Campylobacter fetus infections in two patients with AIDS.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
J R Harris
Publications and source records attributed to J R Harris.
Field trial of oral cholera vaccines in Bangladesh: evaluation of anti-bacterial and anti-toxic breast-milk immunity in response to ingestion of the vaccines.
In a field trial conducted in Bangladesh, ingestion of either B subunit-killed whole cell (BS-WC) or killed whole cell (WC) oral cholera vaccines by mothers was associated with a 47% reduction of the risk of cholera in their non-vaccinated children aged under 36 months. Because vaccine-induced breast-milk immunity seemed a possible explanation for these findings, we evaluated anti-lipopolysaccharide (LPS) and anti-cholera toxin (CT) IgA antibody responses in breast milk collected during the trial from 53 lactating women who ingested three doses of BS-WC, WC, or an Escherichia coli K12 strain (K12). Despite induction of moderate vibriocidal (1.4 to 2.0-fold) and anti-CT (4.5-fold) serum antibody responses, the vaccines did not elicit significant rises of anti-LPS or anti-CT IgA breast-milk antibodies. The failure of the vaccines to elicit significant levels of breast-milk anti-cholera antibodies suggests an alternative explanation for protection of young children by maternal vaccination, such as interruption of maternal-child transmission of Vibrio cholerae 01.
Administration, Oral↗
Is radiotherapy as curative as mastectomy for patients with ductal carcinoma in situ?
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Breast Neoplasms↗
Can simulation measurements be used to predict the irradiated lung volume in the tangential fields in patients treated for breast cancer?
A simple method of estimating the amount of lung irradiated in patients with breast cancer would be of use in minimizing lung complications. To determine whether simple measurements taken at the time of simulation can be used to predict the lung volume in the radiation field, we performed CT scans as part of treatment planning in 40 cases undergoing radiotherapy for breast cancer. Parameters measured from simulator films included: (a) the perpendicular distance from the posterior tangential field edge to the posterior part of the anterior chest wall at the center of the field (CLD); (b) the maximum perpendicular distance from the posterior tangential field edge to the posterior part of the anterior chest wall (MLD); and (c) the length of lung (L) as measured at the posterior tangential field edge on the simulator film. CT scans of the chest were performed with the patient in the treatment position with 1 cm slice intervals, covering lung apex to base. The ipsilateral total lung area and the lung area included within the treatment port were calculated for each CT scan slice, multiplied by the slice thickness, and then integrated over all CT scan slices to give the volumes. The best predictor of the percent of ipsilateral lung volume treated by the tangential fields was the CLD. Employing linear regression analysis, a coefficient of determination r2 = 0.799 was calculated between CLD and percent treated ipsilateral lung volume on CT scan. In comparison, the coefficients for the other parameters were r2 = 0.784 for the MLD, r2 = 0.071 for L, and r2 = 0.690 for CLD x L. A CLD of 1.5 cm predicted that about 6% of the ipsilateral lung would be included in the tangential field, a CLD of 2.5 cm about 16%, and a CLD of 3.5 cm about 26% of the ipsilateral lung, with a mean 90% prediction interval of +/- 7.1% of ipsilateral lung volume. We conclude that the CLD measured at the time of simulation provides a reasonable estimate of the percent of the ipsilateral lung treated by the tangential fields. This information may be of value in evaluating the likelihood of pulmonary complications from such treatment and in minimizing toxicity.
Breast Neoplasms↗
Factors influencing cosmetic outcome of conservative surgery and radiotherapy for breast cancer.
Increasing acceptance of conservative therapy for early breast cancer has made the cosmetic outcome of the treated breast an important endpoint for evaluation. A number of interrelated patient, tumor, and treatment factors will determine the ultimate cosmetic outcome. Attention to surgical and radiotherapeutic technique should lead to good to excellent overall cosmetic results in the majority of patients.
Biopsy↗
Death in shigellosis: incidence and risk factors in hospitalized patients.
The total number of admissions and deaths of patients with shigellosis were ascertained at the Dhaka Treatment Centre of the International Centre for Diarrhoeal Disease Research, Bangladesh, 1974-1988, and the characteristics of 67 patients who died were compared with those of 134 discharged alive. Of 9780 Shigella-infected inpatients, 889 (9.1%) died; 32.3% of deaths occurred in children less than 1 year of age. Fatality rates were highest (10.3%) in Shigella sonnei-infected patients and lowest (6.7%) in Shigella dysenteriae type 1-infected patients. Age less than 1 year, lack of breast feeding in patients 1-2 years of age, hypothermia, severe malnutrition, severe dehydration, altered consciousness, abdominal distension, thrombocytopenia, hypoproteinemia, hyponatremia, hypoglycemia, renal failure, and bacteremia were all significantly more common in case patients. In a multivariate analysis, younger age, decreased serum protein, altered consciousness, and thrombocytopenia were predictive of death. Thus in Bangladesh the fatality rate for hospitalized patients infected with any species of Shigella remains high despite relatively intensive inpatient care, and young, hypoproteinemic patients are at greatest risk of fatal illness.
Adolescent↗
Seroepidemiologic evaluation of anti-toxic and anti-colonization factor immunity against infections by LT-producing Escherichia coli in rural Bangladesh.
To evaluate serologic immunity against clinical infections by heat-labile enterotoxin-producing Escherichia coli (LT-ETEC) in rural Bangladesh, 124 children and adult women with LT-ETEC diarrhea (cases) were compared with 347 age-matched community controls. In paired acute-convalescent sera from the cases, IgG anti-CFA I and anti-CFA II antibody titers increased eight-to ninefold after infection by LT-ETEC with the homologous CFA, and IgG anti-LT antibody titers increased fourfold for all LT-ETEC infections. Anti-CFA and anti-LT titers peaked in controls aged 12-23 months, the age group with the highest incidence of ETEC infections. However, antibody titers were similar in acute sera from cases and in sera from controls. Although serum IgG anti-CFA and anti-LT antibodies rose in response to LT-ETEC infections and paralleled the age-specific incidence of ETEC in the community, these antibodies were not associated with a lower risk of LT-ETEC diarrhea.
Adolescent↗
Comparison of ofloxacin with doxycycline in the treatment of non-gonococcal urethritis and cervical chlamydial infection.
The efficacy of ofloxacin was compared with that of doxycycline in the treatment of non-gonococcal urethritis (NGU) and cervical chlamydial infection in an open randomized study. In total, 182 men and 100 women were enrolled: 92 men and 50 women received ofloxacin at a dose of 400 mg once daily for seven days, and 90 men and 50 women received doxycycline at a dose of 100 mg twice daily for seven days. All women and 42 men, that is 29 men in the ofloxacin group (32%) and 13 in the doxycycline group (14%) were chlamydia-positive on entry into the study. Patients were reviewed on completion of the treatment course (day 8) and two weeks later (day 22). Clinical cure rates for NGU in assessable patients in each treatment group were similar; 73% in the ofloxacin group and 63% in the doxycycline group at day 8, and 70% and 90% in the respective treatment groups on study completion. Repeat tests for chlamydiae were negative for all male and female patients at both day 8 and day 22. Both ofloxacin and doxycycline were well tolerated. We conclude that ofloxacin given at a dose of 400 mg once daily for seven days is a safe and effective alternative treatment for NGU and cervical chlamydial infection.
Adolescent↗
Breast feeding and the risk of severe cholera in rural Bangladeshi children.
The association between breast feeding and the risk of severe cholera was examined in a case-control study of rural Bangladeshi children under 36 months of age who were studied in 1985-1986 during a field trial of killed oral cholera vaccines. A total of 116 cases who were treated for severe cholera were compared with 464 age-matched community controls without severe cholera. Overall, the odds ratio relating breast feeding to severe cholera (0.30, p less than 0.0001) reflected a 70% reduction in the risk of severe cholera among breast-fed children. The estimated reduction of risk declined with age, but was clearly evident in children up to 30 months of age. Although the association between breast feeding and a reduced risk of severe cholera was not significantly greater in children of mothers who had received cholera vaccine than in children whose mothers had received placebo during the trial, maternal vaccination per se was suggestively associated with a reduced risk of severe cholera in their nonvaccinated children (odds ratio = 0.53, p = 0.05). These results indicate that breast feeding was associated with a substantial reduction of the risk of severe cholera and raise the possibility that vaccination of mothers may provide protection to their young children in endemic settings.
Bangladesh↗
The impact of HIV-1 infection on child survival in the developing world.
In this study we have used a mathematical projections model and HIV-1 seroprevalence data from samples of pregnant women to estimate infant HIV-1-infection prevalence and HIV-1-attributable mortality among children. This paper presents the results of samples from six developing country capitals and Martinique. The estimated impact of HIV-1 infection on overall infant mortality is low in regions where maternal HIV-1 seroprevalence is low and overall infant mortality is high, but substantial in locations where either maternal HIV-1 seroprevalence is high, or where maternal HIV-1 seroprevalence is moderate and overall infant mortality is low. The estimates for child (ages 1-4 years) and under-5 mortality suggest that the impact of HIV-1 infection on overall mortality in children may exceed the impact on infant mortality. The recent gains made in ensuring child survival are likely to be increasingly reversed in regions where HIV-1 infection is being transmitted in a substantial proportion of pregnancies and births.
Child↗
Intraprostatic antibody deposition in chronic abacterial prostatitis.
Sixty patients with chronic abacterial prostatitis and 21 men without prostatitis were studied. Transperineal prostatic biopsies taken under transrectal ultrasound control were examined for antibody, complement (C3) and fibrinogen deposition using a direct immunofluorescence (IF) technique; 34 patients (57%) had prostatic tissue that displayed IF staining compared with only 1 (5%) in the non-prostatitis group. IF staining for IgM was found in 85%, for C3 in 44%, for IgA in 35% and for fibrinogen in 24%, but the IgG subclass was not detected. Antibody deposition was mainly periglandular and glandular and in the wall of vessels. Five symptoms, particularly poor urinary flow, irritative voiding and urgency, were significantly correlated with IgM and C3 deposition and, to a lesser extent, fibrinogen deposition. The aetiology of chronic abacterial prostatitis remains obscure but several possible mechanisms are discussed. The link between symptomatology and immunology could rest with functional outflow obstruction causing intraprostatic reflux of urine, this in turn inciting an immunological response, the inducing antigens being organism remnants or products, urinary constituents or autoantibodies.
Adult↗
Epstein-Barr virus associated oesophageal ulcers in AIDS.
Epstein-Barr virus (EBV) associated ulceration has not previously been included in the differential diagnosis of oesophageal ulcers in AIDS. We report five cases of oesophageal ulceration in homosexual men with advanced human immunodeficiency virus infection in whom this was considered to be the most likely cause. DNA in situ hybridisation studies showed EBV in biopsy material from three of four patients with oesophageal ulcers and in none of three controls. Of other viruses studied, only human papillomavirus was present, and this was found in both patients and control subjects. These findings support the hypothesis that EBV is an aetiological factor in some cases of AIDS-associated oesophageal ulceration.
Acquired Immunodeficiency Syndrome↗
Campylobacter pylori in the upper gastrointestinal tract of patients with HIV-1 infection.
Fifty one patients with human immuno-deficiency virus (HIV-1) infection who had been consecutively endoscoped for upper gastrointestinal symptoms were biopsied (stomach or duodenum, or both) and compared with 59 age and sex matched controls for the presence of Campylobacter pylori. In 28 (47%) of the control group but in only seven (14%) of the HIV seropositive patients were C pylori seen on histological examination (p less than 0.001, odds ratio 5.6, 95% confidence interval 2.2-14.5). Sixteen patients who were HIV antibody positive had other index diseases for the diagnosis of AIDS in the biopsy material and, when these were excluded, comparison with the control group still showed a significant difference; p less than 0.01, odds ratio 3.6, 95%, confidence interval 1.4-9.6. In this series, therefore, C pylori were far less common in HIV antibody positive patients than in controls. Among the HIV positive patients, a higher proportion of C pylori negative cases had AIDS but this trend was not significant. The findings of this study indicate that whatever abnormalities of cell mediated mucosal immunoregulation are caused by HIV infection, they do not seem to be important in the response to infection by C pylori.
Acquired Immunodeficiency Syndrome↗
Sexual assault of men: a series.
The case records of five male victims of sexual assault presenting to two genito-urinary clinics are presented. The cases were chosen to illustrate the variety of presentations and possible sequelae of sexual assault of adult males.
Adolescent↗
Male prostitution and sexually transmitted disease.
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HIV Infections↗
A herpes simplex skin ulcer in a patient with AIDS--an unusual presentation.
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Acquired Immunodeficiency Syndrome↗
Risk factors of female HIV-seropositive patients attending the clinic for sexually transmitted diseases at St Mary's Hospital, London.
Of 3450 women tested for antibodies to human immunodeficiency virus HIV-1 and HIV-2 between September 1985 and July 1989, 61 were positive (1.8%). Twenty-seven of these (44%) were presumed to have acquired their HIV infection by heterosexual contact and 23 (38%) were intravenous drug addicts. In geographical origin, 23 (38%) of the patients were from the UK and 19 (31%) from Africa. Amongst these 61 women, 2 (3%) have since died, one committed suicide and one was suspected of committing suicide.
Adolescent↗
Setting up a support service for male prostitutes in London.
Estimating the number of male prostitutes working at any given time is fraught with difficulties. We suggest that perhaps around 600-700 men were selling sex in London in 1989. We report some preliminary observations gained during the setting up of a specific service for male prostitutes. Of 32 male prostitutes seen, 26 worked as rent-boys, 4 worked through agencies and 2 worked independently from home. Forty-one per cent had evidence of at least one sexually transmissible disease and 3 of 16 men tested (19%) were human immunodeficiency virus (HIV) positive.
Adolescent↗