J Clin Pathol: first published as 10.1136/jcp.26.12.985-c on 1 December 1973. Downloaded from

The Association of Clinical Pathologists: 91st general meeting 985 survey. Seventy-three of the organisms M. H. (1973). J. med. Microbiol., 6, In the human liver is far below that of human were urinary-tract isolates, 14 respiratory press. serum, even when steps are taken to tract isolates, and 27 were isolated from ensure solubilization of lysosomal and other sites. Two-thirds of the 97 patients Serum Amylase and Related Enzymes in microsomal enzymes whereas the hepatic studied in detail had been in hospital for Diabetic Ketoacidosis content of acid phosphatase and b_ta- more than seven days and three-quarters glucuronidase are respectively approxim- had been on antibiotic therapy before D. M. GOLDBERG, R. J. SPOONER, AND ately 30-fold and 6000-fold, the upper Serratia marcescens was first isolated. A. H. KNIGHT (Royal Hospital, Sheffield) normal limit for serum. Details of antibiotics used before the In previous studies we have confirmed the first isolation of Serratia marcescens, high incidence of hyperamylasaemia in References and of the in vitro antibiotic susceptibility diabetic ketoacidosis and have shown Belfiore, F., Napoli, E., and Lo Vecchio, L. (1972). of the Serratia marcescens isolates would that this is not related to acute pan- Clin. Chem., 18,1403. Belfiore, F., and Napoli, E. (1973). Clin. Chem., 19, be presented. creatitis, renal failure, macroamylasaemia, 387. or hepato-biliary disease (Knight, Knight, A. H., Williams, D. N., Ellis, G., and Factors Affecting Transfer of Antibiotic Williams, Ellis, and Goldberg, 1973; Goldberg, D. M. (1973). Brit. med. J., 3, 128. Resistance between Gram-negative Knight, Williams, Spooner, and Goldberg, Knight, A. H., Williams, D. N., Spooner, R. J., and Bacteria in the Human Intestine 1973) nor does it appear to influence the Goldberg, D. M. (1973). Diabetes, in press. prognosis in individual cases. Aspects of EB Virus Infection J. D. ANDERSON (University of Bristol) It has recently been proposed that the In the absence of chemotherapy, no source of the amylase in such subjects R. N. P. SUTTON (King's College Hospital transfer of bacterial antibiotic resistance is the hepatocyte, and that amylase is Medical School, London, introduced by transfer (R) factors could be detected in released from its endoplasmic reticulum H. A. SISSONs) The association of the the faeces of four subjects who swallowed as a consequence of attack by lysosomal EB virus with Burk;tt's lymphoma, potential donor and recipient organisms enzymes (Belfiore, Napoli, and Lo infectious mononucleosis, nasopharyngeal even though the plasmids concerned Vecchio, 1972; Belfiore and Napoli, 1973). carcinoma, and possibly with some other could be freely transferred in broth, both This proposal rested on the demonstration conditions (notably Hodgkin's disease) to the ingested potential recipients and to that raised levels of lysosomal enzymes is now well recognized. Asymptomatic

a variety of faecal coliforms. The faeces were found in the serum of subjects with infection with this virus is also frequentcopyright. of these subjects contained such large diabetic ketoacidosis and hyperamylas- and most of the population have acquired populations of the relevant organisms that aemia and followed a similar time-course antibodies by early adult life. one would have expected transfer to to the latter. Although the isolation of EB virusfrom occur if the bacteria had been in a broth The following lines of evidence exclude nasopharyngeal secretions is possible in medium (Anderson, Gillespie, and the hepatocyte as the source of hyper- acute infectious mononucleosis, this Richmond, 1973). Reasons for the amylasaemia in diabetic ketoacidosis and procedure is not practicable at the discrepancy between results obtained cast doubt on the role of lysosomes in its moment as a routine measure and evidence in vivo and in vitro were therefore in- release from other tissues. of infection depends upon the demon- vestigated. 1 Sequential determinations of serum stration of rising antibody titres. A variety

R factor transfer between donor and enzyme activities in 10 consecutive patients of such antibodies may be demonstrated, http://jcp.bmj.com/ recipient strains of Escherichia coli was revealed that whereas beta-glucuronidase including antibodies to virus capsid found to be completely inhibited in was elevated at some time in all patients, antigen, membrane, and complement- nutrient broth by dense suspensions of amylase was raised in only eight and acid fixing antibodies. We have observed that Bacteroides fragilis. Comparable amounts phosphatase in only four. antibodies to EB virus capsid antigen of inert bacterial matter (formolized 2 A low correlation was found between develop more rapidly than those to EB suspensions of E. coli or B. fragilis), amylase and beta-glucuronidase, and soluble complement-fixing antigen and populations of Streptococcus faecalis, between amylase and acid phosphatase in this discrepancy could form the basis or bile salts were only moderately the above, whether peak activities or for a relatively simple diagnostic test for on October 2, 2021 by guest. Protected inhibitory. Strict anaerobiosis had no activities of all samples were considered. the presence of recent infection. effect upon R factor transfer. Population 3 Measurement of the same enzymes in Infections with EB virus also result in densities of organisms used in these 24 cases of acuteviralhepatitisshowedthat the development of autoimmune anti- studies were similar to those found in whereas raised beta-glucuronidase activit- bodies and in the impairment of cell- faeces. ies were found in 20, amylase was raised mediated immunity. In our report, we The presence of Bacteroides fragilis in only three, and acid phosphatase in describe some of these phenomena in thus provides a satisfactory explanation but a single case. Again, correlation active infectious mononucleosis and also for the almost total inhibition of con- between amylase and beta-glucuronidase in asymptomatic infections. jugation in the human gastrointestinal was poor. tract in the absence of antibiotics. Other 4 Analysis of six samples of normal SYMPOSIUM IN POLYCYTHAEMIA factors inhibiting conjugation to a lesser postmortem human liver revealed that, degree may reinforce the effect of B. in contrast to acid phosphatase and beta- The Assay of Erythropoietin fragilis. glucuronidase, its amylase content was negligible, especially when care was J. S. MALPAS (Department of Medical Reference taken to remove all pooled blood. In Oncology, St Bartholomew's Hospital, Anderson, J. D., Gillespie, W. A., and Richmond, fact the concentration of amylase in London) Investigation of erythro-