Biomedical subjects
K G Nicholson
Publications and source records attributed to K G Nicholson.
Malaria in Leicester 1983-1988: a review of 114 cases.
We have reviewed 114 episodes of malaria in 110 patients who were admitted to the Infectious Diseases Unit in Leicester during the 5 year period from February 1983-January 1988. There were 71 episodes of vivax malaria (62%), 33 episodes of falciparum malaria (29%), four patients with mixed infection and six patients with negative blood films who were diagnosed on clinical suspicion alone. Most patients presented in the summer months, 68% were aged under 40 years, 39% were born in the Indian subcontinent, 23% in East Africa and 23% in Britain. Eighty-two per cent of patients with falciparum malaria had recently returned from Africa whereas 82% with vivax malaria had visited Asia. Thirty six per cent had been given antimalarial chemoprophylaxis but only half of these took medication correctly. Seventy five per cent of episodes of falciparum malaria presented within 2 weeks of arrival in Britain, however vivax malaria could present at any time and 49% of cases occurred over 3 months after exposure. Presenting symptoms and signs were often non-specific. Twenty nine per cent of patients had been treated with antibiotics and 11% received antimalarials prior to admission. Vivax malaria was generally a mild infection but falciparum malaria was often severe with 39% of patients experiencing complications including one death. Although Plasmodium vivax and P. falciparum are morphologically similar the diseases caused by the two species of parasite are quite distinct. Physicians must ensure that malaria is excluded in anyone who has travelled to an endemic area.
Acute upper respiratory tract viral illness and influenza immunization in homes for the elderly.
Occupants of 482 long-stay and 33 short-stay beds in 11 Leicester City Council homes for the elderly were studied during a 30-week period from September 1988 to March 1989 to determine the incidence, aetiology, morbidity, and mortality of acute upper respiratory tract viral infections and the use of influenza vaccine. Influenza immunization rates by home ranged from 15.4 to 90% (mean 45%). There were no differences in the distribution of medical conditions by home. The highest immunization rates were seen in people with chest disease (77%), heart disease (60%), diabetes (56%), and those with three medical conditions (75%). There was an average of 0.7 upper respiratory episodes per bed per annum with a mortality of 3.4% (6/179). Half of all episodes were seen by a general medical practitioner and 81 of 90 (90%) referrals were prescribed antibiotics costing approximately 7.50 pounds per patient. Lower respiratory tract complications developed during 45 (25%) of 179 episodes including 3 of 12 coronavirus infections, 3 of 9 respiratory syncytial virus infections, 2 of 4 adenovirus infections, 1 of 11 rhinovirus infections, but none of 5 influenza infections. Respiratory infections were caused mostly by pathogens other than influenza virus during the influenza period documented nationally. This highlights the role of coronaviruses, respiratory syncytial virus, and unidentified agents in the elderly, and questions the assumptions made in American estimates on the impact of influenza and the value of influenza vaccines.
Inflammation of the retinal pigment epithelium: a unique presentation of ocular schistosomiasis.
We report the first case of inflammation of the retinal pigment epithelium (RPE) caused by Schistosoma mansoni and discuss its possible pathogenesis. This is of particular interest because the lesions resembled those found in acute multifocal placoid pigment epitheliopathy (AMPPE).
Failure of interferon alfa and tribavirin in rabies encephalitis.
OBJECTIVE: To test the effect of interferon alfa and tribavirin (ribavirin) in patients with rabies encephalitis. DESIGN: An open trial of chemotherapy and intensive care in patients with early rabies. SETTING: The intensive care unit of a Bangkok hospital. PATIENTS: Four conscious men with clinical rabies encephalitis. INTERVENTIONS: Rapid virological diagnosis of rabies. Treatment with intravenous and intraventricular injections of high doses of lymphoblastoid interferon alfa in three patients and tribavirin in one patient. Intensive care was given throughout. MAIN OUTCOME MEASURES: Rabies infection confirmed by antigen detection and virus isolation. Rabies neutralising antibody and specific IgM sought in serum and cerebrospinal fluid. Interferon concentrations monitored before and during treatment in three patients. RESULTS: Interferon alfa treatment produced high concentrations in serum and cerebrospinal fluid. All four patients died after 5 1/2 to 12 1/2 days of treatment with no evidence of virostatic or clinically beneficial effects from either treatment. CONCLUSION: Interferon alfa treatment is not effective in rabies encephalitis. The use of tribavirin warrants further study, possibly combined with new therapeutic methods.
Uptake of influenza vaccination by patients with serious cardiac disease.
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Malaria prophylaxis in travellers from Britain.
A short questionnaire about malarial prophylaxis was completed by 376 travellers departing from Gatwick Airport to destinations in Asia, Africa, Australasia and South or Central America. Only 263 (70%) had sought advice, 80% of them from a general practitioner. Of travellers born in Britain, 81% had sought advice compared to 38% of those born abroad (P less than 0.001). Advice about protective measures to reduce mosquito bites had been given to 52% travellers. Although 264 were travelling to areas where prophylaxis is advised, only 167 (63%) were taking antimalarials, while 22% travelling to malaria-free destinations were taking unnecessary prophylaxis. Many British travellers do not take effective antimalarial chemoprophylaxis. This has undoubtedly contributed to the recent increase in incidence of the disease in the U.K. General practitioners should ensure that they give correct advice and the immigrant population need to understand the risk of malaria when they return home.
Effects of alpha-interferon on theophylline pharmacokinetics and metabolism.
1. The influence of alpha-interferon (Roferon-A) on the pharmacokinetics and metabolism of theophylline was studied in healthy adults. Roferon-A was administered as an intra-muscular injection (3 x 10(6) iu) once-a-day over 3 days. One week prior to and immediately after this course a single 20 min aminophylline infusion (4 mg kg-1) was given. 2. Blood samples for theophylline analysis were taken over 48 h. Urine was collected up to 72 h and assayed for theophylline and its major metabolites 3-methylxanthine, 1,3-dimethyluric acid and 1-methyluric acid. 3. Pharmacokinetic parameters for theophylline in plasma were calculated. From urinary excretion data the overall metabolic clearance of theophylline and clearances for formation of the metabolites were calculated. 4. After interferon administration, there was a significant increase of approximately 15% in the mean values of the terminal elimination half-life, area under the curve and mean residence time of theophylline in association with a similar decrease in plasma clearance (P less than 0.05). Formation clearances of the metabolites tended to be smaller after treatment, but only the change in the overall clearance of theophylline was significantly different (P less than 0.05). There was no systematic shift in the metabolic pattern of theophylline. 5. Additional investigations of the influence of the duration of alpha-interferon treatment are necessary before definite conclusions can be drawn about the mechanism and the clinical relevance of the described interaction.
Retinochoroiditis in acute Epstein-Barr virus infection.
The case is reported of a 17-year-old male with secondary glaucoma and retinochoroiditis complicating acute clinical infectious mononucleosis. The diagnosis was confirmed by Epstein-Barr virus specific serology. Toxoplasmic infection was initially suspected. The differential diagnosis and relevant literature are discussed.
Mycoplasma pneumoniae infection associated with Henoch-Schonlein purpura.
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Still's disease and myocarditis associated with recent mumps infection.
We describe a 16 year old patient who developed Still's disease with evidence of myocarditis. A rise in the mumps 'V' antigen indicated that the disease was associated with recent mumps infection.
Pre-exposure studies with purified chick embryo cell culture rabies vaccine and human diploid cell vaccine: serological and clinical responses in man.
Clinical reactions and neutralizing antibody responses to six pre-exposure regimens of purified chick embryo cell culture rabies vaccine (PCECV) and human diploid cell strain rabies vaccine (HDCSV) were studied in 177 volunteers. Antibody kinetics, height of the response and persistence of antibody over two years were virtually identical after PCECV and HDCSV. An antibody response was detected in all subjects on day 14 when the highest titres were found after two intramuscular (i.m.) 1.0 ml doses of a schedule of immunization on days 0, 7 and 21. In comparison, a schedule of immunization on days 0, 28 and 56 ultimately evoked the highest titres 21 days after the final injection, but antibody persisted equally well over two years with either schedule. Neutralizing antibody titres were lower after intradermal (i.d.) vaccination with 0.1 ml compared to 1.0 ml i.m. on days 0, 7 and 21, but when given on days 0, 28 and 56 the responses were comparable. Three subjects with a personal or family history of atopy developed urticarial lesions after PCECV. Both vaccines were otherwise well tolerated.
Influenza vaccination of the elderly: perceptions and policies of general practitioners and outcome of the 1985-86 immunization programme in Trent, UK.
The policies, organization and outcome of the influenza vaccination programmes for the elderly were studied in randomly selected general practices in Trent during the winter of 1985-86. Data from 127 practices, covering approximately one-fifth of the 668 800 people in Trent 65 years of age and older, were studied in detail. Altogether 87% of practices offered vaccine to selected elderly patients and 93.5% gave it upon request. However, less than one-fifth of the elderly population covered by the survey were vaccinated against influenza and the number of doses prescribed by individual practitioners and practice immunization rates varied considerably. The higher immunization rates were correlated with certain practice immunization policies and procedures Reasons for non-acceptance of vaccine were also identified. The observations suggest that provision of educational materials about the risks and benefits of influenza vaccine and a re-appraisal of practice strategies relating to the influenza immunization programme may increase the number of elderly people who are immunized.
Acute infection with human immunodeficiency virus associated with facial nerve palsy and neuralgia.
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Infectivity and reactogenicity of reassortant cold-adapted influenza A/Korea/1/82 vaccines obtained from the USA and USSR.
The safety and immunogenicity of two live influenza A virus vaccine strains, the CR 59 and 17/25/1 cold-adapted (ca) reassortants, were evaluated in 170 healthy young adult volunteers. The vaccines were produced by recombining A/Korea/1/82 (H3N2) wild-type virus with either A/Ann Arbor/6/60 (H2N2) or A/Leningrad/134/17/57 (H2N2) ca donors of attenuation. Both vaccines were well tolerated in volunteers. The 17/25/1 strain, prepared from A/Leningrad, infected at least 70% of seronegative volunteers after the first dose and 84% after the second; the CR 59 strain infected 62% and 72% of volunteers after first and second doses, respectively. Among the vaccinees who were initially seropositive, 17/25/1 infected 66% after one dose and 85% after two, while CR 59 infected 62% and 71%, respectively. Despite differences in temperature sensitivity, genetic composition, and serological reactivity to monoclonal antibodies, both vaccines behaved almost identically in animal models and man. We conclude that both donors of attenuation may be of great potential value.
Single-radial-immunodiffusion potency tests of inactivated influenza vaccines for use in man and animals.
Single-radial-immunodiffusion (SRD) provides a sensitive and reproducible in vitro assay for haemagglutinin (HA) concentration in inactivated influenza vaccines. The use of SRD for human influenza vaccine standardization and application for equine and avian influenza vaccines is discussed. In clinical trials, vaccine HA concentration measured by SRD has been shown to be directly related to antibody responses and to protection against challenge. The use of SRD may considerably reduce the usage of animals for potency testing of veterinary influenza vaccines.
Economical multiple-site intradermal immunisation with human diploid-cell-strain vaccine is effective for post-exposure rabies prophylaxis.
An economical post-exposure regimen of Mérieux human diploid-cell-strain vaccine (HDCSV) was compared with Semple vaccine (SV), the most widely used vaccine in Asia. 155 patients bitten by animals proved to be rabid received either conventional courses of SV (34 severe and 43 mild cases) or HDCSV, 0.1 ml intradermally, at eight sites on day 0, at four sites on day 7, and at one site on days 28 and 91 (36 severe and 42 mild cases). All severely bitten patients were given equine anti-rabies serum (EARS), 80 IU/kg on day 0. There were no deaths from rabies in either group. Follow-up was 97.5% at 1 year and 93% at 2 years. 88% of patients given HDCSV alone had detectable neutralising antibody on day 7 in contrast to 2% given SV alone. Antibody persisted until 1 year in all sera tested from HDCSV patients in contrast to only 48% of SV sera. The high dose of EARS resulted in pronounced suppression of response to HDCSV. There were no serious systemic side-effects but local side-effects were significantly more common in the SV group. The multiple-site intradermal HDCSV regimen was at least as effective as SV. The amount of HDCSV used was 30% of the conventional dose.