Search PubMed⌕ Search

Biomedical subjects

D B Fishbein

Publications and source records attributed to D B Fishbein.

At least 73 records · Page 4Linked to original sources
PubMed1988

Ehrlichiosis: a cause of bone marrow hypoplasia in humans.

Infection with Ehrlichia canis should be suspected in patients with fever, headache, malaise, leukopenia, thrombocytopenia, and a history of recent exposure to ticks. The cytopenia is caused by bone marrow hypoplasia which may be severe. The disease may be confused with spotless Rocky Mountain spotted fever but can be differentiated from this infection serologically with acute and convalescent sea. In humans, recovery has occurred with and without antibiotic therapy. However, prompt antibiotic therapy is advised prior to serologic studies, especially in immunocompromised individuals, splenectomized persons, and patients with AIDS-who may develop a more overwhelming rickettsial infection.

Bone Marrow↗
PubMed1988

Community outbreak of thyrotoxicosis: epidemiology, immunogenetic characteristics, and long-term outcome.

Between January and March 1984, the first community outbreak of transient thyrotoxicosis in the United States was documented in a seven-county area of southeastern Nebraska; 36 of the total 49 patients resided in York County (2.4 cases per 1,000 population). The median age of patients was 36 years, range six to 82 years; 51 percent were women. By definition, all patients were symptomatic, visited a physician, and had a newly identified elevated serum concentration of thyroxine or triiodothyronine of unknown cause. None had a goiter or a painful thyroid gland. Low 131I uptake measurements were found in all nine patients studied. Six patients were hospitalized; none died. Investigation of all 12 household contacts of eight selected patients revealed five additional persons with thyrotoxicosis and four with asymptomatic hyperthyroxinemia. A case-control study revealed that illness was associated with a significantly higher frequency of a reported recent respiratory viral-like condition. In another case-control study, the HLA-DR3 antigen was present in more case subjects (39 percent) than control subjects (14 percent). In addition, a significantly higher proportion of patients than control subjects purchased beef from one of the three supermarkets in York Country. Concomitant with the outbreak, the supermarket implicated in the outbreak purchased an unusually large quantity of beef (7,000 pounds) from a nonregular supplier in Nebraska, which had reportedly instituted the practice of trimming gullets (a procedure that removes the muscles from bovine larynx for beef) about three months earlier. Thus, it is concluded that the Nebraska outbreak, like one in Minnesota that occurred 18 months later, probably resulted from patients having eaten ground beef that was contaminated with bovine thyroid gland. This form of thyrotoxicosis, perhaps misdiagnosed as painless thyroiditis in the past, probably represents a previously under-recognized public health problem.

Adult↗
PubMed1987

Rabies prevention in primary care. A four-step approach.

Although most physicians in the United States have not seen a person with rabies, the primary care physician is often confronted with a patient who has been bitten by an animal capable of transmitting rabies virus. Rabies is almost always transmitted by a bite; licks and other nonbite exposures hardly ever cause the disease. The control of rabies in domestic animals has greatly reduced the risk of human disease following the bite of a dog or cat, but rabies in wild animals (especially skunks and raccoons) remains a constant threat. By obtaining epidemiologic information about animal rabies in the area where the exposure occurred, the physician can determine whether the animal in question may have been rabid. If any question remains, owned dogs and cats should be observed for ten days and any other animal should be killed and its brain examined for rabies virus. When postexposure prophylaxis is indicated, it should be administered exactly as recommended herein.

Algorithms↗
PubMed1987

Unexplained febrile illnesses after exposure to ticks. Infection with an Ehrlichia?

The Ehrlichia are tick-borne rickettsial organisms that cause disease in animals throughout the world but that have been previously recognized as human pathogens only in Asia. We have identified six patients with serological evidence of recent infection with an Ehrlichia: a fourfold or greater rise or fall in titer to Ehrlichia canis. All of the patients reported recent tick bites. Rigors, myalgia, headache, nausea, and anorexia were each reported by five patients. Fever was present in all patients and was accompanied by relative bradycardia and leukopenia in five patients, thrombocytopenia and abnormal liver function test results in four, and anemia in three. Five of the six patients were treated with tetracycline hydrochloride, and all recovered. Infection with Ehrlichia should be considered in patients with unexplained febrile illnesses after tick exposure.

Adult↗
PubMed1987

An outbreak of thyrotoxicosis caused by the consumption of bovine thyroid gland in ground beef.

We report an outbreak of thyrotoxicosis without true hyperthyroidism that occurred between April 1984 and August 1985 among residents of southwestern Minnesota and adjacent areas of South Dakota and Iowa. One hundred twenty-one cases were identified through surveillance of medical clinics, laboratories, hospitals, and physicians' offices. Investigation of the outbreak demonstrated an association between the occurrence of thyrotoxicosis and the consumption of ground beef prepared from neck trimmings processed by a single slaughtering plant (odds ratio, 19.0; P = 0.0001). The cause was confirmed by the findings of bovine thyroid tissue in samples of these trimmings and high concentrations of thyroid hormone in implicated samples of ground beef and the demonstration of prompt increases in serum thyroid hormone concentrations in volunteers who ate the implicated ground beef. Bovine thyroid tissue had been introduced into the neck trimmings inadvertently during the process of "gullet trimming," a procedure that harvests muscles from the bovine larynx. The outbreak resolved after this procedure was discontinued at the plant. The clinical features of the illness suggested the diagnosis of silent thyroiditis, and it is possible that sporadic cases--or even outbreaks--of thyrotoxicosis factitia caused by this mechanism may have occurred in the past but were not recognized.

Adolescent↗
PubMed1987

Lymphadenopathy syndrome in homosexual men. Evidence for continuing risk of developing the acquired immunodeficiency syndrome.

Seventy-five homosexual men with lymphadenopathy syndrome (LAS) for three months or more and antibody against the human immunodeficiency virus were enrolled in a prospective study in Atlanta in 1982 and 1983. Fourteen developed the acquired immunodeficiency syndrome (AIDS) three to 38 months after enrollment in the study and five to 56 months after onset of LAS. The five-year cumulative incidence rate of AIDS after onset of LAS was 29%; yearly incidence rates showed no decreasing trend with time. Of 18 patients with constitutional symptoms and a low T-helper cell count at their first visit, nine developed AIDS; of the remaining 57 patients, five developed AIDS (five-year cumulative incidence rates, 57% and 18%, respectively, P less than .001). Patients with lymphadenopathy syndrome are at continuing risk for the development of AIDS. Those with constitutional symptoms and a low T-helper cell count at their first visit appear to be at higher risk; other LAS patients are at lower risk but may still develop AIDS.

AIDS-Related Complex↗
PubMed1987

Rabies preexposure prophylaxis with human diploid cell rabies vaccine: a dose-response study.

Recent studies suggest that human diploid cell rabies vaccine (HDCV) may not always produce acceptable titers after intradermal (id) preexposure prophylaxis. To stimulate accidental deviation from the recommended route of administration and to determine the immunogenicity of smaller-than-recommended doses of HDCV, we injected each of 154 persons either intramuscularly (im) with 100%, 10%, or 3% of the standard im dose of vaccine or id with 10%, 3% or 1% of the standard im dose. Seroconversion (titers of antibody greater than or equal to 1:11) was found in all subjects at 49 and 90 days after vaccination. Titers were higher for subjects receiving 100% of the recommended dose im than for those receiving 10% of this dose id (P less than .01); these titers in turn were higher than those from persons receiving smaller doses (P less than .05). Persons receiving 10% or 3% of the standard im dose had lower titers on day 49 than did those receiving the same dose id (P less than .05).

Antibodies, Viral↗
PubMed1987

Microneutralization test for rabies virus based on an enzyme immunoassay.

We have developed an enzyme immunoassay for rabies virus by using acetone-fixed infected cell cultures as the antigen. This test was used to demonstrate virus-neutralizing antibodies in human and animal sera and was as sensitive as and easier to perform than the rapid fluorescent-focus inhibition technique.

Animals↗
PubMed1987

Cellular and humoral immune response to a phenolic glycolipid antigen (PhenGL-I) in patients with leprosy.

The ability of phenolic glycolipid I (PhenGL-I) of Mycobacterium leprae to stimulate in vitro lymphocyte proliferation (LP) was tested in cultures of peripheral blood cells from 42 patients with leprosy in Chicago and Thailand, 9 individuals with household contact in Thailand, and 10 unexposed North American controls. Only 10 responders (24%) were found among the patients, and the degree of LP was small. Responders were found among patients with lepromatous (18%) or tuberculoid (30%) leprosy without relation to age, complications, duration of treatment, or lepromin responsiveness. The specificity of the response was supported by a lack of response to two other glycolipids, by responses by T cells but not B cells, and by the observation that three of four responders tested maintained their responses to PhenGL-I for at least 1 year. Serum immunoglobulin M (IgM) and IgG antibodies were measured in the same patients by using PhenGL-I or its terminal monosaccharide conjugated to a bovine serum albumin carrier in an enzyme-linked immunosorbent assay. The presence of IgM antibody correlated negatively with LP to lepromin and to PhenGL-I in patients with tuberculoid leprosy. We conclude that circulating T cells from some leprosy patients proliferate in the presence of PhenGL-I in vitro, but the response is weak, possibly due to concomitant suppression or inhibition. The predominance of IgM antibody to PhenGL-I may be related to a lack of a T-helper-cell-mediated switch to IgG antibody response.

Antibodies, Bacterial↗
PubMed1987

Antibody response to human immunodeficiency virus in homosexual men. Relation of antibody specificity, titer, and isotype to clinical status, severity of immunodeficiency, and disease progression.

The titers and isotypes of antibodies to specific proteins of the human immunodeficiency virus were determined by Western blot analysis of sera from 107 homosexual men. Antibody titers were generally lower in sera from patients with the acquired immunodeficiency syndrome (AIDS) and in sera from men whose condition subsequently progressed to AIDS than in sera from men who had not progressed to AIDS. We found no evidence of isotypic prominence or restriction of the antibody response. In multivariate analysis, lower levels of CD4 helper cells were most highly associated with progression to AIDS. Lower antibody titers to the envelope protein gp110, the core protein p24, and the reverse transcriptase enzyme p51/65 were also predictive of progression to AIDS independent of their association with CD4 cell levels. These data suggest that differences in antibody levels are not simply a consequence of severe immunodeficiency but may be markers for control of infection.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Antibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine.

We conducted a randomized controlled trial to evaluate the antibody response of freshman veterinary students to intradermal human diploid-cell rabies vaccine administered concurrently with chloroquine, a drug frequently used for chemoprophylaxis against malaria. Fifty-one students who had not been vaccinated against rabies were enrolled: 26 received 300 mg of chloroquine base per week (the recommended dose for malaria prophylaxis); 25 did not receive chloroquine and served as controls. All subjects received 0.1 ml of rabies vaccine intradermally on days 0, 7, and 28. Chloroquine was administered weekly to the treatment group, beginning nine days before the first dose of vaccine and continuing until day 48. The mean rabies-neutralizing antibody titer for the chloroquine group was significantly lower than that for the control group on each day of testing--i.e., day 28 (P = 0.0094), day 49 (P = 0.0008), and day 105 (P = 0.0002)--although both groups had neutralizing antibody titers on days 49 and 105, according to the criteria of the Centers for Disease Control. The blood concentrations of chloroquine and desethylchloroquine (the major metabolite of chloroquine, which also has antimalarial properties) were negatively associated with log antibody titers. These results indicate that chloroquine taken in the dose recommended for malaria prophylaxis can reduce the antibody response to primary immunization with intradermal human diploid-cell rabies vaccine.

Adult↗