Detection of Chlamydia pneumoniae in atheroma specimens.
Explore the source record for details and available documents.
Chlamydophila pneumoniae↗
Biomedical subjects
L A Jackson
Publications and source records attributed to L A Jackson.
Risk of infection with hepatitis A, B or C, cytomegalovirus, varicella or measles among child care providers.
BACKGROUND: Employment as a child care provider has been suggested as an indication for hepatitis A virus (HAV) immunization; however, whether this occupational group is at increased risk of HAV infection is not well-defined. METHODS: We obtained sera samples for testing for antibodies to hepatitis A, B and C, cytomegalovirus, varicella and measles from a sample of child care providers in King County, WA, and administered a questionnaire to assess employment characteristics and other potential risk factors for infection. We also compared the anti-HAV seroprevalence among providers with that of subjects in the Third National Health and Nutrition Survey, representative of the US general population. RESULTS: Thirteen percent (48 of 360) of providers were anti-HAV-positive (46% (22 of 47) of foreign born vs. 8% (26 of 313) of US-born (P < 0.001)). In multivariate analysis anti-HAV seropositivity was associated with foreign birth, age, income and Hispanic ethnicity but was not associated with characteristics of employment. Seroprevalence among US-born providers tended to be lower than that among Third National Health and Nutrition Survey subjects of similar age, sex, race and income. Sixty-two percent of providers were seropositive to cytomegalovirus, which was associated with nonwhite race, changing diapers > or = 3 days/week while at work and having a child in the household. Antibody prevalence was 1.4% to hepatitis B core antigen, 0.6% to hepatitis C, 94% to measles and 98% to varicella. CONCLUSIONS: The anti-HAV prevalence among US-born providers was low, and seropositivity was not associated with employment characteristics, indicating that occupational exposure to HAV is uncommon under non-outbreak circumstances.
Adolescent↗
Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B meningococcal disease.
BACKGROUND: A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure. METHODS: Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated. RESULTS: No cases occurred after prophylaxis. Before prophylaxis 10% (34 of 351) of students were meningococcal carriers and 3.4% (12 of 351) carried the epidemic strain. After prophylaxis 2.5% (5 of 196) were carriers and 1.0% (2 of 196) carried the epidemic strain. Rifampin was 85% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes. CONCLUSIONS: These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.
Adolescent↗
In vitro activities of azithromycin, clarithromycin, and other antibiotics against Chlamydia pneumoniae.
The in vitro susceptibilities of Chlamydia pneumoniae isolates to macrolide, tetracycline, and quinolone antibiotics were determined. Tetracycline, clarithromycin, and erythromycin had the lowest MICs in the first cell culture passage. Azithromycin required the lowest concentration for complete inhibition of inclusion formation on the second pass into antibiotic-free medium, likely reflecting its high intracellular concentrations.
4-Quinolones↗
Predictors of clonidine response in Tourette syndrome: implications and inferences.
Clonidine is an alpha-adrenergic agonist which may alleviate emerging symptoms in Tourette syndrome, an observation that has fueled speculation regarding involvement of stress-sensitive central noradrenergic systems in this disorder. We conducted a retrospective study of 53 juvenile patients with Tourette syndrome to assess predictors of short-term behavioral and tic response to oral clonidine and to examine the relationship, if any, among pretreatment blood pressure, tic severity, and clonidine response. When adverse effects were considered, older subjects experienced a better therapeutic response to clonidine, independent of dose. Improvement in symptoms of attention-deficit hyperactivity disorder was associated with a longer duration of vocal tics before treatment. Baseline sitting diastolic blood pressure was directly correlated with measures of tic severity but not with tic response to clonidine. The findings (1) provide indirect support for involvement of central noradrenergic systems in tic expression; (2) suggest that emergence of a tic-related neurophysiologic dysfunction may be necessary for optimal behavioral response to clonidine in Tourette syndrome; and (3) provide broad guidelines for the clinician considering clonidine therapy for pediatric patients with Tourette syndrome, particularly those with comorbid attention-deficit hyperactivity disorder.
Adolescent↗
Risk factors for group B streptococcal disease in adults.
OBJECTIVE: To determine risk factors for community-acquired and nosocomial group B streptococcal disease in adults. DESIGN: Case-control study. SETTING: 3 metropolitan areas in the United States with an aggregate population of 6.6 million persons. PATIENTS: 219 nonpregnant adults with invasive group B streptococcal infection identified by a population-based surveillance in 1991 and 1992 and 645 hospital-matched controls. RESULTS: The following conditions were associated with a significantly increased risk for community-acquired group B streptococcal infection after controlling for age in multivariate analysis: cirrhosis (odds ratio, 9.7 [95% CI, 3.5 to 26.9]; P < 0.001), diabetes (odds ratio, 3.0 [CI, 1.9 to 4.7]; P < 0.001), stroke (odds ratio, 3.5 [CI, 1.9 to 6.4]; P < 0.001), breast cancer (odds ratio, 4.0 [CI, 1.6 to 9.8]; P = 0.002), decubitus ulcer (odd ratio, 4.0 [CI, 1.6 to 9.8]; P = 0.002), and neurogenic bladder (odds ratio, 4.6 [CI, 1.4 to 15.1]; P = 0.01). Sixty-three percent of community case-patients had at least one of these conditions. Nosocomial infection (48 cases [22%]) was independently associated with the placement of a central venous line (odds ratio, 30.9 [CI, 5.2 to 184.1]; P < 0.001), diabetes, congestive heart failure, and seizure disorder. CONCLUSIONS: Several chronic conditions were independently associated with group B streptococcal disease, and most case-patients had at least one of these conditions. If group B streptococcal vaccines being developed for prevention of neonatal disease are protective in adults, a vaccination strategy targeting those at highest risk has the potential to substantially reduce the burden of invasive group B streptococcal infection in adults.
Adult↗
Serogroup C meningococcal outbreaks in the United States. An emerging threat.
OBJECTIVE: Multiple outbreaks of serogroup C Neisseria meningitidis have recently been reported from diverse areas of the United States. To better define the characteristics of this increasingly important problem, we reviewed data on all known serogroup C outbreaks in the United States from January 1980 through June 1993. DATA SOURCES: MEDLINE searches, Centers for Disease Control and Prevention records, state health department officials, infectious disease experts, and the meningococcal vaccine manufacturer. DEFINITION OF AN OUTBREAK: Three or more cases of serogroup C meningococcal disease within a 3-month period, either among members of a community or persons attending a single school or other institution, for which those cases represented an attack rate of at least five per 100,000 population. RESULTS: Twenty-one outbreaks of serogroup C meningococcal disease were identified; eight occurred since 1991. In 1992 and the first half of 1993, approximately 180,000 doses of vaccine were administered for outbreak control, compared with approximately 34,000 doses from 1980 to 1991. Approximately 50% of community-outbreak cases were between the ages of 5 and 24 years, compared with only 19% of sporadic serogroup C cases (P < .001). Subtyping of patient isolates indicates that outbreaks are clonal; however, at least five distinct but closely related strains have caused recent outbreaks. CONCLUSIONS: Serogroup C outbreaks are occurring more frequently in the United States. The effectiveness of preventive measures depends on early recognition; therefore, physicians should promptly report all cases of suspected meningococcal disease, and the causative serogroup should be established for every case.
Adolescent↗
The effect of various adjuvants on the humoral immune response of sheep and cattle to soluble and membrane midgut antigens of Boophilus microplus.
Sheep and cattle were immunized with soluble and membrane midgut antigens of the cattle tick, Boophilus microplus in association with various adjuvants, and antibody levels to soluble and membrane midgut extracts were measured by enzyme-linked immunosorbent assay (ELISA). The adjuvants used were Quil A, Freund's incomplete adjuvant (FIA) and aluminium hydroxide (A1(OH)3). Significant antibody levels to midgut membrane antigen (GM) were not detected in the sera of sheep immunized with GM plus A1(OH)3. However, membrane and soluble midgut antigens combined with Quil A generated significantly higher levels of antibodies in sheep than these antigens emulsified in FIA (P < 0.05). In cattle, although soluble midgut antigen (GS) plus Quil A induced significantly higher levels of antibodies compared with GS in FIA (P < 0.05), neither preparation provided significant protective immunity against challenge with B. microplus (46% and 22%, respectively). A soluble form of membrane midgut antigen extracted by low ionic strength buffer (LI-GM) when combined with Quil A provided 83% and 87% protection against challenge with B. microplus in two separate experiments. Quil A was clearly superior to FIA and A1(OH)3 as an adjuvant for these tick antigens.
Adjuvants, Immunologic↗
Chlamydia pneumoniae (TWAR).
Chlamydia pneumoniae (TWAR) is a recently recognized third species of the genus Chlamydia that causes acute respiratory disease. It is distinct from the other two chlamydial species that infect humans, C. trachomatis and C. psittaci, in elementary body morphology and shares less than 10% of the DNA homology with those species. The organism has a global distribution, with infection most common among children between the ages of 5 and 14 years. In children, TWAR infection is usually mild or asymptomatic, but it may be more severe in adults. Pneumonia and bronchitis are the most common clinical manifestations of infection, and TWAR is responsible for approximately 10% of cases of pneumonia and 5% of cases of bronchitis in the United States. The microimmunofluorescence serologic assay is specific for TWAR and can distinguish between recent and past infections. The organism can be isolated in cell culture; however, PCR techniques have recently facilitated its detection in tissues and clinical specimens.
Adult↗
Meningococcal carriage, alcohol consumption, and campus bar patronage in a serogroup C meningococcal disease outbreak.
Community outbreaks of serogroup C invasive meningococcal disease are increasing in North America (L. H. Harrison, JAMA 273:419-421, 1995; L. A. Jackson, A. Schuchat, M. W. Reeves, and J. D. Wenger, JAMA 273:382-389, 1995; C. M. Whalen, J. C. Hockin, A. Ryan, and F. Ashton, JAMA 273:390-394). In a recent 15-month university outbreak, disease was linked to patronage of a specific campus-area bar, suggesting that aspects of a campus bar environment might promote meningococcal transmission (P. B. Imrey, L. A. Jackson, P. H. Ludwinski, et al., Am. J. Epidemiol., in press). To investigate this hypothesis, oropharyngeal carriage results from samples taken from 867 university health service clients and 85 campus-area bar employees during the last 3 months of the outbreak were analyzed to determine factors correlated with carriage of any strain of Neisseria meningitidis. Results were validated with data from samples from 344 health center clients and 211 campus bar employees taken 8 months after the last outbreak case. Recent alcohol consumption (adjusted prevalence odds ratio = 3.8 for > 15 versus 0 drinks in last week [P = 0.0012]) and campus bar patronage (adjusted odds ratio = 1.9 for any versus no patronage in last 2 weeks [P = 0.0122]) showed separate effects in both univariate and multiple logistic regression analyses of data from the 1992 health center clients. Prevalence of meningococcal carriage among 1992 campus bar workers was 3.8 times that among health center clients; this prevalence ratio was roughly 2.5 after adjustment for alcohol consumption and bar patronage. Recent antibiotic usage was protective (prevalence odds ratio = 0.3) among health center clients and bar workers. These findings were generally supported by the validation samples. If alcohol consumption and other aspects of the campus bar environment facilitate transmission of and/or colonization by N. meningitidis, then the introduction of a highly pathogenic substrain into the campus bar environment may provide an unusual opportunity for invasive meningococcal disease within a campus community.
Adolescent↗
Clinical evidence of genomic imprinting in Tourette's syndrome.
Recent genetic studies of Tourette's syndrome (TS) have suggested a sex-specific expression of TS behaviors but not a sex-associated difference in their transmission. In a retrospective study designed to assess the influence of gender of the affected parent on childhood TS phenotype, we compared unmedicated TS subjects with patrilineal (n = 25) or matrilineal (n = 25) inheritance of TS, as determined by family history methodology, with respect to demographic variables, temporal profile of tic evolution, and clinical ratings of tics and associated behaviors, particularly obsessive-compulsive symptoms and attention deficit hyperactivity disorder (ADHD). Maternal transmission of TS was characterized by trends toward greater motor tic complexity and more frequent noninterfering rituals (p < 0.05); paternal transmission was associated with increased vocal tic frequency (p = 0.01), an earlier onset of vocal tics relative to motor tics (p < 0.01), and more prominent ADHD behaviors, including motor restlessness (p < 0.01). These findings are consistent with genomic imprinting in TS. Confirmation of this phenomenon promises not only to advance understanding concerning the genetic link between TS and ADHD but may also help to explain the apparent fit of competing models of genetic transmission in TS.
Adolescent↗
Should college students be vaccinated against meningococcal disease? A cost-benefit analysis.
Outbreaks and sporadic cases of meningococcal disease among college students have prompted consideration of a policy of routine vaccination for this group. Purchase and administration of the vaccine for routine vaccination would cost $56 million per year. Savings in medical care and indirect costs would not equal this amount unless the annual rate of disease among students is at least 6.5/100,000. The actual rate among students is unknown; however, surveillance data suggest it could not be more than 1.3/100,000. At rates near this estimate, the net cost of the program would be approximately $45 million annually. More cost-effective prevention strategies might be yielded by further studies to identify students at substantial risk of meningococcal disease, or by the development of a conjugate serogroup C vaccine that could be administered during infancy.
Adolescent↗
John Henryism and blood pressure in black college students.
Previous research on John Henryism, a coping mechanism linked to hypertension in blacks, has focused almost exclusively on rural, low-socioeconomic status (SES), adult populations. Furthermore, these studies have not evaluated mediating influences of John Henryism except in terms of SES. The primary focus of the current investigation was to examine the influence of John Henryism on cardiovascular disease risk factors among a relatively healthy sample of 421 urban, black college students. A second component of the study was to determine the role of social support as a mediating influence on those with limited coping resources and high John Henryism scores. Approximately 30% of males and 9% of females had systolic blood pressures > or = 140 mm Hg or diastolic blood pressures > or = 90. Females had higher John Henryism scores than males. John Henryism was also correlated with social support in females. Gender-specific regression models revealed that John Henryism was not an independent predictor of blood pressure in black college students. The results are discussed in terms of apparent gender differences with regard to overall coping mechanisms in black students and possible explanations for the lack of a John Henryism-blood pressure relationship in this population.
Adaptation, Psychological↗
Prevalence of Neisseria meningitidis relatively resistant to penicillin in the United States, 1991. Meningococcal Disease Study Group.
To estimate the prevalence of Neisseria meningitidis relatively resistant to penicillin in the United States, antimicrobial susceptibility testing was performed on all US meningococcal isolates submitted to the Centers for Disease Control and Prevention in 1991, including isolates identified through population-based surveillance for invasive meningococcal disease in selected areas of the United States. Three of the 100 isolates tested had MICs of penicillin of 0.125 microgram/mL. All were serogroup B, beta-lactamase-negative, and unique by multilocus enzyme electrophoresis subtyping. None of the 3 patients had been treated solely with penicillin; all recovered completely. About 4% of the isolates obtained from the population-based surveillance system were relatively penicillin-resistant. Given the low prevalence and uncertain clinical significance of infection with these organisms, routine susceptibility testing of meningococcal isolates is not indicated at this time; however, continued surveillance is necessary to monitor trends in antimicrobial susceptibility of meningococci in the United States.
Disease Outbreaks↗
What is the significance of black-white differences in risky sexual behavior?
A sample of African-American and white young adults were classified as having multiple sex partners or one sexual partner. Subjects with multiple sexual partners were more likely to use drugs and practice risky sexual behaviors such as having anal intercourse, having sexual experiences with a prostitute, and having a history of gonorrhea (P < .001) and genital warts (P < .01). Additional analyses were conducted to determine African-American versus white differences in risky sexual behaviors. Results indicated that whites in the multiple partners and single partner groups were more likely to engage in anal and oral sex, while African Americans were more likely to have sex with prostitutes. Attitudes about the use of condoms differed significantly by multiple partner status (P < .004) and gender (P < .007), but not ethnicity. However, angry reactions about the use of condoms occurred more with African Americans (P < .003) and males (P < .05) than with whites or females. While whites reported a greater use of drugs and a significantly higher level of knowledge about HIV/AIDS, African Americans reported a significantly greater perception of risk for being exposed to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (P < .01) and significantly more gonorrhea (P < .10), syphilis (P < .05), and HIV/AIDS (P < .05). No whites in our sample were treated for syphilis nor had they tested positive for HIV/AIDS. On the other hand, 4.5% of the total sample of African Americans reported testing positive for HIV/AIDS. Finally, the results from discriminant analysis indicate that a large number of variables significantly discriminate between subjects who engage in risky sexual behaviors and those who do not. Although there is some similarity in the variables for African Americans and whites, there was tremendous variability between the ethnic groups in the factors that predict risky behaviors. These findings are discussed with reference to the need to develop HIV/AIDS prevention programs for African Americans that are based on data derived from African-American populations rather than from black versus white comparison studies.
Acquired Immunodeficiency Syndrome↗
Quil A and ISCOMs as adjuvants for midgut membrane antigens of Boophilus microplus.
Quil A used with Boophilus microplus gut membrane antigen (GM) had a significant effect on antibody levels induced in sheep (P < 0.05) since GM alone did not induce a significant level of antibodies. Injection of a vaccine containing GM and Quil A, either subcutaneously or intramuscularly, induced similar levels of antibodies in sheep. However, Quil A injected subcutaneously induced acute inflammatory reaction. The amount of Quil A for use with GM was determined to be 1000 micrograms/ml. Immunostimulating complexes (ISCOMs) incorporating detergent-solubilized membrane midgut antigens (TX-GM) failed to induce an immune response in cattle without the addition of Quil A. The addition of Quil A to the ISCOMs containing TX-GM did not stimulate antibody responses greater than those stimulated by TX-GM plus Quil A, and protection in vaccinated cattle was 86% and 74%, respectively.
Adjuvants, Immunologic↗
Laboratory-based surveillance for meningococcal disease in selected areas, United States, 1989-1991.
PROBLEM/CONDITION: Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in the United States. Accurate surveillance for meningococcal disease is required to detect trends in patient characteristics, antibiotic resistance, and serogroup-specific incidence of disease. REPORTING PERIOD COVERED: January 1989 through December 1991. DESCRIPTION OF SYSTEM: A case of meningococcal disease was defined by the isolation of N. meningitidis from a normally sterile site, such as blood or cerebrospinal fluid, in a resident of a surveillance area. Cases were reported by personnel in each hospital laboratory in the surveillance areas. The surveillance areas consisted of three counties in the San Francisco metropolitan area, eight counties in the Atlanta metropolitan area, four counties in Tennessee, and the entire state of Oklahoma. RESULTS: Age- and race-adjusted projections of the U.S. population suggest that approximately 2,600 cases of meningococcal disease occurred annually in the United States. The case-fatality rate was 12%. Incidence declined from 1.3/100,000 in 1989 to 0.9/100,000 in 1991. Seasonal variation occurred, with the highest attack rates in February and March and the lowest in September. The highest rates of disease were among infants, with 46% of cases affecting those < or = 2 years of age. Males accounted for 55% of total cases, with an incidence of 1.2/100,000, compared with 1.0/100,000 among females (relative risk (RR) = 1.3, 95% confidence interval (CI) 1.0-1.6). The incidence was significantly higher among blacks (1.5/100,000) than whites (1.1/100,000) (RR = 1.4 [95% CI 1.1-1.8]). Serogroup B caused 46% of cases and serogroup C, 45% Thirty-eight percent of isolates were reported to be resistant to sulfa; none were reported to be resistant to rifampin. INTERPRETATION: The decline in incidence of meningococcal disease from 1989 through 1991 cannot be explained by any change in public health control measures; this trend should be monitored by continued surveillance. The age, sex, and race distribution and seasonality of cases are consistent with previous reports. The proportion of N. meningitidis isolates resistant to sulfa continues to be substantial. A relatively small proportion of cases is potentially preventable by the use of the currently available polysaccharide vaccine, which induces protection against serogroups, A, C, Y, and W135 and is effective only for persons > 2 years of age. ACTIONS TAKEN: Current recommendations against the use of sulfa drugs for treatment or prophylaxis of meningococcal disease unless the organism is known to be sensitive to sulfa should be continued. Since resistance to rifampin is rarely reported, it continues to be the drug of choice for prophylaxis. The development of vaccines effective for infants and vaccines inducing protection against serogroup B would be expected to have a substantial impact on disease.
Adolescent↗
Phenotypic analysis of bovine leukocyte cell lines infected with Theileria annulata.
Six cell lines that were infected with Theileria annulata were compared for expression of a range of surface molecules. Immunofluorescence staining with the panel of monoclonal antibodies formulated for the Second Workshop was analysed by flow cytometry. Four lines generated from bovine peripheral blood mononuclear cells by exposure to sporozoites in vitro and one line generated in vivo from an infected calf were phenotypically similar. Phenotypic analysis of those lines did not demonstrate a monocyte or B cell origin, but indicated they were not derived from T cells. An uncloned line generated in vivo from an infected calf was CD3+ and gamma/delta TCR+. The results indicate that a wider range of host cell types may be infected in vivo than suspected hitherto and that some of the cells may express an abnormal pattern of surface molecules. Both could have profound consequences for the pathogenesis of T. annulata infection.
Animals↗