OBJECTIVES: The declining incidence of tuberculosis (TB) in developed countries has recently been reversed with the advent of HIV disease. This study proposes to document in vitro T-cell responses to mycobacterial antigens in HIV-infected individuals. DESIGN: T-cell-mediated immunity is recognized as one of the mechanisms of defence against TB. The cellular immunodeficiency and the importance of TB in the context of HIV disease has prompted use of in vitro assays of lymphocyte proliferation and cytolytic activity. METHODS: Peripheral blood mononuclear cells isolated from 29 HIV-infected patients (four with recent TB) and 11 healthy volunteers were stimulated with purified protein derivative (PPD). The responding blasts were presented to autologous antigen-primed macrophages to measure specific cytolytic T-lymphocyte (CTL) activity in vitro. RESULTS: T-cell proliferative responses were significantly lower in late stages of HIV disease. The degree of specific CTL activity was higher in healthy individuals than in Centers for Disease Control (CDC) stage II-III (P = 0.037), and CDC stage IV patients (P = 0.029). CONCLUSIONS: The clinical presentation of TB tends to be typical in early stages of HIV disease and atypical in late stages. The manifestations reflect the degree of immunodepression. This study documents the declining proliferative and cytolytic T-cell-mediated responses in HIV patients with progression of immunodeficiency.

Adolescent↗

PubMed1992

T-lymphocyte responses to Pneumocystis carinii in healthy and HIV-positive individuals.

Pneumocystis carinii pneumonia (PCP) is a well-recognized cause of morbidity in patients with impaired T-cell function. In this study of cellular immunity to P. carinii, peripheral blood mononuclear cells from 25 HIV antibody-positive (HIV+) patients and 11 healthy individuals were stimulated in vitro with P. carinii antigen. The responding T-cell blasts were cocultured with autologous P. carinii antigen-pulsed macrophages to measure P. carinii-specific cytolytic T-lymphocyte activity (CTL). T-cell blasts from two healthy donors were used to generate P. carinii-specific clones by limiting dilution. T cells from HIV+ patients proliferated less to P. carinii antigen than T cells from healthy volunteers. In contrast, the level of specific cytotoxicity was identical in all groups when equal numbers of CTLs were used. Within the group of symptomatic patients, CTL activity was higher in those with a history of PCP (p = 0.033). Pneumocystis carinii antigen-specific T-cell clones proved to be CD4+ and MHC class II restricted; six of eight clones tested showed P. carinii-specific cytolytic activity. Cell-mediated immune response to P. carinii in healthy individuals include CD4+, class II MHC-restricted T cells with P. carinii-specific cytotoxicity. There is an increasing loss of P. carinii-specific proliferative responses in HIV+ patients as disease progresses, but a cytotoxic response is still detected in the absence of proliferation.

Adolescent↗

PubMed1991

Ophthalmic complications of spina bifida and hydrocephalus.

The article reviews the ophthalmic literature on spina bifida and hydrocephalus and presents the findings of a six-year survey of 322 children. Ophthalmic complications were found to occur very frequently. Forty-two per cent had a manifest squint, 29% lateral rectus palsy or musculoparetic nystagmus, 14% papilloedema and 17% optic atrophy. Only 27% definitely had normal visual function. Seventy per cent of proven episodes of shunt dysfunctions had positive ophthalmological evidence of raised intracranial pressure. The sudden appearance of a squint, other ocular motility disorder or papilloedema usually denotes uncontrolled hydrocephalus. Shunt surgery is the first priority but may not restore normal ocular motility and visual function. Subsequent treatment should be tailored to the special needs of these children. Regular ophthalmic supervision of these children saves life and sight.

Adolescent↗

PubMed1989

Managing the red eye.

The commonest causes of a red eye, excluding trauma, are conjunctivitis, allergies and lid conditions. These can usually be managed by the GP and are not serious if properly treated. Keratitis and corneal ulcers, acute iritis and acute glaucoma are uncommon conditions but are always serious and require immediate referral to an ophthalmologist for treatment.

Conjunctival Diseases↗

PubMed1985

Does the spina bifida clinic need an ophthalmologist?

322 children who were suffering from either spina bifida or hydrocephalus were examined over a six year period. Regular examinations were made of visual acuity and field, ocular motility and fundus starting at the time of birth or diagnosis and repeated, whenever possible, at each clinic visit or hospital admission. A particular effort was made to see children about to have exploratory surgery for suspected shunt dysfunction or raised intra-cranial pressure to determine the frequency of positive eye findings in such cases. Ophthalmic complications were found to be very common in the children studied. 136 (42%) had a manifest squint, 93 (29%) a lateral rectus palsy or musculo-paretic nystagmus, 44 (14%) had papilloedema and 55 (17%) had optic atrophy. Only 86 (27%) definitely had normal visual function. 70% of proven episodes of shunt dysfunction had positive ophthalmological evidence of raised intracranial pressure. The presence of an ophthalmologist in the spina bifida and hydrocephalus clinic was increasingly valued as the study progressed. Every spina bifida and hydrocephalus clinic should have an ophthalmologist in its medical team. He should undertake regular examinations of visual acuity and field, ocular motility and fundi, starting at the time of birth or diagnosis, and tailor ophthalmic care to the special needs of these children. This should ensure that these children achieve and maintain the best possible standard of vision and that the earliest ophthalmic signs of raised intracranial pressure can be detected in patients where the diagnosis is in doubt.

Adolescent↗

PubMed1983

Steroid responsiveness in connective tissue diseases.

Thirty-four patients with connective tissue disease used dexamethasone drops 0.1% in one eye for 6 weeks. There was a higher incidence of positive steroid response than would be expected in a normal population. Most of the male patients were responders. Care should be exercised when prescribing local steroids for these patients. Males should be offered regular screening for glaucoma.

Adult↗

PubMed1979

Breast or bottle.

Explore the source record for details and available documents.

Bottle Feeding↗