA). TRBC-HA assay seems to offer the advantages of being more sensitive and easier to perform than the SRBC-HA method. More important, with the TRBC-HA assay, we found that the HA values greater than 0.5 H.U./ml always correspond to NT values greater than 0.01 IU/ml. Therefore this value (0.5 H.U./ml) was chosen as a discriminating level between protected and non protected persons. On this rationale base we have tested sera from injured persons in order to individualize a single prophylactic treatment under a rationale guideline against the alternative of a blind intervention under anamnestic basis. Among 437 persons tested 248 did not remember if they had been vaccinated or not. According to the anamnestic basis all these persons should require injection of human antitetanus Ig plus a basic course of vaccination. On the contrary antitetanus antibody levels monitored by TRBC-HA assay indicate that 132 were protected and did not require any treatment; 79 were partially protected and required a boosting of tetanus toxoid and only 37 were not protected and needed human antitetanus IgG plus a complete course of vaccination. These results underline the necessity of monitoring a single person for antitetanus antibodies in order to prevent both under or over evaluation of their tetanus immune status.

A technique based on the indirect haemagglutination for the study of antitetanus immunity was developed. The test implies the use of turkey formolated, tanned and tetanus toxoid sensitized erythrocytes, subsequently lyophilized. Some details on the technical modalities of the test, on the sensitivity of the technique and the criteria for the interpretation of the results are reported.