Biomedical subjects
Publications and source records attributed to J M Knox.
We believe that humoral and cellular immunity both are involved in the response of the host to infection with T. pallidum. A complex interaction between stimulation and suppression of cell-mediated immunity may be involved. This interaction may explain the unusual clinical course in which secondary syphilis waxes and wanes before culminating in immunity.
In a collaborative prospective study 327 women with uncomplicated gonococcal cervicitis or proctitis were randomly assigned to one of four treatment groups: (1) aqueous procaine penicillin G, 4.8 million units IM in one session plus 1.0 g probenecide; (2) tetracycline HCI, 9 g over 4 days; (3) trimethoprim, 80 mg-sulfamethoxazole, 400 mg (TMP-SMX) six tablets once daily for 3 days; (4) TMP-SMX, six tablets wtice on 1 dat at a 6-hour interval. They were re-examined 4 to 8 days and 10 to 15 days after completion of therapy. There was no significant difference between the results of the four regimens in the 4- to 8-day period (P greater than 0.36). However, at the 2-week point the results of TMP-SMX given for 3 days were less effective (P smaller than 0.05) than those obtained by penicillin plus probenecid. There was no significant difference between the results of the other regimens at this latter period.
Several treatment regimens of trimethoprim-sulfamethoxazole (TMP-SMZ) were compared to the USPHS-recommended schedules for treatment of uncomplicated gonorrhea with ampicillin plus probenecid, tetracycline, or aqueous procaine penicillin G in both men and women. TMP-SMZ, six tablets as a single oral dose daily for 3 days, was as effective as the ampicillin or tetracycline schedules. The drug was well tolerated.
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The relative importance of the environment versus the physiology of the host in the control of Gram negative bacteria on skin has been examined by two experimental designs. (I) The changes in incidence of Gram negative carriage from three skin sites in a climate controlled chamber at 35 degrees C and 90% humidity for 64 h were determined. Following 2 weeks of tetracycline treatment the above experiment was repeated. High temperatures and humidity increased the overall frequency of isolation of Gram negative bacteria although there were individual differences. This effect was reversed 24 h after a return to the natural environment. Tetracycline inhibited the increase in isolation of Gram negative organisms in six subjects, enhanced it in three and had no effect on one subject. Gram negative populations were less than 10 colony forming units/cm2 of skin in most instances but ranged up to 10,000/cm2 skin. No residual effect occurred after return to natural environment and at no time was there a loss of normal flora. (2) Klebsiella pneumoniae, Proteus vulgaris and Pseudomonas aeruginosa were inoculated on normal skin of ten volunteers and survival determined during a 24 h period. Viability was lost between 2 and 6 h on most subjects as compared to 24 h or longer for K. Pneumoniae and P. vulgaris on an inert surface and between 8 and 24 h for Ps. aeruginosa. It was concluded that extremes of environment can affect Gram negative skin carriage but under normal conditions in healthy individuals there is evidence of physiological control of Gram negative flora.
The hands of 50 nurses and 50 controls were tested for coagulase-positive staphylococcus. Twenty-eight percent of both groups were carriers. The mean staphylococcal count on the palm of the hand was 13.7 per 16 cm-2 in nurses as compared to 442.7 per 16 cm-2 in the control group. The number of persistent carriers was the same for each group, but 25 percent of all cultures from nurses were positive for Staphylococcus aureus as compared to 14.2 percent of the cultures from the control group. It was concluded that there was no direct correlation between high staphylococcal counts and persistence of carriage. The skin as a site of carriage of Staphylococcus aureus was found to be of greater importance in nurses than in control subjects.
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The authors discuss the main characteristics which enable a differential diagnosis to be made between the dermatoses due to atypical mycobacteria. Persistent bacteriological and epidemiologic studies are likely to result in a solution to the challenging problem presented by the conditions under consideration.
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The response of lymphocytes from patients with syphilis and normal subjects was studied in vitro by using phytohemagglutinin (PHA), pokeweed mitogen (PWM), streptolysin O (SLO), and a preparation of Treponema refringens. Normal lymphocytes exhibited a dose-response curve to treponemes. Although lymphocytes from patients with primary and secondary syphilis responded normally to PHA and PWM, their response to SLO was suppressed and they failed to show significant stimulation by treponemes. Serum from syphilitic patients did not affect normal lymphocytes, and culturing lymphocytes from patients with syphilis in normal serum did not restore their responsiveness. Six to 10 weeks after syphilitic patients had been treated, the degree of stimulation by treponemes was the same as for normal subjects. These data give indirect support to the hypothesis that immunological suppression occurs during active infection with T. pallidum.
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