Showing papers in "The Journal of Infectious Diseases in 1983"
553 citations
535 citations
TL;DR: Investigation of normal and diseased brain tissue, including tissue from six subjects with multiple sclerosis, failed to reveal the presence of either JCV DNA or BKV DNA, and viral DNA detected appeared not to be integrated with host DNA and to be isolated in foci.
Abstract: Available evidence suggests that BK virus (BKV) and JC virus (JCV) persist in the kidneys of healthy individuals after primary infection and may reactivate when the host's immune response is impaired. Data supporting this hypothesis are presented. A previous study had shown BKV to be present in the kidneys of eight (57%) of 14 subjects. In the present study, which extended the investigation to a total of 30 subjects, BKV DNA was found in the renal tissues of 10 (33%) subjects, and JCV DNA was found in the renal tissues of three (10%) subjects. The viral DNA detected appeared not to be integrated with host DNA and to be isolated in foci. Investigation of normal and diseased brain tissue, including tissue from six subjects with multiple sclerosis, failed to reveal the presence of either JCV DNA or BKV DNA.
522 citations
TL;DR: Immune response to the pediatric serotypes was poor until the age of 4.5 years, and levels of serum antibody to all serotypes increased after immunization in all age groups tested.
Abstract: Sera were analyzed by radioimmunoassay for type-specific pneumococcal antibody in 249 children aged six to 54 months, who were participating in a controlled trial of a 14-valent pneumococcal vaccine. Levels of serum antibody to all serotypes increased after immunization in all age groups tested. For all serotypes, the antibody response increased progressively with age whether response was viewed as antibody doubling, relative increase in geometric mean, or final antibody level. Responses were poor up to the age of five years for the important pediatric serotypes 6A, 14, 19F, and 23F. Seventeen children under the age of two years at the time of primary immunization received booster doses of vaccine six months later. There was no significant increase in antibody to any serotype, and the geometric mean antibody levels fell for most types. Immune response to the pediatric serotypes was poor until the age of 4.5 years.
377 citations
TL;DR: The early occurrence and nutritional impact of diarrhoea and weaning, as well as the major etiologic agents of diarrhea and their different seasonal patterns have been defined for this region in which life-threatening diarrhea is endemic.
Abstract: isolated during the rainy season of October to March (P < 0.03), whereas 71% of rotaviral illnesses occurred during the drier months of June to October (P < 0.03). In the present study, the early occurrence and nutritional impact of diarrhea and weaning, as well as the major etiologic agents of diarrhea and their different seasonal patterns have been defined for this region in which life-threatening diarrhea is endemic.
339 citations
TL;DR: A three-step stool examination was developed to demonstrate Cryptosporidium oocysts and the diagnostic and infective stages of the infection in 10 homosexual men with AIDS and has been designed to prevent confusion caused by yeast cells that are frequently present in stool, leading to a false diagnosis.
Abstract: Cryptosporidiosis, a zoonosis caused by Cryptosporidium species, is a newly recognized coccidial protozoan infection causing severe protracted watery diarrhea in humans. In August 1981, the first case of cryptosporidiosis in a homosexual man with acquired immune deficiency syndrome (AIDS) was reported; diagnosis was determined by intestinal biopsy. It is necessary to adopt a simple laboratory diagnostic procedure to screen large numbers of suspected cases. A three-step stool examination was developed to demonstrate Cryptosporidium oocysts and the diagnostic and infective stages of the infection in 10 homosexual men with AIDS. This is a less invasive, less costly, and more sensitive test than intestinal biopsy and has been designed to prevent confusion caused by yeast cells that are frequently present in stool, leading to a false diagnosis. The examination consists of preliminary differential determination by iodine wet mount, definitive identification by modified Kinyoun acid-fast staining, and a more effective method of concentrating oocysts, by Sheather's sugar cover-slip flotation method.
320 citations
TL;DR: Findings provide a compelling epidemiologic rationale for trials of selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease.
Abstract: Between 1973 and 1981, 61 cases of neonatal group B streptococcal early-onset disease occurred among 32,384 infants born at Michael Reese Hospital and Medical Center, Chicago. Forty-one (67%) of the 61 affected infants were bacteremic at birth, implying intrapartum acquisition of infection. No significant deviations from the overall attack rate of 1.9 per 1,000 live births were associated with maternal demographic factors, but increased attack rates were associated with birth weights of less than or equal to 2.5 kg (7.9 per 1,000), rupture of amniotic membranes greater than 18 hr before birth (7.6 per 1,000), and intrapartum fever (6.5 per 1,000). Forty-five (74%) of the 61 affected infants and 15 (94%) of the 16 with fatal outcome had one or more of these three perinatal risk factors. Based on an intrapartum vaginal carriage rate of 16.7% among parturients with perinatal risk factors, an attack rate of 45.5 per 1,000 was estimated for infants born to colonized "high-risk" parturients, a subgroup comprising approximately 3% of our obstetric population. These findings provide a compelling epidemiologic rationale for trials of selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease.
315 citations
TL;DR: Between June 1981 and February 1983, the Centers for Disease Control (Atlanta) received reports of 1,000 patients living in the United States who met a surveillance definition for the acquired immune deficiency syndrome (AIDS).
Abstract: Between June 1981 and February 1983, the Centers for Disease Control (Atlanta) received reports of 1,000 patients living in the United States who met a surveillance definition for the acquired immune deficiency syndrome (AIDS). Seventy-three percent of these patients were diagnosed after January 1, 1982. The 1,000 patients included 284 with Kaposi's sarcoma (KS), 497 with Pneumocystis carinii pneumonia (PCP), 83 with KS and PCP, and 136 with opportunistic infections other than PCP. The overall mortality has been 39.2%. Cases have been reported from 32 states and the District of Columbia; New York, California, New Jersey, and Florida account for 82.7% of the reports. All but 61 of the patients could be classified into one or more of the following groups: homosexual or bisexual men, intravenous drug abusers, Haitian natives, or patients with hemophilia. Epidemiologic trends in AIDS cases are consistent with the gradual extension of an infectious agent into new populations.
299 citations
TL;DR: The encapsulated drug was as effective as the free drug when used in similar concentrations, while the animals treated with higher concentrations of liposomal amphotericin B had a longer survival time and an improved therapeutic index resulted by encapsulating amph esotericin B in liposomes.
Abstract: The toxicology of liposome-encapsulated amphotericin B in mice and its efficacy in the treatment and prophylaxis of systemic candidiasis in these animals were studied. The toxicology studies indicated that the maximal tolerated dose of free amphotericin B was 0.8 mg/kg of body weight and the 50% lethal dose (LD50) was reached at 1.2 mg/kg, while neither the maximal tolerated dose nor the LD50 for the liposomal amphotericin B was reached at a dose of 12 mg/kg. No abnormalities in blood chemistry or histology were observed in the animals injected with encapsulated amphotericin B, while the administration of free amphotericin B was associated with nephrocalcinosis and renal parenchymal edema. The encapsulated drug was as effective as the free drug when used in similar concentrations, while the animals treated with higher concentrations of liposomal amphotericin B (4 mg/kg) had a longer survival time. Thus, an improved therapeutic index resulted by encapsulating amphotericin B in liposomes.
296 citations
TL;DR: The results suggest that there is a close relationship between the fact that morphine exacerbates infections and thefact that morphine depresses phagocytic functions, and the negative effect of morphine onphagocytosis is at least one of the reasons for its negative effect on the development of infections.
Abstract: Morphine was demonstrated to exacerbate infections. Experiments were performed to evaluate variations of phagocytic physiology during morphine treatment. In mice, morphine drastically reduced reticuloendothelial system activity, phagocyte count, phagocytic index, killing properties, and superoxide anion production in polymorphonuclear leukocytes and macrophages. Similar effects on alveolar macrophage count, phagocytosis, and killing were found in rabbits, a result which suggested a lack of species specificity. Additional experiments demonstrated that morphine (1) induces a reduction of lymphoid organ weight, (2) impairs the ability to eradicate infections and (3) is counteracted in its depressing activity on phagocytic physiology by small amounts of Corynebacterium parvum. The results suggest that there is a close relationship between the fact that morphine exacerbates infections and the fact that morphine depresses phagocytic functions; therefore, the negative effect of morphine on phagocytosis is at least one of the reasons for its negative effect on the development of infections.
285 citations
TL;DR: Density of colonization, however, strongly influenced rates of vertical transmission to neonates and rates of heavy infant colonization, and density of colonization at parturition was not predicted by the sites of prenatal colonization.
Abstract: To determine the value of prenatal cultures in defining maternal colonization status at delivery, 5,586 pregnant women were screened at prenatal visits for vaginal and rectal carriage of group B streptococci (GBS). GBS were isolated from 1,272 (22.8%). At delivery, semiquantitative cultures were obtained from 393 prenatal carriers, of whom 264 (67.2%) retained carriage at delivery. Seventeen (8.5%) of 200 women with negative prenatal cultures acquired carriage. The predictive value of a positive prenatal culture was highest (72.5%) in women with prenatal vaginal and rectal colonization and lowest (59.7%) in women with only rectal colonization. The predictive value varied inversely with the interval between prenatal sampling and delivery. In mothers with prenatal carriage, density of colonization at parturition was not predicted by the sites of prenatal colonization. Density of colonization, however, strongly influenced rates of vertical transmission to neonates and rates of heavy infant colonization. Ten infants born to prenatally cultured mothers developed group B streptococcal early-onset disease; the mothers of eight (80%) of the 10 had prenatal colonization with the homologous GBS serotype.
TL;DR: Intermittent dosing of aminoglycosides, causing infrequent large maximum serum concentrations, may be less toxic and equally efficacious as frequent dosing.
Abstract: The dosing frequency of aminoglycoside antibiotics may alter efficacy and toxicity independent of total daily dose. Once-daily tobramycin dosing was compared with continuous infusion in three models of efficacy. Acute pneumonia due to Pseudomonas aeruginosa in guinea pigs responded better to once-daily dosing, and chronic pneumonia in rats and endocarditis in rabbits responded equally to both regimens. Dogs given gentamicin, tobramycin, or netilmicin once daily, with maximum serum concentrations of greater than 100 mg/liter, had less nephrotoxicity than dogs given continuous infusions. Tobramycin was given once daily or continuously to 52 patients with cystic fibrosis who in 10 days had no change in creatinine clearance or hearing despite maximum serum tobramycin concentrations of 40 mg/liter. Intermittent dosing of aminoglycosides, causing infrequent large maximum serum concentrations, may be less toxic and equally efficacious as frequent dosing.
TL;DR: This workshop discussed epidemiologic, pathophysical, genetic, and evolutionary problems relating to the clone concept and expressed the hope that recently developed techniques would make it possible to characterize phenotypes within the many bacterial groups thereby allowing a more precise definition of bacterial clones.
Abstract: Participants in this workshop included Mark Achtman, Max-Planck Institut ffir Molekulare Genetik, Berlin; Alan G. Barbour, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rocky Mountain Laboratory, Hamilton, Mont; Michael Barile, US Food and Drug Administration, Bethesda, Md; Louis S. Baron, Walter Reed Army Institute of Research, Washington, DC; Mark Beaubien, Fogarty International Center, NIH; Thomas M. Buchanan, University of Washington, Seattle; B. Wesley Catlin, The Medical College of Wisconsin, Milwaukee; P. Patrick Cleary, University of Minnesota, Minneapolis; Mitchell L. Cohen, Center for Infectious Diseases, Centers for Disease Control (CDC), Atlanta; Alan S. Cross, Walter Reed Army Institute of Research; J. P. Duguid, University of Dundee Medical School, Scotland; Robert Edelman, NIAID; John J. Farmer, III, Center for Infectious Diseases, CDC; Samuel B. Formal, Walter Reed Army Institute of Research; Carl E. Frasch, US Food and Drug Administration; Peter Gemski, Walter Reed Army Institute of Research; Robert C. Goldman, National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases, NIH; Carolyn M. Hardegree, US Food and Drug Adminstration; James B. Kaper, University of Maryland School of Medicine, Baltimore; Dennis J. Kopecko, Walter Reed Army Institute of Research; Loretta Leive, National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases; Bruce R. Levin, University of Massachusetts, Amherst; Myron M. Levine, University of Maryland School of Medicine, Baltimore; Frits and Ida Orskov, International Escherichia and Klebsiella Centre, Statens Seruminstitut, Copenhagen; John B. Robbins, US Food and Drug Administration; Bernard Rowe, Central Public Health Laboratory, London; R. Bradley Sack, The Johns Hopkins University, Baltimore; J. C. Sadoff, Walter Reed Army Institute of Research; Rachel Schneerson, US Food and Drug Administration; Robert K. Selander, University of Rochester, New York; Richard Silver, US Food and Drug Administration; David H. Smith, University of Rochester, New York; Lucy S. Tompkins, University of Washington, Seattle; Kaye Wachsmuth, Center for Infectious Diseases, CDC; the late Lewis Wannamaker, University of Minnesota Medical School, Minneapolis; T. S. Whittam, University of Rochester, New York; Richard A. Wilson, Pennsylvania State Bethesda, Md. Investigators from Europe and the United States discussed epidemiologic, pathophysical, genetic, and evolutionary problems relating to the clone concept. T e workshop was opened by Dr Mark Beaubien, Acting Director of the Fogarty International Center, and by Dr Frits Orskov, who noted that Herbert John Webber first used the word clone in 1903 to designate a population in which all members have been derived from one and the same progenitor by nonsexual multiplication. For present purposes, the word clone will be used to denote bacterial cultures isolated independently from different sources, in different locations, and perhaps at different times, but showing so many identical phenotypic and genetic traits that the most likely explanation for this identity is a common origin. Dr Orskov pointed out that the concept of a clonal connection between isolates from a clear-cut outbreak of disease caused by a phenotypically well-characterized pathogen has probably always been accepted, even though the word "clone" itself may not have been used. In recent years, however, the clone concept has also been applied to bacteria (such as many serotypes of Escherichia coli) that usually do not cause clearcut outbreaks or epidemics. Dr Orskov concluded by expressing the hope that recently developed techniques would make it possible to characterize phenotypes within the many bacterial groups, thereby allowing a more precise definition of bacterial clones.
TL;DR: The incidence of hepatitis B virus (HBV) infections during the second and third year of life was determined for 105 children whose mothers were carriers of hepatitisB surface antigen.
Abstract: The incidence of hepatitis B virus (HBV) infections during the second and third year of life was determined for 105 children whose mothers were carriers of hepatitis B surface antigen. Children were given hepatitis B immune globulin (HBIG) at birth and in some instances three and six months later to protect against HBV infection. Passive antibodies from the dose of HBIG disappeared in three to four months. Infants negative for HBV markers at 12 months were selected and subsequent infections were analyzed in relation to the e system markers in the mother. Over an average of 17.5 months of follow-up, 38.1% of the infants became infected, an annual incidence rate of 26.0%. The rate was highest for children whose mothers were positive for hepatitis B e antigen (HBeAg) (57.1%), moderate for those whose mothers were negative for both HBeAg and antibody to HBeAg (anti-HBe) (20.4%), and lowest for those whose mothers were positive for anti-HBe (11.3%).
TL;DR: Ampicillin treatment was associated with a highly significant reduction in maternal postpartum vaginal colonization by GBS and virtually eliminated vertical transmission in the treatment group with no risk factors and in both treatment groups with premature labor and/or prolonged membrane rupture.
Abstract: The effect of intrapartum ampicillin treatment on vertical transmission of group B streptococci (GBS) was examined in 575 prenatally colonized parturient women and their 580 newborn infants. Eighty women (43 receiving ampicillin) with premature labor and/or prolonged rupture of amniotic membranes were randomized. The other 495 were stratified into groups of 358 (31 receiving ampicillin) with no perinatal risk factors; 119 (28 receiving ampicillin) with premature labor and/or prolonged membrane rupture; and 23 (18 receiving ampicillin) with intrapartum fever. Ampicillin virtually eliminated vertical transmission in the treatment group with no risk factors and in both treatment groups with premature labor and/or prolonged membrane rupture. GBS colonization of neonates was detected only in women with intrapartum fever or brief (less than 1 hr) duration of treatment prior to delivery. Ampicillin treatment was associated with a highly significant reduction in maternal postpartum vaginal colonization by GBS. There were six group B streptococcal early-onset infections in infants of untreated subjects and no cases in treated subjects.
TL;DR: Two separate and distinct episodes of non-At non-B hepatitis were induced in each of two chimpanzees by two inocula: one containing a chloroform-resistant agent and the other containing a chlorine-sensitive agent.
Abstract: Two separate and distinct episodes of non-A, non-B hepatitis were induced in each of two chimpanzees by two inocula: one containing a chloroform-resistant agent and the other containing a chloroform-sensitive agent. Both agents were recovered from liver tissue and plasma obtained from a single chimpanzee during the acute and chronic phases of infection with a factor VIII concentrate, respectively. The chloroform-resistant agent did not cause unique changes in hepatocytes; in contrast, the chloroform-sensitive agent did induce the formation of cytoplasmic tubules, convoluted endoplasmic reticulum, and dense reticular inclusion bodies. The latter changes are similar in character to those induced in infected cells by some enveloped mammalian RNA viruses.
TL;DR: A matched case-control study of host risk factors showed that leukopenia, prior administration of antibiotics, and treatment with azathioprine and antilymphocyte serum were not significantly related to the development of aspergillosis, while the administration of high-dose corticosteroids posed a significant risk.
Abstract: During a 31-month period in 1979-1981, nine patients at a renal transplant center in Tennessee developed invasive infections with Aspergillus species. Despite an extensive search, no common environmental source of contamination was found. A matched case-control study of host risk factors showed that leukopenia, prior administration of antibiotics, and treatment with azathioprine and antilymphocyte serum were not significantly related to the development of aspergillosis. In contrast, the administration of high-dose corticosteroids posed a significant risk. An average daily dose of greater than or equal to 1.25 mg of prednisone/kg per day for the entire interval studied was the best predictor of subsequent invasive infection with Aspergillus.
TL;DR: Nine clinical isolates of Streptococcus faecalis from a university hospital were found to be resistant to high levels of gentamicin, tobramycin, amikacin, streptomycin, and kanamycin, finding high-level resistance to these aminoglycosides and resistance to penicillin-aminoglycoside synergism were transferable by conjugation to a susceptible recipient strain.
Abstract: Nine clinical isolates of Streptococcus faecalis from a university hospital were found to be resistant to high levels (minimal inhibitory concentration, greater than 2,000 micrograms/ml) of gentamicin, tobramycin, amikacin, streptomycin, and kanamycin. The high-level resistance to these aminoglycosides and resistance to penicillin-aminoglycoside synergism were transferable by conjugation to a susceptible recipient strain. In three strains tested, the aminoglycoside resistance was mediated by four aminoglycoside-modifying enzymes: a 3'-phosphotransferase transferred from two strains, a 2"-phosphotransferase and a 6'-acetyltransferase transferred from all three strains, and a streptomycin adenylyltransferase transferred from two strains. This is the first report of the occurrence of high-level gentamicin resistance in enterococcal isolates from the United States.
TL;DR: The data presented suggest that antibodies to toxins A and B are present in the majority of older children and adults and that patients with C difficile-induced disease develop serologic responses to one or both toxins.
Abstract: An enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to toxins A and B of Clostridium difficile was developed. Serum samples from 340 patients were tested for determination of the age-related prevalence of antitoxin. Antibody to toxin A was present in 64% of patients more than two years old and antibody to toxin B in 66% of patients more than six months old. A strongly positive ELISA value correlated with the presence of cytotoxicity-neutralizing antibody (P less than 0.001). Strongly positive ELISA values were obtained more commonly in convalescent sera from 16 patients with C difficile-induced colitis than in sera from the control population (antibody to toxin A, P less than 0.05; antibody to toxin B, P less than 0.001). Testing of paired sera revealed significant increases in the titer of IgG antibody to toxin A or B. Ten of the 16 patients with colitis had IgM titers of greater than or equal to 1:160 to one or both toxins. The data presented suggest that antibodies to toxins A and B are present in the majority of older children and adults and that patients with C difficile-induced disease develop serologic responses to one or both toxins.
TL;DR: The frenzied behavior and subsequent blindness in immunocompetent adults were attributed to a uniquely transient immunopathologic reaction targeted to centers in the limbic system and retinal neurons.
Abstract: Borna disease virus is an unclassified agent that causes a rare but fatal encephalitis in horses in Germany. In experimental animals the virus causes acute fatal encephalitis in some instances and chronic encephalitis with abnormal behavior in others. In initial studies of the pathogenesis of the latter disease in rats, the virus was shown to replicate only in the nervous system, with the greatest concentration of infectivity in the cerebrum and eyes. Viral replication continued indefinitely in both newborn and adult rats. The adult animals developed self-limiting, necrotizing encephalitis in the cerebrum, with inflammation spreading to the retina. Inflammation receded after two months, however, with concomitant cessation of necrosis; static hydrocephalus was observed at this point. Levels of viral replication were unaffected by these changes. Rats became frenzied and aggressive during the encephalitic period but became permanently passive and inactive after inflammation receded. Infected neonates and immunosuppressed adults did not become ill. The frenzied behavior and subsequent blindness in immunocompetent adults were therefore attributed to a uniquely transient immunopathologic reaction targeted to centers in the limbic system and retinal neurons.
TL;DR: Physical and chemical factors that may affect the growth of strains of Staphylococcus aureus that are associated with toxic-shock syndrome were examined and significant amounts of PE-C were made in beef-heart medium, brain-heart infusion broth, and Todd-Hewitt broth.
Abstract: Physical and chemical factors that may affect the growth of strains of Staphylococcus aureus that are associated with toxic-shock syndrome were examined for their effect on expression of pyrogenic exotoxin type C (PE-C). Significantly more PE-C was made when cultures were incubated at 37 C rather than at 30 C, although bacterial growth was similar at the two temperatures. Furthermore, 32-fold more toxin was made aerobically versus anaerobically for the seven strains tested, whereas only a twofold difference in bacterial growth was seen. Maximal toxin production occurred at pH 7 and pH 8, although the strains grew well in the range of pH 6 to pH 8. Glucose had little effect on growth and toxin production at levels from 0 to 0.3% but suppressed bacterial growth and, more extensively, toxin production at a level of 3%. Significant amounts of PE-C were made in beef-heart medium, brain-heart infusion broth, and Todd-Hewitt broth, but lesser amounts were made in trypticase soy broth.
TL;DR: The epidemiologic data suggest that HTLV is etiologically linked to a specific subtype of mature T-cell malignancy, and virus positivity varies by country, region within country, age, and possibly race and sex.
Abstract: Human T (thymus-derived)-cell leukemia/lymphoma virus (HTLV) is the first retrovirus consistently isolated from humans. Seroepidemiologic testing for antibodies to HTLV document the following. (1) HTLV is associated with a spectrum of mature T-cell lymphoreticular neoplasms. (2) HTLV is strongly associated with clusters of adult T-cell leukemia in Japan and a related syndrome, lymphosarcoma T-cell leukemia in the Caribbean. (3) Virus-positive infections from other areas of the world share similar clinicopathologic features, with some overlap with cutaneous T-cell lymphoma (CTCL). Antibodies to HTLV are lacking in most persons with CTCL. (4) Virus-associated malignancy clusters in geographic areas where HTLV infection is prevalent, and virus positivity varies by country, region within country, age, and possibly race and sex. Although preliminary, the epidemiologic data suggest that HTLV is etiologically linked to a specific subtype of mature T-cell malignancy.
TL;DR: The LPS profiles of non-b, typable strains of H influenzae were generally similar in microheterogeneity to those of type b strains, while those of untypable isolates usually displayed less electrophoretic variation.
Abstract: Lipopolysaccharide (LPS) was extracted from 50 isolates of Haemophilus influenzae by a rapid micromethod and was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining. LPS isolated by this method was electrophoretically indistinguishable from conventionally purified LPS but lacked the large degree of heterogeneity indicative of variable polymerization of O-side-chain repeating units; one to four bands appeared in gels. Electrophoretic profiles of LPS from H influenzae type b varied among strains and were useful for subtyping. Thirty-three isolates of type b were classified into 11 subtypes on the basis of stable band mobilities. Certain isolates of identical outer-membrane-protein subtype differed in LPS subtype. The LPS profiles of non-b, typable strains of H influenzae were generally similar in microheterogeneity to those of type b strains, while those of untypable isolates usually displayed less electrophoretic variation.
TL;DR: The increase in immunity to VZV in many immune subjects exposed to V zoster virus suggests the occurrence of subclinical reinfection.
Abstract: Resistance to reinfection with varicella-zoster virus (VZV) was evaluated in immune adults who had household exposure to varicella. Sixty-four percent of 25 adults exposed to varicella had a fourfold or greater rise in IgG antibody to VZV or had a high initial IgG antibody titer to VZV that declined by fourfold. IgM antibody was detected in only 12% of 25 VZV-immune subjects. Seventy percent of 23 subjects exposed to varicella had IgA antibody to VZV compared with 13% of 23 subjects with antibody to VZV who had no recent exposure (P less than 0.001, chi 2 test). Enhanced cellular immunity was documented by an increase in lymphocyte transformation to VZV antigen from a mean +/- SE index of 7.8 +/- 1.30 to 15.3 +/- 2.56 (P = 0.01, paired t-test). The increase in immunity to VZV in many immune subjects exposed to VZV suggests the occurrence of subclinical reinfection.
TL;DR: Data indicate that VZIG can be used to protect immunosuppressed children from severe chicken pox and double the dose administered reduced the rate of subclinical infection.
Abstract: Varicella-zoster immune globulin (VZIG), an immunoglobulin prepared from normal donor plasma selected for high titer of antibody to varicella-zoster virus (VZV), and zoster immune globulin (ZIG), prepared from the plasma of donors convalescing from herpes zoster, were compared in a double-blind, randomized clinical trial to determine their relative efficacy in protecting immunosuppressed children from severe varicella. VZV infection occurred in 49 (60.4%) of 81 recipients of VZIG and in 57 (68.6%) of 83 recipients of ZIG. These rates and the clinical severity of varicella were not significantly different; however, the subclinical infection rate was significantly higher in ZIG recipients (31.3% vs. 16.0%). This difference was accounted for by a subgroup of patients receiving immunosuppressive therapy for nonneoplastic diseases. Doubling the dose of VZIG administered reduced the rate of subclinical infection. These data indicate that VZIG can be used to protect immunosuppressed children from severe chicken pox.
TL;DR: Data may suggest that acyclovir-resistant virus will not be the cause of significant clinical illness among immunosuppressed patients and not all instances of "resistance," defined by the persistence of virus during treatment, will be caused by virus strains that are resistant to acyClovir in vitro.
Abstract: The sensitivity to acyclovir of virus isolates from 52 consecutive marrow transplant patients who received acyclovir for herpes simplex virus infections was studied in vitro. The median sensitivity of viruses obtained during first, second, third, and fourth recurrences was similar, and the median duration of virus positivity (three days) was the same for first and second treatment courses. However, acyclovir-resistant virus was recovered from one of 52 patients (1.9%) during the initial treatment course and from two of 22 patients (9.1%) treated for second recurrences. All three strains had reduced thymidine kinase activity. None caused severe infection. Three other patients remained virus-positive during treatment despite the isolation of acyclovir-sensitive virus. Although continuing surveillance is necessary, these data may suggest that acyclovir-resistant virus will not be the cause of significant clinical illness among immunosuppressed patients. In addition, not all instances of "resistance," defined by the persistence of virus during treatment, will be caused by virus strains that are resistant to acyclovir in vitro.
TL;DR: Intensified infection control efforts are particularly necessary with high-risk groups such as bacteriuric men--especially among those patients with UTIs due to S marcescens--to reduce the incidence of secondary, hospital-acquired BSIs.
Abstract: During a 23-month study, we identified 1,233 patients with nosocomial urinary tract infections (UTIs) among 40,718 consecutive admissions by using a standardized, prospective system of hospital-wide surveillance. Nosocomial bloodstream infections (BSIs) occurred in 565 patients, 32 of whom had BSIs originating from UTIs, for an attack rate of 2.7 per 100 patients with nosocomial bacteriuria. Patients with UTIs due to Serratia marcescens were most likely to develop secondary BSIs (rate, 16 per 100) compared to patients with nosocomial UTIs due to other organisms (rate, less than or equal to 4.3 per 100; P less than 0.05). Furthermore, the median interval between documentation of UTI and of secondary BSI was 24 days for patients with infections due to S marcescens compared to one day for the entire group (P less than 0.005). Risk factor analysis indicated that men with UTIs were more likely to develop secondary BSIs than were women (P less than 0.05). Intensified infection control efforts are particularly necessary with high-risk groups such as bacteriuric men--especially among those patients with UTIs due to S marcescens--to reduce the incidence of secondary, hospital-acquired BSIs.
TL;DR: The interaction of meningococci with the nasopharyngeal epithelium may be an important means whereby these bacteria establish a carrier state or invade the host.
Abstract: The mechanisms by which Neisseria meningitidis establishes a carrier state or invades mucosal surfaces of the host to cause septicemia and meningitis are unknown. An experimental model of human columnar nasopharyngeal tissue in organ culture was developed, and the interaction of encapsulated, piliated N meningitidis with this mucosal surface was studied. Electron microscopic studies showed that meningococci attached selectively to nonciliated columnar cells of the nasopharynx. After attachment, the microvilli of these nonciliated cells elongated and surrounded the organisms. Six to twelve hours after infection, endocytic vacuoles containing meningococci were seen in the apical portion of some nonciliated columnar cells. Later, diplococci were seen in the subepithelial tissues adjacent to lymphoid tissue; this observation suggested that meningococci had penetrated the epithelial layer. The interaction of meningococci with the nasopharyngeal epithelium may be an important means whereby these bacteria establish a carrier state or invade the host.
TL;DR: Enterotoxigenic Aeromonas species can be identified with 97% accuracy using a simple hemolysin assay which should be considered for use by routine diagnostic laboratories, particularly in children's hospitals.
Abstract: A prospective, 12-month study of 975 non-Aboriginal children with diarrhea and age- and sex-matched children without diarrhea, in Perth, Western Australia, was designed to investigate the significance of enterotoxigenic Aeromonas species as a cause of diarrhea. Enterotoxigenic Aeromonas species were found in the fecal specimens of 10.8% of the patients with diarrhea but in only 0.7% of those without diarrhea. Most Aeromonas species were isolated during the summer. Other important bacterial pathogens included Campylobacter, Salmonella, Shigella, and enterotoxigenic Escherichia coli; rotavirus infections appeared to be much less important in the Western Australian environment. Most of the patients were younger than two years of age and about one-quarter had mixed bacterial and/or viral intestinal infections. Enterotoxigenic Aeromonas species can be identified with 97% accuracy using a simple hemolysin assay which should be considered for use by routine diagnostic laboratories, particularly in children's hospitals.
TL;DR: It is suggested that positive surveillance cultures for Trichosporon species may correlate with systemic infection in the severely immunocompromised patient and that repeated positive urine cultures may indicate dissemination.
Abstract: Trichosporon beigelii and Trichosporon capitatum have recently been recognized as systemic pathogens in the immunosuppressed host. We studied the incidence of colonization and systemic infection with these organisms in 353 highly immunocompromised patients over a 37-month period. Thirteen patients (3.7%) had positive surveillance cultures for Trichosporon species in stool, skin, or urine. Three of the 13 patients developed systemic infections after having positive surveillance cultures. In two of these three patients, urine cultures were positive near the time of systemic infection. The route of entry appeared to have been enteric in two patients and cutaneous in one patient. Both colonizing and infecting organisms showed in vitro susceptibility to amphotericin B and nystatin. This study suggests that positive surveillance cultures for Trichosporon species may correlate with systemic infection in the severely immunocompromised patient and that repeated positive urine cultures may indicate dissemination.