Ecology of Ixodes dammini-borne human babesiosis and Lyme disease.
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Animals↗
Biomedical subjects
J F Levine
Publications and source records attributed to J F Levine.
Mice as reservoirs of the Lyme disease spirochete.
In evaluating the white-footed mouse as a reservoir host for the Lyme disease spirochete, we compared spirochete infection in vector ticks (Ixodes dammini) having different histories of attachment to these mice, estimated their relative importance as hosts for immature I. dammini and compared the seasonality of tick activity and spirochetemia in mice. Infection in trapped white-footed mice appears to be universal. Prevalence of spirochetal infection in I. dammini correlates with frequency of attachment to mice, and in mice, with the season of vector activity. The relative abundance of this mouse makes it numerically the most important host for I. dammini. Most immature I. dammini appear to attach to white-footed mice. Taken together, these considerations demonstrate that the white-footed mouse serves as reservoir for the Lyme disease spirochete in coastal Massachusetts.
Animals↗
Cost containment of the second-generation cephalosporins by prospective monitoring at a community teaching hospital.
All patients receiving cefoxitin and cefamandole were prospectively reviewed for appropriate and inappropriate utilization. There were two eight-week survey periods. In period 1, 81 (70%) of 115 patients received cefoxitin appropriately and six (40%) of 15 patients received cefamandole appropriately. In patients receiving antibiotics inappropriately, 12 (35%) of the 34 receiving cefoxitin and eight (89%) of the nine receiving cefamandole had infections that could have been treated with less expensive, equally efficacious antibiotics. Changes in antibiotic therapy were made in 79% of patients based on our recommendations. The estimated annual cost saving for these antibiotics was $40,290. During period 2, 73 (91%) of 80 patients were given cefoxitin appropriately and 14 (61%) of 23 patients received cefamandole appropriately. Forty-three percent of those receiving cefoxitin and 33% of those receiving cefamandole inappropriately could have been treated with a less expensive, equally efficacious antibiotic. In 88% of patients, the attending physicians followed our recommendations.
Bacterial Infections↗
The effect of postoperative and primary radiation therapy on delivered dose of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy in breast cancer.
The dose of adjuvant chemotherapy for breast cancer may be an important factor in the success of the treatment program. In a retrospective analysis, the authors determined whether patients who were irradiated either postoperatively (N = 29) or as part of primary treatment (N = 13) received a lower dose of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy than patients who were not irradiated (N = 42). The 84 evaluable patients received either cyclical or weekly CMF. Radiation therapy included the chest wall or breast and regional lymph nodes. The mean percentage of maximum chemotherapy dose delivered (59.9% versus 73.5%; P less than 0.001), mean percent prescribable or theoretical maximum dose (83.1% versus 91.3%; P less than 0.001), and mean leukocyte count (3.9 versus 4.5; P less than 0.01) during therapy were statistically significantly lower in irradiated patients. The lower delivered chemotherapy dose in irradiated patients was not related to the radiation dose to the thoracic spine. The authors conclude that radiation therapy to the chest wall or breast and regional lymph nodes reduces the dose of adjuvant CMF that can be delivered.
Antineoplastic Combined Chemotherapy Protocols↗
3T3-L1 adipocytes promote the growth of mammary epithelium.
Murine mammary epithelium grows in association with predominantly adipocyte stroma in vivo. To investigate potential growth-promoting effects of adipocytes on mammary epithelium, we developed a co-culture system of mammary epithelium and adipocytes by taking advantage of the 3T3-L1 cell line. These cells undergo adipocyte differentiation when the culture reaches confluence and growth ceases. Mid-pregnant murine mammary epithelium was plated on lethally irradiated feeder layers of 3T3-L1 adipocytes, undifferentiated 3T3-L1 cells, 3T3-C2 fibroblasts (a subclone of 3T3 cells that does not undergo adipocyte differentiation), or tissue culture plastic. Mammary epithelial colony size on adipocyte feeder layers was 2-fold larger than colonies on 3T3-C2 cells and 4-fold larger than colonies on tissue culture plastic. Measurement of tritiated thymidine [3H]TdR incorporation and labelling index in mammary cells was significantly higher on adipocytes than on other feeder layers or plastic. There was a 6-fold increase in mammary cell number after 5 days in culture when mammary epithelium was plated on substrate-attached material ('extracellular matrix') derived from 3T3-L1 cells and a 4-fold increase in cell number when plated on plastic in conditioned medium derived from 3T3-L1 adipocytes compared with growth on plastic in unconditioned medium. We conclude that interaction of mammary epithelium with adipocytes results in a marked increase in proliferation of mammary epithelium and that extracellular components may mediate this effect.
Adipose Tissue↗
House mouse mites infesting laboratory rodents.
Liponyssoides sanguineus, principal vector of Rickettsia akari, infested mongolian gerbils (Meriones unguiculatus) mice (Mus musculus) and laboratory-reared egyptian gerbils (Meriones libycus). Only a few mites were present on each animal and no manifestations of disease were observed. Numerous mites were present in the bedding.
Animals↗
Outbreak of central-nervous-system toxoplasmosis in western Europe and North America.
Acute encephalitis caused by Toxoplasma gondii was diagnosed in ten patients in Belgium, the U.S.A., and Canada. None had underlying conditions usually associated with toxoplasmosis. Three had evidence of extraneural infection at necropsy. Nine patients died. Only two of the patients had a history of homosexuality, and one was a heroin addict. Five were Haitian, and four of them had lived in North America for 2-5 years. Eight of the patients had pronounced lymphopenia. Diagnosis of toxoplasmosis was hampered by a lack of suspicion that Toxoplasma could be the agent causing necrotising encephalitis in the non-immunocompromised host, the protean manifestations of the encephalitis, and a lack of a specific antibody response. The large number of cases appearing in western Europe and North America emphasise the necessity of including toxoplasmosis in the differential diagnosis of encephalitis of unknown aetiology.
Acute Disease↗
Phase I study of human leukocyte interferon in patients with advanced cancer.
Seventeen patients with disseminated cancer were treated with a human leukocyte interferon preparation in doses ranging from 3 X 10(6) to 50 X 10(6) IU daily for 30 days. Doses above 18 X 10(6) IU were considered intolerable in this schedule of administration due to severe fatigue and weight loss. Serum concentrations of interferon were lower than those achieved with either partially pure native or recombinant leukocyte interferon. Three of 17 patients in this study showed minimal evidence of tumor regression. Two patients treated at doses of 18 X 10(6), 36 X 10(6), and 50 X 10(6) IU also received a 5 X 10(6)-IU dose of a second human leukocyte interferon preparation. The latter resulted in less toxicity but similar serum levels. These results suggest that human leukocyte interferons prepared in the same manner may differ significantly in their in vivo biologic properties.
Adult↗
Pneumococcal meningitis associated with retroperitoneal abscess. A rare complication of lumbar puncture.
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Abscess↗
Clinical and immunologic effects of recombinant leukocyte A interferon in eight patients with advanced cancer.
The clinical and immunologic effects of a biosynthetic human leukocyte interferon, recombinant leukocyte A interferon (IFL-rA), are reported in eight patients with advanced cancer. Single escalating doses from 3 X 10(6) units to 198 X 10(6) units were given by intramuscular injection in a phase I study. Major toxic effects included pyrexia, fatigue, myalgia, and headache. Data on the effects of IFL-rA on lymphocyte subpopulations and peripheral blood mononuclear-cell surface beta 2-microglobulin are presented. Four of eight patients had objective tumor regression, indicating that further investigation of this biologically active material is warranted.
Cytotoxicity, Immunologic↗
Efficacy of a twelve-hourly ceftriaxone regimen in the treatment of serious bacterial infections.
Eighteen patients with 21 serious infections were treated with ceftriaxone, 1 g intravenously every 12 h, for a mean duration of 8 days. Eighteen gram-negative and two gram-positive organisms were isolated. Sites of infection included blood (three patients), urinary tract (six patients), respiratory tract (seven patients), biliary tract (three patients), ascitic fluid (one patient), and skin (one patient). Serum, bile, and ascitic fluid concentrations of ceftriaxone were in excess of the minimal bactericidal concentration required for the infecting organism in all cases. A bacteriological response was demonstrated in 94% of the infections. A clinical response occurred in four infections from which no pathogens were recovered. In one patient, ceftriaxone failed to eradicate a peritoneal infection due to Bacteroides fragilis. In two patients, superinfection with enterococci developed both during and after therapy. Systemic tolerance to ceftriaxone was excellent.
Aged↗
Recombinant leukocyte A interferon: pharmacokinetics, single-dose tolerance, and biologic effects in cancer patients.
Sixteen patients with advanced cancer were treated with recombinant-DNA-produced pure leukocyte A interferon (IFLrA) intramuscularly in doses ranging from 3 to 198 X 10(6) units. with interval periods of 72 to 96 hours between doses. At the two lowest doses of 3 and 9 million units, there was a cross-over evaluation between IFLrA and partially pure leukocyte interferon (IFN-C) produced from human cells. THe maximum observed serum concentration of IFLrA measured by enzyme immunoassay and bioassay increased with increasing doses. The mean serum concentrations of IFLrA and IFN-C were similar. Clinical effects produced by IFLrA and IFN-C were similar, including fever, chills, myalgias, headache fatigue, and reversible leukopenia and granulocytopenia. Eight patients had transient and mild numbness of the hands or feet, or both. Three patients developed low titers of antibody to IFLrA, Seven of 16 patients showed objective evidence of tumor regression during the study.
Adult↗
Mycobacterium avium-intracellulare: a cause of disseminated life-threatening infection in homosexuals and drug abusers.
Five men developed disseminated infection with Mycobacterium avium-intracellulare. These patients all lived in the New York City area and presented with their illnesses between January 1981 and September 1981; four were homosexual and one was an intravenous drug abuser. Four patients died. All five patients had defects in the cell-mediated immune response. The infections were characterized histopathologically by poor or absent granulomatous tissue reaction. Clinical isolates of M. avium-intracellulare from all five patients agglutinated commonly used antimycobacterial drugs. The spectrum of opportunistic infections among populations of homosexuals and drug abusers should be expanded to include disseminated disease due to M. avium-intracellulare.
Adult↗
Penicillin sensitive nutritionally variant streptococcal endocarditis: relapse after penicillin therapy.
Studies to date have indicated that nutritionally-variant streptococci (NVS) causing bacterial endocarditis are frequently inhibited but not killed by low concentrations of penicillin. We report a patient with endocarditis due to a NVS strain which was killed in vitro by penicillin at a concentration of 0.09 microgram/ml. Despite therapy with intravenous penicillin for four weeks, the infection relapsed and was then cured by combined penicillin-gentamicin in therapy. In vitro studies demonstrated a synergistic effect of these two antibiotics. This experience suggests that combination therapy with penicillin and an aminoglycoside may be required for cure of all cases of nutritionally-variant streptococcal endocarditis regardless of in vitro susceptibility to penicillin.
Aged↗
Efficacy and toxicity of doxorubicin/cyclophosphamide maintenance therapy in dogs with multicentric lymphosarcoma.
Doxorubicin/cyclophosphamide were evaluated as maintenance drugs for dogs with multicentric lymphosarcoma (n = 28). Median remission time of all dogs was 173 days. Remission duration was shorter, however, in dogs with stage IV/V disease, in dogs with pretreatment hypoalbuminemia, and in dogs that had received glucocorticoids before initiation of chemotherapy (P less than 0.04). Nineteen dogs were evaluable for toxicity. Dose-limiting gastrointestinal toxicosis was observed in three dogs, neutropenia was observed in three dogs, and cardiomyopathy was observed in three dogs. The doxorubicin/cyclophosphamide protocol described in this report is safe and effective in treating canine multicentric lymphosarcoma. Clinical stage, pretreatment steroid therapy, and hypoalbuminemia are prognostic factors for response to this protocol.
Animals↗
Factors associated with failure of passive transfer of colostral antibodies in Standardbred foals.
The records of 361 Standardbred mares and their 1986 or 1987 foals were evaluated to identify factors associated with failure of passive transfer (FPT) of colostral antibodies in equine neonates. Sixty-five foals (18%) were classified as FPT based on a serum immunoglobulin concentration of less than 400 mg/dl at 24 to 36 hours of age, determined by the glutaraldehyde coagulation test. The potential association of mare- and foal-related factors with FPT were assessed by reviewing a series of multiple logistic regression models. The season in which the mare foaled and foal exam score, a subjective assessment of foal vigor, maturity, and general health, were the primary factors associated with the development of FPT. Foals with FPT were more likely (odds ratio = 3.50; 95% confidence interval = 1.81-6.68) than normal foals to require medical therapy during the first 3 months after parturition.
Age Factors↗
Thrombocytosis in 24 horses (1989-1994).
The records of horses presented to the Veterinary Teaching Hospital of North Carolina State University College of Veterinary Medicine between January 1, 1989 and April 30, 1994 were evaluated to determine risk factors associated with thrombocytosis. Of the 2,346 horses for which a CBC was performed, 24 (1.0%) had a platelet count > 400,000/microL. Demographic, diagnostic, physical examination, and clinicopathologic variables from these cases were compared with a reference population consisting of 189 horses with a normal platelet count presenting during the same period. Infectious/ inflammatory disorders were observed more commonly in horses with high platelet counts than in horses with normal platelet counts. Initial independent evaluation of demographic variables revealed that horses more than 3 years of age, females, and geldings were less likely to have thrombocytosis than were younger horses or stallions. Independent analysis of clinicopathologic variables revealed that horses with thrombocytosis were more likely to have hyperfibrinogenemia, leukocytosis, hypoproteinemia, and anemia than were horses with normal platelet counts. Physical examination parameters associated with thrombocytosis included tachycardia and pyrexia. In the final multivariable model, the variables with the strongest association with thrombocytosis included leukocytosis, anemia, and hyperfibrinogenemia. Thrombocytosis rarely causes clinical problems in horses and is not likely to require specific antiplatelet therapy. The strong association of thrombocytosis with infectious/inflammatory disorders, however, should lead clinicians to suspect these types of conditions in horses with high platelet counts.
Anemia↗
Vectorial capacity of North American Ixodes ticks.
Ixodes dammini, the vector of Lyme disease and babesiosis, is distributed in various locations in the northeastern quadrant of the United States and nearby Canada. The life cycle of this tick, which includes larval, nymphal, and adult stages, spans at least two years. The tick over-winters between larval and nymphal feeding. Horizontal transmission of pathogens is facilitated by a feeding pattern in which both the larval and nymphal stages feed on the white-footed mouse, Peromyscus leucopus, and by a seasonal pattern of activity in which nymphs precede larvae. The species range appears to have expanded from a single island location, and has invaded new sites since the 1940s, some as recently as 1980. This increased abundance appears to be related to the increased abundance of deer, the preferred host of the adult stage. I. muris predominated in coastal Massachusetts before I. dammini became abundant, but is probably now extinct. I. scapularis, which is present in the southern U.S., is a poor vector of mouse parasites because about 90 percent of these immature ticks feed on lizards. To the extent that horizontal transmission occurs, we suggest that mice serve as the principal reservoir for the Lyme spirochete as well as Babesia microti.
Animals↗