Showing papers in "The Journal of Infectious Diseases in 1982"
TL;DR: The very high prevalence of bacteriuria--virtually 100%--was a result of a high incidence caused by many different species combined with the prolonged residence of some gram-negative bacilli in the catheter and urinary tract.
Abstract: Bacteriuria is common in chronically catheterized patients and is associated with both acute and chronic complications. Of 605 consecutive weekly urine specimens from 20 chronically catheterized patients, 98% contained bacteria at high concentrations and 77% were polymicrobial. The mean interval between new episodes of bacteriuria was 1.8 weeks. Most species of bacteria caused five to seven new episodes of bacteriuria per 100 weeks of catheterization. Even though access to the catheter lumen was similar, the duration of bacteriuric episodes varied greatly by species. Of the episodes of bacteriuria caused by nonenterococcal gram-positive cocci, greater than 75% lasted less than one week. Mean durations of episodes of bacteriuria due to Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa were four to six weeks, whereas those due to Providencia stuartii averaged 10 weeks and ranged up to 36 weeks. Thus, the very high prevalence of bacteriuria--virtually 100%--was a result of a high incidence caused by many different species combined with the prolonged residence of some gram-negative bacilli in the catheter and urinary tract.
596Â citations
TL;DR: An animal model involving the subcutaneous implantation of tissue cages into guinea pigs and subsequent infection with Staphylococcus aureus was used for study factors pertinent to foreign body infection.
Abstract: An animal model involving the subcutaneous implantation of tissue cages into guinea pigs and subsequent infection with Staphylococcus aureus was used for study factors pertinent to foreign body infection. Whereas 10(8) colony-forming units (cfu) of S. aureus strain Wood 46 did not produce any abscesses in the absence of foreign material, 10(2) cfu was sufficient to infect 95% of the tissue cages despite the presence of polymorphonuclear leukocytes (PMNLs) in sterile tissue cage fluid. Opsonization of S. aureus by tissue cage fluid was adequate during the first hour of infection, but opsonic coating of the organisms decreased at 20 hr after the induction of infection. PMNLs from sterile tissue cage fluid showed decreased phagocytic and bactericidal activities when compared with PMNLs from either blood or peritoneal exudate obtained after short- or long-term stimulation (P less than 0.001).
589Â citations
TL;DR: Regular sampling of specimens demonstrated adhesion of the staphylococci to the catheter surface followed by cell proliferation, possible breakdown of catheter components, and production of a slimy material covering the bacterial colonies.
Abstract: Colonization of intravenous catheters by coagulase-negative staphylococci was followed by scanning electron microscopy. Regular sampling of specimens demonstrated adhesion of the staphylococci to the catheter surface followed by cell proliferation, possible breakdown of catheter components, and production of a slimy material covering the bacterial colonies. The implications of these findings with reference to nosocomial infections of prosthetic devices are discussed.
566Â citations
TL;DR: Observations suggest that the transmission of virus from donors who are shedding large amounts could occur for 2-8 hr via stainless steel surfaces and for a few minutes via paper tissues, suggesting that under conditions of heavy environmental contamination, the Transmission of influenza virus via fomites may be possible.
Abstract: To investigate the transmission of influenza viruses via hands and environmental surfaces, the survival of laboratory-grown influenza A and influenza B viruses on various surfaces was studied. Both influenza A and B viruses survived for 24-48 hr on hard, nonporous surfaces such as stainless steel and plastic but survived for less than 8-12 hr on cloth, paper, and tissues. Measurable quantities of influenza A virus were transferred from stainless steel surfaces to hands for 24 hr and from tissues to hands for up to 15 min. Virus survived on hands for up to 5 min after transfer from the environmental surfaces. These observations suggest that the transmission of virus from donors who are shedding large amounts could occur for 2-8 hr via stainless steel surfaces and for a few minutes via paper tissues. Thus, under conditions of heavy environmental contamination, the transmission of influenza virus via fomites may be possible.
510Â citations
TL;DR: Amniotic fluid was collected through an intrauterine catheter from 52 women with clinical intraamniotic infection and from 52 uninfected matched control women and cultured quantitatively for anaerobes and aerobes.
Abstract: Amniotic fluid was collected through an intrauterine catheter from 52 women with clinical intraamniotic infection and from 52 uninfected matched control women. The amniotic fluid was cultured quantitatively for anaerobes and aerobes. Patients with intraamniotic infection were matched with the control women on the basis of gestational age, interval from membrane rupture to specimen collection, and interval from membrane rupture to delivery. The patients with intraamniotic infection had a significantly higher mean temperature (38.4 vs. 37.1 C) and a higher mean leukocyte count (15,740 vs. 11,740 cells/mm3). In 80.6% of specimens from the women with intraamniotic infection and 30.8% of those from the control subjects, greater than or equal to 10(2) colony-forming units (cfu)/ml were isolated from the amniotic fluid (P less than 0.001). Also, in 69.2% of the former and 7.7% of the latter, there were greater than or equal to 10(2) cfu of isolates considered to be "high-virulence" isolates/ml (P less than 0.001).
486Â citations
TL;DR: Strains of Escherichia coli previously implicated or proven to be causes of diarrhea were examined for production of a toxin similar to that of Shigella dysenteriae type 1 (Shiga), suggesting that Shiga-like toxin may be another heretofore undiscovered factor in the pathogenesis of diarrhea caused by some E. coli strains.
Abstract: Strains of Escherichia coli previously implicated or proven to be causes of diarrhea were examined for production of a toxin similar to that of Shigella dysenteriae type 1 (Shiga). Organisms grown in an iron-depleted broth were lysed by pressure disruption followed by ultracentrifugation. Saline-dialyzed extracts were tested for cytotoxic effects on HeLa cells that were neutralizable with antiserum to Shiga toxin. Among the 13 E. coli strains so analyzed, 11 made a Shiga-like cytotoxin in levels ranging from trace (two avirulent isolates) to amounts equivalent to S. dysenteriae type 1 (two noninvasive strains that did not make E. coli heat-labile or -stable enterotoxins but were isolated from infants with diarrhea). As with extracts of Shiga toxin, lysates of these E. coli strains that produced high levels of Shiga-like toxin were enterotoxic for rabbits, paralytic and lethal for mice, and inhibited protein synthesis in HeLa cells. Thus, these data suggest that Shiga-like toxin may be another heretofore undiscovered factor in the pathogenesis of diarrhea caused by some E. coli strains.
443Â citations
TL;DR: The early appearance of virus in tonsil, retropharyngeal and mesenteric-portal lymph nodes, and intestine suggests that primary infection occurs by way of the alimentary tract, either prenatally from virus in amniotic fluid or postnatallyFrom virus in a contaminated environment.
Abstract: A better understanding of the infectious process in scrapie was sought by studying the temporal distribution of virus in naturally infected Suffolk sheep. Virus was detected (by mouse inoculation) first in lymphatic tissues and intestine of clinically normal lambs (age, 10-14 months). Titers were generally low. Infection of the central nervous system was first detected in a 25-month-old clinically normal sheep whose nonneural tissues had moderate amounts of virus. In sheep affected with scrapie, similar amounts in nonneural tissues accompanied high concentrations in the central nervous system, notably in sites of severest neurohistologic changes. No virus was found in clinically normal high-risk sheep 54 to 104 months old. The early appearance of virus in tonsil, retropharyngeal and mesenteric-portal lymph nodes, and intestine suggests that primary infection occurs by way of the alimentary tract, either prenatally from virus in amniotic fluid or postnatally from virus in a contaminated environment.
435Â citations
TL;DR: Serologic assessments revealed that HSV encephalitis occurred as both a primary (30%) and recurrent (70%) infection and the need for development of noninvasive diagnostic procedures is indicated.
Abstract: Laboratory procedures were compared with brain biopsy findings in 113 biopsy-proven patients with herpes simplex virus (HSV) encephalitis and 93 biopsy-negative individuals. Examinations of brain tissue by histopathology, immunofluorescence, and electron microscopy demonstrated evidence of HSV infection in 56%, 70%, and 45% of proven cases and apparently false-positive results in 14%, 9% and 2% of those biopsy-negative. Serologic assessments revealed that HSV encephalitis occurred as both a primary (30%) and recurrent (70%) infection. Among patients with HSV encephalitis, 28% failed to seroconvert or seroboost within one month of the onset of disease. Titers of passive hemagglutinating and IgG immunofluorescent antibodies increased fourfold in the cerebrospinal fluid in 74% and 94%, respectively, of patients with proven disease. Similar percentages of patients had antibody ratios in serum and cerebrospinal fluid of less than 20 over the same interval. These data indicate the need for development of noninvasive diagnostic procedures.
355Â citations
TL;DR: The hybridization technique detected ETEC in all stool samples of patients with diarrhea from whom ETEC was isolated and in ETEC-inoculated water containing other species of bacteria.
Abstract: The applicability of examining clinical specimens with a DNA hybridization technique for genes encoding enterotoxins was examined using enterotoxigenic Escherichia coli (ETEC) that produced both heat-labile toxin (LT) and heat-stable toxin (ST) (24 isolates), ETEC that produced LT only (17 isolates), and ETEC that produced ST only (22 isolates) from Thailand. ETEC was identified with Y-l adrenal cell and suckling mouse assays. All were homologous with radiolabeled fragments of DNA encoding LT or ST of porcine origin (ST-P) or of human origin (ST-H). Strains of ETEC that produced ST only from rural Thailand were homologous with the ST-H probe only, whereas strains isolated in Bangkok were homologous with the ST-H probe, the ST-P probe, or both probes. The hybridization technique detected ETEC in all stool samples of patients with diarrhea from whom ETEC was isolated and in ETEC-inoculated water containing other species of bacteria. The DNA hybridization assay is useful for characterizing and identifying environmental sources of ETEC.
335Â citations
TL;DR: The results document the existence of an urban cycle for Hantaan virus, which had been suspected on the basis of the occurrence of sporadic urban cases in humans of KHF, and suggest that Rattus-borne HantaAn virus may be widely distributed in urban centers.
Abstract: Urban rats captured in Seoul and four nearby Korean cities were found to have immunofluorescent antibodies reactive with Hantaan virus, the etiologic agent of Korean hemorrhagic fever (KHF). Serum antibodies were detected in 13% from 477 Rattus norvegicus and 11% of 47 Rattus rattus. Hantaan viral antigen was found in pulmonary tissues of 42 animals, and Hantaan virus was recovered from 23 rats, all but two of which were R. norvegicus. Wistar rats were qualitatively much more sensitive than Apodemus agrarius rodents for isolation of virus from tissues of wild rats. Wistar rats inoculated with one of these strains had virus in lung and spleen for at least 75 days. These results document the existence of an urban cycle for Hantaan virus, which had been suspected on the basis of the occurrence of sporadic urban cases in humans of KHF, and suggest that Rattus-borne Hantaan virus may be widely distributed in urban centers.
322Â citations
TL;DR: Findings suggest that an autoimmune disorder may underly lymphadenopathy and KS in homosexual men, similar to the HuIFN-alpha found in patients with SLE.
Abstract: Some immunologic parameters in homosexual patients with Kaposi's sarcoma (KS) or unexplained lymphadenopathy resemble findings in patients with autoimmune diseases such as systemic lupus erythematosus (SLE). Many patients with SLE have an unusual acid-labile form of human leukocyte interferon (HuIFN-alpha) in their serum. Sera from 91 homosexual men were tested for the presence of HuIFN. Of 27 patients with KS, 17 had significant titers of HuIFN in their serum. Ten of 35 patients with lymphadenopathy and three of four patients with other clinical symptoms also had circulating HuIFN. In contrast, only two of 25 apparently healthy subjects had serum HuIFN. All 32 samples of HuIFN had antiviral activity on bovine cells, a characteristic of HuIFN-alpha, and all of 14 representative samples tested were neutralized by antibody to HuIFN-alpha. In addition, the HuIFN-alpha in six of eight representative patients was inactivated at pH 2 and therefore appears to be similar to the HuIFN-alpha found in patients with SLE. These findings suggest that an autoimmune disorder may underly lymphadenopathy and KS in homosexual men.
TL;DR: Results indicate that, in the dose schedule used, the Ty 21a mutant strain, which is stable and safe, is protective for a period of at least three years.
Abstract: A controlled field trial of Salmonella typhi strain Ty 21a oral vaccine against typhoid was carried out in Alexandria, Egypt, from March 1978 to March 1981. A total of 32,388 children was included in the study. The children were divided in two comparable groups, one given three doses of vaccine and the other three doses of placebo. Each dose of vaccine contained 1-8 X 10(9) live Ty 21a bacteria. The population was monitored, and each suspected case of typhoid was investigated bacteriologically and serologically. The effectiveness of the vaccine was assessed by analyzing the number of confirmed cases of typhoid fever in the two groups. The incidence of typhoid fever was 4.9 cases per 10,000 children per year in the control group and 0.2 cases per 10,000 children per year in the vaccine group. The results indicate that, in the dose schedule used, the Ty 21a mutant strain, which is stable and safe, is protective for a period of at least three years.
TL;DR: The incidence of HBV infections was significantly associated with the frequency of previous injections, and HBsAg persistence was age-related, with most carriers being among the youngest children infected.
Abstract: To determine the incidence of infections with hepatitis B virus (HBV) among Chinese preschool children, 1,510 children (mean age, 29 months) were tested for HBV markers; 15.9% were infected with HBV (7.8% positive for hepatitis B surface antigen [HBsAg] and 8.1% positive for antibody to HBsAg) and 84.1% were susceptible when the children were enrolled in the study. The average length of follow-up was 2.1 years among 1,110 children. Among the 924 susceptible children who were followed up, 10.6% had seroconversions for HBV markers, none of which was associated with clinical illness; the annual incidence of HBV infections was 5.0%. Among the 98 children who experienced HBV infections during the study, 23% became HBsAg carriers, and HBsAg persistence was age-related, with most carriers being among the youngest children infected. In contrast, among the children with HBV markers at the time of enrollment, 118 (49.2%) were HBsAg-positive and 86% were still positive on follow-up. The incidence of HBV infections was significantly associated with the frequency of previous injections.
TL;DR: The contention that staphylococcal outbreaks periodically resulted when, in the presence of overcrowding, serious understaffing made frequent handwashing between infant contacts difficult is supported.
Abstract: Understaffing and overcrowding in the neonatal nursery are thought to contribute to the spread of infectious diseases among neonates, although little scientific documentation exists to support the view. In the present investigation of recurring epidemics in one nursery, the incidence rate of clustered staphylococcal infection was 16 times higher after periods when the infant:nurse ratio exceeded 7, seven times higher after periods when the infant census exceeded 33, three times higher in the summer months, and 1.5 times higher in the absence of bathing with hexachlorophene. All four factors were significantly associated with infection in a multivariate statistical model which predicted the occurrence of infection well (goodness-of-fit chi 2 = 6.08; df = 9; P = 0.73). These results support the contention that staphylococcal outbreaks periodically resulted when, in the presence of overcrowding, serious understaffing made frequent handwashing between infant contacts difficult. Elimination of these problems appears to be important in reducing cross infection in the nursery.
TL;DR: Genital infection in the guinea pig shares many features with genital herpes in humans and provides a model to explore mechanisms of latency and reactivation and to evaluate several methods for control of recurrent disease.
Abstract: Guinea pigs inoculated intravaginally with herpes simplex virus type 2 (HSV-2) developed a self-limiting infection characterized by vesiculo-ulcerative lesions on the external genital skin, urinary retention, and hindlimb paralysis. Infection rarely resulted in death. Virologic, histologic, and immunoperoxidase data suggested the following scheme for viral pathogenesis: initial replication in the introitus, vagina, and bladder; spread via sensory nerves to the lumbosacral dorsal root ganglia and spinal cord, and transmission via peripheral nerves to the external genital skin to produce the characteristic lesions. After recovery from primary infection, animals developed recurrent vesicular lesions, shed virus from genital sites in the absence of lesions, and harbored latent HSV-2 in dorsal root ganglia. Genital infection in the guinea pig shares many features with genital herpes in humans and provides a model to explore mechanisms of latency and reactivation and to evaluate several methods for control of recurrent disease.
TL;DR: The intestinal tract appears to be a primary reservoir for group B streptococci and the likely source of vaginal or urogenital colonization in pregnant women.
Abstract: A longitudinal prospective study of carriage of group B streptococci during pregnancy was conducted in 2,540 women over a three-year period. Carriage was documented in 18% of the women by anorectal culture, in 4% by vaginal culture, and in 13% by simultaneously obtained anorectal and vaginal cultures (overall carriage rate, 35%). The rate and pattern of carriage were nearly identical from year to year. In sequential cultures in the second and third trimesters of 754 women, carriage rates were 31% and 28%, respectively; only 17% of the women were carriers in both trimesters. (1) Persistence of carriage was most common when the initial anorectal swabs were positive, (2) spread from the intestinal tract to the vagina occurred, and (3) the intestinal tract was commonly the primary site of acquisition in patients with previously negative cultures. The intestinal tract appears to be a primary reservoir for group B streptococci and the likely source of vaginal or urogenital colonization in pregnant women.
TL;DR: A history of previous clinical hepatitis and serologic markers indicating previous hepatitis B infection were found in patients with non-A, non-B hepatitis more often than in the control patients.
Abstract: Patients with acute viral hepatitis were identified at five hospitals in Baltimore, Maryland between February 1979-August 1980. Of the 295 patients with serologically diagnosed hepatitis, 42% had non-A, non-B hepatitis; 48% had hepatitis B; and 10% had hepatitis A. Compared with matched control patients with no liver disease, patients with non-A, non-B hepatitis more often had received a blood transfusion (11% vs. O, P less than 0.001), used parenteral drugs (42% vs. 4%, P less than 0.001), were employed as health workers in direct patient care or hospital laboratory work (6% vs. 3%, P less than 0.05), had personal contact with others who had hepatitis (16% vs. 1%, P less than 0.001), or had ingested raw shellfish (34% vs. 20%, P less than 0.01). A history of previous clinical hepatitis and serologic markers indicating previous hepatitis B infection were found in patients with non-A, non-B hepatitis more often than in the control patients. Chronic non-A, non-B hepatitis was found in 34 (42.5%) of 80 patients with non-A, non-B hepatitis.
TL;DR: Cross contamination is the most likely explanation of the spread of C. difficile among hospitalized infants; the organism could spread among adults who are at risk of developing antibiotic-associated colitis in a similar manner.
Abstract: The epidemiology of Clostridium difficile was studied prospectively in 451 newborn infants by daily screening of fecal samples. Colonization rates in three postnatal wards ranged from 2% to 52%. Many colonizations were sporadic, but on two wards there was evidence of clustering. On one of these occasions prospective environmental sampling yielded C. difficile organisms from a potential common source. Mothers were shown not to be the sources of their infants' organisms. Both toxin-producing and non-toxigenic strains were common; differentiation according to toxin type was epidemiologically useful. Cross contamination is the most likely explanation of the spread of C. difficile among hospitalized infants; the organism could spread among adults who are at risk of developing antibiotic-associated colitis in a similar manner.
TL;DR: Findings show that P. carinii is naturally acquired as an airborne organism in a de novo infection.
Abstract: Axenic rats maintained in germfree isolators were found to be free of Pneumocystis carinii after three months of immunosuppression with dexamethasone. This P. carinii-free rat model was used to identify the mode of acquisition of P. carinii from the natural environment. Germfree were exposed in selective manner to potential sources of P.carinii, including air, water, and food. Animals exposed in the isolator with filtered (sterile) air and to regular (unsterile) water and food did not acquire P. carinii. Rats exposed in open cages to room air but maintained on sterile water and food acquired the infection. Animals fed lung tissue infected with P. carinii did not acquire the infection. These findings show that P. carinii is naturally acquired as an airborne organism in a de novo infection.
TL;DR: AMBL is a novel vehicle of administration that reduces toxicity and concentrates the drug in the appropriate target organs and survived longer and had lower tissue counts of cryptococci than mice treated with AMBD or untreated control mice.
Abstract: Liposomes were prepared to incorporate large amounts of amphotericin B. BALB/c mice were challenged with Cryptococcus neoformans and given liposome-associated amphotericin B (AMBL) or amphotericin B-deoxycholate (AMBD) intravenously. Mice that were treated with AMBL survived longer and had lower tissue counts of cryptococci than mice treated with AMBD or untreated control mice. The reduced acute toxicity of AMBL permitted much larger doses of amphotericin B to be given than were possible with AMBD. AMBL is a novel vehicle of administration that reduces toxicity and concentrates the drug in the appropriate target organs.
TL;DR: It is recommended that a typhoid control program include the identification of carriers followed by health education and therapeutic interventions.
Abstract: As part of a program to control endemic typhoid fever in Santiago, Chile, an assessment was made of the magnitude of the reservoir of chronic carriers of Salmonella typhi. The availability of an accurate census and reliable data on the prevalence of biliary disease and of S. typhi carriage among persons with cholecystitis allowed an unusually precise estimate of the number of carriers. In 1980 there existed 25,019 female and 4,575 male carries in a population of 4,264,514, yielding a crude prevalence of 694 carriers per 10(5) population. Because of the magnitude of this human reservoir, which includes many females of greater than 40 years of age, it is recommended that a typhoid control program include the identification of carriers followed by health education and therapeutic interventions.
TL;DR: Legionnaires' disease may be caused by contaminated aerosols from respiratory devices, and the use of contaminated tap water in such devices represents a previously unrecognized hazard to which corticosteroid-treated patients should not be exposed.
Abstract: Five cases of nosocomial Legionnaires' disease which occurred over a five-month period were retrospectively investigated. Chart review showed that during the two- to 10-day incubation period before the onset of illness, all of the patients inhaled aerosolized tap water from jet nebulizers (four patients) or from a portable room humidifier (one patient), and all received high dosages of corticosteroids or adrenocorticotropic hormone. Exposure to both factors was highly significant (P less than 0.000001) when compared with the rate of exposure in 69 control patients. Environmental cultures yielded Legionella pneumophila from tap water and from reservoirs of tap water-filled respiratory devices. The yield was highest from hot tap water, in which the free chlorine level was less than 0.05 parts per million. Thus, Legionnaires' disease may be caused by contaminated aerosols from respiratory devices, and the use of contaminated tap water in such devices represents a previously unrecognized hazard to which corticosteroid-treated patients should not be exposed.
TL;DR: Of 3,816 homosexual men examined in five sexually transmitted disease clinics in the United States, 6.1% had hepatitis B surface antigen, 52.4% had antibody to hepatitis Bsurface antigen, and 3.0% of the men who had no other indicator of infection with hepatitis B virus (HBV) had antibodyto hepatitis B core antigen.
Abstract: Of 3,816 homosexual men examined in five sexually transmitted disease clinics in the United States, 6.1% had hepatitis B surface antigen, 52.4% had antibody to hepatitis B surface antigen, and 3.0% of the men who had no other indicator of infection with hepatitis B virus (HBV) had antibody to hepatitis B core antigen. The rate of seropositivity for HBV indicated by the presence of one or more of these serologic markers was 61.5%; seropositivity was significantly related to the duration of regular homosexual activity and to the number of nonsteady male sexual contacts in the four months before the patients were interviewed. Anal-genital intercourse, oral-anal intercourse, and rectal douching were significantly related to evidence of HBV infection, but oral-oral contact and oral-genital contact were not. Trauma to the rectal mucosa is a feature common to the practices that were significantly related to seropositivity for HBV.
TL;DR: There was no difference in the frequency of upper or lower respiratory tract disease caused by RSV between the live RSV vaccine recipients who developed vaccine-induced antibody and the placebo vaccine recipients, and this liveRSV vaccine administered parenterally was not efficacious.
Abstract: A live respiratory syncytial virus (RSV) vaccine administered parenterally was evaluated for efficacy in a double-blind, placebo-controlled field trial in 510 children six to 47 months of age. Among the 233 recipients of live RSV vaccine, 68 of 98 initially seronegative children (as determined by enzyme-linked immunosorbent assay) developed antibody to RSV; 25 of the 30 initially seronegative children who did not develop antibody were less than 12 months old, which suggested that very low levels of maternal antibody (undetectable by enzyme-linked immunosorbent assay) inhibited replication of the vaccine virus. The children were monitored for the occurrence of naturally acquired RSV infection in two RSV epidemics, and there was no difference in the frequency of upper or lower respiratory tract disease caused by RSV between the live RSV vaccine recipients who developed vaccine-induced antibody and the placebo vaccine recipients. Thus, this live RSV vaccine administered parenterally was not efficacious.
TL;DR: Acyclovir-resistant HSV-1 can emerge in certain clinical settings but may be associated with diminished virulence, and linked resistance with idoxuridine was detected in the isolates from the patient's eye.
Abstract: Sequential isolates of herpes simplex virus type 1 (HSV-1) from a child with severe combined immunodeficiency were examined for sensitivity to acyclovir. Early intravenous courses of acyclovir resulted in dramatic clinical improvement and were associated with the isolation of sensitive strains of HSV-1 (ID50[dose inhibiting 50% of control plaques], 0.010-0.106 microgram/ml), whereas later recurrences following intravenous, oral, and ophthalmic therapy were characterized by low-grade chronic lesions (ID50, 1.04-9.43 microgram/ml) that were unresponsive to acyclovir despite serum levels of up to 10.45 microgram/ml. Diminished sensitivity was associated with reduced viral thymidine kinase activity, and linked resistance with idoxuridine was detected in the isolates from the patient's eye. Intracerebral and cutaneous snout inoculation of a resistant isolate into BALB/c, hairless, and athymic nude mice revealed a 100- to 1,000-fold decrease in virulence as compared with an early sensitive isolate. Acyclovir-resistant HSV-1 can emerge in certain clinical settings but may be associated with diminished virulence.
TL;DR: Two outbreaks of peritonitis caused by a Mycobacterium chelonei-like organism--a previously unrecognized pathogen--occurred among patients receiving intermittent chronic peritoneal dialysis (CPD).
Abstract: Two outbreaks of peritonitis caused by a Mycobacterium chelonei-like organism--a previously unrecognized pathogen--occurred among patients receiving intermittent chronic peritoneal dialysis (CPD). In one center, five of 22 patients who had undergone CPD during a one-month period developed peritonitis caused by an M. chelonei-like organism acquired from a single contaminated automated CPD machine. In a second center, five of eight patients who had received CPD during a several-week period became infected, apparently as a result of cross-infection from contaminated machines. Seven sporadic cases of peritonitis due to an M. chelonei-like organism were also found. M. chelonei-like organisms can survive and proliferate in water and are relatively resistant to formaldehyde. Defects in the design of CPD machines and disinfection procedures were identified that may have permitted M. chelonei-like organisms to survive attempted disinfection.
TL;DR: The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old.
Abstract: The epidemiologic and clinical characteristics of 412 patients infected with Shigella from a systematic sample of approximately 100,000 patients attending Dacca Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between December 1, 1979, and November 30, 1980, were reviewed. Shigella was isolated from 11.6% of the 3,550 patients in the sample and was the second most common isolate in patients over two years old. Two clinical presentations of shigellosis were found: (I) watery diarrhea occurring in younger children and associated with a shorter duration of illness and with more vomiting and dehydration and (2) dysentery with stool blood and abdominal pain. These different presentations may reflect two mechanisms in the pathogenesis of shigellosis or different stages of the disease. The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old. Simple visual inspection of stool for blood correctly identified 44% of all patients infected with Shigella.
TL;DR: It is suggested that in sexually active women, most urinary tract infections are intercourse-related, and frequency was higher in infected women than in uninfected women.
Abstract: To assess the significance of sexual intercourse as a precipitating factor of urinary tract infection in premenopausal women with recurrent infection, 15 patients were monitored with daily dipslides and calendar recording of intercourse episodes after antimicrobial prophylaxis was discontinued. Eleven patients experienced 16 infections; 12 infections occurred within 24 hr of an intercourse episode, two occurred during the menstrual period, and two had no recognizable association. In 12 control subjects, followed in a similar fashion, three infections--all within 24 hr of an intercourse episode--were documented. There was no difference in frequency of intercourse between patients and controls, but the frequency was higher in infected women than in uninfected women (P less than 0.02). These data suggest that in sexually active women, most urinary tract infections are intercourse-related.
TL;DR: In a small group of cardiac transplant recipients with recurrent symptomatic disease, IgM titers were low at the time of viruria and did not increase with CMV tissue involvement, a result which suggests that quantitative deficiencies in IgM may be related to the severity of CMV infections.
Abstract: Levels of IgG and IgM antibodies t human cytomegalovirus (CMV) were measured using a solid-phase radioimmunoassay Individuals positive by complement-fixation test consistently had detectable IgG titers by radioimmunoassay, but no quantitative relationship was apparent An elevated IgM titer was considered specific for CMV infection because sera from individuals with other herpesvirus infections did not cross-react In patients with mononucleosis, elevated titers of IgM antibody to CMV correlated (P less than 0001) with active infection and were highest during viremia Titers of IgG antibody to CMV during and after symptomatic infection were similar to those of asymptomatic positive individuals Increases in CMV-specific IGM were observed in both primary and reactivated infections in cardiac transplant recipients In a small group of cardiac transplant recipients with recurrent symptomatic disease, IgM titers were low at the time of viruria and did not increase with CMV tissue involvement, a result which suggests that quantitative deficiencies in IgM may be related to the severity of CMV infections