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Biomedical subjects

D B Fishbein

Publications and source records attributed to D B Fishbein.

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

Lack of correlation between human herpesvirus-6 infection and the course of human immunodeficiency virus infection.

Human herpesvirus-6 (HHV-6) and human immunodeficiency virus (HIV) are both tropic for CD4+ lymphocytes. To determine whether HHV-6 infection affects the susceptibility to or the course of HIV infection, HHV-6 titers were measured by an anticomplement immunofluorescence assay in serum of three groups of homosexual or bisexual men: (1) those with AIDS (n = 78), (2) those with HIV-associated lymphadenopathy (LAS; n = 81), and (3) those who were HIV-seronegative (n = 55). Early and late serum samples were available for 45 men with LAS (median interval 49 months). Men with early LAS did not differ from HIV-seronegative men in either the percentage that were HHV-6-seropositive or in the distribution of titers. There was a significantly lower percentage of seropositives in AIDS patients than in the other two groups (P less than .01). LAS patients who progressed to AIDS did not differ in percentage seropositivity or distribution of titers from nonprogressors. HHV-6 titers tended to decrease over time. HHV-6 titers late in LAS were similar to those in AIDS patients. These findings suggest that it is unlikely that previous exposure to HHV-6 either predisposes to or affects the course of HIV infection.

AIDS-Related Complex↗
PubMed1990

Diagnosis of human ehrlichiosis with the indirect fluorescent antibody test: kinetics and specificity.

Human ehrlichiosis, an acute febrile illness caused by Ehrlichia canis or a closely related rickettsial organism, was first identified in 1986. From 1986 through 1988, sera from 85 patients demonstrated a fourfold rise or fall in antibody titer to E. canis. Seven (22%) of 32 patients initially tested during the first week after onset of illness. 17 (68%) of 25 tested during the second week, and all 18 tested during the third week had titers that exceeded the minimum positive titer of greater than or equal to 80. Of the 85 confirmed ehrlichiosis patients, 31 (36.5%) also had indirect fluorescent antibody titers considered diagnostic of infection with Rickettsia rickettsii, Rickettsia typhi, or Coxiella burnetti, but in most these diagnoses were not supported by epidemiologic, clinical, or serologic evidence. These results emphasize that patients suspected of having a tick-borne infection should be tested for antibodies to E. canis as well as for those to other rickettsiae.

Antibodies, Bacterial↗
PubMed1990

Rabies prevention in Hawaii.

The scientific basis of Hawaii's public health rabies prevention program is discussed, as is a proposed minor modification offered to assist Hawaii residents who use guide dogs and who want to travel out of state. Hawaii's current quarantine program has successfully prevented the introduction of the disease. Alternative programs involve risks that are not easily evaluated.

Animals↗
PubMed1989

Deterioration in immunologic status of human immunodeficiency virus (HIV)-infected homosexual men with lymphadenopathy: prognostic implications.

Changes in immunologic parameters were followed in members of a cohort of human immunodeficiency virus (HIV)-positive homosexual or bisexual men with lymphadenopathy and were analyzed for differences between those who have and those who have not progressed to the acquired immunodeficiency syndrome (AIDS) (progressors, nonprogressors). T helpers and the Th/Ts ratio were lower in progressors than in nonprogressors both at entry into the study and at the latest visit. T suppressors were not different in the two groups at entry but were higher in nonprogressors at the latest visit. Evaluation of the patterns of change over time showed that T helpers and Th/Ts ratios tended to decrease over time in both nonprogressors and progressors, while T suppressors increased in nonprogressors and decreased in progressors. Although progressors had a greater deterioration in immunologic parameters over time, nonprogressors also had significant deterioration when compared with controls. Based on the respective percentages of men with abnormal or normal T helpers or Th/Ts ratio at entry who have already progressed to AIDS, we would conservatively estimate, considering their latest T helpers and Th/Ts ratio, that at least an additional 16 (32%) of our nonprogressors will develop AIDS in the next 5 years.

AIDS-Related Complex↗
PubMed1989

Two-year comparative trial on the immunogenicity and adverse effects of purified chick embryo cell rabies vaccine for pre-exposure immunization.

The human diploid cell rabies vaccine (HDCV) has been shown to be highly immunogenic when used for pre-exposure immunization. However, the high cost of the product and the adverse reactions seen following booster doses of HDCV have limited its use. A purified chick embryo cell (PCEC) rabies vaccine was compared with the HDCV by two routes of administration for reactogenicity, antibody response, duration of antibody, and anamestic response to boosters over a 2 year period. The study showed that the two vaccines were comparable in their immunogenicity and reactogenicity after initial three dose series. No adverse reactions were noted following the 2 year booster with PCEC. The PCEC can be produced at less than one-half the cost of the HDCV.

Adult↗
PubMed1989

Human diploid cell rabies vaccine purified by zonal centrifugation: a controlled study of antibody response and side effects following primary and booster pre-exposure immunizations.

Systemic allergic reactions following booster immunizations have complicated rabies pre-exposure prophylaxis with the human diploid cell rabies vaccine licensed in the US (conventional HDCV). We conducted two studies comparing an HDCV purified by zonal centrifugation to conventional HDCV. In a study of primary pre-exposure immunization, volunteers received one of four regimens: three 1.0-ml intramuscular (i.m.) or 0.1-ml intradermal (i.d.) doses of conventional or purified HDCV over 28 days. Although volunteers vaccinated i.m. had significantly greater rabies neutralizing antibody titres (VNA) 49 days, 91 days and 26 months after immunization began than volunteers vaccinated i.d. (p less than 0.005-p less than 0.05), there were no significant differences between vaccines. In a study of booster immunizations, 77 volunteers immunized with conventional HDCV 2 years earlier received a 0.1-ml i.d. booster with either conventional or purified HDCV. VNA was significantly greater with the conventional HDCV on days 7 and 28 after booster, but not on day 365. A moderate or severe reaction was reported by 5 (13%) of the 40 persons who received boosters with conventional HDCV, versus none of 37 who received the purified HDCV (p = 0.03). Purified HDCV appears to be preferable to conventional HDCV for booster vaccination.

Antibodies, Viral↗
PubMed1989

An outbreak of ehrlichiosis in members of an Army Reserve unit exposed to ticks.

An outbreak of unexplained illness occurred in members of an army reserve unit after field training in an area of New Jersey endemic for Lyme disease. Nine (12%) of the 74 who attended the exercise had serological evidence of Ehrlichia infection, defined as a single rise in titer of antibody to Ehrlichia canis greater than or equal to 1:160 four weeks after training. Two reservists with early serum samples had documented seroconversion, defined by a four-fold or greater increase in titer of antibody to E. canis, with a peak titer of greater than or equal to 1:160. Reservists with serological evidence of Ehrlichia infection were more than three times as likely to report arthralgia, myalgia, headache, appetite loss, nausea, eye pain, and abdominal pain than the other reservists. No reservist with serological evidence of Ehrlichia infection was hospitalized and most had minimal or no symptoms. This outbreak of ehrlichiosis suggests that the usual symptoms of Ehrlichia infection are milder than previously reported and that ehrlichiosis must be considered in symptomatic persons with recent tick exposure.

Animals↗
PubMed1989

Human ehrlichiosis: prospective active surveillance in febrile hospitalized patients.

Between 1 April 1987 and 30 September 1988 prospective active surveillance of human ehrlichiosis was conducted among febrile patients hospitalized in southeast Georgia. If disease of the immune system, bacterial infection, pneumonia, or surgical illness was documented by the end of the first full day of hospitalization, the patient was excluded. Of 75 patients enrolled in the study, 8 (10.7%) had a fourfold rise or fall in titer to Ehrlichia canis (case-patients). The rate was 5.3 cases/100,000 population. Case-patients were more likely than noncase patients to have become ill in May or June (P = .008) and to report a recent tick bite (P less than .001). At hospital admission, case-patients had lower white blood cell counts (median, 4,450/mm3; P = .001), platelet counts (median, 133,000/mm3 P less than .001), and higher aspartate aminotransferase (median, 68 IU/ml; P = .004) and alanine aminotransferase levels (median, 62 IU/ml; P = .038).

Animals↗
PubMed1989

An epidemic of acute hemorrhagic conjunctivitis in American Samoa caused by coxsackievirus A24 variant.

Between May 25 and July 5, 1986, an epidemic of acute hemorrhagic conjunctivitis affected an estimated 47% of the population on American Samoa. Coxsackievirus A24 variant was isolated from 18 of 22 patients. This is the first documented outbreak of acute hemorrhagic conjunctivitis due to coxsackievirus A24 variant outside of Southeast Asia and the Indian subcontinent. When this outbreak was compared with an outbreak on the island in 1981-1982 caused by enterovirus 70, conjunctival hemorrhage or injection and the severity of hemorrhage were less prevalent among cases in 1986, while upper respiratory and systemic symptoms were more common. Residents of traditional housing had significantly higher attack rates (48%) than residents of government housing (23%). Serum specimens collected from the residents of Samoa in 1985, before the outbreak, unexpectedly revealed the presence of neutralizing antibodies against coxsackievirus A24 variant. The presence of these antibodies correlated with protection against coxsackievirus A24 variant infection in this outbreak.

Adolescent↗
PubMed1989

Human ehrlichiosis.

Ehrlichiosis is one of the latest tick-borne illnesses to be reported in humans. The authors describe two cases of this rickettsial disease that were apparently acquired in Missouri. They discuss diagnosis and treatment.

Animals↗
PubMed1988

A six-year follow-up of HIV-infected homosexual men with lymphadenopathy. Evidence for an increased risk for developing AIDS after the third year of lymphadenopathy.

Seventy-five homosexual men with generalized lymphadenopathy for at least three months (lymphadenopathy syndrome [LAS]), subsequently shown to be seropositive for antibody against human immunodeficiency virus, were enrolled in a prospective study in Atlanta in 1982 and 1983. As of Nov 30, 1987, twenty-two (29%) of the 75 were known to have developed acquired immunodeficiency syndrome (AIDS) three to 60 months after enrollment and five to 69 months after onset of LAS. The six-year cumulative incidence of AIDS, by Kaplan-Meier survival analysis, was 38%. The cumulative incidence in years 4, 5, and 6 (30%) was significantly higher than in years 1, 2, and 3 (11%), suggesting that the risk for AIDS increases after the third year of LAS and that many more study participants will eventually develop AIDS. A precipitous decline in the T-helper cell count frequently heralds the diagnosis of AIDS; this decrease appears to occur at different times after the onset of LAS in different persons. The four-year cumulative incidence of AIDS following observations of T-helper cell counts less than 200/mm3, 200 to 299/mm3, 300 to 399/mm3, and 400/mm3 or greater was 84%, 41%, 25%, and 18%, respectively; these data are important for determining prognosis in the individual patient as well as for determining the suitability of candidates and baseline data for drug trials.

AIDS-Related Complex↗