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Biomedical subjects

L Corey

Publications and source records attributed to L Corey.

At least 415 records · Page 23Linked to original sources
PubMed1978

Recurrent genital herpes among women: symptomatic v. asymptomatic viral shedding.

To investigate whether asymptomatic shedding of herpes simplex virus occurs in women with recurrent genital herpes, six women with documented disease were followed up twice weekly with viral cultures and pelvic examination. During the study period of 1330 patient days and 452 patient visits, 26 episodes of genital herpesvirus infection were recorded. Twenty-three (88%) episodes were accompanied by signs and symptoms. Three (14%) of the culture-positive recurrences were asymptomatic. In one episode an asymptomatic lesion was noted, and in two instances viral shedding from the vulva or cervix occurred in the absence of visible herpetic lesions. Three of the six women had evidence of recurrent cervical herpesvirus infection. No relationships between menstrual cycle and sexual activity and the onset of recurrence were noted.

Adult↗
PubMed1977

Influenza B-associated Reye's syndrome: incidence in Michigan and potential for prevention.

Prospective surveillance for Reye's syndrome in Michigan revealed the occurrence of 46 cases between December 15, 1973 and June 1, 1974. In an attempt to determine the incidence of influenza B-associated Reye's syndrome, a randomized point-prevalence survey of 1,041 schoolchildren was done in a county in Michigan where there had been simultaneous outbreaks of influenza B and Reye's syndrome. Of the children tested, 20% had titers of hemagglutination-inhibiting antibody to influenza virus B/Hong Kong/5/72 of greater than or equal 1:20. Based upon this countywide survey, the incidence of Reye's syndrome following influenza B was estimated as between 30.8 and 57.8 cases of Reye's syndrome per 100,000 cases of influenza B. A detailed epidemiologic investigation of the patients who developed Reye's syndrome indicated that the syndrome occurred four times more frequently in children living in rural areas than in children in the urban areas of the state. These studies indicate that, in addition to antecedent viral infections such as influenza B, factor(s) that are most likely extrinsic or environmental also play a role in the pathogenesis of Reye's syndrome.

Adolescent↗
PubMed1977

Diagnostic criteria for influenza B-associated Reye's syndrome: clinical vs. pathologic criteria.

Between December 15, 1973, and Jun 30, 1974, a total of 379 cases of Reye's syndrome was reported to the Center for Disease Control. One hundred forty-seven (40%) were confirmed by either autopsy or biopsy, while 232 were diagnosed by clinical and laboratory parameters. Comparisons of the epidemiologic and demographic characteristics, the hospital course, the outcome, and the laboratory abnormalities of the clinically diagnosed and the pathologically confirmed cases revealed no significant differences. In the epidemiologic setting of influenza B outbreaks, children who have the acute onset of noninflammatory encephalopathy associated with elevated serum transaminase levels, hypoprothrombinemia, and elevated blood ammonia levels should be considered to have Reye's syndrome. Further evaluation of diagnostic criteria is needed, however, for sporadically occurring, nonepidemic cases of noninflammatory encephalopathy associated with hepatic dysfunction.

Acid-Base Imbalance↗
PubMed1977

Reye's syndrome: clinical progression and evaluation of therapy.

The hospital course and therapy of 369 patients with Reye's syndrome were evaluated. Eighty-three percent of patients had deepening coma during hospitalization. Stage of coma on admission, evidence of increased intracranial pressure, and blood ammonia levels greater than 300 microgram/100 ml were all significantly associated with increasing mortality. Among survivors of Reye's syndrome, 30% of those who developed either decerebrate posturing or seizures during hospitalization had serious neurologic sequelae upon discharge. When analyzed by (1) stage of coma during admission (2) progression of coma during hospitalization, (3) degree of blood ammonia level elevation, and (4) presence of increased intracranial pressuring, no significant differences were noted between patients receiving intensive supportive care and those receiving exchange transfusions and/or peritoneal dialysis.

Ammonia↗
PubMed1976

Pressure monitoring devices. Overlooked source of nosocomial infection.

Contaminated pressure monitoring devices recently have been implicated as a source of epidemic organisms in three outbreaks of nosocomial bacteremia, one outbreak of candidemia, and one outbreak of hepatitis. Measures necessary to prevent monitoring-related infections have not always been appreciated or taken. As a minimum, pressure monitoring devices should be sterilized between use with different patients; strict aseptic technique should be employed when setting up and using monitoring systems; and each patient's monitoring tubing, fluid, and monitoring devices should be changed at regular intervals.

Blood Pressure Determination↗
PubMed1976

A nationwide outbreak of Reye's Syndrome. Its epidemiologic relationship of influenza B.

Between December 15 and June 30, 1974, 379 cases of confirmed Reye's syndrome were reported to the Center for Disease Control. Of these, 316 occurred during February and March 1974. A simultaneous surveillance system for influenza B indicated that this clustering of cases of Reye's syndrome correlated both temporally and geographically with influenza B outbreaks. The incidence of Reye's syndrome was higher in rural than in urban centers. Epidemiologically, two groups of cases of Reye's syndrome emerge: those which occur in older children (median age 11 years), cluster in time and geographic region, and are associated with antecedent influenza B infection; and those which occur sporadically thoughout the year, are isolated in occurrence, occur in younger children (median age 6 years), and are associated with a wide variety of antecedent viral illnesses.

Adolescent↗
PubMed1976

Dealing with possible rabies exposure.

When a patient has come in contact with a domestic or wild animal that may be rabid, the physician must decide whether postexposure rabies prophylaxis is warranted. Among the factors that must be weighed are the animal species involved, the epizootiology of rabies, and the circumstances surrounding the exposure.

Animals↗
PubMed1976

Live, attenuated influenza A/England/42/72 (H3N2) virus vaccine: a field trial.

Two doses of a live, attentuated influenza A/England/42/72 (H3N2) vaccine virus (inhibitor-insensitive Alice strain) were administered intranasally to 130 university students, and placebo was given to 134 students. Fourfold or greater rises in titer of hemagglutination-inhibiting antibody occurred in 68% of all vaccine recipients and in 88% of those with initial titers of less than 1:8; the geometric mean titer of hemagglutination-inhibiting antibody increased from 1:15 to 1:77. A 3.2-fold rise in titer of neuraminidase-inhibiting antibody occurred in 24% of the students. Side effects produced by administration of the vaccine include mild rhinitis and sore throat, which were found only during the first four days after administration of the first dose. Inhibitor-insensitive virus was shed only by three of 31 intensively studied vaccine recipients; these three subjects all had initial serum titers of hemagglutination-inhibiting antibody of less than 1:8. No transmission of vaccine virus to spouses was detected. During a 12-month interval after vaccination, the geometric mean titer of hemagglutination-inhibiting antibody in serum and the prevalence of antibody decreased minimally among the 47 vaccine recipients still available for study.

Administration, Intranasal↗
PubMed1976

Clinical use of human globulin immune to rabies virus.

Studies of human globulin immune to rabies virus before licensure showed that it suppressed active antibody responses when individuals received 16 doses of duck embryo vaccine but not when they received 23 doses of duck embryo vaccine. Prospective surveillance of use of human globulin immune to rabies virus since licensure in 1974 has revealed that 40% of persons who receive 14-16 doses of duck embryo vaccine have low or undetectable antibody responses 30-90 days after initiation of the series. Ten percent of individuals receiving 21-23 doses of duck embryo vaccine have inadequate antibody responses, a percentage not significantly different from that found in recipients of 14 doses of vaccine alone. Human globulin immune to rabies virus has also been used for treatment of one case of clinical human rabies; this use was based on the observation that antibodies to rabies virus in serum do not develop until after the seventh day of clinical illness, and antibodies are absent from spinal fluid as long as 19 days after onset of symptoms. Intracranial pressure and neurological function remained stable after administration of human globulin immune to rabies virus, but two days after initiation of therapy, the patient died of progressive pulmonary dysfunction and tension pneumothorax.

Adult↗
PubMed1976

Serum neutralizing antibody after rabies postexposure prophylaxis.

One hundred seventy-seven persons submitted specimens for serum neutralizing antibody titer detreminations 30 to 90 days after starting postexposure rabies prophylaxis. Ninety-two percent of those who received duck embryo vaccine alone developed adequate antibody titers. However, 23% of those who received equine antirabies serum plus duck embryo vaccine failed to develop an adequate antibody titer; one of these inadequate responders subsequently died of rabies. Factors that increased the risk of a poor antibody response included the receipt of steroids during the course of postexposure prophylaxis, and the use of more than 55 lu/kg of equine antirabies serum. Many persons receiving postexposure rabies prophylaxis fail to develop adequate humoral immunity and may have an increased risk of developing rabies. We suggest that persons receiving postexposure rabies prophylaxis should have serum neutralizing antibody determinations 30 to 40 days after starting treatment.

Adolescent↗
PubMed1975

HBs-Ag-negative hepatitis in a hemodialysis unit: relation to Epstein-Barr virus.

Eleven of 40 patients in a hemodialysis unit had clinical or biochemical evidence of hepatitis during a five-week period. The clinical disease was mild, being limited solely to dialysis patients. Epidemiologic investigation indicated that the incubation period was between 17 and 35 days and that 10 of 11 patients had been exposed to a single venous-pressure monitor before onset. Dried blood and evidence of blood reflux up the venous-pressure gauge suggested that cross-contamination of the blood of successive patients probably resulted in transmission of disease. No association with the hepatitis B surface antigen or anti-hepatitis B antibody was demonstrated, but 10 of the 11 patients with elevated transaminase levels had evidence of recent exposure, to Epstein-Barr virus as manifested either by Ox-cell hemolysin titers or rises in titers to viral capsid antigen.

Adult↗
PubMed1975

Treatment of persons exposed to rabies.

Several clinical and epidemiologic criteria have been formulated by the Center for Disease Control in advising physicians on the treatment of persons exposed to possibly rabit animals. When deciding whether or not to institute rabies prophylaxis, the physician must consider (1) the type of exposure, (2) the animal species involved in the exposure and the regional epidemiology of rabies, (3) the circumstances surrounding the exposure, and (4) the treatment alternatives and complications.

Animals↗
PubMedDate not supplied

Difference between herpes simplex virus type 1 and type 2 neonatal encephalitis in neurological outcome.

24 infants consecutively treated with acyclovir or vidarabine for neonatal herpes simplex virus (HSV) encephalitis were followed up for 6 months to 3 years to assess neurological and developmental outcome. 15 patients had HSV-2 and 9 had HSV-1 encephalitis. Infants with HSV-2 encephalitis presented with a higher frequency of seizures, greater pleocytosis and protein concentrations in the cerebrospinal fluid, and more frequent evidence of structural damage on computerised tomographic scans of the brain than did those with HSV-1 encephalitis. 1 patient died. All 9 HSV-1 patients were normal at follow-up (mean 19.4 months) compared with only 4 (23%) of the 14 surviving HSV-2 infected infants (p = 0.003). Among infants with HSV-2 encephalitis, 50% became microcephalic; 57% had seizure disorders; 64% had ophthalmological defects; 64% had cerebral palsy; and 57% had mental retardation. Infants with neonatal HSV-1 encephalitis treated with systemic antiviral chemotherapy have excellent neurological outcomes; the neurological morbidity of those with HSV-2 encephalitis is still high.

Acyclovir↗
PubMedDate not supplied

Presentation of neonatal herpes simplex virus infections: implications for a change in therapeutic strategy.

To identify clinical signs of disease that might lead to more rapid recognition in treatment, we reviewed the time from onset of illness to diagnosis of 42 consecutive cases of neonatal herpes simplex virus (HSV) infection seen between 1965 and 1984. The first signs of illness included mucocutaneous lesions in 14, central nervous system signs in 20, fever in 6 and respiratory insufficiency in 2 infants. The median time from onset of illness to presentation to medical personnel was 1 day. The median time from presentation to medical personnel to obtaining viral cultures was 3 days (range, 1 to 11) and was similar in infants who did and did not have mucocutaneous lesions. Viral cultures were performed within 24 hours of admission on 8 of 13 noncongenitally infected infants born between 1982 and 1984 compared to 5 of 24 seen between 1965 and 1981 (P less than 0.03). However, a greater than 72-hour delay between presentation to medical personnel and obtaining viral diagnostic studies occurred in 33, 40 and 14% of infants born in the years 1965 to 1977, 1978 to 1981 and 1982 to 1984. Involvement of additional organ systems by HSV was noted in 57% of infants between the time from presentation to medical personnel and diagnosis. Neonatal HSV infection was often severe by the time patients presented to medical personnel, and the disease usually progressed rapidly. To achieve a better therapeutic outcome for infants with neonatal herpes, consideration should be given to the initiation of antiviral therapy on presumptive clinical and epidemiologic grounds. Future strategies for therapy of neonatal herpes should be directed at preventing the acquisition of disease.

Female↗
PubMedDate not supplied

Historical findings in subjects from a high socioeconomic group who have genital infections with herpes simplex virus.

A highly motivated, self-selected group of 1,535 men and 1,607 women of middle-to-high socioeconomic class who had recurring genital herpes were surveyed in an assessment of the historical characteristics of these subjects and their disease. All subjects lived in the continental United States and were members of the national herpes organization, HELP, sponsored by the American Social Health Association. Subjects were predominantly well-educated white persons (mean educational level, 15.2 years) earning > $20,000 per year. The mean ages of acquisition of genital herpes were 26.9 years for women and 30.8 years for men. The mean durations of infection were 3.9 years for women and 5.1 years for men. Women usually acquired genital herpes between the ages of 20 and 29 years, whereas substantial numbers of men experienced their initial episodes of infection when they were in their thirties. The population studied was predominantly heterosexual. Many of the subjects, especially the men, had experienced other sexually transmitted diseases such as gonococcal or nongonococcal urethritis. Over two-thirds of the subjects experienced more than five relapses every year, and the percentage of subjects with more than five recurrences yearly did not decrease with time.

Adolescent↗