Biomedical subjects
Publications and source records attributed to L I Lutwick.
This contribution highlights factors involved with maintaining and enhancing antigen delivery or immunogenicity. Areas discussed include the cold chain, adjuvants, recombinant vectors for antigen delivery, routes for antigen delivery, and edible plant vaccines. It is doubtless that the technological understanding that underlies these advances is about to revolutionize vaccinology in the near future.
Vaccine technology can be applied to targets of intervention that currently have not been considered preventable by immunization. Targets include some diseases caused by, or related to, infectious agents, and other conditions clearly unassociated with disease pathogens. This article considers vaccines for pregnancy, peptic ulcer disease, gastric cancer, cocaine abuse and atherosclerosis.
Although poliovirus vaccination is nto new, the recent changes in ACIP recommendations involving polio vaccinations are. Currently, wild type poliovirus has been eliminated in the Western hemisphere, but vaccine-associated cases (VAPP) still occur. The new recommendations are intended to continue providing protection and to eliminate VAPP cases from occurring in vaccinees or close contacts.
We performed a randomized prospective study of 5-day treatment with topical mupirocin or bacitracin for the elimination of Staphylococcus aureus nasal colonization in healthcare workers (HCWs). Nasal cultures were obtained from 141 HCWs, 37 (26%) of whom showed S. aureus. After 72 to 96 hours of treatment, the organism was eradicated in 15 (94%) of 16 by mupirocin and in 8 (44%) of 18 by bacitracin (P = .0031). Similar efficacy was demonstrated at 30 days. Mupirocin may be more effective than bacitracin for eradication of S. aureus in healthy HCWs.
Infections following cardiac surgery, although generally uncommon, are associated with difficult management decisions and significant morbidity and mortality. They often present while the patient is either in a critical care unit, or requires CCU management. This review analyzes infections related to median sternotomy wounds, prosthetic heart valves, transvenous permanent pacemakers, automatic implantable cardioverter-defibrillators, and left ventricular assist devices. The diagnosis, microbiology, treatment and outcome of each is also discussed.
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The timely facilitation of immunologic (immunoglobulin or vaccine) or antimicrobial prophylaxis is used in individuals who have been exposed to certain infectious diseases. Such methodology has been shown to be helpful in infections such as viral hepatitis types A and B, measles, varicella, rabies, and tuberculosis. The data supporting such use in rubella and mumps are not strong and information is still needed in hepatitis C, human immunodeficiency virus, and Lyme borreliosis. This article reviews postexposure prophylaxis in these situations. Preventive strategies for meningococcal disease, group A streptococcus, tetanus, diphtheria, and pertussis are discussed elsewhere in this issue.
The in vitro activities of bacitracin and mupirocin were compared for seven different strains of methicillin-resistant Staphylococcus aureus. Six of seven strains showed bacitracin minimum inhibitory concentrations (MICs) of 0.5 to 1.0 units/mL, and all seven had mupirocin MICs of 0.5 to 2 micrograms/mL. Time-kill studies revealed 2.6- to 4.5-log reduction in 24 hours with strains susceptible to bacitracin (4 units/mL) and 0 to 2.2 reduction with mupirocin (16 micrograms/mL). Bacitracin should be considered further for in vivo studies because of enhanced bacteriocidal effect and lower cost.
In a community hospital in Brooklyn, New York, over a 3-year period, 79 methicillin-resistant Staphylococcus aureus (MRSA) isolates from five different case clusters were subtyped by Southern blot hybridization with two previously characterized gene probes, mec and Tn554. Together, the genotyping enabled the hospital infection control team to differentiate simultaneous MRSA clusters in the surgical intensive care unit (type I:A) and the open heart unit (type II:J), document the spread of one strain (type I:A) between roommates, identify an endemic strain (type II:J) from cardiac monitors and medical personnel, and identify an unrelated outbreak strain (type II:NH) in the labor and delivery unit. On the basis of this investigation it is clear that the routine DNA fingerprinting of MRSA in health care facilities, to monitor their spread and identify cases of nosocomial infections, is an important infection control measure.
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Explore the source record for details and available documents.
We present the case of an elderly man with chronic obstructive pulmonary disease who had a 4-month history of multiple fluctuant masses of the dorsum of the right hand, which began at the site of an intravenous catheter. Medications included inhaled and oral steroids. Fungal cultures of the fluid obtained grew a pigmented mold identified as Exophiala species after several routine cultures were reported as negative. The patient underwent radical excision of the masses and received a perioperative course of oral itraconazole. This is one of the first known cases of a possible nosocomially acquired phaeomycotic cyst. Unusual fungi should be considered in the differential diagnosis of skin lesions in immunocompromised patients.
OBJECTIVE: To report a case of pancreatitis related to paromomycin administration. CASE SUMMARY: A 39-year-old man with AIDS developed pancreatitis concurrent with successful treatment of intestinal cryptosporidiosis with paromomycin. The hyperamylasemia resolved with discontinuation of the agent and recurred when paromomycin treatment was reinstituted. DISCUSSION: To our knowledge, this is the first reported case of pancreatitis believed to be induced by paromomycin. Although pancreatitis in HIV-infected patients has multiple causes, the nature of this case suggests the involvement of paromomycin. The mechanism of action is unclear. CONCLUSIONS: Pancreatitis should be considered in the differential diagnosis of abdominal pain in patients who are treated with paromomycin.
Neurocysticercosis cases were identified in 1991 in an Orthodox Jewish community. Transmission was linked to tapeworm-infected immigrant housekeepers from countries where Taenia solium is endemic. To evaluate the extent of and risks for locally acquired cysticercosis, a seroprevalence survey was conducted in 9% of the households in this community. Cysticercosis antibodies were detected in 23 (1.3%) of 1,789 persons from 612 families. All 23 seropositive persons were asymptomatic, and no intracerebral lesions were found for the 21 seropositive persons who underwent brain imaging. Seropositivity was associated with female sex (relative risk [RR] = 2.45, P = 0.049), hiring a domestic worker for child care duties (RR = 3.79, P = 0.05), and with employees from Central America (RR = 2.70, P = 0.0001). Exposure to T. solium in this community is unexpectedly high. Widespread employment of domestic workers from endemic regions and high employee turnover contributes to exposure risk.
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Mucormycosis is an unusual complication of cardiothoracic surgery. The fungi may infect the sternotomy wound causing a progressive gangrene or seed the implanted prosthetic valve or graft resulting in endocarditis or graft failure. There have been six previous reports of mucormycosis following cardiothoracic surgical procedures. Four cases involved prosthetic devices, the remaining two are examples of sternal wound mucormycosis acquired from the use of contaminated elasticized bandages. The first case of sternal wound mucormycosis not associated with elasticized bandages is reported here. The infection occurred in a diabetic patient who had undergone coronary artery bypass surgery and mitral valve replacement. The patient received corticosteroids and broad-spectrum antibiotics at the time of and after operation. The patient developed invasive sternal mucormycosis and died on day 10 after surgery, despite aggressive surgical débridement and amphotericin B therapy. No elasticized bandages were used and the source of the infection was not identified. Previous cases of mucormycosis in cardiothoracic surgery are reviewed and the specific clinical setting in which this fungal disease should be suspected defined.
7 individuals who were negative for HIV-1 antibody in a licensed serum enzyme immunoassay (EIA) were positive in a urine EIA and western blot (WB). Follow-up in individuals by use of a cell-mediated immune response showed 1 positive and 1 negative for HIV-1 peptide reactivity. In a second study, 4 out of 5 subjects positive by urine EIA and indeterminate or negative by serum WB were HIV-1 peptide positive in the cell-mediated immune test. Comparison of cell-mediated responses with urine antibody responses may help to resolve discrepant HIV-1 results.