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This report describes genome sequences for nine Listeria innocua strains that varied in hemolytic phenotypes on sheep blood agar. All strains were sequenced using Pacific Biosciences (PacBio) single-molecule real-time (SMRT) chemistry; overall, the average read length of these sequences was 2,869,880 bp, with an average GC content of 37%.

BACKGROUND Pneumococcal infections are a leading global cause of morbidity and mortality, complicated by the increasing antimicrobial resistance of pneumococcal isolates. OBJECTIVE To evaluate morbidity and mortality associated with both invasive pneumococcal disease (IPD) and non-IPD in Jamaica in both the paediatric and adult population. Pneumococcal isolates (n= 94) were collected over a 2-year period (2008-2009). METHODS Risk factors for poor clinical outcomes: death, complicated disease and length of hospitalization (LOH) were evaluated and antimicrobial resistance patterns were determined by Kirby-Bauer disc diffusion. RESULTS The case fatality rate was 6.8%. Independent mortality risk factors included complicated disease [OR 30.9 (3.4-276.6)] and diabetes mellitus [OR 8.3 (1.4-48.8)]. Independent risk factors for the development of complicated disease included sickle cell disease [OR 36.5 (4.2-320.3)] and sepsis [OR 3.5 (1.2-10.4)]. The LOH was increased most in patients with invasive disease (4.6-fold) and resistance to ceftriaxone (4.3-fold). Penicillin (16.0%) and erythromycin (14.9%) resistance was most prevalent, while ceftriaxone (4.3%) resistance was least prevalent. CONCLUSIONS The high burden of IPD in at-risk groups in our population and the associated increase in morbidity and mortality underlie the need for improved preventive and therapeutic management strategies in these patients.

BACKGROUND Pneumococcal serotypes circulating in any population vary over time and between countries and impacts the effectiveness of pneumococcal vaccination. OBJECTIVE This study investigated the epidemiology of pneumococcal disease in Jamaica. METHODS Streptococcus pneumoniae isolates (n= 349) along with demographic and clinical information were collected from patients presenting at the 4 major hospitals in Jamaica over a 2-year period. Serotyping was done using latex agglutination tests and the Quellung reaction assay. RESULTS Invasive pneumococcal disease (IPD) incidence was 45.4/100,000 in children under 5 yrs and 16.3/100,000 in adults over 65 yrs. Thirteen serogroups were identified among the 120 isolates subjected to grouping; the most common being serogroups: 19 (22/120,18.3%), 6 (20/120,16.7%), 14 (20/120,16.7%), 23 (18/120,15.0%), 3 (11/120,9.2%) and nontypeable (8/120,2.3%). The estimated vaccine coverage rates for the PCV7 and PCV13 vaccines in children less than 5 yrs were 82.5% and 88.7% respectively. The 23-valent PPV23 provided 100% coverage rate in adults over 65 yrs and 82.9% coverage rate for the entire population. CONCLUSIONS Pneumococcal vaccine coverage rates in Jamaica are comparable to those reported in certain developed countries and higher than in other developing countries. The high incidence of IPD in the paediatric population indicates that routine vaccination would be beneficial.

Objectives We evaluate the performance characteristics of antiphosphatidylserine (anti-PS), antiphosphatidylinositol (anti-PI), and antiphospholipid mixture (APhL) enzyme-linked immunosorbent assays (ELISAs) compared with anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) in a large group of patients with antiphospholipid (aPL)-related diseases. Methods Serum samples from 548 patients from the Hopkins and Jamaican systemic lupus erythematosus cohorts, the PROMISSE cohort, and the Antiphospholipid Standardization Laboratory were examined for immunoglobulin G (IgG)/immunoglobulin M (IgM) positivity in aCL, anti-β2GPI, anti-PS, anti-PI, and APhL ELISA assays. Results All IgG assays were associated with one or more thrombotic and/or obstetric manifestations, with an increased risk associated with higher antibody titers. Analytical performance was similar among assays, but IgG assays performed better than IgM counterparts. Conclusions Increasing titers of APhL, anti-PS, and anti-PI antibodies could indicate an increased risk of thrombotic and/or obstetric aPL-related manifestations. These assays may be promising biomarkers for particular APS manifestations.

Streptococcal protein-G (SpG), type III bacterial Fc receptor, is a small globular protein produced by several Streptococcal species and it is composed of two or three nearly identical domains, each of 55 amino acids. Streptococcal protein G has been shown to have high binding affinity to sera from various mammalian species including rabbit, human, pig, goat, sheep, cow and many other animal species. Of concern are patients with invasive infections by Streptococcus spp, where large amount of secreted SpG could interfere with the outcome of the gel technique by getting false negative tests. It has been shown and reported that the bacterial protein SpA was already found to inhibit the Coomb's test. We hypothesize that SpG as well as many other immunoglobulin-binding bacterial proteins with binding affinity to human IgG could cause false negative results in patients with bacteraemia. With the intention of proving this hypothesis we conducted two sets of experiments, which proved that SpG has the potential of inhibiting the gel test for the detection of sensitized erythrocytes in vitro. We concluded that is important to exercise caution, when evaluating a result of gel technique in patients with septicemia caused by IgG-producer Streptococci. The experiments used in this research were novel modifications of existent techniques and they proved reliable in demonstrating our hypothesis.

Background While essential for the classification of antiphospholipid syndrome (APS), anticardiolipin (aCL) assays lack specificity and anti-β2glycoproteinI (anti-β2GPI) assays lack sensitivity in this regard. Our aim was to perform a comparative analysis of the APhL ELISA assay (IgG/IgM) and criteria antiphospholipid (aPL) immunoassays in identifying APS-related clinical manifestations in a large group of patients with systemic lupus erythematosus (SLE). Methods Serum samples from 1178 patients from the Hopkins ( n = 543), LUMINA ( n = 588) and Jamaican SLE cohorts ( n = 47) were examined for IgG/IgM positivity in aCL (in-house), anti-β2GPI (two commercial kits) and APhL (Louisville APL) ELISA assays. Correlation of assay positivity with clinical manifestations and sensitivity, specificity, positive and negative predictive values and likelihood ratios were evaluated. A case series analysis was also performed in patients for whom there was isolated positivity in the specific aPL assays. Results The prevalence of aCL positivity was 34.9%, anti-β2GPI kit A was 22.6%, APhL was 11.5% and anti-β2GPI kit B was 7.6% in the study population. Anti-β2GPI kit B, aCL and APhL assays were correlated with venous thrombosis, while only APhL was significantly correlated with arterial thrombosis and consistently correlated with pregnancy-related morbidity. No significant correlations were noted for anti-β2GPI kit A. Sensitivity was greatest for aCL assays followed by anti-β2GPI kit A, APhL and anti-β2GPI kit B, while specificity was greatest and equal for anti-β2GPI kit B and APhL assays. Conclusions Overall, APhL antibodies, especially IgG, represent a promising biomarker for the classification of APS patients in the context of autoimmunity and in risk assessment with regards to pregnancy morbidity and thrombotic manifestations.

Dengue fever, a mosquito borne viral infection, is endemic to Jamaica. The seroprevalence of dengue IgG and IgM antibodies were determined in 277 healthy Jamaicans by enzyme linked immunosorbent assay (ELISA). The seroprevalence of dengue IgG antibodies was 100% (277/277) while dengue IgM antibodies were found in 3.6% (10/277). A statistically significant association was found between the presence of dengue IgM antibodies and gender (males 10/105, 9.5% vs females 0/172, 0.0%); chi(2) = 17.0, p=0.000.The high seroprevalence rate of dengue IgG antibodies and the presence of dengue IgM in the healthy population are in keeping with the endemicity of the virus in Jamaica. Therefore tests for dengue IgG antibodies are of limited usefulness in Jamaica and can be safely excluded from diagnostic testing as a cost saving measure. Serological diagnosis of current dengue infection should be centred around the dengue IgM tests although the limitations in the predictive values of such tests should also be considered. The results also suggest that the risk of emergence of the more severe forms of dengue, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) in the Jamaican population, due to the presence of enhancing antibodies, is high.

The patterns of dengue immunoglobulin (Ig) M and IgG antibodies in patients presenting with dengue-like illnesses during 2003-2006 were investigated using enzyme linked immunosorbent assays (ELISA). The seroprevalence of dengue antibodies, dengue IgM and dengue IgG antibodies were 59.4% (979/1647), 15.4% (254/1647) and 51.1% (841/1647), respectively. A statistically significantly increasing trend in the prevalence of dengue IgG antibodies with age was observed, ranging from 38.4% in patients aged less than 1 year to 90% in those 60 of years and over (p = 0.000; 95% confidence interval (CI) = 0.000-0.002). Conversely the seroprevalence of dengue IgM did not differ significantly with age and no seasonality in the number of cases was observed. The patterns of IgM and IgG antibodies found in the present study are consistent with those found in dengue endemic countries during inter-epidemic periods indicating that an increasing risk of a new dengue outbreak due to the accumulation of susceptible population. Preventive measures should be maintained to control the endemic spread and reduce the risk of outbreaks of dengue in Jamaica. The high seroprevalence rate of dengue IgG antibodies might have implications for the emergence of the more severe forms dengue infection in the Jamaican population.

The prevalence of diabetes and other autoantibodies in patients with recently diagnosed youth onset diabetes was evaluated. Fifty-seven patients (95% black, age 19 +/- 5 years, 36% male, diabetes duration 2.6 +/- 2.2 years) were clinically diagnosed as having type 1 (n = 35), type 2 (n = 13) and lipoatrophic diabetes (n = 3) while 6 remained untyped. GAD65 was the most common diabetes-associated autoantibody in patients with type 1A diabetes (12/17; 71%). The prevalence of any diabetes-associated autoantibodies decreased with diabetes duration (OR[95%CI]/yr after diagnosis 0.50[0.31,0.82]) and was not associated with age of onset, duration or gender. Rheumatoid factor (13/57; 23%), smooth muscle (6/57; 11%), gastric-parietal cell (5/57; 9%) and thyroid microsomal antibodies (5/57; 9%) were the most frequent non-diabetes associated autoantibodies and were more common in patients with type 1A diabetes. Only one patient had clinical autoimmune disease (hypothyroidism). Type 1A diabetes may constitute up to half the cases of newly diagnosed type 1 diabetes in Jamaican youth and is associated with a higher prevalence of other organ-specific autoantibodies.

Objective Restoration of euthyroidism with l-thyroxine reportedly reduces obstetric complications associated with subclinical hypothyroidism (SCH). The objective was to determine if obstetric outcomes of treated subjects were equivalent to euthyroid subjects. Methods This was a prospective cohort study. Subjects were considered euthyroid if serum thyroidstimulating hormone (TSH) was 0.4-3 mIU/L and free thyroxine (FT4) 10.29-17.05 pmol/L with negative thyroid peroxidase antibodies (TPOAb). Subclinical hypothyroidism was diagnosed if FT4 was 10.29-24.45 pmol/L and TSH 2.5-3 mU/L with positive TPOAb, or TSH > 3.0 mU/L regardless of antibody status. Subclinical hypothyroidism subjects were treated with l-thyroxine until TSH < 2.5 mIU/L. Data were analysed with Stata (StataCorp, USA). Results Seven hundred and sixty-nine singleton pregnancies were screened; 96% at 14 weeks gestation. Five hundred and eleven (66%) were euthyroid by study definition. Prevalence of SCH was 1.9% (15/769); 26% (4/15) were TPOAb positive. Eighty-one per cent were treated according to protocol; compliance was 54%. Mean gestational age (GA) at first endocrinologist visit was 22.7 ± 2.7 weeks. Normal TSH was documented in 36% at GA 33 ± 2.94 weeks. Subjects with SCH had significantly greater pre-existing history of preterm premature rupture of membranes (PPROM) and preterm labour, Caesarean sections for non-reassuring fetal heart rate and neonatal necrotizing enterocolitis. Conclusion L-thyroxine appeared to reduce obstetric complications. However, prevalence of SCH was low and compliance was < 50%.

The objective of this study was to assess whether providing a choice of condoms would increase condom acceptability increase self-reported use and decrease incident sexually transmitted infection. We randomized 414 men presenting with urethral discharge in Jamaica to receive either the "standard" clinic condom or a choice of 4 different types of condoms. Men were treated presumptively at enrollment and followed up at 1 2 4 and 6 months. Participants in the choice group had a strong preference (P < 0.01) for the most popular condom available in Jamaica. This preference did not translate into higher condom use (P = 0.16). The 6-month cumulative probability of first incidence of gonorrhea chlamydia or trichomoniasis was slightly higher in the choice group (21%; 95% confidence interval [CI] 15-28%) versus the control group (17%; 95% CI 11-23%); the difference in the survival curves was not significant (P = 0.35). A choice of condoms may increase perceived acceptability but not lead to increased condom use and subsequently lower sexually transmitted infection rates. (authors)

A prevalence survey of anticardiolipin antibodies (aCL) was done among 924 primiparae. aCL were measured in serum by the standardised anticardiolipin enzyme linked immunosorbent assays (ELISA) and beta(2)-glycoprotein 1 assays to determine the seroprevalence of both beta(2) glycoprotein 1 dependent aCL and beta(2)-glycoprotein 1 independent aCL in Jamaican primiparae, to determine whether aCL are associated with abnormal pregnancy outcomes and if treatment with aspirin had any effect on pregnancy outcome in aCL positive primiparae. The prevalence of aCL was (32/671) 4.8% (95%CI 3.2-6.4) in women who were tested twice. A total of 49 of 924 primiparae or 5.3% (95%CI 3.9-6.7) were positive for aCL on at least one occasion. Only three of the 32 primiparae 3/32 (9.4%) who were positive for aCL on two occasions were positive for beta(2)-glycoprotein 1 dependent aCL. Pregnancy outcome did not differ significantly with respect to aCL status. Aspirin therapy did not influence pregnancy outcome in the 49 aCL positive primiparae studied.

Haemophilic patients (n = 90) and household contacts (n = 40) were tested for serological markers of hepatitis B virus (HBV), hepatitis C virus (HCV) and elevated serum aminotransferases using commercially prepared reagents. Of the haemophiliacs 41% (37/90) tested positive for antibodies to HCV (anti-HCV); 36% (32/90) antibodies to hepatitis B core antigen (anti-HBc); 54% (49/90) antibodies to hepatitis B surface antigen (anti-HBs) and 2% (2/90) hepatitis B surface antigen. On the other hand, 29% (26/90) of the patients and 90% (36/40) of the household contacts tested negative for all of the viral markers. Anti-HCV positivity in the haemophilic patients correlated positively with anti-HBc (p < 0.025). Increasing age (odds ratio 2.09; p < 0.01), severity of disease (odds ratio 6.2; p < 0.05) and the requirement for transfusion (odds ratio 3.2; p < 0.05) were risk factors for anti-HCV positivity. The presence of anti-HBc (odds ratio 3.8; p < 0.01) and coinfection with HCV and HBV also correlated positively with age (odds ratio 2.5; p < 0.01). The provision of anti-HCV screened donor blood and virally inactivated blood products for treatment of all haemophilic patients are goals that must be achieved.

Background The prevalence and characteristics of autoimmune hepatitis (AIH) in black populations are not well documented. Objectives To describe the clinical and laboratory features of AIH in patients presenting at a Jamaican hospital, 1969-2009. Methods A retrospective review of hospital records was done and patients were classified by the revised international scoring system. Results Fifty patients satisfied criteria for diagnosis of AIH type-1 and most presented late at hospital. Almost one third of cases presented with chronic liver disease (32%) while 8% presented with fulminant hepatic failure and 2% with acute liver disease. Jaundice (92%) was the most common presenting feature. Other associated autoimmune diseases (10%) systemic lupus erythematosus and insulin dependent diabetes mellitus, were found. All patients (100%) had abnormal liver biochemical tests, 81% had hypergammaglobulinaemia and 82% AIH associated autoantibodies. The prevalence of autoantibodies increased with age (P=0.05). Liver biopsy, performed in 33 cases, showed chronic hepatitis (45%), cirrhosis (24%) chronic hepatitis with bridging necrosis (15%), chronic hepatitis with rosetting (6%) and nonspecific findings (10%). Patients were treated with prednisone with or without azathioprine. Relapse occurred in 4% and death 6%. Conclusion Autoimmune hepatitis is rare in Jamaicans and prognosis is similar to that reported in developed countries.

BACKGROUND Anticardiolipin antibodies (aCL) are a heterogeneous group of antiphospholipid antibodies that are associated with arterial and venous thrombosis. We measured aCL in women, aged 15-49 years, to determine if they are an independent risk factor for thromboembolic disease. STUDY DESIGN Case--control study METHODS Fifty cases were studied including venous thromboembolism (n=29), stroke and myocardial infarction (n=21), along with 148 age-matched controls. Serum samples were assayed for aCL and anti-beta2 glycoprotein 1 antibodies using the enzyme-linked immunosorbent assay (ELISA). Information on other risk factors was obtained by a standardized questionnaire. RESULTS aCL were present in 16/50 (32%) of cases compared with 25/148 (17%) of controls (P[?]=[?]0.02). Unadjusted odds ratio (OR) and 95% confidence interval (95% CI) for thromboembolic disease associated with aCL was 2.32 (1.10--4.87). Other risk factors were hypertension, 2.93 (1.20--7.17) and a history of other heart diseases, 12.78 (1.32--123.60). Adjustment for hypertension, diabetes, oral contraceptive use, smoking, alcohol use, varicose veins, a family history of cardiovascular disease and a history of other heart diseases yielded OR (95%CI) 2.99 (1.32--6.80). beta2 glycoprotein 1-dependent aCL were also an independent risk factor, OR 4.56 (1.76--17.83). Subgroup analysis was carried out separately for cases of MI and stroke and for venous thrombosis. Adjusted OR (95% CI) associated with aCL in cases of MI and stroke was 1.76 (0.46--6.73) and 3.32 (1.15--9.54) for venous thromboembolism. CONCLUSION aCL are a risk factor for thromboembolic disease in young Jamaican women. They confer a strong independent risk for venous thromboembolism.

OBJECTIVES Graves' disease is associated with different human leucocyte antigen (HLA) genes in different populations. This study was designed to examine the HLA class II associations with Graves' disease in Jamaicans. PATIENTS One hundred and six Jamaicans with Graves' disease and 104 controls. DESIGN Oligotyping for HLA-DRB1, DRB3, DQA1 and DQB1 alleles was performed using the polymerase chain reaction sequence specific oligonucleotide probe (PCR-SSOP) technique. RESULTS The frequency of HLA-DRB3 *0101 was increased significantly in the patients compared to controls (38·7% vs. 19·2%; RR = 2·72; Pc

The clinical, laboratory and epidemiological characteristics of 38 adult Jamaican patients with polymyositis were evaluated. Twenty-four patients (63%) were human T-lymphotropic virus 1 (HTLV-1) seropositive and 14 patients (37%) were HTLV-1 seronegative. Polymyositis runs a more protracted course in seropositive patients who had more frequent hospital admissions and a significantly longer duration of symptoms prior to presentation. Joint swelling, chest pain and dyspnoea were more frequent complaints among the seronegative patients. There was no significant difference between the two serological groups in muscle enzyme levels, antinuclear antibody positivity or frequency of Jo-1 antibodies. HTLV-1 infection may define a subgroup of polymyositis patients with a more insidious presentation and poorer response to corticosteroid therapy.

Substance use including alcohol and illicit drugs increases the risk for the acquisition and transmission of sexually transmitted infections (STIs). The aim was to determine the prevalence of bloodborne STIs including HIV human T-cell lymphotrophic virus type 1 hepatitis B virus and syphilis in residents of a detoxification and rehabilitation unit in Jamaica. The demographic characteristics and the results of laboratory investigations for STIs in 301 substance abusers presenting during a 5-year period were reviewed. The laboratory results were compared with those of 131 blood donors. The substances used by participants were alcohol cannabis and cocaine. None of the clients was an IV drug user. Female substance abusers were at higher risk for STIs. The prevalence of STIs in substance abusers did not differ significantly from that in blood donors (12% vs. 10%); however the prevalence of syphilis in substance abusers was significantly higher than that in blood donors (6% vs. 3% P < 0.05). The prevalence of syphilis was dramatically increased in female substance abusers and female blood donors (30% P < 0.001 and 13% P < 0.05 respectively). An excess of human T-cell lymphotrophic virus type 1 was also observed in female compared with male substance abusers. Unemployment was identified also as a risk factor for sexually transmitted disease in substance abusers. The results endorsed the policy of screening detoxification clients for STIs and indicate a need for gender-specific approaches to the control of substance abuse and STIs in Jamaica. (authors)

Due to overlapping clinical features with other febrile illnesses, the diagnosis of leptospirosis is often overlooked, resulting in delay in treatment and increased mortality. In this study the prevalence of leptospirosis was determined in 590 patients with dengue-like illnesses using the Leptospira IgM dipstick and dengue enzyme-linked immunosorbent assays. Leptospira IgM antibodies were found in 27 (5.0%) patients. Dengue IgM negative (6.9% versus 2.5%, P < 0.05) and dengue IgG positive patients (8.0% versus 3.5%, P < 0.01) were more likely to be leptospira IgM positive. Fever, skin rash, central nervous system and respiratory involvement were the most common presenting features. The presence of arthralgia ( P = 0.016), hepatitis ( P = 0.000), jaundice ( P = 0.003), splenomegaly ( P = 0.041) and haematuria ( P = 0.029) were associated with leptospirosis. In countries with an endemicity of leptospirosis and dengue it is important that patients with dengue-like illnesses, especially those with no serological evidence of current primary dengue infection, be investigated for leptospirosis.

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU ( n = 339), and control groups including asymptomatic men who were STD contacts ( n = 61), asymptomatic men who were not STD contacts ( n = 32) and men with gonococcal urethritis (GU) ( n = 61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts ( P < 0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)= 1.76; P < 0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P < 0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.

The clinical usefulness of commercially prepared haemagglutination kits for thyroperoxidase (TPO) antibody and thyroglobulin (TG) antibody was evaluated in 145 consecutive Jamaicans with Graves' disease. Sixty two (43%) of the patients were newly diagnosed, 12 (8%) were in remission and 71 (49%) had relapsed. Sera from 65 (45%) patients were positive for thyroid antibodies. The TPO antibodies were found in 43% (63/145), thyroglobulin antibodies in 12% (17/145) fifteen (10%) patients had both anti-TPO and TG antibodies. Similar prevalences of TPO antibody were found in newly diagnosed patients and those who had relapsed (44% v. 41%) but the prevalence in the patients in remission was significantly higher (75%; X2 = 4.8, P < 0.05). The prevalence of TPO antibody increased significantly with age at onset before age 35 years compared to later onset (56% v. 32%; X2 = 8.09, P < 0.005). The presence of both TPO antibody (64% v. 31%; X2 = 13.1, P < 0.001) and TG antibody (22% v. 6%; X2 = 8.8, P < 0.005) correlated positively with Graves' ophthalmopathy. Neither of the tests was adequately sensitive in detecting GD in Jamaicans but we recommend testing for TPO antibody without TG antibody as a cost-effective approach. The presence and titres of TPO antibody and TG antibody do not correlate with disease activity and are not reliable enough for monitoring antithyroid drug therapy in GD. There is a need for antibody tests which are efficacious in diagnosing and monitoring antithyroid drug therapy in GD, and suitable for use in developing countries.

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35%, 47%, and 55% in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis infection were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95% confidence interval (CI) = 1.2-3.9; p = 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95% CI = 1.4-10.6; p = 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95% CI = 1.8-6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence of C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk.

The reports of the occurrence of HTLV-1 infection and/or HTLV-1 associated myelopathy (HAM/tropical spastic paraparesis (TSP) in patients with certain organ-specific and nonorgan-specific autoimmune diseases prompted us to assess the relationship between TSP and humoral autoimmunity. Blood samples from 76 TSP patients, 60 asymptomatic HTLV-1 carriers and 100 HTLV-1 seronegative blood donors were examined for the presence of organ-specific and nonorgan-specific autoantibodies, reactive serological tests for syphilis, immunoglobulin and complement concentrations as well as immunecomplexes. High prevalences of autoantibodies (39/76, 51%), reactive serological tests for syphilis (23/76; 30%), hypergammaglobulinaemia (69/76, 90%) and complement fixing immune complexes (44/76, 58%) were found in the TSP patients. These indicators of immunological disorder were found in statistically significantly lower prevalences in asymptomatic HTLV-1 carriers (12/60, 20%; p < 0.001; 6/60, 10%; p < 0.05; 32/60, 53%; p < 0.001 and 8/60, 13%; p < 0.001, respectively) and HTLV-1 seronegative blood donors (8/100, 8%; p < 0.001; 3/100, 3%; p < 0.001; 15/100, 15%; p < 0.001 and 5/100, 5%; p < 0.001, respectively). The profiles of autoimmune phenomena observed in the patient and control groups revealed that they were associated with TSP rather than mere HTLV-1 infection and consequently pathogenetic significance. The array of immunological features present in TSP was suggestive of autoimmune disease resulting from immune dysfunction. Studies which explore the possible existence of HTLV-1 induced autoantibodies with specificity for antigens of the spinal cord in TSP might be useful in elucidating its pathogenesis.

The aim of this preliminary study was to investigate the presence of proteins in the tissue fluids of the sea mussel Isognomon alatus. Protein extraction was done by the chloroform-cold ethanol technique. Immunization for production of antibody to be used as reagents in Western blotting, assessment of the protein concentration by the Bradford method, protein characterization by native polyacrylamide gel electrophoresis (PAGE) were also performed as a part of the methodology of this study. The results showed a protein content of 65 mg/ml in tissue fluids and a protein band approximately of 220 kDa in PAGE that was further confirmed by the Western blotting. Future work should investigate the structure and function of the proteins separated from the tissue fluids and we considered it as a limitation of this investigation. The sea bivalve literature is scanty. However the limitation of this work we still can conclude that there are high molecular weight proteins in large concentrations in tissue fluids of the sea mussel Isognomom alatus.

Background: Subclinical hypothyroidism (SCH) has been reported to be associated with adverse pregnancy outcomes, however universal screening and treatment is controversial. Objectives: Our objectives were to determine population-specific pregnancy reference values (R1) for serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) at 14 weeks' gestation, along with the prevalence of SCH and thyroid peroxidase antibody (TPOAb). Methods: This was a prospective hospital-based cohort study. 1,402 subjects were recruited. Blood samples were obtained from 769 singleton pregnancies due to default between recruitment and scheduled blood draw. The prevalence of SCH was determined using R1, the laboratory non-pregnant reference values (R2) and previously recommended pregnancy reference values (R3). Results: R1 for TSH and FT4 was 0.03-3.17 mU/l (mean ± SD, 1.1 ± 0.76) and 8.85-17.02 pmol/l (mean ± SD, 11.96 ± 2.06), respectively. The prevalence of SCH using reference values R1, R2 and R3 was 1.4% (11/769), 0.5% (4/769) and 1.9% (15/769). Prevalence was significantly greater using R3 when compared to R2 (p = 0.011). TPOAb prevalence was 2.6%. A significantly greater prevalence of TPOAb was found in subclinical hypothyroid subjects using all three reference values than in euthyroid subjects (∼25 vs. 2%, p Conclusions: These reference values are the first to be reported for an Afro-Caribbean population. Our findings support the use of pregnancy-specific reference values in our population.

Immunoglobulin Y (IgY) is the mayor protein present in the avian egg yolk. This antibody fulfils important functions in the protection of the embryo against several challenging stimuli. Separation of IgY from the egg yolk of several birds was carried out by the Polson method. Their capacity to react with immunoglobulin-binding bacterial protein: protein A, L or LA was investigated. The cross-reactivity of an anti-chicken-IgY-HRP conjugate with different avian IgY was tested by ELISA. The results showed that protein L reacts with bantam hem IgY; and proteins A and LA react with ostrich, bantam hen or duck IgYs. These findings are important for the development of methods of detection and purification of avian IgY proteins.

The aim of this preliminary study was to investigate the presence of proteins in the tissue fluids of the sea mussel Isognomonalatus. Protein extraction was done by the chloroform-cold ethanol technique. Immunization for production of antibody to be used as reagents in Western blotting, assessment of the protein concentration by the Bradford method, protein characterization by native polyacrylamide gel electrophoresis (PAGE) were also performed as a part of the methodology of this study. The results showed a protein content of 65 mg/ml in tissue fluids and a protein band approximately of 220 kDa in PAGE that was further confirmed by the Western blotting. Future work should investigate the structure and function of the proteins separated from the tissue fluids and we considered it as a limitation of this investigation. The sea bivalve literature is scanty. However the limitation of this work we still can conclude that there are high molecular weight proteins in large concentrations in tissue fluids of the sea mussel Isognomomalatus.

The aim of this preliminary study was to produce anti HIV antibodies against the fragment 579 601 of the HIV gp41 and fragments 308 331 and 421 438 of the HIV gp120 from the human immunodeficiency virus (HIV) in layer hens. Keyhole limpet hemocynin (KLH) was conjugated to HIV synthetic peptides by the glutaraldehyde method after they were dimerized by cysteine oxidation with dimethyl sulfide. Two healthy brown Leghorn layer hens (per immunogen) were injected intramuscularly on the breasts with KLH peptide conjugated vaccines. They were immunized on days 0,21,45 and 60. Enzyme linked immunosorbent assays (ELISA) were used to test for anti HIV antibodies and there was a statistical significance in the mean of optical density readings between pre immunized and post immunized animals, proving the formation of specific antibodies. These molecules can potentially be used as therapeutic agents or diagnostic reagents. The limitations of this investigation were the small number of cases, viral neutralization produced by anti HIV antibodies was not tested in cell cultures neither their capacity to inhibit the HIV entry into the CD4+ lymphocyte. We conclude that KLH peptide conjugated vaccines against regions of the gp120 and gp41 effectively produced a strong immune response in egg yolks from layer hens. Despite of limitations of this investigation we report an outcome that encourages us to design and perform a larger study, which can be done in future.

This study investigates the ability of antibodies to SpA (a protein produced by the bacterium Staphylococcus aureus) to inhibit the growth of the bacteria. Chickens immunised with SpA produced anti -SpA antibodies in their eggs (primarily the yolk). These anti-SpA antibodies were used to feed chicks, which produce antibodies that recognise the original antigen. When these antibodies were purified from their sera and included in the growth medium of the Staphylococcus aureus, there was inhibition of the bacterial growth. This indicates that these antibodies had specifically bound to the cell surface of the bacteria and prevented growth of the bacteria, i.e. the antibodies could protect against bacterial infection. The potential of such antibody in the hyper-immune egg to act as oral therapeutic agents is discussed.

The human leukocyte antigens (HLA) are associated with susceptibility to systemic lupus erythematosus (SLE) and manifestations of SLE in different ethnic groups.A DNA-based HLA-typing method was used to determine alleles of HLA-DRB1, DRB3, DRB4 and DRB5 in Jamaican patients. A total of 70 patients and 100 control subjects were studied.HLA-DRB3*01/03 was significantly associated with susceptibility to SLE, while DRB1*15/16 was associated with the presence of oral ulcers in patients with SLE. The haplotype DRB1*13/14.DRB3*01/03 was also more frequent in SLE patients. No other significant associations were found.The SLE HLA associations in Jamaicans differ from those in other black populations.

Blood samples from 50~women who had had recurrent spontaneous abortions and 135 healthy multiparous women were investigated for anticardiolipin (aCL) antibodies and anti-β₂ Glycoprotein 1 (anti-β₂ GP1) dependent aCL antibodies by enzyme-linked immunosorbent assays (ELISA), lupus anticoagulant activity was measured by activated partial thromboplastin time, antinuclear antibodies, rheumatoid factors and thyroid antibodies using standard techniques. Serological tests for syphilis were performed on all sera and thyroid function was evaluated. There was no significant difference in the prevalence of autoantibodies in habitual aborters and control subjects (60% and 44%, respectively). Habitual aborters differed from controls only in the prevalence of positive aCL antibody tests (15/50, 30% vs. 15/135, 11%; χ² = 8.5, P= 0.01); medium/high concentrations of aCL antibodies (9/50, 18% vs. 9/135, 7%; χ² 4.3, P= 0.05); aCL antibodies of the IgM isotype (8/50, 16% vs. 7/135, 5%; χ² = 4.5, P= 0.05) and anti-β₂- GPI antibodies (7/50, 14% vs. 3/135, 2%; χ² 6.1, P= 0.05). We recommend aCL antibody screening in habitual aborters and the performance of the anti-β₂ GP1 antibody tests to identify those most at risk.

The role of non-injecting drug abuse in viral hepatitis has not been studied widely and is not well understood. A total of 301 substance abusers, residents of a detoxification/rehabilitation unit, were investigated for exposure to hepatitis B virus (HBV) and hepatitis C virus (HCV). Samples of serum were tested for anti-HCV and anti-HBc antibodies and HBsAg. All of the patients were non-injecting drug users (non-IDUs). The prevalence of anti-HCV was 1.7%; anti-HBc was found in 28.7% and HbsAg in 0.6% of patients. Anti-HCV positivity correlated with the presence of elevated aminotransferases (80%). Exposure to HBV correlated significantly with gender (p < 0.05); age (p < 0.05); and duration of substance abuse (p < 0.05), No significant correlations were found between HCV and/or HBV infection, the drug of abuse, HIV, HTLV-1 or syphilitic infection. Residential detoxification/rehabilitation provides an opportune moment to identify and treat HCV positive substance abusers in the attempt to avert the severe hepatic sequelae. Measures which exclude substance abusers from volunteer blood donation should be considered.

Background Disparities in cervical cancer incidence and mortality rates exist among women of African ancestry (African-American, African-Caribbean and African). Persistent cervical infection with Human papillomavirus (HPV) is associated with cervical dysplasia and if untreated, could potentially progress to invasive cervical cancer. Very few studies have been conducted to examine the true prevalence of HPV infection in this population. Comparisons of cervical HPV infection and the type-specific distribution of HPV were performed between cancer-free Caribbean and US women. Results The Caribbean population consisted of 212 women from Tobago and 99 women from Jamaica. The US population tested, consisted of 82 women from Pittsburgh. The majority of the US subjects was Caucasian, 74% (61/82) while 12% (10/82) and 13% (11/82) were African-American or other ethnic groups, respectively. The age-adjusted prevalence of any HPV infection among women from Tobago was 35%, while for Jamaica, it was 81% (p < 0.0001). The age-adjusted prevalence of HPV infection for Caribbean subjects was not statistically significantly different from the US (any HPV: 47% vs. 39%, p > 0.1; high-risk HPVs: 27% vs. 25%, p > 0.1); no difference was observed between US-Blacks and Jamaicans (any HPV: 92% vs. 81%, p > 0.1; high-risk HPV: 50% vs. 53%, p > 0.1). However, US-Whites had a lower age-adjusted prevalence of HPV infections compared to Jamaican subjects (any HPV: 29% vs. 81%, p < 0.0001; high-risk HPV: 20% vs. 53%, p < 0.001). Subjects from Jamaica, Tobago, and US-Blacks had a higher proportion of high-risk HPV infections (Tobago: 20%, Jamaica: 58%, US-Blacks: 40%) compared to US-Whites (15%). Similar observations were made for the presence of infections with multiple high-risk HPV types (Tobago: 12%, Jamaica: 43%, US-Blacks: 30%, US-Whites: 8%). Although we observed similar prevalence of HPV16 infections among Caribbean and US-White women, there was a distinct distribution of high-risk HPV types when comparisons were made between the ethnic groups. Conclusion The higher prevalence of cervical HPV infections and multiple high-risk infections in Caribbean and US-Black women may contribute to the high incidence and prevalence of cervical cancer in these populations. Evaluation of a larger sample size is currently ongoing to confirm the distinct distribution of HPV types between ethnic groups.

Perinatal HIV infection is characterized by a sustained high-level viremia and a high risk of rapid progression to AIDS, indicating a failure of immunologic containment of the virus. We hypothesized that age-related differences in the specificity or function of HIV-specific T cells may influence HIV RNA levels and clinical outcome following perinatal infection. In this study, we defined the HIV epitopes targeted by 76 pediatric subjects (47 HIV infected and 29 HIV exposed, but uninfected), and assessed the ability of HIV-specific CD8 and CD4 T cells to degranulate and produce IFN-γ, TNF-α, and IL-2. No responses were detected among HIV-uninfected infants, whereas responses among infected subjects increased in magnitude and breadth with age. Gag-specific responses were uncommon during early infancy, and their frequency was significantly lower among children younger than 24 mo old (p = 0.014). Importantly, Gag responders exhibited significantly lower HIV RNA levels than nonresponders (log viral load 5.8 vs 5.0; p = 0.005). Both the total and Gag-specific T cell frequency correlated inversely with viral load after correction for age, whereas no relationship with targeting of other viral proteins was observed. Functional assessment of HIV-specific T cells by multiparameter flow cytometry revealed that polyfunctional CD8 cells were less prevalent in children before 24 mo of age, and that HIV-specific CD4 cell responses were of universally low frequency among antiretroviral-naive children and absent in young infants. These cross-sectional data suggest that qualitative differences in the CD8 response, combined with a deficiency of HIV-specific CD4 cells, may contribute to the inability of young infants to limit replication of HIV.

Background This study was conducted to determine whether use of hormonal contraceptives is associated with cervical dysplasia and cancer in a population where there is widespread use of hormonal contraception and the rates of cervical cancer remain high at 27.5/100,000. Methods A case-control study was conducted among women visiting the colposcopy and gynaelogical clinics at a tertiary referral hospital. Two hundred and thirty six cases CIN I (72), II (59), III (54), cancer (51) and 102 controls, consented and were interviewed on use of contraceptives using a structured questionnaire. Logistic regression was used to determine odds ratios (ORs) and 95% confidence intervals (CIs) associated with use of hormonal contraception in cases and controls and in low and high risk cases. Recruitment was carried out from 2001–2002. Results Contraceptives used were: oral contraceptives – 35%, injections (depot medroxy progesterone acetate (Depo-provera) – 10%, Intrauterine devices – 2%, combinations of these and tubal ligation – 30%. 23% reported use of 'other' methods, barrier contraceptives or no form of contraception. Barrier contraceptive use was not significantly different between cases and controls. Current and/or past exposure to hormonal contraceptives (HC) by use of the pill or injection, alone or in combination with other methods was significantly higher in the cases. In multivariate analysis with age and number of sexual partners as co-variates, use of hormonal contraception was associated both with disease, [OR, 1.92 (CI 1.11, 3.34; p = 0.02] and severity of the disease [OR, 2.22 (CI 1.05, 4.66) p = 0.036]. When parity and alcohol consumption were added to the model, hormonal contraception was no longer significant. The significant association with high risk disease was retained when the model was controlled for age and number of sexual partners. Depo-provera use (with age and number of sexual partners as covariates) was also associated with disease [OR, 2.43 (CI 1.39, 4.57), p = 0.006] and severity of disease [OR 2.51 (1.11, 5.64) p = 0.027]. With parity and alcohol added to this model, depo-provera use retained significance. Exposure to HC > 4 years conferred more risk for disease and severity of disease. Conclusion Hormonal contraception did confer some risk of dysplasia and women using HC should therefore be encouraged to do regular Pap smear screening.

We investigated the outcome of a cohort of black Jamaican patients with systemic lupus erythematosus (SLE) with nephritis. In 66 patients, 0 (0%), 15 (23%), 4 (6%), 32 (48%), 6 (9%), and 3 (5%) had classes 1, II, III, IV, V, and VI, respectively. Six (9%) had interstitial nephritis. The patients were placed in 2 groups for comparison. Group 1 (n = 36) consisted of classes III and IV and group 2 (n = 27), classes II and V, and interstitial nephritis. The patients in group 1 had significantly lower hemoglobin, higher mean serum creatinine, higher prevalence of hypertension, and chronicity scores. The duration of follow-up was similar between the 2 groups. The percent events free for ESRD or death at 1 year was 80.1% for group 1 and 77.4% for group 2; 2 years, 69.0% for group 1 and 77.4% group 2; 5 years, 69.0% for group 1 and 57.4% for group 2. The percent events free for death at 1 year was 93.4% in group 1 and 90.9% in group 2; at 2 years, 86.7% for group 1 and 90, 9% for group 2; and at 5 years was 86.7% for group 1 and 67.3% (29.5 to 88.0) for group 2. Sixteen patients (25.4%) developed ESRD or died. Prognosis was not different between the groups for ESRD or death (P = 0.22) or death alone (P = 0.63).

Some antibiotics have been shown to modify the host immune response. Infection with Stenotrophomonas maltophilia, is often difficult to treat due to multiresistance to antibiotics. The authors examined the effect of four commonly used antimicrobial agents (ciprofloxacin, ceftazidime, cotrimoxazole and piperacillin-tazobactam) on tumour necrosis factor alpha (TNF alpha) production by human peripheral blood mononuclear cells (PBMC) stimulated with heat-killed S maltophilia. Cotrimoxazole was the only antibiotic that suppressed TNFa secretion at clinically achievable concentrations. This may explain its use with good effect in the treatment of S maltophilia infections. However at supratherapeutic concentrations, ceftazidime and ciprofloxacin, but not piperacillin-tazobactam, also inhibited significantly the production of TNF alpha. Cotrimoxazole, in addition to its antimicrobial effect against S maltophilia, has an immunomodulatory effect on peripheral blood mononuclear cells stimulated by S maltophilia.

Invasive opportunistic fungal infections have increased in frequency over the last two decades, while Candida sp remains the most common cause of fungemia (1, 2). This report describes the fourth documented case of Paecilomyces lilacinus fungemia, the first such case to be reported at the University Hospital of the West Indies (UHWI). A 35-week gestation female infant, weighing 3.5 kg was born to a 31-year old mother with a normal antenatal history at a hospital in rural Jamaica. At birth, the infant was jaundiced and was diagnosed as having Downs Syndrome. The infant subsequently developed a low grade pyrexia and was transferred to the UHWI on day thirteen. Significant findings included jaundice, pyrexia (100oF), abdominal distention and cardiac murmurs consistent with a ventricular septal defect and patent ductus arteriosus. A diagnosis of sepsis with necrotizing enterocolitis was made. Results of a full septic screen were negative. A nasogastric tube was inserted for oral feeds and intravenous ampicillin, cloxacillin, gentamicin and metronidazole were administered through a peripheral intravenous catheter. These antibiotics were administered for seven days with resolution of the fever and abdominal distention, and incomplete resolution of jaundice. Oral feeds were subsequently commenced. The infant remained mildly icteric and again developed abdominal distention and fever on day 14, when a second septic screen was done. An ultrasound investigating the infant’s abdominal distention revealed multiple abscesses, aspirates from which were culture positive for Citrobacter diversus and Escherichia coli. A new antibiotic regimen was commenced with intravenous rocephin, metronidazole and ampicillin. The infant however remained febrile. Results of the two sets of blood cultures taken from the peripheral vein on day 14 at the UHWI were positive for a fungus initially identified as Penicillium spp. This isolate was subsequently referred to Mayo Clinic, Minnesota, USA, for further identification. Antimicrobial treatment was changed to include intravenous amphotericin B, amikacin and ceftazidime. Amphotericin B was given for 18 days. The isolate was later confirmed by Mayo Clinic to be Paecilomyces lilacinus (Figure). The patient responded favourably to treatment with amphotericin B and was discharged on maintenance fluconazole. Paecilomyces lilacinus is a ubiquitous fungal saprophyte and an uncommon human pathogen which is known to infect a variety of organs with varying degrees of morbidity and mortality (1, 3, 4). Identification of the fungus is difficult as it is closely related to the genus Penicillium (1). Prolonged use of antibiotics and invasive procedures, including peripheral intravenous catheters predispose to acquisition of opportunistic pathogens, such as Paecilomyces. Although Paecilomyces lilacinus has been reported to be resistant to amphotericin B and fluconazole, the infant herein presented responded favourably to this management (5).

The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0%); one (0.8%) isolate each of subtypes C, D and E was found and 7 (4.9%) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.

Persons infected with the human immunodeficiency virus (HIV) may have protean clinical manifestations. These characteristics have not been described for adult patients in Jamaica. This study was conducted to determine the clinical and epidemiological characteristics of adult and adolescent persons newly diagnosed with HIV presenting at a specialized clinic for sexually transmitted infections (STI). A retrospective analysis of the medical records of adult and adolescent patients newly diagnosed with HIV was undertaken over a 12-month period. The results showed that most patients (64%) were between 20 and 39 years old (age range 14–68 years, M:F ratio 1.4: 1). Heterosexual practice was admitted to by 77% of patients. At the time of presentation most patients (53%) were asymptomatic while 24% had some symptoms and 21% had acquired immunodeficiency syndrome (AIDS). The most common presentation was generalized lymphadenopathy (67%) which was significantly higher than skin rash (27%), oral candidiasis (24%), cough (24%), weight loss (24%) and pallor of mucous membranes (19%, p < 0.001). This study affirms that young people account for the majority of new cases of HIV infection. The heterosexual route was the predominant mode of transmission. Generalized lymphadenopathy was the commonest presenting feature of persons newly diagnosed with HIV infection.

One hundred and thirty-eight (138) pregnant women who had spontaneous abortions were screened for immunoglobulin G (IgG) antibodies to cardiolipin (aCL) by enzyme immunoassay (EIA). A total of 85 (61.6%) tested negative, while 53 (38.4%) had positive aCL test results. A review of the patients' hospital notes was conducted and comparisons were made between patients with moderate/high positive (21/138, 15.2%), those with low positive (32/138, 23.1%) and those with negative aCL results (85/138, 61.6%). The variables examined were a history of previous abortions, the number of previous fetal deaths and a past history of medical problems such as thrombosis or high blood pressure. No significant differences were found between the patients with moderate/high positive aCL; low positive aCL; and those with negative aCL test results for any of the clinical variables examined. In conclusion, the prevalence of positive IgG aCL tests was high in this cohort of patients with spontaneous abortion. However, intervention is not necessary in many of these patients who have only a positive aCL test, but none of the clinical conditions of the antiphospholipid syndrome.

The frequent occurrence of false positive results in the anticardiolipin (aCL) enzyme linked immunosorbent assay (ELISA) hampers its application in identifying the antiphospholipid syndrome (APS), a condition characterized by a myriad of clinical presentations. This study highlights some of the pitfalls in the use of assays for antiphospholipid (aPL) antibody in clinical practice. The aCL ELISA, commercially prepared anti-beta2-gylcoprotein 1 (beta2-GP1) and antiphospholipid (APhL) assays were evaluated in the diagnosis of antiphospholipid syndrome (APS) in 94 pregnant women who had spontaneous abortion and a group of 177 healthy blood donors. Serological tests were used to rule out syphilis as the cause of false positive results in the aCL ELISA. The prevalences of positive aCL ELISA results (29/94, 31% v 26/177, 14%; p = 0.001) and aCL antibodies of the IgM isotype (19/94, 20% v 6/177, 3%; $p = 0.001$) were significantly higher in aborters compared to healthy subjects. The majority of the sera which were positive in the aCL ELISA were shown to be false positives as 93% (27/29) of aCL positive aborters and 67% (8/24) of aCL positive healthy subjects were negative in the anti-beta2-GP1 assay. Similarly, the sensitivity of the APhL ELISA was low and only 1% (1/94) of the sera of aborters and 6% (11/177) of healthy subjects were positive in this assay. The frequent occurrence of anticardiolipin antibodies of the authentic non-autoimmune variety and the low sensitivity of the other more specific aPL assays make the positive aCL ELISA difficult to interpret. We recommend that the diagnosis APS be made with strict adherence to the preliminary criteria for classification of APS.

Haemophilic patients (n = 90) and household contacts (n = 40) were tested for serological markers of hepatitis B virus (HBV), hepatitis C virus (HCV) and elevated serum aminotransferases using commercially prepared reagents. Of the haemophiliacs 41% (37/90) tested positive for antibodies to HCV (anti-HCV); 36% (32/90) antibodies to hepatitis B core antigen (anti-HBc); 54% (49/90) antibodies to hepatitis B surface antigen (anti-HBs) and 2% (2/90) hepatitis B surface antigen. On the other hand, 29% (26/90) of the patients and 90% (36/40) of the household contacts tested negative for all of the viral markers. Anti-HCV positivity in the haemophilic patients correlated positively with anti-HBc (p0.025). Increasing age (odds ratio 2.09; p0.01), severity of disease (odds ratio 6.2; p0.05) and the requirement for transfusion (odds ratio 3.2; p0.05) were risk factors for anti-HCV positivity. The presence of anti-HBc (odds ratio 3.8; p0.01) and coinfection with HCV and HBV also correlated positively with age (odds ratio 2.5; p0.01). The provision of anti-HCV screened donor blood and virally inactivated blood products for treatment of all haemophilic patients are goals that must be achieved.

Objectives: To determine the prevalence of hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus (HIV) infections, and risk factors for HCV and HBV infections in sexually transmitted disease (STD) clinics in Jamaica. Methods: A prospective observational cohort study was carried out. Blood was collected from 485 consecutive patients attending the comprehensive health centre in Kingston, Jamaica. Serum was tested using commercially prepared reagents and standard procedures for antibodies to HCV (anti-HCV), hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), HIV-1 infection, and syphilitic infection. Sociodemographic and sexual characteristics of the patients were recorded for assessment as risk factors for HCV and HBV infections. Results: None of the patients had anti-HCV, 21.0% had anti-HBc, 3.2% HBsAg, 2.5% tested positive for HIV-1, and 5.2% had reactive serological test for syphilis. Age was the only independent risk factor identified for anti-HBc positivity. Conclusions: The data obtained in this study were not in support of sexual transmission of HCV or HBV infections in Jamaica. Carefully designed multicentre studies could provide more consistent information on the transmission of these viruses by sexual routes.

A total of 19,067 sera were screened for biological false positive (BFP) reactivity by the Venereal Disease Research Laboratory (VDRL) test. Sera which were reactive in the VDRL test were confirmed by the fluorescent treponemal antibody absorption (FTA-ABS) test. BFP reactions were detected in 0.59% of the general population, 0.72% of pregnant women and 11.8% of patients with systemic lupus erythematosus (SLE). The rate of BFP reactors among pregnant women did not differ significantly from the general population. The female to male ratio of BFP in the general population was 2:1 whilst that in the group of patients with SLE was 8:1. The overall seroprevalence of syphilis was 2.2%.The Venereal Disease Research Laboratory (VDRL) test for syphilis was used to screen 19,067 Jamaican sera, and positive were confirmed with the fluorescent Treponema pallidum haemagglutination assay (FTA-ABS). The group included 15,876 persons applying for emigration, 3039 pregnant women attending prenatal care, and 152 patients with systemic lupus erythematosus (SLE). 2.8% of the general population were VDRL positive, and of these 21.3% had titers 1:4. 4.7% of the pregnant women were positive, 48.2% with titers 1:4. 27.1% of the VDRL positive in the general population and 30.9% of the pregnant women were false positive, i.e.negative on the FTA-ABS test. 78.2% of the SLE patients were false positive on the VDRL, including 1 patient with a titer of 1:128. Thus the percentage of false positive taking the whole group as denominator was 0.59% in the general population, 0.72% in the pregnant women, but 11.8% among SLE patients. The overall seroprevalence of syphilis was 2.2%. These results are atypical in that pregnant women are usually considered to have a high rate of false positive results on the VDRL.