249

HTLV-I SEROPREVALENCE IN ADULTS ON

MAHE,

SEYCHELLES

Specific IgE to Dermatophagoides pteronyssinus, Dactylis glomerata, germanica (German cockroach) was measured by the radioallergosorbent test (RAST) using the ’CAP’ system (Pharmacia, Uppsala, Sweden). 4-7% of the study population were RAST positive (ie, RAST class 1 or greater) for Bgermanica, 9.1% for D pteronyssinus, and 8.5% for D glomerata. Among RASTpositive sera, 63% were positive for IgE to both B germanica and D pteronyssinus. Since there is no proven cross-reactivity between the allergens,8 these findings suggest that they frequently coexist in

and Blatta

This study has identified a new region that is highly endemic for HTLV-I infection, at a level comparable with that found in Okinawa, Japan. The mode of transmission remains an issue: because intravenous drug abuse is unknown on the Seychelles, sexual transmission, intrafamilial spread, uteroplacental haemorrhage, breastfeeding, and blood transfusions have to be considered. No new case of TSP has been recorded on the Seychelles since 1982. A risk estimate for adult T-cell leukaemia is not available but seems to be low. The age and sex standardised seroprevalence of HTLV-1 of almost 5% suggests that systematic screening for antibodies to HTLV-1 in blood donors may need to be considered for the Seychelles. This study was Division of

supported by the Seychelles-Swiss Jura Cooperation.

Immunology and Allergy,

CHU Vaudois, CH-1011 Lausanne, Switzerland

D. LAVANCHY

Ministry of Health, Victoria, Seychelles

P. BOVET J. HOLLANDA C. F. SHAMLAYE

J. D. BURCZAK H. LEE

1. Lee H, Swanson P, Shorty VS, Zack JA, Rosenblatt JD, Chen ISY. High rate of HTLV-II infection in seropositive iv drug abusers in New Orleans Science 1989; 244: 471-75 2 Zella D, Morri L, Sala M, et al HTLV-II infection in Italian drug abusers. Lancet 1990, 336: 573-76 3. Kelly R, DeMol B. Paraplegia m the islands of the Indian Ocean. Afr J Neurol Sci 1982; 1: 5-7. 4 Roman GC, Schoenberg BS, Madden DL, Sever JL, Hugon J, Spencer PS. Human T-lymphotropic virus type I antibodies in the serum of patients with tropical spastic paraparesis in the Seychelles. Arch Neurol 1987; 44: 605-07. 5. Roman GC, Spencer PS, Schoenberg BS, et al. Tropical spastic paraparesis in the Seychelles Islands. a clinical and case control neuroepidemiologic study. Neurology

1987, 87: 1323-28. 6 Perez G, Ortiz-Interian C, Bourgoignie JJ, et al. HIV-1 and HTLV-I infection in renal transplants. J AIDS 1990; 3: 45-40. 7 Anderson DW, Epstein JS, Lee TH, et al. Serological confirmation of human T-lymphotropic virus type I infection in healthy blood and plasma donors. Blood

1989, 74: 2585-91

Kajiyama W, Kashiwagi S, Hiyashi J, Nomura H, Ikematsu H, Okochi K. Intrafamilial clustering of anti-ATLA-positive persons. Am J Epidemiol 1986; 124: 800-06.

Cockroach

1. Bessot JC, Pauli G. Poussière de maison In. Pans: Flammarion, 1986: 270-77.

allergens

SIR,-House dust contains many allergens,l of which mites of the

Pyroglyphidae family are the most important source.2

Cockroach debris is also found in house dust, and cockroach allergens can induce cutaneous hypersensitivity and increase specific IgE. Pollart and co-workers7 reported that levels of specific IgE to cockroach were higher in patients during asthma attacks than in controls. However, the relevance of cockroach as a sensitising factor in a general population is not known. We wished to determine the relative importance of cockroach allergens among the major aeroallergens. Sera were collected from 623 volunteers at the Public Healthcare Centre, Marseille, France. Donors were between 20 and 60 years old and were free of major disease. The study population was population in the area with regard

representative of the general to sex,

age, and

occupation.

Charpin J,

ed.

Allergologie,

2nd edn.

2. Voorhorst

R, Spieksma-Boezeman MIA, Spieksma FThM. Is a mite (Dermareshagoides spp.) the producer of house dust allergen? Allerg Asthma 1964;

10: 329-34 3 Romanski B, Dziedziczko A, Pawlick-Miskiewicz K, Wilewska-Klubo T, ZhikowskaGotz M. Allergy to cockroach antigens in asthmatic patients. Allergol Immunopathol (Madr) 1981; 9: 427-32. 4. Kang B, Vellody D, Homburger H, Yunginger JN. Cockroach cause of allergic asthma: its specificity and immunologic profile. J Allergy Clin Immunol 1979; 63: 80-86. 5. Lan JL, Lee DT, Wu CH, Chang CP, Yen CL. Cockroach hypersensitivity: preliminary study of allergic cockroach asthma in Taiwan. J Allergy Clin Immunol 6.

Abbott Laboratories, North Chicago, Illinois, USA

8

the same location. Our results justify the classification of cockroach allergen as a major house-dust allergen and its inclusion in routine skin tests. The availability of specific monoclonal antibodies9 will allow precise determination of the distribution of this antigen in house dust and air and the threshold above which sensitised subjects will have respiratory symptoms. J. BIRNBAUM L. GUILLOUX Department of Chest Diseases and Allergy, D. CHARPIN Hôpital Sainte-Marguerite, 13277 Marseille, France D. VERVLOET

1988; 82: 732-40. Dechamp C, Fleury M, Hoch D, cafard, allergène méconnu de

Tricaud A, Devillier P, Perrin LF. La blatte ou certaines habitations. Allerg Immunol 1985; 17:

261-66.

SM, Chapman MD, Fiocco GP, Rose G, Platts-Mills TAE. Epidemiology of asthma: IgE antibodies to common inhalant allergens as a nsk factor for emergency room visits. J Allergy Clin Immunol 1989; 83: 875-82. 8. Kang B, Sulit N. A comparative study of prevalence of skin sensitivity to cockroach and house dust antigens. Ann Allergy 1978, 41: 333-36. 9. Pollart SM, Smith T, Gelber LE, Plans-Mills TAE, Chapman MD. Monoclonal antibodies (mAb) to cockroach (CR) allergen: uses in assaying commercial CR extracts and house dust samples J Allergy Clin Immunol 1990; 85: 156.

7. Pollart

acute

A

new

device for

measuring blood

pressure

in adults SiR,—Your Aug 18 editorial (p 410) noting the work of Croft and Cruickshankl suggests that the 15 x 33 cm cuff be standard for blood pressure measurement in adults. This may be a rational solution to the difficulty of convincing staff to switch cuffs according to the patient’s arm circumference.2,3 The risk of failure to detect hypertension is accepted as an alternative to the risk of false labelling of patients as having high blood pressure. It is estimated that the annual cost of treating hypertension increases by about 10% for every mm Hg that the diastolic blood pressure limit used for definition of hypertension is lowered (M. Johannesson et al, unpublished). Concerned with the burden of spurious diagnosis created by mis-cuffing, we developed a method that, we believe, fits in with your editorial view without sacrificing the advantages gained by selecting cuff size according to the 40% rule.4 A triple combination rubber bag is enclosed in a cuff cover. The choice between three bladder sizes (9, 12, and 15 cm wide), according to recommended arm circumference limits in adults, is made automatically as the cuff is applied. The rubber bag consists of three bladder sections on top of each other connected with tubes. A clamp is held in position at one end of the bladder in a pocket in the cuff cover. The cuff is wrapped around the patient’s arm with the end holding the clamp closest to the skin, and secured with ’Velcro’. The clamp is then closed around the tubing at the point where the cuff overlaps (figure). Whether this is at A, B, or C depends on the patient’s arm circumference and needs no decision on the part of the person measuring the blood pressure. The tubing is designed to meet the 40% rule. With a thin arm only the small bladder will be inflated, with a medium sized arm the

250

Are

prophylactic anticonvulsants required in severe pre-eclampsia?

SiR,—The choice of drug

to

prevent convulsions in

severe

pre-eclampsia is controversial, furthermore, the most appropriate indications for routine seizure prophylaxis in pre-eclamptic women In North America, parenteral is used;’ in the UK, intravenous widely magnesium sulphate phenytoin has been advocated for seizure prophylaxis in severe pre-eclampsia.2-5 Unfortunately, there have been no properly controlled trials of the different anticonvulsant regimens. We report the results obtained in our clinic between January, 1987, and September, 1990, of a policy of not routinely prescribing anticonvulsants in severe pre-eclampsia. Criteria for entry into the studyS were blood pressure? 170/110 mm Hg on two occasions 30 min apart and 2 + proteinuria; or blood pressure? 140/90 mm Hg with 2 + proteinuria and one of the following: (i) persistent headache, visual disturbance, or epigastric pain; (ii) clonus > 3 beats; or (iii) thrombocytopenia 100 000/1 or aspartate aminotransferase (AST) ? 50 U/1. 78 women with severe pre-eclampsia met the criteria for entry into the study. Their case records were reviewed retrospectively. 21 had blood pressures 170/110 mm Hg with 2 + proteinuria but were otherwise symptom-free. The remainder had symptoms or had raised AST or thrombocytopenia. Blood pressure in 53 of these 57 women was 170/110 mm Hg, and in the rest it was consistently ? 140/100 mm Hg. Patients were managed intensively by a small team with attention to continuity of care. When blood pressure exceeded 170/ 110 mm Hg on two or more occasions 30 min apart, sublingual nifedipine, supplemented if necessary by parenteral hydralazine, was given to lower hypertension in the acute phase. Regular antihypertensive therapy with methyldopa, supplemented if necessary by nifedipine, was given to achieve longer-term control. Anticonvulsants were not used. 46 (59%) of the women required delivery within a week of study entry, and a further 15 (19%) within the second week. But we were able to defer delivery safely in 3 patients (chiefly because of severe prematurity) for more than four weeks after study criteria had been met. The value of close monitoring was emphasised by the need for emergency caesarean section before onset of labour in 50 (64%) of the 78 women. A further 7 had emergency caesarean after onset of labour (in all cases for fetal reasons), 3 had planned elective caesarean, and 15 patients delivered vaginally after induction of labour. Only 1 patient went spontaneously into labour, at 38 weeks. Symptoms developed in 2 patients after delivery. 42 women had caesarean section or induced delivery for maternal reasons, 18 for fetal reasons, 5 for both maternal and fetal reasons, and 10 were delivered pre-emptively to prevent maternal (8) or fetal (2) complications (all the indications were assigned prospectively). Perinatal mortality was 8% (6 of 78). Severe pre-eclampsia occurred before 28 weeks’ gestation in 4 patients, and labour was induced for maternal reasons with the fetus unmonitored. 1 baby, born at 29 weeks’ gestation, died in the neonatal period after intestinal perforation secondary to necrotising enterocolitis. In the sixth case, the patient was admitted at 36 weeks’ gestation with massive antepartum haemorrhage and complaining of severe headache and blurred vision. Blood pressure was 170/110 mm Hg and there was 4 + proteinuria. Intrauterine death was diagnosed and labour induced. Maternal symptoms regressed after delivery.1 woman developed eclampsia. An emergency lower segment caesarean section was done when the patient was first seen at 33 weeks’ gestation because of severe proteinuric pre-eclampsia associated with sudden onset of severe epigastric pain; AST was 178 IU/1. There were no other symptoms. Post delivery, she had headache associated with exacerbation of her hypertension. Two generalised grand mal seizures occurred, which were controlled have

Section

through

the three-bladder rubber bag.

medium bladder is connected, whereas with a large arm the large bladder is inflated. Only the largest connected section inflates whereas the smaller collapses. When the arm is large enough to require a "thigh cuff’ (circumference > 43 cm), the clamp does not reach the tube, which is open at the end, and the cuff cannot be inflated. This is true also with very thin arms (circumference

A new device for measuring blood pressure in adults.

249 HTLV-I SEROPREVALENCE IN ADULTS ON MAHE, SEYCHELLES Specific IgE to Dermatophagoides pteronyssinus, Dactylis glomerata, germanica (German cock...
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