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Biomedical subjects

M W Kline

Publications and source records attributed to M W Kline.

At least 55 records · Page 3Linked to original sources
PubMed1994

A comparative study of human immunodeficiency virus culture, polymerase chain reaction and anti-human immunodeficiency virus immunoglobulin A antibody detection in the diagnosis during early infancy of vertically acquired human immunodeficiency virus infection.

The infection status of 91 infants born to mothers with human immunodeficiency virus (HIV) infection was determined. Twenty-eight (31%) infants had confirmed HIV infection and 63 (69%) had seroreverted to HIV and lack evidence of infection. During the first 6 months of life HIV culture had a sensitivity and specificity for diagnosis of HIV infection of 80 and 100%, respectively. False negative HIV cultures were observed in only 7 of 35 specimens, 6 from among the 12 infected infants tested at birth. The sensitivity and specificity of polymerase chain reaction (PCR) detection of HIV were 95 and 93% respectively. A single false negative PCR test result was observed among the 19 tests performed on specimens from HIV-infected infants. False positive PCR test results were observed occasionally throughout the first 6 months of life. Detection of HIV-specific IgA antibody lacked diagnostic sensitivity; positive test results were observed in only 53% of specimens obtained from infected infants. Culture and PCR detection offer excellent sensitivity and specificity for diagnosis of HIV infection during the first 6 months of life; however, false-negative HIV cultures sometimes are observed, particularly during the newborn period, and either false negative or false positive PCR test results may be noted occasionally. For purposes of clinical decision-making, any positive test result should be confirmed with a second HIV culture or PCR test performed on a separate blood specimen.

False Negative Reactions↗
PubMed1994

Infectious disease of public health significance among children and adolescents in Texas.

In the past decade, many infectious diseases in children that were perceived to have been almost eliminated have returned with a vengeance in Texas. Across the state, vaccination rates are exceptionally low, and outbreaks of measles, mumps, and pertussis have been identified. Tuberculosis cases in children increased 77%, and cases of congenital syphilis increased 578% between 1987 and 1991. The new epidemic of HIV infection has placed additional strain on an already overburdened, inadequate public health system in Texas. This article identifies some of the major infections of public health significance among the children of Texas. A common theme for most of these problems is that they are preventable diseases that are not being prevented. Many children in Texas will suffer now and in the future if these public health problems remain ignored.

Adolescent↗
PubMed1993

Study of human immunodeficiency virus resistance to 2'-3'-dideoxyinosine and zidovudine in sequential isolates from pediatric patients on long-term therapy.

Resistance to zidovudine (3'-azido-3'-deoxythymidine) and 2',3'-dideoxyinosine (ddI) has been reported for human immunodeficiency virus (HIV) isolates from adults, but little is known about these drugs in children. A new micrococulture assay was developed for evaluation of drug susceptibility using single-passage HIV isolates cocultured with peripheral blood mononuclear cells from healthy donors. HIV isolates from children treated with zidovudine or ddI were evaluated to define the emergence of resistance to these antiretroviral agents. Four patients were treated with ddI and 3 with zidovudine for > 15 months. There was a > or = 20-fold decrease in susceptibility to ddI for sequential isolates of HIV recovered from 4 patients treated with ddI for 22-31 months and a 4- to 10-fold decrease in susceptibility to zidovudine in 3 patients. HIV isolates from 3 patients treated with ddI or zidovudine alone showed a minor amount of cross-resistance to the other antiretroviral agent. Results indicate the importance of monitoring antiretroviral drug susceptibility of HIV isolates when assessing clinical deterioration in children treated for > 1 year.

Child↗
PubMed1993

Sensitivity, specificity and predictive value of physical examination, culture and other laboratory studies in the diagnosis during early infancy of vertically acquired human immunodeficiency virus infection.

The medical records of 142 infants referred for evaluation solely because they were born to human immunodeficiency virus (HIV)-infected mothers (i.e. not because of signs or symptoms suggesting HIV infection), were reviewed. The infection status of 85 of these infants has been determined; 17 (20%) have confirmed HIV infection and 68 have seroreverted to HIV and lack evidence of infection. During the first 6 months of life HIV culture had better sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of HIV infection than did physical examination, serum immunoglobulin determination or HIV p24 antigen determination. Of the 16 HIV-infected infants who were available for evaluation during the first 6 months of life, all had at least one culture from blood positive for HIV. Two of 4 and 10 of 11 infants were culture-positive at birth and during the first 3 months of life, respectively. A positive HIV culture results was the earliest finding of infection in 15 infants; 10 of these infants concomitantly were found to have hyperimmunoglobulinemia (8 cases) and/or an abnormal physical examination (4 cases). One HIV-infected infant developed hyperimmunoglobulinemia G and A at age 3 months without other evidence of HIV infection until age 5 months when a positive HIV culture was noted. All HIV-infected infants had abnormal findings by physical examination, a positive HIV culture, and/or hyperimmunoglobulinemia by 3 months of age. Infants with normal physical examination and laboratory test results at 3 and/or 6 months of age invariably were HIV-uninfected.

Female↗
PubMed1992

Impact of human immunodeficiency virus infection on women and infants.

Infection with HIV is a problem of growing magnitude among women and children in the United States. During 1991, AIDS will be among the five leading causes of death for women of childbearing age. Over 80% of children with HIV have acquired the infection vertically, and AIDS is now a leading cause of death of children in many urban areas of the United States. Gender and age have important influences on the progression of HIV disease and on the occurrence of complicating illnesses. Zidovudine can slow HIV disease progression, and several regimens of prophylaxis are effective against P. carinii pneumonia, which is the leading cause of death among adults and children with AIDS. Intravenous immunoglobulin may be effective for prevention of serious infections in some children with symptomatic HIV infection. Ultimately, prevention of HIV infection among women and children depends on targeted education and, possibly, the development of medical strategies for interruption of vertical transmission.

Adolescent↗
PubMed1991

Extrapulmonary cryptococcosis in children with acquired immunodeficiency syndrome.

There is a paucity of published information available on extrapulmonary cryptococcosis (EC) in children infected with human immunodeficiency virus, the etiologic agent of the acquired immunodeficiency syndrome. We surveyed investigators in pediatric acquired immunodeficiency syndrome around the country regarding their experience with EC. Investigators from 33 (87%) of 38 institutions responded and information on 13 patients from 11 institutions was analyzed. EC was the acquired immunodeficiency syndrome indicator disease in 9 (69%) of 13 patients. Median age was 8 years with a range of 2 to 17 years. Human immunodeficiency virus risk factors were transfusion (5 patients), hemophilia (4 patients) and perinatal exposure (4 patients). Meningitis, seen in 62% of patients, was the most common clinical manifestation. Although 2 patients with fulminant disease died before therapy was started, 10 (91%) of 11 had a clinical response to amphotericin B with or without flucytosine. Our study indicates a spectrum of EC in pediatric human immunodeficiency virus infection ranging from fulminant, fatal fungemia to chronic meningitis and fever of unknown origin. Cryptococcosis was generally not the cause of death in patients who initially responded to amphotericin B therapy. Optimal antifungal therapy, including the role of fluconazole, warrants further study.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Extreme leukocytosis in patients presenting to a pediatric emergency department.

We determined the frequency and clinical significance of white blood cell (WBC) counts greater than or equal to 25,000/microliters in children presenting to an emergency department (ED) and defined a degree of leukocytosis which might be considered extreme in this setting. Records of all patients seen in the ED between February 1985 and December 1986 with WBC counts greater than or equal to 25,000/microliters were identified. Each patient was paired with the chronologically nearest patient with a WBC count between 15,000 and 25,000/microliters. Of the total WBCs obtained, 5.8% were greater than or equal to 25,000/microliters; only 1% were greater than or equal to 35,000/microliters. Eighteen percent of patients with counts greater than or equal to 25,000/microliters had a serious disease, and 6% had bacteremia. Twenty-six percent of patients with counts greater than or equal to 35,000/microliters had a serious disease, and 10% had bacteremia. On the basis of infrequency and severity of illness, we suggest that, in children presenting to a pediatric emergency department, WBC counts greater than or equal to 35,000/microliters be considered extreme leukocytosis.

Adolescent↗
PubMed1990

Genotypic heterogeneity of strains of Citrobacter diversus expressing a 32-kilodalton outer membrane protein associated with neonatal meningitis.

Genetic diversity and relationships among 42 strains of Citrobacter diversus recovered from the cerebrospinal fluid of human infants with meningitis and from other clinical sources in the United States were estimated on the basis of electrophoretically detectable allelic variation in 20 genes encoding metabolic enzymes. Sixteen distinctive multilocus enzyme genotypes were identified, among which the mean genetic diversity per locus was 0.244. The recovery of isolates of the same genotype in several regions of the United States and over periods as long as 20 years indicates that the population structure of C. diversus is clonal. There was little association between multilocus enzyme genotype and biotype, piliation, or presence of a 32-kilodalton outer membrane protein. The observation that the 32-kilodalton outer membrane protein, which is expressed predominantly by strains recovered from infants with meningitis, occurs in a variety of genotypically diverse clones belonging to several phylogenetic lineages supports the hypothesis that this protein confers virulence.

Alleles↗
PubMed1989

Invasion of the inner ear by Haemophilus influenzae type b in experimental meningitis.

Bacterial interstrain variation for cochlear invasion was studied by intraperitoneal inoculation of infant rats with Haemophilus influenzae type b. Eight pairs of CSF isolates from children with or without deafness due to meningitis were injected into half of each litter in separate experiments. At 48 h, quantitative CSF culture results and CSF white blood cell counts were equivalent for the two groups. Organisms within the cochlea were detected in four of eight animals in each group. There was no difference between the deaf and nondeaf isolates in the degree or frequency of inner ear inflammation in formalin-fixed sections. In separate experiments, animals were inoculated with H. influenzae type b and 24 h later treated with ampicillin, or ampicillin plus dexamethasone. At 48 h, although CSF white blood cell counts were significantly reduced in the steroid group, no difference was noted in the degree of cochlear inflammation between the two groups. The ability of H. influenzae type b to invade the inner ear of infant rats does not correlate with the development of sensorineural deafness in children following H. influenzae type b meningitis. Steroid administration does not appear to diminish the inflammatory reaction within the cochlea more than antibiotics alone in this model, but may delay CSF sterilization by ampicillin.

Ampicillin↗