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Biomedical subjects

F L Ruben

Publications and source records attributed to F L Ruben.

At least 37 records · Page 2Linked to original sources
PubMed1989

The prevention of severe lower respiratory infections in chronic bronchitis.

Chronic bronchitis remains as a serious medical problem for many adults and a smaller proportion of children in the United States. The frequency of severe lower respiratory infections in patients with chronic bronchitis is quite variable. The infectious agents most likely responsible for severe lower respiratory disease include pneumococci, nontypable Haemophilus influenza, Mycoplasma pneumoniae, and Branhamella catarrhalis among the bacteria, and influenza A and B viruses, with parainfluenza and adenoviruses less common. Prophylactic antibiotics, particularly tetracycline and derivatives, were the only drugs suggesting efficacy in controlled trials for decreasing exacerbation, but many studies failed to show efficacy. Killed influenza vaccines should be used annually in any patient with chronic bronchitis. Pneumococcal vaccine has had questionable benefit for bronchitics but should nevertheless be considered for use because of its low cost and proven safety. The antiviral drug amantadine may be useful in bronchitics unable to take influenza vaccines.

Adult↗
PubMed1988

Fatal adult respiratory distress syndrome in a patient with Lyme disease.

A dry cough, fever, generalized maculopapular rash, and myositis developed in a 67-year-old woman; she also had markedly abnormal liver function test results. Serologic tests proved that she had an infection of recent onset with Borrelia burgdorferi, the agent that causes Lyme disease. During a two-month course of illness, her condition remained refractory to treatment with antibiotics, salicylates, and steroids. Ultimately, fatal adult respiratory distress syndrome developed; this was believed to be secondary to Lyme disease.

Aged↗
PubMed1988

Immune responses to killed influenza vaccine in patients with type 1 diabetes: altered responses associated with HLA-DR 3 and DR 4.

To assess the immunologic differences related to histocompatibility leukocyte antigen (HLA) haplotypes in patients with type 1 diabetes, trivalent killed influenza virus vaccine was given in the fall, when no influenza occurred, to 59 patients with diabetes (mean age 16 years) and 64 siblings without diabetes (mean age 36 years). All subjects had normal hemagglutination inhibition antibody responses at days 14 and 42 after vaccination, with no significant differences noted between patients with diabetes and those without diabetes. However, subjects with HLA haplotypes DR 3, DR 4, or both had lower antibody responses to influenza A/Chile and B/USSR at 14 days after vaccination (p less than 0.02) than DR x/x controls (who lacked 3 or 4). Lymphocyte transformation (LT) responses before and after vaccination were similar for patients with diabetes and those without diabetes. Of significance was that subjects with HLA haplotypes DR 3, DR 4, or both had 41.1% LT responders at 42 days after vaccination, compared with subjects with HLA-DR x/x (lacking 3 or 4) who had 22.6% responders (p less than 0.03), when influenza A/Chile was used as an antigen. Although not significant, influenza antigens A/Philippines and B/USSR each showed similar trends with increased postvaccine LT responses. The HLA associations were independent of sex, age, and the presence of diabetes. These studies suggest that HLA haplotypes DR 3 and DR 4, which were clearly linked to type 1 diabetes mellitus, were also associated with altered immune responsiveness to influenza viral proteins.

Adolescent↗
PubMed1988

Prophylactic treatment of chronic bronchitis.

Exacerbations of chronic bronchitis may be caused by a variety of bacterial and viral agents. There is ample documentation of a role for Hemophilus influenza, Streptococcus pneumonia, Mycoplasma pneumoniae, influenza A and B viruses, and several other respiratory viruses in causing these exacerbations. Because of the lack of frequency of exacerbations (once every 20 to 78 weeks) and the wide range of pathogens, trials of prophylaxis with antibiotics have been difficult to conduct. Controlled trials conducted since the 1950s have shown mixed results, some demonstrating a reduction in the number of exacerbations and others failing to show efficacy. Of the antibiotics used, tetracycline seemed the most effective. Both the pneumococcal polysaccharide and killed influenza virus vaccines have been suggested for patients with chronic bronchitis. The antiviral drug amantadine has been recommended when vaccine cannot be used. This reviewer concludes that prophylactic antibiotics should be used in selected patients with one or more exacerbations yearly using a drug such as tetracycline. A one-time dose of pneumococcal vaccine and the annual use of killed influenza vaccine are also reasonable. During an influenza A epidemic, amantadine should be considered for unvaccinated patients. Future studies should study intermittent v chronic prophylaxis with cheap but appropriate antibiotics (chosen for their microbial spectrum), and should test newer antiviral vaccines and antiviral drugs as they become available.

Anti-Bacterial Agents↗
PubMed1987

Prevention and control of influenza. Role of vaccine.

A major component in the prevention and control of influenza should be the use of killed influenza vaccines. These vaccines became possible after the first discovery of human strains of influenza virus in the 1930s. The ensuing decades have seen marked improvement in the available inactivated vaccines. Current vaccines have excellent reliability and assured potency, and they contain the proper antigens to match the frequent changes in circulating influenza viruses. Killed vaccines work by inducing serum antibodies against the hemagglutinin and neuraminidase of the vaccine strains, with sufficient antibodies ensuring protection against infection. The antibody responses to current vaccines appear to be adequate in all age groups. Although antibody responses are depressed in patients receiving chemotherapy or immunosuppressants, current vaccines do provide protection for most populations. Vaccines prevent the manifestations of disease by about 30 to 70 percent in all populations, and they reduce deaths in high-risk individuals by about 60 to 87 percent. Local adverse reactions to vaccine are quite common, but not severe. Fever, also somewhat common, usually does not last beyond 48 hours. Neurologic complications have not been observed since the use of the swine influenza vaccine of 1976. Killed vaccines should be given annually in the fall, but they can be given up to and during an outbreak. Target groups for vaccines have been defined by the Centers for Disease Control. In recent years, these groups have included physicians and nurses who give care to patients at risk for complications of influenza.

Child↗
PubMed1987

Antibody responses after influenza and pneumococcal immunization in HIV-infected homosexual men.

We conducted a study to assess the effect of human immunodeficiency virus (HIV) infection on humoral immunity. Fifty-five homosexual men and 19 heterosexual men had four- to six-week postimmunization antibody responses measured to trivalent influenza vaccine and 23-valent pneumococcal vaccine. The homosexual men were divided into three groups: 20 asymptomatic HIV-seronegative men, 10 asymptomatic HIV-seropositive men, and 25 HIV-seropositive men with persistent generalized lymphadenopathy. Antibody responses to influenza antigens in the subgroups of homosexual men did not significantly differ from those of heterosexual controls. The IgG antibody responses to pneumococcal capsular types 9N and 18C in men with lymphadenopathy, and type 18C in HIV-seronegative homosexual men, were lower than those of heterosexual controls. Otherwise, responses to other ten capsular types showed no significant differences. There was no evidence of an immunosuppressive effect of vaccination on T-cell numbers, or deterioration of clinical status associated with vaccination. This study demonstrates that HIV-infected homosexual men, asymptomatic or with persistent generalized lymphadenopathy, are able to mount appropriate antibody responses to two commonly used vaccines.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Efficacy of pneumococcal vaccine in severe chronic obstructive pulmonary disease.

Although pneumococcal vaccine has been recommended for patients with chronic obstructive pulmonary disease (COPD), its efficacy in this population has not been shown. A double-blind randomized controlled trial of 14-valent pneumococcal vaccine was carried out in 189 men and women aged 40 to 89 years with a clinical diagnosis of COPD and a forced expiratory volume in 1 second of less than 1.5 L. Of the 189, 92 received the vaccine and 97 received saline placebo. In a randomly chosen subsample of those who received the vaccine the mean titres of specific IgG antibody to selected pneumococcal polysaccharide serotypes increased two- to threefold by 4 weeks after vaccination. Over a 2-year period the rates of death, hospital admissions and emergency visits and the mean length of hospital stay were not significantly different in the two groups. Although a protective effect of 14-valent pneumococcal vaccine could not be shown, the small size of the sample and the relatively low follow-up rates preclude firm conclusions about efficacy from these data alone. The elevated antibody levels before vaccination in some of the patients, suggesting prior infection with Diplococcus pneumoniae, may partly explain the findings.

Aged↗
PubMed1987

Tobramycin and ticarcillin as empiric therapy for febrile patients with granulocytopenia: a reevaluation.

The combination of tobramycin and ticarcillin is an established regimen used to empirically treat patients with granulocytopenia and fever. However, the clinician now has a plethora of newer alternative antibiotic combinations from which to choose. In this retrospective study of 25 granulocytopenic patients recently treated with tobramycin and ticarcillin, a combined favorable or partial response rate of 78% was achieved, without loss of efficacy over time as a result of emerging resistance of organisms. Our reevaluation of this antibiotic regimen emphasizes that it continues to be as efficacious and safe as newer antibiotic combinations, and supports its continued use until a newer regimen is shown to have significant advantages. This study also emphasizes the significance of staphylococci as pathogens in granulocytopenia, and suggests the need to add specific antistaphylococcal coverage whenever catheter-related infection is suspected.

Adolescent↗
PubMed1987

Influenza pneumonia.

Influenza A and B viruses exhibit frequent minor antigenic drift and type A viruses undergo a major antigenic shift every one to four decades, thus assuring that at least a portion of the population is always susceptible. Children and young adults have the highest incidence of influenza infection each winter, but the highest incidences of severe or complicated influenza illness leading to hospitalization or death are in infants, elderly persons (especially those in nursing homes), and persons of all ages with underlying heart or lung disease. Influenza viruses infect respiratory epithelial cells and can themselves cause diffuse pulmonary infiltrates and severe hypoxia, but concomitant or secondary bacterial pneumonia is a much more frequent complication of influenza. Although pneumococci predominate in these secondary pneumonias, the relative incidence of Staphylococcus aureus pneumonia also increases during influenza epidemics; empiric antibiotic therapy in this setting should be directed against both of these organisms. A variety of other bacteria can cause postinfluenzal pneumonia, especially in patients with alcoholism or chronic obstructive pulmonary disease, and broad antimicrobial coverage including gram-negative bacteria is justified in such patients when diagnostic studies provide no guidance. Early amantadine therapy of influenza-like illness during an influenza A epidemic will reduce the duration of symptoms and possibly reduce complications. Successful therapy of influenza virus pneumonia with ribavirin aerosol has been reported but not yet officially approved. Annual vaccination of persons at greatest risk for severe or complicated influenzal disease will reduce the morbidity and mortality due to this infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1987

Antibody responses to immunization of patients with hemophilia with and without evidence of human immunodeficiency virus (human T-lymphotropic virus type III) infection.

Antibody responses after immunization with 23-valent pneumococcal polysaccharide and trivalent influenza virus vaccines were evaluated in 30 adults with hemophilia and in 17 healthy controls. The 30 patients with hemophilia included 13 who were human immunodeficiency virus (HIV) antibody positive with acquired immune deficiency syndrome (AIDS) or AIDS-related complex (group 1), 11 who were asymptomatic HIV antibody positive (group 2), and six who were asymptomatic HIV antibody negative (group 3). Sera were obtained before and 4 weeks after immunization, and levels of antibody were measured by enzyme-linked immunoassay or by hemagglutination inhibition assay. All three groups of patients with hemophilia showed significantly higher preimmunization geometric mean titers of antibodies (groups 1 and 2, fivefold, group 3, 2.8-fold higher), with little increase after pneumococcal vaccine, when compared with controls. Defective humoral responses were noted in groups 1 and 2, with depressed antibody responses after influenza vaccine, significantly elevated levels of IgG and IgM, and depressed blastogenic responsiveness to pokeweed mitogen. Group 3 demonstrated normal responses to pokeweed mitogen, normal antibody responses to influenza vaccine, and normal level of IgG and IgM, although levels of IgG and IgM were higher than those of controls. These data suggest that humoral immune abnormalities are found frequently in patients with hemophilia who are HIV antibody positive. Further, prolonged administration of blood products, regardless of the recipient's HIV status, appears to be associated with polyclonal activation of B cells for T-independent but not T-dependent antigens.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Secondary pulmonary alveolar proteinosis occurring in two patients with acquired immune deficiency syndrome.

This report describes two patients with acquired immune deficiency syndrome (AIDS) in whom respiratory failure and opportunistic infection associated with secondary alveolar proteinosis developed. In one patient, the alveolar proteinosis was apparently secondary to Mycobacterium tuberculosis and in the other to Pneumocystis carinii and cytomegalovirus infection. Both patients died of respiratory failure, and it was suspected that secondary alveolar proteinosis could have been a contributing cause of death.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Specific immunoglobulin-class antibody responses in the elderly before and after 14-valent pneumococcal vaccine.

Using an enzyme-linked immunosorbent assay for measuring IgG-, IgA-, and IgM-class antibodies to pneumococcal capsular polysaccharides, we studied responses of debilitated patients 71 to 95 years of age (average, 85 years) in nursing homes to 14-valent pneumococcal vaccine. A control group consisting of normal adults 23 to 41 years of age (average, 27 years) was used for comparison. Normal adults at 28 days postvaccination showed rises in IgG-, IgA-, and IgM-class antibodies to nearly all capsular polysaccharides. The IgG- and IgA-class antibody responses of the elderly patients did not differ significantly from those of the normal adults in most instances. IgM-class responses of the elderly subjects were poor and were significantly lower than those of the control group for six of 14 serotypes. Overall, these studies demonstrate that elderly patients, like healthy younger adults, mount a polyclonal antibody response to pneumococcal polysaccharide vaccine.

Adult↗
PubMed1984

Pneumococcal bacteremia at a medical/surgical hospital for adults between 1975 and 1980.

All 72 episodes of pneumococcal bacteremia from 1975 through 1980 at Montefiore Hospital, Pittsburgh, a medical/surgical hospital for adults, were reviewed. There were 10 to 14 episodes per year, accounting for 4 to 5 percent of all bacteremias; it was estimated that one episode occurred for every thousand patients discharged. Patients' ages ranged from 16 to 94 years (mean 61 years); 65 percent were male. There was an underlying disease in 87 percent of all patients, and 78 percent of the infections were community-acquired. Treatment with antimicrobial drugs was given to all but six patients. Overall mortality was 43 percent, but it was higher for asplenic patients (five of six died). In 44 percent of patients, one to four complications occurred. Outcome correlated with presence of coexisting disease (p less than 0.03), development of one or more complications (p less than 0.04), presence of asplenia (p = 0.04), and the type of antimicrobial treatment used (p less than 0.001; patients treated with penicillin alone fared better). Typing of isolates in the last two study years revealed that 67 percent of isolates were pneumococcal types present in 14-valent pneumococcal vaccine available at the time of the study. It is concluded that pneumococcal bacteremia occurs primarily in patients with underlying disease, and that pneumococcal vaccine should be offered to such patients.

Adolescent↗
PubMed1984

Antibody responses to meningococcal polysaccharide vaccine in adults without a spleen.

Asplenic persons are at risk for the development of overwhelming sepsis from certain encapsulated bacteria, including meningococci. Since it is not known if asplenic persons can have antibody responses, this study compared such responses following bivalent groups A and C meningococcal polysaccharide vaccine in 22 asplenic subjects and healthy control subjects. There were no adverse reactions to the vaccine. Antibody responses were measured using a solid-phase radioimmune assay; results were compiled for both seroconversions and changes in mean antibody titers of IgG, IgA, and IgM classes. Subjects who underwent splenectomy for trauma and control subjects with spleens showed a polyclonal antibody response to both vaccine antigens. Those persons who underwent splenectomy for nonlymphoid tumors had nearly as good a response as normal subjects. By contrast, asplenic subjects with lymphoid tumors who had received prior chemotherapy and radiotherapy had poor responses to both antigens. It is concluded that meningococcal vaccine is immunogenic in asplenic persons, with the aforementioned exceptions, and that this vaccine should be routinely administered to such persons.

Adolescent↗
PubMed1984

An outbreak of Streptococcus pyogenes infections in a nursing home.

An outbreak of serious infections caused by Streptococcus pyogenes occurred in a nursing home for elderly patients. The outbreak began in mid-winter and continued for 12 months. Thirteen residents and two nurses had infections. Severity of infection was worse in residents, who developed sepsis, necrotizing fasciitis, cellulitis, septic arthritis, pneumonia, and conjunctivitis; in contrast, the nurses had pharyngitis only. Six of thirteen residents required acute hospital care, and the index case died with sepsis. Typing of S. pyogenes was done in 13 of 15 cases, and the same serotype (M-non-typable, T-25) was found. Control measures consisted of identifying all patients with infections, obtaining cultures, and providing prompt treatment. Patients in nursing homes are highly susceptible to serious infections with S. pyogenes.

Aged↗
PubMed1983

Nonsurgical treatment of cerebral nocardiosis.

In previously healthy, 49-year-old man, CNS infection due to Nocardia asteroides was manifested initially as sterile meningitis and then as a single large brain abscess and was treated successfully with medical therapy alone. Resolution of the brain abscess was documented with serial computed tomographic scans. The strain of N asteroides was sensitive to both sulfisoxazole and ampicillin. Although surgical intervention must always be considered in the treatment of brain abscess caused by N asteroides, medical therapy is preferable if the patient responds initially.

Ampicillin↗