P.L. Perine

Bio: P.L. Perine is an academic researcher from Centers for Disease Control and Prevention. The author has contributed to research in topics: Louse-Borne Relapsing Fever & relapsing fever. The author has an hindex of 9, co-authored 12 publications receiving 394 citations.

Louse-Borne Relapsing Fever; A Clinical and Laboratory Study of 62 Cases in Ethiopia and a Reconsideration of the Literature

Abstract: : Sixty-two patients with louse-borne relapsing fever in Addis Ababa, Ethiopia, from 1966 to 1968 were studied. The clinical presentation varied. Fever, headache, skeletal and abdominal pain, and the usual symptoms of acute infection were common. Tachypnoea and upper abdominal tenderness with a palpable liver and spleen were found in two-thirds of the patients, jaundice in one- third, and purpura in one-sixth. Thrombocytopenia was the rule. Biochemical evidence of hepatocellular damage was found in most patients. Myocardial damage was suspected in one third of them. Pulmonary ventilation and cardiac output were increased and there was evidence of impaired gas exchange. Evidence of renal and cerebral damage was less striking. The literature on the immune response has been reviewed in order to understand the phenomenon of the crisis. Treatment was with intravenous tetracycline, and was followed by a Jarisch- Herxheimer raction. The clinical and physiological features of this reaction are described. Spirochaete death and phagocytosis, resulting in the release of endogenous pyrogen, may be responsible for all its features. Hyperpyrexia in the chill phase and hypotension and cardiac failure in the flush phase can be fatal. The mortality was 5 per cent. The epidemic and pathological processes which determine the prognosis of this disease are discussed.

Pathophysiology and Immunology of the Jarisch-Herxheimer-Like Reaction in Louse-Borne Relapsing Fever: Comparison of Tetracycline and Slow-Release Penicillin

Abstract: Twelve men with louse-borne relapsing fever were treated with single doses of procaine penicillin plus aluminum monostearate (PAM) intramuscularly or of tetracycline intravenously All patients experienced a definite Jarisch-Herxheimer-like reaction Fever and spirochetemia were significantly prolonged and peak temperature was lower and occurred later in the PAM-treated group Peak pulmonary ventilation, metabolic rate, and arterial PO2 were significantly higher in the tetracycline-treated group Circulatory changes were similar in the two groups but were prolonged in the PAM-treated patients Thus, tetracycline is recommended for treatment because it is more rapidly effective in eliminating Borrelia spirochetes and produces a reaction no more stressful physiologically than the one after PAM There was no evidence of complement activation, and there was no change in immunoglobulin levels throughout the reaction Immune complexes were detected in serum of five patients before treatment, but in fewer patients at the peak of the reaction and subsequently

Penicillinase-Producing Neisseria gonorrhoeae: Results of Surveillance in the United States

Abstract: In September 1976 the Center for Disease Control (Atlanta, Georgia) initiated surveillance for cases of infection due to penicillinase-productin Neisseria gonorrhoeae in the United States. One hundred ninety-one cases of penicillinase-producing gonococcal infection were confirmed through June 30, 1977. Of 177 cases for which histories of sexual exposure were available, 69 were traced to sexual contact in the Far East, and one was traced to sexual contact in West Africa. Of 181 cases for which clinical information was available, 174 were uncomplicated anogenital infections, but local complications, such as salpingitis, epididymitis, and a Bartholin's gland abscess, were reported. Spectinomycin is the only drug now recommended by the U.S. Public Health Service for treatment of gonorrhea that is effective against uncomplicated infections due to penicillinase-producing gonococci. For these organisms, the distribution of minimal inhibitory concentrations (MICs) of penicillin, ampicillin, tetracycline, erythromycin, and spectinomycin was higher than and significantly different from the distribution of MICs for isolates of non-penicillinase-producing gonococci collected in this country. Since surveillance began the incidence of confirmed cases of penicillinase-producing gonococcal infection has decreased from 20.8 cases per month in 1976 to 16.8 cases per month in 1977.

Bleeding in louse-borne relapsing fever I. Clinical studies in 37 patients

Abstract: 37 patients with louse-borne relapsing fever (LBRF) were investigated. In 21 there was evidence of bleeding. Thrombocytopenia, with platelelet counts below 150,000/c.mm., was found in 31 (84%). This was attributed to increased consumption due to intravascular clotting and to pooling in the enlarged spleen. There was a significant correlation between bleeding and duration of illness, platelet count and SGOT. 7 out of 10 patients with prolonged prothrombin (PT) and partial thromboplastin times (PTT) and evidence of severe hepato-cellular damage, had epistaxis and purpura. Plasma fibrinogen levels were raised in 29 patients. Death of 1 patient who had hypo-fibrinogenaemia was attributed to DIC.

The Spirochetal Etiology of Lyme Disease

Abstract: We recovered a newly recognized spirochete from the blood, skin lesions (erythema chronicum migrans [ECM]), or cerebrospinal fluid of 3 of 56 patients with Lyme disease and from 21 of 110 nymphal or adult lxodes dammini ticks in Connecticut. These isolates and the original one from l. dammini appeared to have the same morphologic and immunologic features. In patients, specific IgM antibody titers usually reached a peak between the third and sixth week after the onset of disease; specific IgG antibody titers rose slowly and were generally highest months later when arthritis was present. Among 40 patients who had early disease only (ECM alone), 90 per cent had an elevated IgM titer (greater than or equal to 1:128) between the ECM phase and convalescence. Among 95 patients with later manifestations (involvement of the nervous system, heart, or joints), 94 per cent had elevated titers of IgG (greater than or equal to 1:128). In contrast, none of 80 control subjects had elevated IgG titers, and only three control patients with infectious mononucleosis had elevated IgM titers. We conclude that the I. dammini spirochete is the causative agent of Lyme disease.

The interaction of bacterial pathogens with platelets.

Abstract: In recent years, the frequency of serious cardiovascular infections such as endocarditis has increased, particularly in association with nosocomially acquired antibiotic-resistant pathogens. Growing evidence suggests a crucial role for the interaction of bacteria with human platelets in the pathogenesis of cardiovascular infections. Here, we review the nature of the interactions between platelets and bacteria, and the role of these interactions in the pathogenesis of endocarditis and other cardiovascular diseases.

The Body Louse as a Vector of Reemerging Human Diseases

Abstract: The body louse, Pediculus humanus humanus, is a strict human parasite, living and multiplying in clothing. Louse infestation is associated with cold weather and a lack of hygiene. Three pathogenic bacteria are transmitted by the body louse. Borrelia recurrentis is a spirochete, the agent of relapsing fever, recently cultured on axenic medium. Historically, massive outbreaks have occurred in Eurasia and Africa, but currently the disease is found only in Ethiopia and neighboring countries. Bartonella quintana is now recognized as an agent of bacillary angiomatosis bacteremia, trench fever, endocarditis, and chronic lymphadenopathy among the homeless. Rickettsia prowazekii is the agent of epidemic typhus. The most recent outbreak (and the largest since World War II) was observed in Burundi. A small outbreak was also reported in Russia in 1997. Louse infestation appears to become more prevalent worldwide, associated with a decline in social and hygienic conditions provoked by civil unrest and economic instability.

Ceftriaxone: a review of its antibacterial activity, pharmacological properties and therapeutic use

Abstract: Cefuroxime is a new semisynthetic cephalosporin for parenteral administration. It is resistant to destruction by beta-lactamases produced by staphylococci and most Gram-negative aerobic bacteria and is active against many bacteria resistant to cephalothin. Cefuroxime is the most active of the cephalosporins against gonococci and Haemophilus influenzae particularly against beta-lactamase producing strains. Given by intramuscular or intravenous injection cefuroxime is effective against a wide variety of infections caused by Gram-positive or Gram-negative aerobes, but has no effect against infections caused by Pseudomonas aeruginosa or B. fragilis. Cefuroxime is of value in the treatment of respiratory infections due to Haemophilus influenzae and Streptocococcus pneumoniae and is useful against cephalosporin-resistant Klebsiella and Enterobacter infections. Cefuroxime is an alternative to spectinomycin for the treatment of beta-lactamase producing Neisseria gonorrhoeae infections. It is generally well tolerated and appears not to be nephrotoxic when given alone at usual dosages.