925 oral hypoglycasmic agent. They consider this property of karela to be an unwanted "food-drug interaction" and say that "no formal reports "of a blood-sugar-lowering effect of karela have been published. Many diabetics and diabetologists on the Indian subcontinent believe that karela possesses a very slight hypoglycxmic property. There are several reports from India (in the English language) on karela in the treatment of diabetes mellitus.1-5 Ajgaonkar,4 in his excellent review on indigenous drugs in diabetes mellitus, mentions karela and six other vegetable products (Cephalandra indica, Ccesaria esentalita, Coccinia in-
dica, Eugenia jambolana, Gymnema sylvestre, Pterocarpus studied by pharmacologists in India many years in 1962 demonstrated the hypoglyca:mic action Sharma6 ago. of karela juice in animal experiments, and Kulkarni and Gaitonde3 in the same year reported a potentiating action on tolbutamide, but others found no significant change in blood-glucose levels.5 No one has noted severe hypogtycsemia with the use of karela. Karela, despite its bitter taste, is a popular vegetable in some Indian homes, and the slight hypoglycoemic property may be put to pharmacological use. It might be helpful in the dietary management of diabetic patients who enjoy the taste of this vegetable. (Karela is not an ingredient of generally prepared curry or curry powder.) Chlorpropamide induces several unwanted metabolic effects, and is losing popularity. It may be worthwhile to examine these vegetable products scientifically for clinically useful hypoglycoemic effects. Already we have some scientific evidence for the usefulness of another vegetable
marsupium)
product, guar. Section of Gastroenterology,
Part of
blood vessel in the
lung ( x 60 000). LcglOncfla pnc1lll1ophíla orgamsms (arrowed) lumen. E: erythrocytes, B: basement membrane. a
are
present in the
munoferritin reaction,’ showed legionella organisms within the lumen of a blood vessel in the lung (figure). This supports the existence of a bacteraemic phase in legionnaires’ disease. Public Health Laboratory, University Hospital, Queen’sMedical Centre, Nottingham NG7 2UH
F. G. RODGERS
Department of Medicine.
New York Medical College/Metropolitan Hospital Center New York, N.Y. 10029, U.S.A.
C. S. PITCHUMONI
ADENOVIRUS INFECTION AND HETEROPHILE ANTIBODY PRODUCTION
SIR,-Mr Aslam and Dr Stockley report a significant interaction between a curry ingredient (karela) and chlorpropamide ascribed to a hypoglycasmic effect of Momordica charantic (karela). However, the important contribution made by Lotlikar and Rajarama Rao’ was not mentioned-indeed Aslan and Stockley claim that there are no formal reports of hypoglvcxmic effects of karela. Lotlikar isolated charantin in th< pure state from the fruits of M. charantia and reported th< lowering of blood-sugar concentrations in fasting rabbits. In India, Pakistan, and other Eastern countries karela fruit are used not only as a curry ingredient but also as a vegetable 1k’e feel that the effect of this fruit and/or its extract on tht blood-sugar in man should be studied. This might lead to < new oral hypoglycoemic agent. School of Pharmacy, Texas Southern University, Houston, Texas 77004, U.S.A.
KIRIT SHAH EUGENE HICKMAN,
SR
ISOLATION OF LEGIONELLA PNEUMOPHILA FROM BLOOD
SIR,-Dr Edelstein and colleagues (April 7, p. 750) reported the isolation on bacteriological media of Legionella pneumophila from the blood and a necropsy specimen of lung from a patient who died from consolidating bronchopneumonia. When necropsy lung tissues were examined by thin-sectioning electron microscopy for the presence of legionellx, a positive sample, confirmed by specific immunofluorescence and the im1. Ram, S
J Indian med. Ass. 1950, 19, 181. 2 Gupta, S. S., Sheth, C. B. ibid 1962, 39, 581. 3 Kulkarni, R D., Gaitonde,B B. Indian J. med. Res. 1962, 50, 715. 4. Ajgaonkar, S.S Wld Congr.Diabetes Tropics; p. 623.Bombay, 1966. 5 Patel, J C., Khirawani, M K, Doshi, J.C. ibid.p. 626. 6 Sharma,V.N. Indian J. med.Res 1962, 50, 715. 7. Lothkar, M. M., Rajarama Rao, M R. Indian J. Pharm. 1966, 28, 129
S!R,—We would like to comment on the response by Captain Schumacher and his colleagues (March 31, p. 722) to the report by Dr Smith (Feb. 10, p. 229) on fatal adenovirus infection with misleading positive serology for infectious mononucleosis (i.M.). We have investigated a patient with incomplete absorption of heterophile antibody by ox cells.2 Ourpatient had the following titres with sheep erythrocytes: in saline, 1/3584; after absorption with guineapig kidney, 1/3584; and after absorption with ox cells, 1/1792. A ten-fold increase in ox cells was necessary to absorb the heterophile antibody. As suggested by Schumacher et al. this requirement for extra ox cells may be because the titre of sheep agglutinins is high. However, because two other i.M. sera with titres of 1/3584 against sheep erythrocytes showed complete absorption with the normal ox cell concentration, there is probably an additional qualitative defect, possibly a difference of specificity of the heterophile antibody. The presence of IgG and IgM anti-Epstein-Barr virus antibodies in our patient indicated i.M. infection. Relative lymphocytosis and the prevalence of atypical lymphocytes reach a peak in the first two weeks of illness and return to normal in the third and fourth weeks, whereas the heterophile antibody titre reaches a peak by the fourth week.3 Thus, the Paul-Bunnell result, the lack of atypical lymphocytes, and the presence of IgG but not IgM anti-Epstein-Barr virus antibodies, described by Smith for his patient, are all consistent with recent i.M. The explanation suggested by Schumacher et al.-that adenovirus type 7 may have caused the Paul-Bunnell results-seems unlikely. Certainly, adenovirus can produce the clinical and hxmatological findings of t.vt., but adenovirus 1 Rodgers, F G, Macrae, A. D Lancet, 1979, i, 786 2 Parratt, D, Ho-Yen, D. O. J clin Path in the press) 3 Finch, S C in Infectious Mononucleosis edited by R. L. Carter and H. G. Penman , p 47. Oxford, 1969.
dica, Eugenia jambolana, Gymnema sylvestre, Pterocarpus studied by pharmacologists in India many years in 1962 demonstrated the hypoglyca:mic action Sharma6 ago. of karela juice in animal experiments, and Kulkarni and Gaitonde3 in the same year reported a potentiating action on tolbutamide, but others found no significant change in blood-glucose levels.5 No one has noted severe hypogtycsemia with the use of karela. Karela, despite its bitter taste, is a popular vegetable in some Indian homes, and the slight hypoglycoemic property may be put to pharmacological use. It might be helpful in the dietary management of diabetic patients who enjoy the taste of this vegetable. (Karela is not an ingredient of generally prepared curry or curry powder.) Chlorpropamide induces several unwanted metabolic effects, and is losing popularity. It may be worthwhile to examine these vegetable products scientifically for clinically useful hypoglycoemic effects. Already we have some scientific evidence for the usefulness of another vegetable
marsupium)
product, guar. Section of Gastroenterology,
Part of
blood vessel in the
lung ( x 60 000). LcglOncfla pnc1lll1ophíla orgamsms (arrowed) lumen. E: erythrocytes, B: basement membrane. a
are
present in the
munoferritin reaction,’ showed legionella organisms within the lumen of a blood vessel in the lung (figure). This supports the existence of a bacteraemic phase in legionnaires’ disease. Public Health Laboratory, University Hospital, Queen’sMedical Centre, Nottingham NG7 2UH
F. G. RODGERS
Department of Medicine.
New York Medical College/Metropolitan Hospital Center New York, N.Y. 10029, U.S.A.
C. S. PITCHUMONI
ADENOVIRUS INFECTION AND HETEROPHILE ANTIBODY PRODUCTION
SIR,-Mr Aslam and Dr Stockley report a significant interaction between a curry ingredient (karela) and chlorpropamide ascribed to a hypoglycasmic effect of Momordica charantic (karela). However, the important contribution made by Lotlikar and Rajarama Rao’ was not mentioned-indeed Aslan and Stockley claim that there are no formal reports of hypoglvcxmic effects of karela. Lotlikar isolated charantin in th< pure state from the fruits of M. charantia and reported th< lowering of blood-sugar concentrations in fasting rabbits. In India, Pakistan, and other Eastern countries karela fruit are used not only as a curry ingredient but also as a vegetable 1k’e feel that the effect of this fruit and/or its extract on tht blood-sugar in man should be studied. This might lead to < new oral hypoglycoemic agent. School of Pharmacy, Texas Southern University, Houston, Texas 77004, U.S.A.
KIRIT SHAH EUGENE HICKMAN,
SR
ISOLATION OF LEGIONELLA PNEUMOPHILA FROM BLOOD
SIR,-Dr Edelstein and colleagues (April 7, p. 750) reported the isolation on bacteriological media of Legionella pneumophila from the blood and a necropsy specimen of lung from a patient who died from consolidating bronchopneumonia. When necropsy lung tissues were examined by thin-sectioning electron microscopy for the presence of legionellx, a positive sample, confirmed by specific immunofluorescence and the im1. Ram, S
J Indian med. Ass. 1950, 19, 181. 2 Gupta, S. S., Sheth, C. B. ibid 1962, 39, 581. 3 Kulkarni, R D., Gaitonde,B B. Indian J. med. Res. 1962, 50, 715. 4. Ajgaonkar, S.S Wld Congr.Diabetes Tropics; p. 623.Bombay, 1966. 5 Patel, J C., Khirawani, M K, Doshi, J.C. ibid.p. 626. 6 Sharma,V.N. Indian J. med.Res 1962, 50, 715. 7. Lothkar, M. M., Rajarama Rao, M R. Indian J. Pharm. 1966, 28, 129
S!R,—We would like to comment on the response by Captain Schumacher and his colleagues (March 31, p. 722) to the report by Dr Smith (Feb. 10, p. 229) on fatal adenovirus infection with misleading positive serology for infectious mononucleosis (i.M.). We have investigated a patient with incomplete absorption of heterophile antibody by ox cells.2 Ourpatient had the following titres with sheep erythrocytes: in saline, 1/3584; after absorption with guineapig kidney, 1/3584; and after absorption with ox cells, 1/1792. A ten-fold increase in ox cells was necessary to absorb the heterophile antibody. As suggested by Schumacher et al. this requirement for extra ox cells may be because the titre of sheep agglutinins is high. However, because two other i.M. sera with titres of 1/3584 against sheep erythrocytes showed complete absorption with the normal ox cell concentration, there is probably an additional qualitative defect, possibly a difference of specificity of the heterophile antibody. The presence of IgG and IgM anti-Epstein-Barr virus antibodies in our patient indicated i.M. infection. Relative lymphocytosis and the prevalence of atypical lymphocytes reach a peak in the first two weeks of illness and return to normal in the third and fourth weeks, whereas the heterophile antibody titre reaches a peak by the fourth week.3 Thus, the Paul-Bunnell result, the lack of atypical lymphocytes, and the presence of IgG but not IgM anti-Epstein-Barr virus antibodies, described by Smith for his patient, are all consistent with recent i.M. The explanation suggested by Schumacher et al.-that adenovirus type 7 may have caused the Paul-Bunnell results-seems unlikely. Certainly, adenovirus can produce the clinical and hxmatological findings of t.vt., but adenovirus 1 Rodgers, F G, Macrae, A. D Lancet, 1979, i, 786 2 Parratt, D, Ho-Yen, D. O. J clin Path in the press) 3 Finch, S C in Infectious Mononucleosis edited by R. L. Carter and H. G. Penman , p 47. Oxford, 1969.
