Biomedical subjects
Publications and source records attributed to B Bannister.
We report a case of transverse myelitis presenting with fever and rapidly deteriorating neurological signs associated with Chlamydia psittaci infection. It resolved with no long-standing neurological consequences. Only one previous report has described transverse myelitis in association with psittacosis, and this resulted in permanent neurological sequelae.
This study examines the levels of serum bilirubin, aspartate transaminase and alkaline phosphatase in adults with Plasmodium falciparum malaria. One hundred and six sets of liver function tests were obtained, and 63 (59.4%) patients had one of the above indices elevated outside the local reference range. Serum bilirubin and aspartate transaminase were relatively higher than alkaline phosphatase. Neither duration of illness nor severity of infection showed any significant correlation with any of the indices measured.
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882C87 [1-(beta-D-arabinofuranosyl)-5-propynyluracil] is a nucleoside analogue with potent and specific antiviral activity against varicella-zoster virus (VZV). The IC50 of 882C87 against VZV ranges from 0.6 to 3.8 microM. Potentially therapeutic plasma concentrations are readily achieved in humans; the pharmacokinetics have been previously evaluated in healthy young and elderly (> 65 years) volunteers following single oral doses of 50-400 mg. Thirty immunocompetent patients with localised herpes zoster were treated with 882C87. Groups of patients received 50 mg, 100 mg, or 200 mg tablets of 882C87 every 12 hours for 7 or 7.5 days (14 or 15 doses). Six patients in each group were over 60 years of age. Blood samples for determination of 882C87 concentrations were taken at entry, steady state, and during the elimination phase following the last dose. After the final doses of the 50 mg 100 mg, and 200 mg dosage regimens, the Cmax of 882C87 in patients over 60 years old was 7.7 +/- 3.1 microM, 12.6 +/- 3.5 microM, and 24.8 +/- 14.0 microM, respectively, and the AUCs 0-12 were 78.4 +/- 31.8 microM.hr, 137.5 +/- 22.8 microM.hr, and 272.5 +/- 170.5 microM.hr, respectively. Preliminary estimates of the elimination half-life ranged from 15.1 to 20.0 hr. These preliminary pharmacokinetic data confirmed good dose proportionality for AUC and Cmax with values between those predicted from single dose data in the young and those in elderly volunteers. The plasma concentration profiles at these doses were in excess of IC50 values and support the use of once- or twice-daily regimens in future studies of 882C87 in herpes zoster.
BACKGROUND: A study was designed to determine the extent of the interaction between tuberculosis and human immunodeficiency virus infection in England and Wales. METHODS: Data were obtained from the United Kingdom national AIDS surveillance and the Medical Research Council tuberculosis notification surveys in England and Wales (1983 and 1988). The proportion of patients reported with AIDS known to have had tuberculosis and the proportion of patients notified with tuberculosis known to have HIV infection were estimated. RESULTS: Of the 4360 patients with AIDS reported by 30 June 1991, 200 (4.6%) were in patients reported to have had tuberculosis. Only one of the 3002 patients (0.03%) reported in the 1983 survey of tuberculosis notifications in England and Wales was known to be infected with HIV compared with nine of 2163 patients (0.42%) in the 1988 survey. CONCLUSION: Although the reported number of cases of HIV infection with tuberculosis in this country is increasing it remains small. Complete reporting of cases of AIDS and notification of cases of tuberculosis are essential to enable the two infections to be monitored as the HIV epidemic develops. Special studies, such as those reported here, will need to be undertaken regularly to assess the future extent of the interaction.
In an attempt to improve the isolation of the antibiotic rubradirin from fermentations of Streptomyces achromogenes var. rubradiris, the use of preparative reversed-phase chromatography was investigated. The product isolated was a mixture of rubradirin and a new antibiotic named protorubradirin, of extremely similar structure, which is converted into rubradirin on exposure to light and air. Methanolysis of protorubradirin in the dark yields an anomeric mixture of methyl glycosides of a C-nitroso-sugar, converted photo-oxidatively into the methyl rubranitrosides derived from rubradirin. Thus, protorubradirin is the C-nitroso-analogue of rubradirin. It is suggested that the same relationship between protorubradirin and rubradirin may apply to the anthracycline antibiotics viriplanin A and viriplanin D.
Twenty-nine healthy persons were Schick tested as part of their occupational health examination. All but three of them had been previously immunised against diphtheria. One unimmunised person had a history of diphtheria. Blood samples were taken before and at varied intervals after the Schick tests in order to determine whether the Schick test antigen was immunogenic. Of the 29 persons tested, 21 were Schick-negative, three were Schick-positive. Four pseudoreactors were Schick-negative, one pseudoreactor was Schick-positive. Only four of the 29 had any significant rise in antitoxin titre after Schick testing. Three of these were Schick-negative, while one was a pseudoreactor who was negative at a later reading. We conclude that Schick testing is not reliably immunogenic and that, contrary to expectation, it cannot be assumed to elicit a useful booster response in previously immunised persons.
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The surveillance of cases of the acquired immune deficiency syndrome (AIDS) in the United Kingdom is described and a preliminary analysis made of the 1012 cases that were reported to the end of August 1987. Homosexuals were the largest risk group. For the first time it is possible to present cases by the date of diagnosis and by the regional health authority of residence. The rate of increase of new cases shows no sign of slowing down. One third of patients with AIDS lived in a different regional health authority from that in which their disease had been diagnosed. The geographical distribution varied with the risk group. The commonest presenting clinical feature at diagnosis was Pneumocystis carinii pneumonia. Kaposi's sarcoma was considerably more common among homosexuals than among people in other groups at risk.
Two surveys of antibiotic resistance in hospital pathogens are described. The first is a long-term, multi-center, laboratory based investigation in which antibiotic resistance data from laboratories with computerized reporting is collected. The difficulties of this type of investigation are discussed and some solutions suggested. In the second investigation reports of the isolation of methicillin-resistant Staphylococcus aureus (MRSA) were collected from microbiological laboratories on a nation-wide basis. The results were useful in monitoring the spread of the organism and in its control.
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The aetiology of acute viral hepatitis in 172 patients admitted to an infectious diseases hospital in North London was: hepatitis A in 88 (51%), hepatitis B in 58 (34%), Epstein-Barr (EB) virus in four (2%) and non-A, non-B in 22 (13%). NANB hepatitis was a milder disease than that associated with the other viruses. It predominantly occurred in young men (77%). In half of the cases there was evidence of parenteral transmission. It was not transmitted by sexual contact.
Five days after arriving in London from Jos a young Nigerian women developed a severe and prolonged illness that proved to be Lassa fever. Virus was not detected in urine during the first three weeks but then appeared and reached a peak during the sixth week, with continuing excretion for 67 days after the onset of illness. Laboratory investigations showed evidence of extensive tissue damage and disturbance of clotting, but there was no serious bleeding and she eventually made a complete recovery despite a high sustained viraemia and severe liver damage. Convalescent serum was used in treatment but it was difficult to assess its contribution to the favourable outcome.
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