Search PubMed⌕ Search

Biomedical subjects

C M Wilfert

Publications and source records attributed to C M Wilfert.

At least 55 records · Page 3Linked to original sources
PubMed1990

Epidemiology of Haemophilus influenzae type b infections.

Haemophilus influenzae type b is a human bacterial pathogen that causes approximately 12,000 cases of H influenzae type b meningitis and 7500 cases of other forms of invasive disease annually in the United States. This organism is the leading cause of bacterial meningitis in the United States. The cause of meningitis can be established more accurately than that of other forms of invasive bacterial disease because the isolation of the bacterium from the cerebrospinal fluid or blood and/or the detection of bacterial antigen can correctly attribute the infection to a specific bacterial agent and dictate appropriate antimicrobial therapy. In children, more than 95% of all invasive diseases attributable to Haemophilus species, including septicemia, pneumonia, epiglottis, cellulitis, arthritis, osteomyelitis, and pericarditis, are due to H influenzae type b. It has been estimated that systemic disease caused by H influenzae type b occurs in approximately 1 in 200 children in the United States before the age of five. The case fatality rate for H influenzae type b meningitis is approximately 5%, and substantial morbidity has also been documented to result from central nervous system infection with this agent. Of surviving children reported in a 1969 paper, 40% had significant neurologic sequelae after meningitis. A more recent study demonstrated substantial neurologic improvement during the first few months after hospitalization, but at 1 year of age 8% of the children had neurologic or intellectual sequelae of their meningitis. Milder defects with an array of developmental problems have been reported in as many as one third to one half of all survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Immunogenicity of Haemophilus b conjugate vaccine (meningococcal protein conjugate) in children with prior invasive Haemophilus influenzae type b disease.

Children younger than 2 years of age with previous invasive Haemophilus influenzae (Hib) type b disease may not develop protective antibodies to antigens of Hib and may be at risk of developing a second episode of Hib disease. Twenty-three children with prior Hib disease were immunized with Haemophilus b conjugate vaccine (meningococcal protein conjugate). Children 12 to 24 months of age were given one dose of vaccine and children younger than 12 months of age were given 2 doses 2 months apart. Antibody to the polysaccharide capsule of Hib (PRP) was measured by radioimmunoassay. Eighteen children had preimmunization serum antibody concentrations less than 0.150 micrograms/ml. All 18 children responded with greater than 0.150 micrograms/ml of antibody after a single dose of vaccine. Only 1 of the 23 children had a preimmunization serum antibody concentration greater than 1.000 micrograms/ml. Seventeen children ultimately responded with greater than 1.000 micrograms/ml of antibody (P less than 0.0001), concentrations of antibody thought to correlate with protection. Haemophilus b conjugate vaccine (meningococcal protein conjugate) is immunogenic in children with invasive Hib disease. Children younger than 2 years of age with invasive Hib disease should be subsequently immunized with a Hib conjugate vaccine.

Age Factors↗
PubMed1988

Cytomegalovirus infection in a neonatal intensive care unit. Blood transfusion practices and incidence of infection.

We studied blood transfusion variables and cytomegalovirus (CMV) infection in 385 infants admitted to the Duke University Medical Center, Durham, NC, neonatal intensive care unit over 14 months. Cytomegalovirus antibody titers were measured at birth and monthly thereafter. Urine cultures for CMV were performed regularly. Infants admitted in the first six months (n = 197) received conventionally prepared blood. Infants admitted in the remaining eight months (n = 188) were given frozen, deglycerolized blood. Of the 105 infants weighing 1250 g or less (low birth weight [LBW]), 90 (86%) received transfusions. Two hundred eighty infants weighed more than 1250 g (non-LBW), and 111 (40%) of these were given blood. In the first six months of the study, three infants had CMV viruria. One case was congenital; two were acquired. Both infants who acquired infection were antibody-positive at birth and received multiple transfusions. In the remaining eight months, five infants had CMV viruria. Two cases were congenital; three were acquired. The three infants who acquired infection were antibody-positive at birth and received multiple transfusions. Our study demonstrates that infants with an LBW are more likely to receive blood transfusion and to be given significantly more blood than non-LBW infants. There was no difference in the number of infants acquiring CMV in the two periods despite the use of different preparations of blood.

Antibodies, Viral↗
PubMed1986

Persistent infection of rat insulinoma cells with Coxsackie B4 virus. Brief report.

Plaque purified Coxsackie B4 virus (CB4) caused a persistent infection of rat insulinoma (RIN) cells which lasted for the 70 day observation period. Infectious virus was produced and no cytopathic effect was observed. Indirect immunofluorescence and infectious center assays demonstrated that a majority of RIN cells were infected. Defective interfering particles were not demonstrated. Despite persistent infection, insulin synthesis by RIN cells was not altered.

Adenoma, Islet Cell↗
PubMed1986

Herpes simplex virus encephalitis in children: analysis of cerebrospinal fluid and progressive neurodevelopmental deterioration.

In this retrospective study of six patients (five infants and one child) with herpes simplex virus (HSV) encephalitis, we report the results of developmental evaluations and assays of cerebrospinal fluid (CSF) that were performed more than one month after the onset of disease. Two infants had recurrence or worsening of disease immediately after completing parenteral therapy. Two other infants had late developmental deterioration of previously attained abilities, which was associated with pleocytosis and/or elevation of the protein concentration in CSF during the year after acute HSV encephalitis. Three of the five infants had severe neurological and developmental impairment, and all of them had late CSF pleocytosis and/or elevated protein concentrations. Two infants were treated with oral acyclovir after completing parenteral therapy; they had mild neurological impairment and no further CSF abnormalities. Periodic activation of latent virus may be the cause of inflammatory responses of the CSF that lead to continued or intermittent neurological and developmental damage. Our data suggest that HSV encephalitis in infants may result in late persistent or recurrent disease of the central nervous system.

Antibodies, Viral↗
PubMed1985

The prevalence of antibodies to Rickettsia rickettsii in an area endemic for Rocky Mountain spotted fever.

A study of Rickettsia rickettsii was conducted in Rowan, Cabarrus, and Granville counties, North Carolina in an attempt to define the prevalence of endemic infection in this area. Serum samples were obtained from 1,976 healthy persons and tested by indirect hemagglutination for detectable antibodies to R. rickettsii. Of this group, 568 (28.7%) had detectable antibody (greater than or equal to 1:8), 80 (4%) had titers greater than or equal to 1:64, and 1,408 (70%) had no detectable antibody (less than or equal 1:8). Indirect immunofluorescence testing for antibody was also performed for 315 (15%) of the serum samples, of which 301 (95%) had undetectable titers and 14 (5%) had detectable titers ranging from 1:8 to greater than or equal to 1:64. Serological reactivity by indirect hemagglutination was detected in persons in the absence of known Rocky Mountain spotted fever. The study failed to show a good correlation of either the height of the geometric mean titer or percentage of seropositive persons with the previously determined age-related rates of acquisition of the disease. These data suggest that the antibodies measured may not be specific for R. rickettsii or that the antibody levels wane with time or both. It is probable that unrecognized infection occurs, but the true incidence or prevalence cannot be determined by available serological tests.

Adolescent↗
PubMed1985

Serological evidence of Hantaan virus infection in the United States.

We found low titers of fluorescent antibodies against Hantaan virus, the etiologic agent of Korean hemorrhagic fever, in sera from 7 of 1,035 patients with febrile illnesses of unknown origin and from 6 of 664 blood donors in the United States. All but 1 of these individuals possessed neutralizing antibodies against Hantaan virus. This was a 31-year-old research technician who had worked with laboratory rodents with virus-induced tumors, but had not traveled abroad, suggesting that infection with Hantaan virus or a closely related agent was locally acquired. However, the precise source of his infection remains unclear.

Adult↗
PubMed1984

Epidemiology of Rocky Mountain spotted fever as determined by active surveillance.

Prospective, active surveillance for Rocky Mountain Spotted fever (RMSF) was undertaken in two North Carolina counties for the years 1979-1981. Appropriate age, sex, and geographically matched controls were compared with the serologically confirmed cases of disease. Patients who were suspected of having infection, but were shown not to have RMSF, were also compared with the serologically proven cases. Ninety-eight cases were identified, and three of these patients died. The mean annual incidence of RMSF in these two counties was 14.59 cases/100,000 population. Identified cases occurred between the months of March and September. The overall mean annual incidence for men was 19.65/100,000 and for women 10.3/100,000. The study suggests that persons contracting RMSF are exposed to the vectors at their residences, which tend to be detached dwellings in woody, brushy areas. Children are more likely than adults both to be seen by physicians early in the illness and to be checked for ticks. Eighty-four percent of patients with serologically confirmed cases developed a rash. The epidemiology of RMSF in these two endemic counties is described.

Adolescent↗
PubMed1983

Disseminated parainfluenza infection in a child with severe combined immunodeficiency.

An 8-month-old male infant with severe combined immunodeficiency syndrome was admitted to the hospital with pneumonitis and, subsequently, died at 21 months of age. During his lengthy hospitalization, parainfluenza virus type 3 (PIV-3) was isolated from respiratory secretions and unusual sites, such as pericardial fluid, CSF, and WBCs. A postmortem examination showed apparent viral pancreatitis, and PIV-3 was isolated from the lung, brain, and pericardial fluid. To our knowledge, this is the first reported case of disseminated parainfluenza infection identified during life. We speculated that a mutant fusion protein may have been elaborated by the virus, allowing dissemination beyond the respiratory tract.

Brain↗
PubMed1983

Detection of Rickettsia rickettsii antibodies in human sera by crossed immunoelectrophoresis.

To identify Rickettsia rickettsii antigens of immunological importance, we examined sera from patients with serologically confirmed cases of Rocky Mountain spotted fever by crossed immunoelectrophoresis for antibodies to antigens extracted from the R strain of R. rickettsii with the detergent Triton X-100. Sixteen antigens were identified in the detergent extract by crossed immunoelectrophoresis with a hyperimmune rabbit serum raised against whole rickettsiae. When the rabbit antiserum was placed in the reference gel and patient sera were placed in the intermediate gel, antibodies to one or more antigens were detected in 61 of 71 North Carolina sera, all of 7 Oklahoma sera, and 9 of 10 Montana sera obtained from 1 day to 40 years after onset of Rocky Mountain spotted fever. Antibodies to antigens 1 and 16 were found as early as 1 day after onset of illness, and antibody to 16 was found in 20 of 29 sera obtained within the first 7 days of illness. Antibodies to antigens 2 and 3 generally did not appear until the third week of illness but were found in six of seven serum samples collected 4 to 40 years after onset of Rocky Mountain spotted fever. Antibodies to R. rickettsii antigens 1, 7, 8, and 16 were found in sera from patients with illnesses caused by other etiological agents. Four of the Oklahoma and Montana sera from Rocky Mountain spotted fever patients, but none of the North Carolina sera, had antibodies to antigen 12. Sera containing antibodies against antigens 3 and 14 prevented death of mice challenged with two 50% lethal doses of R. rickettsii.

Animals↗
PubMed1982

Pathogenicity of acyclovir-resistant herpes simplex virus type 1 from an immunodeficient child.

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.

Acyclovir↗
PubMed1982

Restriction endonuclease analysis of cytomegalovirus deoxyribonucleic acid as an epidemiologic tool.

The possibility of transmission of cytomegalovirus (CMV) from congenitally infected infants to susceptible medical personnel produces anxiety because the risks have not been defined. A physician conceived her first child while caring for an infant in the intensive care nursery who died with congenital CMV infection. The physician had serologic evidence of active CMV infection confirmed by isolation of virus from multiple sites. She elected to have her pregnancy interrupted. CMV was isolated from the placenta and fetal brain. Restriction enzyme analysis was employed to test all the CMV isolated for genetic relatedness. Virus isolated from the physician and her fetus was identical. The virus from the index nursery infant was different from the strain infecting the physician and her fetus. These data indicate that the physician acquired her virus from a source other than the index infant.

Abortion, Therapeutic↗
PubMed1981

Fungal infection in chronic granulomatous disease. The importance of the phagocyte in defense against fungi.

Among 245 cases of chronic granulomatous disease which were evaluated, fungal infection occurred in 20.4 percent. Fungi encountered include Aspergillus, Torulopsis and Candida. In 18 percent of the patients with fungal infection, the disease was limited to soft tissue or bone; all did well. Most of the patients had fungal pneumonia and/or widely disseminated disease; diagnosis was usually confirmed by open lung biopsy. Patients with pneumonia or disseminated disease who received no therapy succumbed to infection, whereas more than half the patients who received antifungal therapy were cured. Modalities of treatment included antifungal chemotherapy, surgical removal of infected tissue and granulocyte transfusion. Although several patients showed dramatic improvement during granulocyte transfusions given in combination with antifungal chemotherapy, the improvement achieved was not statistically significant when compared with that achieved with chemotherapy alone. These results emphasized the importance of phagocytic cells in defense against fungi and the need for further evaluation of granulocyte transfusion therapy in compromised hosts in whom fungal infections develop.

Adolescent↗
PubMed1981

Longitudinal assessment of children with enteroviral meningitis during the first three months of life.

Nine children who had enteroviral meningitis during the first three months of life and nine matched control children were evaluated for possible sequelae of their infection. The mean age of the children with meningitis was 46.67 months at the time of testing and that of the control subjects was 47.33 months. The mean IQ level of 89.67 obtained in the control children. Receptive vocabulary testing suggested that the receptive language functioning of the group with meningitis was significantly less than that of the control group. There was no significant difference in head circumference, no detectable sensorineural hearing loss, and no detected difference in intellectual functioning between the meningitis group and matched control subjects.

Cephalometry↗