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Biomedical subjects

D T Durack

Publications and source records attributed to D T Durack.

At least 55 records · Page 3Linked to original sources
PubMed1988

Manifestations of human T-lymphotropic virus type I infection.

HTLV-I, the first human oncovirus, is a type C retrovirus linked to the development of ATLL. The virus shows a striking ethnogeographic distribution that is only partially understood. Certain populations at high risk for AIDS appear to have a higher incidence of HTLV-I infection. The extended latent period renders present knowledge of the sequelae and natural history of HTLV-I seropositivity incomplete, although recent data suggest that HTLV-I infection may have important implications for blood transfusion, organ transfer, and public health policy. A variety of clinical syndromes have been associated with infection, ranging from an asymptomatic carrier state to acute ATLL with lymphadenopathy, hepatosplenomegaly, hypercalcemia, cutaneous lesions, and systemic immunosuppression. Conventional chemotherapy is marginally effective; innovative approaches to therapy are presently being evaluated.

Deltaretrovirus↗
PubMed1988

Intravenous acyclovir therapy of first episodes of genital herpes: a multicenter double-blind, placebo-controlled trial.

PURPOSE: A collaborative multicenter double-blind, placebo-controlled trial of intravenous acyclovir treatment of first-episode genital herpes was performed in order to substantiate previous findings on the efficacy and safety of this drug, to evaluate the influence of parenteral therapy on recurrence frequency, and to obtain further data on the natural history of genital herpes. PATIENTS AND METHODS: Eighty-two patients with first episodes of genital herpes simplex virus (HSV) infection were randomly assigned in a double-blind fashion to treatment with intravenous acyclovir (5 mg/kg every eight hours) or placebo for five days. Before therapy, all lesions in the genital/perineal area and in extragenital sites were cultured. New lesions appearing in both areas after the onset of therapy were cultured separately. Lesions in all groups were cultured until completely healed. Sera were collected from all patients on entry to the study and on Day 21 to determine presence or absence of antibodies to HSV-1 and HSV-2. Time to healing, time to crusting, time to cessation of viral shedding, and appearance of new lesions during therapy were compared for each treatment group. RESULTS: Patients receiving acyclovir experienced a significant reduction in the median duration of pain (4.3 versus 4.8 days, p = 0.019), viral shedding (1.9 versus 8.4 days, p less than 0.001), and time to healing (8.4 versus 11.5 days, p = 0.02) compared with placebo recipients. These differences were largely attributable to the effect of therapy in the subset of patients with primary disease in whom acyclovir reduced the median duration of pain from 10.6 days to 4.2 days, the median duration of viral shedding from 17.1 days to 1.9 days, and the median time to healing from 14.2 days to 8.3 days. The rate of subsequent recurrence of genital herpes was not altered by acyclovir treatment: 24 of 32 acyclovir recipients (75 percent) experienced one or more recurrences during a mean follow-up of 14 months compared with 19 of 27 placebo recipients (70 percent). Among patients experiencing recurrences, the mean number of recurrences per month among acyclovir recipients was 0.25 compared with 0.19 for patients given placebo. CONCLUSION: This multicenter trial confirms the efficacy of intravenous acyclovir in the management of first-episode genital herpes, especially in patients with primary infection. However, therapy did not alter the frequency of recurrences.

Acyclovir↗
PubMed1988

Cerebrospinal fluid macrophage response to experimental cryptococcal meningitis: relationship between in vivo and in vitro measurements of cytotoxicity.

The functional abilities of macrophages from cerebrospinal fluid (CSF) have so far been little studied. We examined the acquisition of activation characteristics by CSF macrophages during the course of experimental cryptococcal meningitis. CSF macrophages developed the ability for increased reactive oxidative intermediate (H2O2) production and tumor and fungal cytotoxicity. Despite having been activated, CSF macrophages could not inhibit the growth of Cryptococcus neoformans in vitro. Immunosuppression with cyclosporine, which eliminates the natural resistance of rabbits to cryptococcal meningitis, did not prevent or diminish H2O2 production by CSF macrophages but did reduce their tumoricidal activity. Activation of CSF macrophages appears to be an integral part of the central nervous system immune response to C. neoformans in this model, but alone is insufficient to eliminate C. neoformans from the central nervous system.

Animals↗
PubMed1988

Specific amino acid (L-arginine) requirement for the microbiostatic activity of murine macrophages.

The microbiostatic action of macrophages was studied in vitro employing peritoneal cytotoxic macrophages (CM) from mice acting against Cryptococcus neoformans cultured in Dulbecco's medium with 10% dialyzed fetal bovine serum. Fungistasis was measured using electronic particle counting after lysis of macrophages with detergent. Macrophage fungistasis failed in medium lacking only L-arginine. Complete fungistasis was restored by L-arginine; restoration was concentration dependent, maximal at 200 microM. Deletion of all other essential amino acids did not abrogate fungistasis provided that L-arginine was present. Of twenty guanido compounds, including D-arginine, only three (L-arginine, L-homoarginine, and L-arginine methylester) supported fungistasis. Known activators or mediators of macrophage cytotoxicity (endotoxin, interferon gamma, tumor necrosis factor) did not replace L-arginine for CM-mediated fungistasis. The guanido analogue NG-monomethyl-L-arginine was a potent competitive inhibitor of CM-mediated fungistasis giving 50% inhibition at an inhibitor/L-arginine ratio of 1:27. Although CM completely blocked fungal reproduction via an L-arginine-dependent mechanism, the majority of the dormant fungi remained viable. Thus, this mechanism is viewed as a microbiostatic process similar or identical to the tumoristatic effect of macrophages. This suggests the production of a broad spectrum biostatic metabolite(s) upon consumption of L-arginine by cytotoxic macrophages.

Animals↗
PubMed1987

Effects of antifungal agents and gamma interferon on macrophage cytotoxicity for fungi and tumor cells.

The activated macrophage may play a central role in host effector mechanisms against invading fungi. Here we demonstrate the importance of the activation state of murine macrophages for both fungistatic and fungicidal activity. Host factors such as gamma interferon and microbial products such as endotoxin can interact synergistically to initiate this cytotoxicity. This activated state may be aided by antifungal agents such as amphotericin B. Both a methyl ester derivative of amphotericin B and liposomal amphotericin B Both a methyl ester derivative of amphotericin B and liposomal amphotericin B potentiated macrophage activation but were less potent than amphotericin B. Other available antifungal agents such as azole compounds and flucytosine did not possess this ability to interact with the intrinsic macrophage effector mechanisms. However, ketoconazole and itraconazole avidly bind to macrophages as the biologically active drug. The azole-loading of macrophages may be a factor in macrophage cytotoxicity for fungi.

Animals↗
PubMed1987

Penetration of new azole compounds into the eye and efficacy in experimental Candida endophthalmitis.

We studied the penetration of three azole compounds, ketoconazole, itraconazole, and fluconazole, into the ocular tissues and fluids of rabbits in the presence and absence of ocular inflammation. Drug concentrations were compared with those found in serum and cerebrospinal fluid. The rank order of penetration into eye tissue was fluconazole greater than ketoconazole greater than itraconazole. Fluconazole penetrated freely into both inflamed and uninflamed eyes. The presence of inflammation improved penetration of all three compounds into ocular fluids and tissues. Penetration of these azoles into the anterior chamber of uninflamed eyes and into the cerebrospinal fluid was similar. All three azole compounds reduced the number of yeasts found in the eye in hematogenous Candida albicans endophthalmitis in rabbits when therapy was initiated within 24 h of inoculation. However, only ketoconazole significantly reduced yeast counts in the eye when therapy was postponed for 7 days.

Animals↗
PubMed1987

Efficacy of immune therapy in early experimental Naegleria fowleri meningitis.

Naegleria fowleri meningoencephalitis is usually fatal in humans despite treatment. As a new approach, we tested intracisternal passive immune therapy in rabbits with amebic meningoencephalitis by using antinaegleria immune serum, an immunoglobulin G fraction, and a newly developed monoclonal antibody to N. fowleri. Both the immune serum and an immunoglobulin G fraction isolated from it by affinity chromatography provided a consistent, although temporary, protective effect, shown by prolongation of survival (P = 0.001). Multiple doses of immune serum further prolonged survival (P = 0.005). The protective effect of serum was retained after heating to 56 degrees C. We then developed a monoclonal antibody to N. fowleri which provided similar protection. Passive intracisternal antibody therapy might serve as an adjunctive component in the treatment of amebic meningoencephalitis.

Amebiasis↗
PubMed1986

Macrophage-mediated fungistasis: requirement for a macromolecular component in serum.

Peritoneal macrophages from Mycobacterium bovis- or Toxoplasma gondii-infected mice cultured in vitro in Dulbecco's medium containing 10% fetal bovine serum (FBS) and endotoxin stopped replication of Cryptococcus neoformans for 30 hr, whereas yeast cells cultured alone reproduced with a 3.0-hr doubling time. Without at least 5% FBS, macrophage fungistasis was poor. FBS without macrophages enhanced the growth rate of cryptococci. Macrophages preincubated in vitro for 24 hr without serum became fungistatic when challenged with cryptococci in medium with FBS but were not fungistatic without FBS. Macrophages preincubated in medium with FBS were never subsequently fungistatic. Dialyzed, heated (56 degrees C, 30 min), or delipidated FBS supported macrophage fungistasis, whereas FBS heated at 70 degrees C for 30 min did not. FBS contained no measurable opsonic activity for C. neoformans. Inclusion of endotoxin and/or murine IFN-gamma over wide concentration ranges did not substitute for FBS. Ultrafiltration estimation of FBS activity localized to 50 to 150 Kd. By gel filtration chromatography, FBS activity ran in the 25 to 100 Kd range. Dye-ligand affinity chromatography on Cibacron blue agarose gel dissociated the FBS activity from the albumin and lipoprotein fractions. Anion-exchange chromatography on DEAE-Sephacel revealed activity in the first fraction eluting at low ionic strength, pointing to a protein(s) with an isoelectric point toward neutral. Activated macrophages can prevent microbial replication within host tissues; the local environment is critical for fulfillment of this important physiologic function. These results point to a macromolecular factor(s) present in serum that is essential for full fungistatic capability of activated macrophages.

Animals↗
PubMed1986

Administration of 3'-azido-3'-deoxythymidine, an inhibitor of HTLV-III/LAV replication, to patients with AIDS or AIDS-related complex.

In a 6-week clinical trial 4 dose regimens of 3'-azido-3'-deoxythymidine (AZT), a thymidine analogue with potent anti-viral activity against HTLV-III in vitro, were examined in 19 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). AZT was given intravenously for 2 weeks, then orally for 4 weeks at twice the intravenous dose. AZT was well absorbed from the gut and crossed the blood-brain barrier. Therapeutic levels were maintained with 5 mg given intravenously or 10 mg given orally every 4 h. Treatment was not limited by side-effects, the commonest of which were headaches and depression of white-cell counts. 15 of the 19 patients had increases in their numbers of circulating helper-inducer T lymphocytes (p less than 0.001) during therapy, 6 who were anergic at entry showed positive delayed type hypersensitivity skin test reactions during treatment, 2 had clearance of chronic fungal nailbed infections without specific anti-fungal therapy, 6 had other evidence of clinical improvement, and the group as a whole had a weight gain of 2.2 kg. Also, with the highest dose regimen cultures of peripheral blood mononuclear cells for HTLV III became negative.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Infective endocarditis in obstetric and gynecologic practice.

Infective endocarditis is an important but uncommon complication in obstetric or gynecologic practice; we found only 124 cases reported in English and selected European papers during the last 40 years. The majority of cases (74%) were caused by streptococci; viridans streptococci predominated, while enterococci and group B streptococci were uncommon except after abortion. The overall mortality rate was 29%, while the mortality rate for the fetus when the mother developed infective endocarditis was 23%. The incidence of endocarditis in this setting is low and seems to be decreasing. Therefore, the risk-benefit ratio may not favor routine use of prophylaxis for endocarditis. We conclude that antibiotics need not be given for prevention of endocarditis before most common obstetric and gynecologic procedures. These include uncomplicated vaginal deliveries, uncomplicated spontaneous or induced abortions, dilatation and curettage, insertion or removal of intrauterine contraceptive devices (in the absence of pelvic infection), and biopsies of the cervix. For patients in whom both the underlying heart lesion and the obstetric or gynecologic procedure seem to pose significant risk for endocarditis, prophylaxis should be given. Two parenteral regimens for patients at highest risk are recommended: ampicillin plus gentamicin or vancomycin plus gentamicin. For lower-risk situations, one oral regimen is suggested: amoxicillin.

Abortion, Spontaneous↗
PubMed1986

Experimental anaerobic liver abscess: observations on treatment.

Various treatment modalities for solitary anaerobic liver abscesses were evaluated in a recently-described rabbit model. In the first phase of the experiment, 35 rabbits with liver abscesses induced with Bacteroides fragilis and Fusobacterium necrophorum were randomized into four groups: surgical drainage alone, drainage plus clindamycin 150 mg IM 8-hourly, clindamycin alone, and untreated controls. Serum clindamycin concentrations in rabbits were similar to those achieved in humans. The survival of rabbits receiving antibiotic chemotherapy alone was significantly better than controls, whereas the survival of those having surgical drainage with or without chemotherapy was not. However, successful surgical drainage was followed by weight gain in surviving rabbits. In the second phase of the experiment 18 rabbits with abscesses were randomized into the same groups. Aspirates of pus from all rabbits receiving clindamycin were sterile by day 7 of treatment, but high bacterial counts were still present in the abscess cavities of control rabbits and of those undergoing drainage alone. These findings illustrate the application of a new model for pyogenic liver abscess in laboratory investigation. Their relevance to management of human pyogenic liver abscesses remains to be assessed.

Animals↗
PubMed1986

Comparison of itraconazole and fluconazole in treatment of cryptococcal meningitis and candida pyelonephritis in rabbits.

Itraconazole and fluconazole, two new triazoles, were examined for their antifungal activity in rabbits. Fluconazole easily crossed the blood-cerebrospinal fluid barrier, and active drug was eliminated in high concentrations in the urine. On the other hand, itraconazole did not cross the blood-cerebrospinal fluid barrier in measurable amounts, and urine concentrations were variable. Despite differences in pharmacokinetics at the site of infection, both agents were equally effective in treating cryptococcal meningitis and candida pyelonephritis in animals. By using a ketoconazole-resistant strain of Candida albicans, we showed that there was cross-resistance in vivo between these two new triazole compounds.

Animals↗
PubMed1986

Macrophage-mediated fungistasis in vitro: requirements for intracellular and extracellular cytotoxicity.

Macrophage cytotoxicity for Cryptococcus neoformans was investigated by culturing mouse peritoneal macrophages with a thin-capsuled clone of cryptococcus under conditions permitting efficient phagocytosis. Yeast replication was quantitated by electronic particle counting after detergent lysis of macrophages, and viability was determined by quantitative plate counts. Under appropriate conditions, reproduction was completely inhibited; stasis began at 2 hr after addition of yeasts and lasted for 30 hr. During this time organisms in medium alone proliferated rapidly, doubling their number every 2.5 hr. After removal from macrophages, 60 to 100% of macrophage-inhibited cryptococci formed colonies, indicating that the cytotoxic effect was primarily fungistatic. When yeast cells were removed from macrophages, replication recommenced within 5 hr. Supernatant medium from fungistatic co-cultures was not inhibitory for fresh yeast cells. Conditions required for complete fungistasis were 1) peritoneal macrophages induced by peptone from BCG-infected mice, 2) endotoxin in nanogram per milliliter range added to serum-containing cell culture medium, 3) confluent macrophage monolayers, and 4) macrophage:cryptococci ratios of 20 to 100:1. Fungistasis occurred without phagocytosis but was more efficient when cryptococci were engulfed. For efficient fungistasis, macrophages must differentiate to and be maintained in the activated state. These results with yeast cells agree with the known requirements for macrophage effector function against neoplastic target cells.

Animals↗