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Biomedical subjects

L S Rickman

Publications and source records attributed to L S Rickman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Botryomycosis in the acquired immunodeficiency syndrome.

Botryomycosis is a rare bacterial infection that may mimic fungal disease both clinically and histologically. Cutaneous botryomycosis is uncommon and usually appears as plaques with superficial pustules and crusts. On microscopic examination lesions are characterized by the presence of granules that resemble the sulfur granules of actinomyces with a granulomatous inflammatory response. An increased incidence has been reported in populations with altered immune function and the presentation may be atypical in patients with the acquired immunodeficiency syndrome. We report the successful treatment of a case of mucocutaneous botryomycosis in a patient with acquired immunodeficiency syndrome. A review of the literature is presented, with special emphasis on cutaneous manifestations of botryomycosis in patients with acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Infectious complications of tattoos.

Tattooing carries several medical risks, including the transmission of infectious diseases. We review the published literature on the transmission of hepatitis B virus, human immunodeficiency virus, Treponema pallidum, papillomavirus, Mycobacterium tuberculosis, and other organisms by tattooing. Education, through public health measures, should promote the prevention of infectious disease transmission. Particular populations who could benefit from education include prisoners, individuals involved with correctional facilities, youths, military personnel, and health care providers coming in contact with populations at risk for tattoos.

Female↗
PubMed1994

Rapid clinical diagnosis of pulmonary abnormalities in HIV-seropositive patients by auscultatory percussion.

A prospective, blinded study of pulmonary findings in hospitalized patients with HIV infection compared auscultatory percussion (AusP) with conventional percussion (ConP) and conventional auscultation (ConA) using chest radiographs as the gold standard. Sixty-three patients had chest radiographs and were examined by one to three examiners. Seventy of the 126 lungs had radiographic abnormalities (55.6 percent). Auscultatory percussion proved to be the most sensitive of all techniques for each examiner (range, 51.0 to 69.6 percent) for detecting radiographic abnormalities and also had higher likelihood ratios for two of the three examiners; AusP also had the highest likelihood ratio pooled across examiners. Of the 166 abnormal results of lung examinations, the combination of AusP and ConA detected 31 more abnormalities than ConP and ConA combined, with 14 of these being diagnosed with Pneumocystis carinii pneumonia. No abnormalities were detected by ConP that were not detected by AusP. These findings suggest that AusP, a rapid clinical maneuver, is more sensitive and specific than ConA and ConP in determining pulmonary abnormalities in HIV-infected inpatients.

Adult↗
PubMed1994

Acridine orange diagnosis of Plasmodium falciparum: evaluation after experimental infection.

The value and role of the acridine orange/microhematocrit tube method (quantitative buffy coat [QBC] analysis) in the diagnosis of malaria remains controversial. To establish the true sensitivity of this test in comparison with the thick blood film, we studied 49 subjects who were experimentally infected with Plasmodium falciparum in 10 malaria vaccine and infectivity trials. Diagnosis was made by the acridine orange staining method 1-3 days earlier than by the thick blood film in 23 subjects (47%) and at the same time as the thick blood film in 20. On the other hand, diagnosis was made by thick blood film earlier than by the acridine orange staining method in six individuals. There were no false positive results using acridine orange among 584 specimens studied. Diagnosis was made using acridine orange at a parasitemia of less than 11 parasites/microliters of blood in 65% of cases. Where available, the acridine orange assay is clearly preferable in terms of speed and accuracy to the thick blood film for diagnosis with parasitemias of less than 150/microliters of blood, and perhaps as important, for ruling out infection with P. falciparum in a symptomatic patient.

Acridine Orange↗
PubMed1993

Correlation between CD4+ counts and prevalence of cytomegalovirus retinitis and human immunodeficiency virus-related noninfectious retinal vasculopathy in patients with acquired immunodeficiency syndrome.

We prospectively studied 132 patients with acquired immunodeficiency syndrome (AIDS) to determine the cross-sectional prevalence of cytomegalovirus retinitis. All patients had serum CD4+ lymphocyte counts to determine the degree of immune dysfunction. Correlations between CD4+ counts, the presence of cytomegalovirus retinitis or human immunodeficiency virus (HIV)-related noninfectious retinal vasculopathy, and ocular symptoms were made. The study disclosed that 26 of 132 patients with AIDS (20%) had cytomegalovirus retinitis. However, subset analysis according to CD4+ count disclosed that in patients with CD4+ counts of 50 cells/mm3 or less, 26 of 87 (30%) had cytomegalovirus retinitis, whereas in patients with CD4+ counts of 50 cells/mm3 or more, none of 45 was noted to have cytomegalovirus retinitis. Similarly, 46 of 132 patients (35%) were noted to have HIV-related noninfectious retinal vasculopathy, with a trend toward increasing prevalence associated with declining CD4+ count. In patients with CD4+ counts of 50 cells/mm3 or less, 39 of 87 (45%) had HIV-related noninfectious retinal vasculopathy, whereas seven of 45 patients (16%) with CD4+ counts of 50 cells/mm3 or more were noted to have these changes. We confirmed the clinical impression that cytomegalovirus retinitis and HIV-related noninfectious retinal vasculopathy are late manifestations of AIDS, demonstrated an increased risk for patients with low CD4+ counts, and suggested a basis for coherent chemoprophylaxis and screening strategies for cytomegalovirus retinitis.

AIDS-Related Opportunistic Infections↗
PubMed1993

Combination ganciclovir and foscarnet in the treatment of clinically resistant cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome.

OBJECTIVE: To assess the clinical response and patient tolerance to daily infusions of both ganciclovir sodium and foscarnet sodium for the treatment of clinically resistant cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. DESIGN AND PATIENTS: Nine patients with clinically resistant cytomegalovirus retinitis who had shown progression of retinitis despite extended intravenous induction single-drug therapy or alternating therapy with induction doses of ganciclovir or foscarnet at 6 weeks were subsequently treated with a combination of ganciclovir and foscarnet. The dosing regimen for induction combination therapy was ganciclovir at 5 mg/kg every 12 hours and foscarnet at 60 mg/kg every 8 hours. Maintenance combination therapy was ganciclovir at 5 mg/kg every 12 to 24 hours and foscarnet at 90 to 120 mg/kg every day. Patients were observed closely for signs of a toxic effect or intolerance to the drug regimen. RESULTS: All patients exhibited a favorable response to combination therapy, with complete healing of retinitis in 12 of 14 eyes and partial healing of retinitis with decreased border activity and a cessation of border advancement in two of 14 eyes. Two of the nine patients stopped receiving combination therapy before completion of the study owing to their dissatisfaction with the time commitment. The regimen was otherwise well tolerated, with no significant medical toxic effects attributable to the drugs requiring cessation of therapy. CONCLUSIONS: Combination anticytomegalovirus therapy should be considered in those patients who have shown a poor clinical response to sustained single-drug induction therapy and alternating drug therapy. As survival time for patients with cytomegalovirus retinitis continues to improve, clinical resistance may become more common. Further work to delineate the optimal dosing and indications for combination therapy will be important.

AIDS-Related Opportunistic Infections↗
PubMed1993

Examiner dependence on physical diagnostic tests for the detection of splenomegaly: a prospective study with multiple observers.

OBJECTIVE: To determine the reliability and validity of various physical diagnostic techniques (including three methods of palpation and three methods of percussion) in detecting ultrasonographically identified splenomegaly. DESIGN: Prospective, double-blind study. SETTING: University hospital. PATIENTS: Twenty-seven hospitalized male patients with suspected human immunodeficiency virus (HIV) infection. INTERVENTIONS: Three methods of palpation (bimanual, ballottement, and palpation from above) and three methods of percussion (as described by Nixon, Castell, and Barkun et al.) were performed on each patient by eight examiners. Splenic ultrasonography was performed within 96 hours of admission. MEASUREMENTS AND MAIN RESULTS: The prevalence of splenomegaly by ultrasonography (defined as a spleen > or = 13 cm on the longitudinal scan) in this population was 33.3%. The sensitivity and specificity of each method of palpation and percussion varied by examiner. The ranges of sensitivity across examiners for the three methods of palpation and the three methods of percussion were 0%-64.3% and 7.7%-75%, respectively. The ranges of specificity across examiners for the three methods of palpation and the three methods of percussion were 50%-100% and 60%-100%, respectively. Likelihood ratios pooled across observers revealed that for palpation, palpation from above, and percussion, Castell's method had the highest likelihood ratios [LR = 2.66 and 1.97, respectively; 95% CI = 1.52-4.64 and 1.22-3.19, respectively]. A combination of tests (either palpation or percussion) increased the diagnostic accuracy. CONCLUSION: Physical diagnostic techniques for the detection of splenomegaly are relatively insensitive but specific. In this study there was high interobserver variability, which did not appear to be associated to the level of experience. Combining tests increases diagnostic accuracy.

Adult↗
PubMed1993

Ocular examination and diagnosis in patients with the acquired immunodeficiency syndrome.

Ocular involvement is seen frequently and is an important source of morbidity in patients with the acquired immunodeficiency syndrome. We outline here the general skills of physical diagnosis valuable to primary care physicians or infectious diseases specialists in recognizing and evaluating ocular complaints in patients infected with the human immunodeficiency virus. We provide an overview of common ocular diseases in these patients, with an emphasis on signs and symptoms that aid in the differential diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1993

The potential for transmission of human immunodeficiency virus through human bites.

We review the potential for human immunodeficiency virus (HIV) transmission by human bites. HIV may be present in saliva, although infrequently and at low levels. In prospective studies, 13 people bitten by HIV-infected individuals have remained HIV seronegative. Only two cases have been published in which HIV transmission through bites may have occurred. Both blood-contaminated and cell-free saliva may contain HIV. The presence of blood in the saliva may potentially heighten the theoretical risk of HIV transmission through human bites. We have estimated the risk of HIV transmission through human bites and have compared it with the known risks of HIV seroconversion by needle stick (0.3-0.5%). Needle sticks, on average, could transmit 20 times more HIV-infected cells than would a human bite. We conclude that the transmission of HIV through human bites is biologically possible but remains unlikely, epidemiologically insignificant, and, as yet, not well documented.

Bites, Human↗
PubMed1992

Association of mycoplasma and human immunodeficiency virus infection: detection of amplified Mycoplasma fermentans DNA in blood.

A cross-sectional study was undertaken to determine the prevalence of Mycoplasma fermentans infection in patients with human immunodeficiency virus (HIV) infection using polymerase chain reaction methodology. Targeted M. fermentans DNA sequences could be amplified from the DNA extracted from the blood of 6 (11%) of 55 HIV-seropositive patients but from none of 26 HIV-seronegative subjects at low risk for HIV infection (P = .17). There was no correlation between M. fermentans infection and HIV clinical stage. There was a nonsignificant trend toward an association between M. fermentans infection and a history of syphilis. Infection with M. fermentans may occur more commonly in HIV-infected patients; however, a role as a copathogen or opportunistic infection was not established in this study.

Adult↗
PubMed1991

Use of adjuvant containing mycobacterial cell-wall skeleton, monophosphoryl lipid A, and squalane in malaria circumsporozoite protein vaccine.

Human immune responses to modern synthetic and recombinant peptide vaccines administered with the standard adjuvant, aluminum hydroxide, tend to be poor, hence the search for better adjuvants. Antibody responses to a Plasmodium falciparum circumsporozoite (CS) protein vaccine, R32NS1(81), administered with an adjuvant containing cell-wall skeleton of mycobacteria and monophosphoryl lipid A in squalane (MPL/CWS) have been compared to responses to the same immunogen administered with aluminum hydroxide. 2 weeks after the third dose the following indices were greater in the 5 patients who received MPL/CWS than in controls (p less than 0.05): the geometric mean concentration (2.0 vs 25.4 microgram/ml) and avidity index of antibodies to the P falciparum CS protein by ELISA, the geometric mean titre to P falciparum sporozoites by IFAT (1/115 vs 1/1600), and the geometric mean inhibition of sporozoite invasion of hepatoma cells in vitro (37.6 vs 90.3%). For R32NS1(81) MPL/CWS is superior to aluminum hydroxide as an adjuvant, and the data support the evaluation of this complex as an adjuvant for other vaccines.

Adjuvants, Immunologic↗
PubMed1991

Acridine orange detection of Plasmodium falciparum malaria: relationship between sensitivity and optical configuration.

Blood samples collected from five volunteers participating in a P. falciparum infectivity trial were examined to determine the efficacy of the acridine orange technique. Several lens configurations were tested for efficiency in the diagnosis of malaria using this system. There was no significant difference in the sensitivity for detecting positive specimens or number of parasites among three lens configurations: a 50x long working distance objective (0.34 mm) with either a 10x ocular (total magnification 500x) or a 12.5x ocular (625x) and a 750x configuration using a 50x objective with a shorter working distance (0.24 mm). All three lens configurations were significantly better than the 1,000x configuration using a commonly available 100x oil immersion objective. The results achieved using this lens still exceeded the sensitivity of the thick blood film.

Acridine Orange↗
PubMed1991

The clinical diagnosis of splenomegaly.

Assessing for the presence of splenomegaly is an important component of the physical examination. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. We review the literature comparing various physical examination techniques with noninvasive imaging modalities and conclude that palpation and percussion of the spleen are complementary but frequently insensitive and that further studies are needed to evaluate the efficacy of specific diagnostic methods.

Evaluation Studies as Topic↗
PubMed1991

Epidemic keratoconjunctivitis at a U.S. military base: Republic of the Philippines.

Between August 1988 and January 1989, 2,603 cases of acute conjunctivitis occurred at Clark Air Base in the Philippines. Clinical features of the disease were consistent with epidemic keratoconjunctivitis. Adenovirus types 19 and 8, as well as enteroviruses, were isolated from conjunctival swabs. Approximately 18% of 9,167 active duty personnel were affected. In an attempt to contain the outbreak, active cases were isolated from the workplace, resulting in 9,038 personnel-days lost. Military preparedness was significantly impacted. A case-control study revealed multiple risk factors for acquisition of the disease.

Adenovirus Infections, Human↗