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Biomedical subjects

K E Nelson

Publications and source records attributed to K E Nelson.

At least 217 records · Page 12Linked to original sources
PubMed1985

A study of the immunological effects of cimetidine in patients with lepromatous leprosy.

To test the capacity of cimetidine to enhance cellular immunity in patients with lepromatous leprosy (LL), cimetidine was given for one month to 29 inactive LL patients and 3 active LL patients. Immune function was monitored with skin tests (lepromin, PPD, candida, and trichopytin), lymphocyte transformation tests (phytohemagglutinin, BCG, and Dharmendra lepromin), and quantitation of peripheral blood lymphocyte subpopulations. A small but significant "booster" response to PPD was the only change observed in the study of patients with inactive disease, and leprosy-related reactions did not occur. In the few active LL patients studied, neither immune enhancement nor leprosy-related reactions were observed. The results of this investigation suggest that cimetidine can be used safely in patients with inactive lepromatous leprosy.

Adjuvants, Immunologic↗
PubMed1984

A study of cellular immunity in clinically healthy children of parents with leprosy in northern Thailand.

A study was done of the response to PPD-tuberculin, candida and the tuberculin conversion rate after BCG vaccination among 302 healthy children in northern Thailand. The children were grouped according to whether their parent(s) or other household contact(s) had tuberculoid leprosy (74 children), lepromatous leprosy (47 children), or all family members were healthy (181 children). No significant differences were detected in the responses to candida or PPD-tuberculin on initial skin testing or in the history of a previous BCG vaccination in the three groups of children. However, among the children who were initially tuberculin negative, significantly decreased PPD conversion rates occurred in children from lepromatous families in comparison to those from tuberculoid families (p less than 0.01) or normal families (p less than 0.05). In the children from lepromatous families who were initially PPD and candida negative, 0 of 3 developed PPD-tuberculin conversions after BCG in comparison to 12 of 14 (85.7%) from normal families (p = 0.015). These data indicate that some children from lepromatous families were relatively unresponsive to stimulation with BCG and possibly other mycobacterial vaccines. The immunopathogenesis of this relative unresponsiveness should be further defined, since it might have important implications for the prevention of leprosy with a vaccine.

Adolescent↗
PubMed1983

Transmission of tuberculosis by flexible fiberbronchoscopes.

The development of flexible fiberoptic bronchoscopy was an important technologic advance in the diagnosis and management of patients with pulmonary disease. However, reliable decontamination and sterilization of these delicate instruments have been difficult. Many physicians routinely use a solution of povidone-iodine diluted in 70% ethyl alcohol and water to decontaminate fiberbronchoscopes, despite the fact that these iodophor compounds were developed as skin antiseptics and not as germicidal disinfectants for decontaminating instruments. We isolated a strain of Mycobacterium tuberculosis on a surveillance culture from a bronchoscope after it had been cleaned and disinfected with an iodophor solution. In another hospital, we documented the transmission of M. tuberculosis from one patient to another by a bronchoscope that had been disinfected with a commonly recommended iodophor solution. We then studied the tuberculocidal efficacy of various iodophor preparations used with exposure times from 10 to 30 min. In several experiments these iodophors failed to kill M. tuberculosis. Because iodophors do not reliably kill M. tuberculosis, they should not be used to disinfect fiberoptic bronchoscopes.

Adult↗
PubMed1982

Antibody responses to human diploid cell vaccine for rabies with and without human rabies immune globulin.

One hundred one volunteers with no exposure to rabies were given human diploid cell vaccine (HDCV) for rabies with or without 20 international units of human rabies immune globulin (HRIG)/kg of body weight to evaluate schedules for therapy with HDCV and HRIG after exposure. All of the volunteers who received three or more doses of HDCV alone or four or more doses of HDCV with HRIG developed high titers of neutralizing antibodies by day 35, which persisted for at least 60 days. By day 7, of the 61 volunteers given HRIG and HDCV, 53% had neutralizing antibodies by a mouse neutralization test and 67% had neutralizing antibodies by a rapid fluorescent focus inhibition test. Similar antibody levels were found in volunteers given HRIG alone, a finding which suggests that low or undetectable early titers after administration of HDCV and HRIG were due to inadequate HRIG dosage rather than any interaction between the passive antibody (HRIG) and the vaccine antigen. These results suggest that trials with 30 or 40 international units of HRIG/kg in combination with HDCV are warranted.

Antibodies, Viral↗
PubMed1982

Bacterial meningitis without clinical signs of meningeal irritation.

A clinical diagnosis of meningitis in neonates is difficult because of paucity of physical findings. In older infants and children, nuchal rigidity, Kernig's or Brudzinski's sign, or bulging fontanelles are sought. A review of 1,064 cases of bacterial meningitis beyond the neonatal period revealed that 16 (1.5%) patients had none of those meningeal signs during the entire hospitalization, despite CSF pleocytosis. Eight patients (50%) were 2 years old or older. Lumbar punctures were done because of unexplained fever, changes in behavior or mental status,, seizures, or occurrence of skin petechiae in febrile patients. These patients frequently had moderate pleocytosis and all survived. The meningitis was caused by Neisseria meningitidis in seven patients, Haemophilus influenzae in six, Streptococcus pneumoniae in two, and Salmonella enteritidis in one patient. CSF should be examined in a patient of any age whenever meningitis is a consideration, even if patients lack meningeal signs.

Child↗
PubMed1982

Aberrant immunoregulatory control of B lymphocyte function in lepromatous leprosy.

The capacity of peripheral blood mononuclear (PBM) cells from patients with leprosy to generate immunoglobulin-secreting cells in response to pokeweed mitogen (PWM) was evaluated by a reverse haemolytic plaque forming cell (PFC) assay. The PFC responses of PBM cells from patients with lepromatous (Lpr) leprosy were significantly higher (P less than 0.01) than those of PBM cells from normal controls and patients with tuberculoid leprosy. Co-culture of T lymphocytes from normal donors with PBM cells from Lpr patients reduced the PFC response of these cells to the normal range. T4+-helper lymphocytes from Lpr donors did not induce supranormal responses to PWM by normal PBM cells enriched for B lymphocytes. T8+-suppressor lymphocytes from normal donors greatly reduced the response of cultures containing normal allogeneic B cells plus T4+ cells. Conversely, when T8+ cells from Lpr donors were cocultured with normal B cells plus T4+ cells, they failed to suppress the response to PWM. In summary, these studies have demonstrated abnormally high PWM-stimulated PFC responses by B lymphocytes from patients with Lpr leprosy. This aberration, in turn, is associated with a loss of regulatory function by T8+-suppressor cells in Lpr patients.

Adult↗
PubMed1981

Community-acquired purulent meningitis of unknown etiology. A continuing problem.

The clinical features and hospital course of 132 patients with purulent meningitis of unknown etiology (PMU) were compared with those of 1,032 patients with proven bacterial meningitis; all patients were admitted to a major referral center for meningitis treatment between 1954 and 1976. Most patients had no major underlying illnesses. Patients with PMU were more frequently older, "pretreated" with antibiotics, had longer duration of symptoms, evidenced less marked alterations of mental status, and died later in the hospitalization; however, the mortality and frequency of neurologic complications were similar to those in patients with bacterial meningitis. Patients with PMU who also had hemorrhagic rashes had fewer neurologic complications and none died; these patients comprised a distinct group in terms of better prognosis. New methods for rapid diagnosis of bacterial meningitis have only partially resolved the diagnostic dilemma of PMU.

Adolescent↗
PubMed1981

Sign language and autism.

Research findings and issues in teaching sign language to nonspeaking autistic children are reviewed. Data on over 100 children indicate that nearly all autistic children learn receptive and expressive signs, and many learn to combine signs. These children also exhibit marked improvement in adaptive behaviors. Speech skills are acquired by fewer children and may be developed through simultaneous speech and sign training. Possible explanations for these results are given, together with suggestions for future research and data collection. Recommended innovations include exposure to fluent signers and training in discourse and code-switching. Different sign language teaching methods need to be investigated more fully, including emphasis on training sign language within the children's total environment and with greater staff and parental participation.

Adolescent↗
PubMed1980

Unusual aspects of Salmonella meningitis.

Two cases of salmonella meningitis that demonstrate unusual clinical and epidemiologic features are reported. The first case was a two-month-old infant with relapsing salmonella meningitis in whom ECHO 2 virus and S. enteritidis grew in mixed culture from cerebrospinal fluid. The second case was a five-month-old with typhoid meningitis. Although this patient eventually responded to chloramphenical, repeated CSF cultures grew S. typhi despite his receiving high dose parenteral therapy with ampicillin and chloramphenicol. Stool cultures disclosed that the patient's mother was an asymptomatic carrier of S. typhi. Nine days after the positive stool culture, the mother developed S. typhi bacteremia.

Ampicillin↗
PubMed1979

Tuberculin test conversion during repeated skin testing, associated with sensitivity to nontuberculous mycobacteria.

To determine whether repeating the tuberculin test after a brief interval might result in tuberculin conversion, we tested 213 healthy volunteers twice, 1 month apart, with 5 TU of tuberculin purified protein derivative (PPD). Three nontuberculous mycobacterial antigens (PPD-G, PPD-Y, and PPD-B) were also applied with the first tuberculin test. By widely used criteria, 14 volunteers (6.6 per cent) converted their tuberculin tests from negative to positive on the second testing. Whereas 13 of 103 subjects (12.6 per cent) with nontuberculous antigen sensitivity converted their tuberculin test to positive, only one of 110 subjects (0.9 per cent) with no known prior mycobacterial sensitivity converted to positive (P less than 0.005; x2 = 10.05). When retested with 5 TU of tuberculin PPD 6.5 months after the second test, nine of 13 converters reverted to negative. We conclude that tuberculin conversion may occur when the skin test is repeated at 1 month, and that boosting of cross-reacting mycobacterial sensitivity might have caused a portion of the conversions in this population of young, healthy midwestern volunteers. Sensitivity to Mycobacterium tuberculosis might also be boosted by tuberculin testing. Because the prevalence of sensitization by tuberculous and nontuberculous mycobacteria can be expected to vary in different populations, the significance of tuberculin conversion will also vary with the population being tested.

Adolescent↗
PubMed1977

Purified duck embryo rabies vaccine. An accelerated schedule for preexposure immunization against rabies.

Seroconversion and adverse reaction rates were studied in 92 persons given four or five doses in a two-week period of duck embryo rabies vaccine (DEV) or duck embryo rabies vaccine purified by ultracentrifugation (P-DEV). Mouse-neutralizing antibodies developed in 78 of 92 (84.8%) persons in these accelerated schedules. There were no significant differences in the frequency of antibody conversion or in geometric mean titers of antibody between persons given either vaccine. However, local and systemic adverse reactions were substantially less common with P-DEV. These data suggest that four of five doses of DEV or P-DEV given in a two-week course can be used for preexposure prophylaxis in situations where the more drawn-out regimens would result in continuation of a high-risk of rabies exposure. The antibody response of persons given this more accelerated regimen must be determined.

Animals↗