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Biomedical subjects

H R Harrison

Publications and source records attributed to H R Harrison.

At least 37 records · Page 2Linked to original sources

Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions. A multicenter trial.

Because few clinicians have access to laboratories offering cell culture confirmation of suspected Chlamydia trachomatis genital infections, we evaluated a diagnostic method in which fluorescein-conjugated monoclonal antibodies were used to directly identify C. trachomatis elementary bodies in slides made from genital secretions. Compared with culture results, the direct smear had a sensitivity of 92% and a specificity of 96% in 576 men, most of whom had symptoms and signs of urethritis. Among 595 women attending the same clinics, sensitivity of the direct smear for cervical infection was 89% and specificity was 99%. In 225 pregnant women screened in a prenatal or abortion clinic, the sensitivity and specificity of the test were 86% and 99% respectively. Direct detection of elementary bodies in genital smears offers an alternative diagnostic approach for C. trachomatis infections.

Bacteriological Techniques↗

Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy. Epidemiology and outcomes.

In a prospective study of chlamydial and mycoplasmal infections in pregnancy, Chlamydia trachomatis occurred in 8.0%, Mycoplasma hominis in 23.5%, and Ureaplasma urealyticum in 72.3% of 1,365 enrollees. By multivariate analysis, C trachomatis was correlated with lower socioeconomic status, age 23 years or younger, and 12 years or less of schooling. Ureaplasma urealyticum was correlated with age 23 years or younger and lower socioeconomic status. Mycoplasma hominis was correlated with more than one recent sexual partner, first intercourse at age 17 years or younger, and higher socioeconomic status. These cervical infections did not predict low birth weight, abortion, stillbirth, prematurity, or premature rupture of membranes. Only M hominis predicted endometritis/fever after vaginal delivery (relative risk, 7.3). IgM-seropositive C trachomatis-infected women had more low-birth-weight infants and more premature rupture of membranes than either IgM-negative C trachomatis-infected women or C trachomatis culture-negative women. Thus, only certain subgroups of infected women may experience adverse pregnancy outcomes.

Adult↗

Trapped fourth ventricle in coccidioidal meningitis.

A 4-year-old girl with known coccidioidal meningitis developed posterior fossa signs. CT scanning revealed a large fourth ventricle. Injection of contrast medium into the lateral ventricles revealed free flow into the fourth ventricle, and injection into the fourth ventricle revealed no flow into the aqueduct or third ventricle. The posterior fossa signs cleared after shunting of the fourth ventricle. A one-way aqueductal valve resulting from the ventricular inflammation is hypothesized.

Cerebral Ventricles↗

Chlamydia trachomatis pneumonitis in the C57BL/KsJ mouse: pathologic and immunologic features.

Pneumonitis occurred in both normal and diabetic C57BL/KsJ mice, inoculated with a Chlamydia trachomatis strain isolated from a human infant . Animals were inoculated intranasally under light ether anesthesia. Control animals receiving carrier medium did not develop pulmonary disease. The pneumonitis was focal and involved interstitial and peribronchial structures. Pathological changes were most pronounced at 10 to 14 days after inoculation, but no animals died of their disease. The early cellular response was polymorphonuclear (4 to 6 days); this was followed by a predominantly mononuclear cell infiltrate. Immunopathological examination revealed immunoglobulin- and complement-bearing cells in a peribronchial distribution, corresponding to the mononuclear infiltrates seen by light microscopy. Infected animals seroconverted to C. trachomatis. Specific antichlamydial IgM antibody was detected at days 6 through 21 and higher titer IgG at days 10 through 28. Splenic lymphocyte stimulation responses to chlamydial antigen were observed at 10 and 21 days. C. trachomatis was cultured only from 6-day lung tissue. The histopathological and immunopathological features of the pneumonitis were similar in normal and diabetic mice. In addition, humoral and cellular immunoresponsiveness to chlamydial infection were not compromised in the diabetics. This animal model resembles human infant chlamydial pneumonitis in its pathological manifestations and may increase our understanding of the human disease.

Animals↗

Experimental nasopharyngitis and pneumonia caused by Chlamydia trachomatis in infant baboons: histopathologic comparison with a case in a human infant.

Three infant male baboons were inoculated with a strain of CHLAMYDIA TRACHOMATIS ISOLATED FROM A HUMAN INFANT WITH PNEUMONITIS. One baboon, inoculated by intratracheal, nasopharyngeal, and oropharyngeal seeding, had rales, radiographic evidence of pneumonia, persistent nasopharyngeal C. trachomatis infection, and a four-fold rise in titer of antibody. At sacrifice 24 days after inoculation, nasopharynx, trachea, airways, and lung yielded C. trachomatis, and epithelial inclusions were seen by light and immunofluorescent microscopy. Histopathologic changes noted were nearly identical to those in a lung biopsy specimen from a human infant and pneumonitis and nasopharyngeal C. trachomatis. The second baboon was inoculated by tracheal seeding and maintained nasopharyngeal C. trachomatis until killed 30 days later. Autopsy revealed nasopharyngitis and patchy mild pneumonitis. The third baboon was inoculated by nasopharyngeal seeding and maintained nasopharyngeal C. trachomatis for 49 days. Both of the latter baboons seroconverted. Infant baboons appear to be useful animal models for C. trachomatis nasopharyngitis and pneumonia.

Animals↗

Infection of untreated primary human amnion monolayers with Chlamydia trachomatis.

For development of a laboratory model for chlamydial infection of the human genital tract, untreated primary human epithelial cell monolayers, prepared from each of four placentas, were infected with a stock strain of Chlamydia trachomatis isolated from the nasopharynx of an infant with pneumonia. Infectivity titrations were performed with use of standard procedures of chlamydial inoculation, and inclusions grown in amnion cell monolayers and in McCoy cells were measured versus infectious units inoculated. By linear regression analysis, untreated human amnion cells (y = 0.948x + 4.63, r = 0.9255) were as susceptible as McCoy cells treated with diethylaminoethyl dextran and 5-iodo-2-deoxyuridine (y = 1.104x + 5.35, r = 0.9804). Human amnion may prove a valuable model for study of human chlamydial infection and may have important implications for investigation of clinical disease.

Amnion↗

Inhibition of in vitro synthesis of the second (C2) and fourth (C4) components of complement in guinea pig peritoneal macrophages by a soybean oil emulsion.

Recently a soybean oil emulsion (Intralipid) (IL) has been released in the United States for use as a parenteral nutrient. The study reported here was undertaken to determine the effect of ingestion of IL on the synthesis and secretion of the second (C2) and fourth (C4) components of complement by guinea pig peritoneal macrophages in vitro. Cells exposed to IL had extensive Oil Red 0-positive granular-appearing accumulations of neutral lipid within the cytoplasm. Control cells did not stain with Oil Red 0. Incubation of the cells with concentrations of IL from 2.3--37.5 mg/100 ml resulted in a significant decrease in the production of both C2 and C4, which could not be explained by variability between plates. The decrease in total C2 or C4 production by cells incubated with IL for 4 hr was similar to the decrease in production by cells incubated with IL for 48 hr. Several lines of evidence indicated that the decrease of C2 or C4 was the result of decreased synthesis of these proteins and not interference of IL with the detection of the proteins or their secretion from the cells. Exposure of the cells to IL at all concentrations caused reduction of the number of cells having pseudopodia and a rounding-up of the cells. IL did not affect the rate of detachment of the cells from the plates through the 48-hr incubation period or the ability of the cells to exclude trypan blue. Total protein synthesis and total lysozyme production by control and IL-treated cells was similar.

Animals↗

Amebic liver abscess in children: clinical and epidemiologic features.

Amebiasis, that is, infection with Entameba histolytica, continues to be endemic in the United States, with liver abscess occurring as an infrequent but constant complication. Seven cases are reported, with epidemiologic investigation of two. Reliable findings in hepatic abscess include fever, abdominal pain, respiratory distress, tender abdomen, and large, tender liver. Anemia, elevated white count with left shift, and the radiographic findings of an elevated right hemidiaphragm are constant. Epidemiologically, amebiasis occurs in clusters in the United States with person-to-person transmission predominant in spread. Infection is associated with poor sanitation and crowding. Investigation of the families of two patients documented 9/21 carriers and an additional 3/21 who were seropositive, as well as crowding and poor sanitation. In this country, treatment of a patient with amebic disease should include investigation of his home and family.

Adolescent↗

Chlamydia trachomatis infant pneumonitis: comparison with matched controls and other infant pneumonitis.

We determined the prevalence of Chlamydia trachomatis infection in 30 consecutive hospitalized infants less than six months of age with pneumonitis and in 28 matched controls (nine of 30 vs. one of 28. P less than 0.05). In comparing 16 cases of pneumonitis due to C. trachomatis with 27 not due to that agent, we found several distinguishing clinical and laboratory features: C. trachomatis was highly correlated with radiographic hyperinflation, prolonged cough and congestion, greater than or equal to 400 eosinophils per cubic millimeter and serum lgG greater than or equal to 500 and lgM greater than or equal to 110 mg per deciliter. C. trachomatis was responsible for 13 of 21 cases seen at three to 11 weeks vs. three of 22 seen at other ages. Antibody to C. trachomatis in tears (13 of 14 vs. two of 27), nasopharynx (12 of 14 vs. one of 27) and blood (16 of 16 vs. two of 23) was specific for C. trachomatis pneumonitis. C. trachomatis is prevalent among hospitalized infants with pneumonitis. Conjunctival infection precedes C. trachomatis pneumonitis more commonly than has previously been thought.

Antibodies, Bacterial↗

Role of Chlamydia trachomatis in perinatal infection.

The transmission of Chlamydia trachomatis from the infected cervix of a mother to the eye of an infant, with resultant inclusion conjunctivitis, was documented in humans and in primates 75 years ago by cytologic methods. With modern microbiologic methodology it is possible to quantitate this transmission. It is now known that 2%-24% (usually 7%-12%) of cervices are infected before delivery and that 18%-50% (usually 20%-25%) of infants born to culture-positive mothers develop conjunctivitis. In addition, nasopharyngeal infection occurs in 15%-20% of infants, and 3%-18% develop pneumonia due to C. trachomatis. Bronchiolitis and otitis media are less common infections. The consequence of rectal and vaginal colonization remains unknown, as does the significance of the increase in antibody titers against C. trachomatis throughout early childhood. Early studies suggesting that C. trachomatis was a prominent cause of postpartum endometritis and a cause of premature delivery have not been confirmed in larger prospective studies when mycoplasma species were simultaneously studied. A subset of mothers with active infection, as evidenced by IgM antibody against C. trachomatis, may have earlier delivery, but it is clear that evaluation of the contribution of C. trachomatis to maternal and fetal risk will require larger studies with evaluation of possible concurrent mycoplasmal infection.

Chlamydia Infections↗

Chlamydia trachomatis and chronic respiratory disease in childhood.

We diagnosed lower respiratory infection (LRI) due to Chlamydia trachomatis by retrospective serologic analysis in 10 of 47 (21%) study infants under 6 months of age hospitalized with bronchiolitis or pneumonia. These 47 infants represented all those on whom blood was available (76% of all 62 study infants under 6 months of age). Forty of these 47 infants had been followed from hospitalization for periods up to 5 years (mean, 26.3 months) for development of chronic illness. The patients with C. trachomatis LRI had significantly more reported chronic cough and abnormal lung function on follow-up than did those with LRI due to other agents or no agent found. C. trachomatis LRI patients also had more cough and wheeze than did a group of 71 age-matched normal infants. C. trachomatis LRI severe enough to require hospitalization may be associated with more chronic sequelae than is LRI due to other agents.

Bronchitis↗

Amphotericin B and imidazole therapy for coccidioidal meningitis in children.

Coccidioidal meningitis is a fatal form of Coccidioides immitis infection. Amphotericin B (AMB) therapy has reduced mortality but is itself toxic, and experience with it in very young children is meager. We are treating six children for coccidioidal meningitis diagnosed at 19 to 74 months of age. All had acute hydrocephalus and ventriculitis. The first four patients were initially treated with AMB but were changed to imidazole therapy (miconazole and ketoconazole). In the last two patients therapy was begun with the imidazoles. Ommaya reservoirs for cisternal therapy have been of limited usefulness. AMB therapy has been limited by local and systemic toxicity and by failure in one case. All children have improved with 15 to 22 mg oral ketoconazole per kg per day and 3 to 5 mg intraventricular miconazole for instillation therapy, including those with noncommunicating hydrocephalus in whom the intraventricular drug does not reach the basilar cisterns. Peak concentrations of ketoconazole in ventricular fluid were 0.08 to 5.6 micrograms/ml. Shunt obstruction and bacterial superinfections have been the major causes of morbidity. Imidazole therapy of coccidioidal meningitis may be more effective than is AMB in young children, and it offers the advantages of fewer side effects and not requiring intrathecal or cisternal administration.

Amphotericin B↗