A worldwide effort is underway to eradicate poliomyelitis by the year 2000. Surveillance for wild poliovirus circulation is crucial to this effort. The use of molecular epidemiologic methods has enhanced the precision and reliability of poliovirus surveillance. Because poliovirus genomes evolve rapidly (similar to 10(-2) nt substitutions/site/yr) during replication in humans, the potential resolving power of the molecular epidemiologic studies based upon nucleotide sequence comparisons is very high. Evolution among wild polioviruses occurs by both nucleotide substitution (primarily to synonymous codons) and recombination.Sequence comparisons of poliovirus isolates have revealed the existence of numerous genotypes endemic to different regions of the world. Sequence diversity within a genotype is reduced by epidemics (as one lineage predominates), as well as by intensive immunization (as lineages are eliminated). Molecular epidemiologic approaches have been widely used within the Poliomyelitis Eradication Initiative to: (1) determine the sources of imported viruses, (2) follow the pathways of virus transmission, (3) monitor the progress of control activities, (4) identify reservoirs sustaining virus transmission (5) develop molecular reagents for the rapid detection of wild polioviruses in clinical and environmental samples, and (6) provide critical evidence that poliovirus eradication has been achieved.
Bactericidal activity of phagocytic cells depends largely upon their production of highly reactive compounds via the metabolism of oxygen. A lesion anywhere in the biochemical pathway of hydrogen peroxide production potentially can cause chronic granulomatous disease (CGD). Recent work has shown that CGD results from specific abnormalities in the nicotinamide-adenine dinucleotide phosphate (NADPH) system, which includes membrane-associated proteins, NADPH, cytochrome b-558, and several cytosolic proteins. Pharmacologic alteration of phagocytic oxidative metabolism can now be achieved through use of recombinant interferon-gamma (IFN-gamma). Data from a multicenter clinical trial indicate that sustained administration of IFN-gamma is effective in the management of CGD; for patients who received IFN-gamma, a 72% reduction in the relative risk of serious infection was noted in comparison with the risk for patients who received placebo. IFN-gamma reduced not only the number of serious primary infections but also the length of hospitalizations.
Through transduction, a wild-type strain of Shigella flexneri serotype Y (SFL1) was rendered auxotrophic and dependent on aromatic metabolites that are not available in mammalian tissues. Monkeys that were orally vaccinated with 10(11) bacteria of the transductant strain SFL114 remained healthy when challenged with 10(11) bacteria of wild-type strains of S. flexneri serotypes Y, 1b, and 2a. The safety and immunogenicity of SFL114 were next studied in volunteers who were given either 10(9) or 10(10) SFL114 bacteria orally. Mild intestinal discomfort that lasted for 1-2 days was reported by three (12%) of 25 volunteers given 10(9) live SFL114 bacteria and by 13 (54%) of 24 volunteers given 10(10) live SFL114 bacteria. A local intestinal secretory IgA response to the S. flexneri O-antigen was recorded. The in vitro and in vivo results suggest that the aroD transductant SFL114 possesses properties that are desirable in an oral live candidate vaccine.
The role of antibody and, in particular, antibody-dependent cellular cytotoxicity (ADCC) antibodies, in preventing or reducing the severity of infection with herpes simplex virus (HSV) in neonates is controversial. We have shown that human and murine neonates, in contrast with adults, are relatively deficient in ADCC leukocyte effector cell function. In an adoptive transfer model, the combination of ADCC-active human leukocytes and antibody to HSV could protect neonatal mice from lethal infection with HSV. Use of cells defective in ADCC function (e.g., from human neonates or patients with the CD11,18 deficiency in cell surface adhesive integrin) could not provide protection in this model. Finally, in human neonates the level of ADCC antibody at the time of infection with HSV was associated with severity of illness. Thus, ADCC is an important host defense against neonatal infection with HSV.
The primary problems that predispose to aspiration pneumonia include a reduced level of consciousness, dysphagia, periodontal disease, and mechanical interference that is related to the insertion of various tubes into the respiratory or gastrointestinal tracts. The bacterial flora involved include the indigenous oral flora (among which anaerobes predominate) and, in the hospital or a similar setting, nosocomially acquired pathogens such as Staphylococcus aureus and various aerobic and facultative gram-negative bacilli that may colonize patients. Specific etiologic diagnosis is difficult. The most useful materials for reliable anaerobic and aerobic culture are pleural fluid, transtracheal aspirates, and secretions obtained with a protected bronchial brush and during bronchoalveolar lavage. Special care must be taken to avoid normal and colonizing flora and to keep anaerobes viable. Aside from the drainage of empyemas, the primary therapy for aspiration pneumonia involves antimicrobial agents. A number of options are available; the most appropriate mode of therapy depends on the nature of the infecting flora and the severity of the illness.
One hundred fifty-three patients with moderate to severe infections due to gram-negative bacilli, including septicemia (60 cases), lower respiratory tract infection (32 cases), intraabdominal infection (40 cases), and urinary tract infection (21 cases), were treated with aztreonam (1 g every 12 h). This dosage is lower than usual. Criteria for inclusion in the study included documented infection due to gram-negative bacilli and a measurement of severity of disease of less than 12 (as defined by a Simplified Acute Physiology Score for the 115 cases of community-acquired infection). Other than aztreonam, no antibiotic active against gram-negative bacilli was allowed to be used for treatment. Seventy-one patients in whom gram-positive or anaerobic organisms were detected or suspected were given additional agents effective against the organisms. One hundred forty-one patients (92.2%) were cured; the mean duration of treatment was 10.9 +/- 4.0 days. None of the gram-negative bacilli initially isolated became resistant to aztreonam. Colonization, generally by a gram-positive organism, was observed in 27 patients and superinfection was observed in five. Aztreonam was well tolerated. This study suggests that a dosage of 2 g daily of aztreonam should be appropriate in the treatment of moderate to severe infections due to susceptible gram-negative bacilli.
Live attenuated Towne strain cytomegalovirus vaccine was evaluated in healthy volunteers and renal transplant recipients. Immunization induced humoral and cell-mediated immune responses in both groups, although responses were of a higher magnitude in healthy volunteers. Immunization of candidates for renal transplantation with Towne vaccine significantly reduced the incidence of moderately severe and severe cytomegalovirus disease in high-risk recipients after transplantation. Reactivation of vaccine-strain virus was not detected. While the use of live attenuated Towne strain vaccine for prevention of primary cytomegalovirus infections in solid-organ transplant recipients and pregnant women deserves further consideration, efforts are also under way to develop a subunit cytomegalovirus vaccine.
The guinea pig model of genital herpes has proved useful for the evaluation of experimental herpes simplex virus vaccines. The model shares many of the features of genital herpes in humans, including a natural route of inoculation that results in self-limiting primary vulvovaginitis. Latent infection is established in sensory ganglia, and animals experience both spontaneous and ultraviolet radiation-induced recurrence of infection. Many humoral, cellular, and cytokine responses to herpes simplex virus type 2 infection in the guinea pig have been characterized. Both inactivated subunit immunogens and live, attenuated virus have been shown to afford some protection against primary disease, although they generally do not prevent acute viral replication or the establishment of latency. Because latently infected guinea pigs experience recurrent infections, this model has been used to explore immunotherapeutic approaches to the control of recurrent disease. With the development of more defined immunologic reagents, this model should prove useful for exploring the immune responses that are important in the control of primary, latent, and recurrent herpes simplex virus type 2 infections.
This review covers four areas: the use of prophylactic antibiotics in orthopedic surgery not involving prosthetic devices; the use of prophylactic antibiotics in prosthetic joint implantation; the use of antibiotic-containing cement in prosthetic joint surgery; and the use of prophylactic antibiotics for dental procedures in individuals with implanted prosthetic joints. The major conclusions are as follows: (1) Prophylactic antimicrobial agents lower the rate of wound infection following surgery for closed hip fractures. (2) Antimicrobial prophylaxis reduces the frequency of deep wound infection following total joint replacement; operating rooms with ultraclean air have a similar effect. (3) Antibiotic-impregnated cement is as effective as systemic antibiotics in preventing early infection following total joint replacement. (4) For routine dental work in most patients with total joint replacement, there is insufficient evidence to support antibiotic prophylaxis; for such individuals with periodontal disease or potential dental infection, antimicrobial prophylaxis seems indicated.
Although rates of seroconversion following administration of trivalent oral poliovirus vaccine (TOPV) approach 100% in industrialized countries, only 73% (range, 36%-99%) and 70% (range, 40%-99%) of children in developing countries have detectable antibody to poliovirus types 1 and 3, respectively, after three doses. While factors accounting for these differences have not been fully elucidated, available data suggest that type 2 vaccine virus and enteric pathogens often interfere with responses to types 1 and 3 vaccine viruses but that this interference may be overcome by modifying the absolute and relative dosage of the three Sabin types. Increasing the interval between doses beyond 30 days may also be important, in view of the prolonged excretion of vaccine virus and the potential for interference with responses to subsequent doses. Although advances in molecular biology may ultimately lead to the development of more-immunogenic vaccine candidates, approaches such as increasing the number of doses of TOPV, mass vaccination campaigns, and combined use of oral and inactivated vaccines should also be considered.
The primary problems that predispose to aspiration pneumonia include a reduced level of consciousness, dysphagia, periodontal disease, and mechanical interference that is related to the insertion of various tubes into the respiratory or gastrointestinal tracts. The bacterial flora involved include the indigenous oral flora (among which anaerobes predominate) and, in the hospital or a similar setting, nosocomially acquired pathogens such as Staphylococcus aureus and various aerobic and facultative gram-negative bacilli that may colonize patients. Specific etiologic diagnosis is difficult. The most useful materials for reliable anaerobic and aerobic culture are pleural fluid, transtracheal aspirates, and secretions obtained with a protected bronchial brush and during bronchoalveolar lavage. Special care must be taken to avoid normal and colonizing flora and to keep anaerobes viable. Aside from the drainage of empyemas, the primary therapy for aspiration pneumonia involves antimicrobial agents. A number of options are available; the most appropriate mode of therapy depends on the nature of the infecting flora and the severity of the illness.
Journal Article Prognosis of Enterococcal Endocarditis Get access B. Almirante, B. Almirante Hospital Vall d'Hebrón, Hospital Sant Pau, Hospital de Bellvitge, and Hospital Clinic, Barcelona, Spain Correspondence: Dr. Benito Almirante, Sección de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Vall de'Hebrón, Avda. Vall de'Hebrón s/n°, 08035, Barcelona, Spain. Search for other works by this author on: Oxford Academic PubMed Google Scholar M. P. Tornos, M. P. Tornos Hospital Vall d'Hebrón, Hospital Sant Pau, Hospital de Bellvitge, and Hospital Clinic, Barcelona, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar M. Gurgui, M. Gurgui Hospital Vall d'Hebrón, Hospital Sant Pau, Hospital de Bellvitge, and Hospital Clinic, Barcelona, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar M. Pujol, M. Pujol Hospital Vall d'Hebrón, Hospital Sant Pau, Hospital de Bellvitge, and Hospital Clinic, Barcelona, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar J. M. Miró J. M. Miró Hospital Vall d'Hebrón, Hospital Sant Pau, Hospital de Bellvitge, and Hospital Clinic, Barcelona, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Reviews of Infectious Diseases, Volume 13, Issue 6, November 1991, Pages 1248–1249, https://doi.org/10.1093/clinids/13.6.1248 Published: 01 November 1991
Extrapulmonary tuberculosis accounted for 33% of all new cases of tuberculosis identified at the Soroka Medical Center in Beer Sheva, Israel, during a 10-year period. The most common types of extrapulmonary infection diagnosed were genitourinary tuberculosis (54% of patients), lymphadenitis (13%), pleural tuberculosis (9%), and tuberculosis of bones and joints (8%). Of 92 patients, 51% were Jews of Ethiopian origin, 29% were Jews of non-Ethiopian origin, and 20% were Bedouins. Thus, extrapulmonary tuberculosis remains a significant problem for Israel's heterogeneous population.
Journal Article Pneumonia due to Bordetella bronchiseptica in a Patient with AIDS Get access Gary R. Decker, Gary R. Decker Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC Search for other works by this author on: Oxford Academic PubMed Google Scholar James P. Lavelle, James P. Lavelle Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC Correspondence: Dr. James P. Lavelle, Division of Infectious Diseases, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC 20007. Search for other works by this author on: Oxford Academic PubMed Google Scholar Princy N. Kumar, Princy N. Kumar Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC Search for other works by this author on: Oxford Academic PubMed Google Scholar Phillip F. Pierce Phillip F. Pierce Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC Search for other works by this author on: Oxford Academic PubMed Google Scholar Reviews of Infectious Diseases, Volume 13, Issue 6, November 1991, Pages 1250–1251, https://doi.org/10.1093/clinids/13.6.1250 Published: 01 November 1991
