Biomedical subjects
Publications and source records attributed to O Ruuskanen.
A double blind placebo-controlled study was performed to evaluate the efficacy of salbutamol in the treatment of 25 pertussis patients. The diminishing of paroxysmal cough in the treatment group did not differ significantly from that of the control group.
Eighteen depressive patients and twenty-five healthy control subjects were studied using a comprehensive immunological test system and the dexamethasone suppression test (DST) as well as some additional neuroendocrine parameters. In addition, immune functions of six of the patients were studied serially three times at 1-2 month's intervals. The OKT 4+/8+ ratio (OKT 4+ = helper/inducer phenotype; OKT 8+ = suppressor/cytotoxic phenotype) was slightly higher in those ten depressive patients showing suppression in the DST than in healthy controls, but there were no significant differences between the nonsuppressor and suppressor groups or between the nonsuppressor and suppressor groups or between nonsuppressors and control subjects. Lymphocyte transformation responses induced by phytohaemagglutinin (PHA) were similar in the nonsuppressors and suppressors, but lower in both groups than in control subjects. The number of Ig-secreting cells measured in the absence and presence of pokeweed mitogen (PWM) were similar in the nonsuppressor and suppressor groups. Four of the depressive patients tested repeatedly exhibited an abnormal response in the DST at the beginning of the study. During the follow-up period two of them recovered completely from depression as well as the patients with a normal suppression in the DST. The proportions of T and B lymphocytes and regulatory T lymphocyte subsets as well as the functions of T and B lymphocytes of the nonsuppressors and suppressors in the DST were within normal ranges before and after recovery from depression and comparable to healthy controls in repeated testing. The results indicate that in spite of the importance of cortisol in immunoregulation, the increased cortisol secretion and typical resistance to dexamethasone suppression in endogenously depressive patients is not profoundly and consistently reflected in immune functions. Neither does normalization of cortisol responses induce any major changes in immune status during a patient's recovery from depression. Previous work indicates that suppressed immunity may play an important role in the increased morbidity and mortality associated with bereavement. In the light of present findings we suggest that endogenous depression differs also in this respect from grief reactions.
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Antigens of respiratory viruses were tested by immunoassay of the middle ear fluids and nasopharyngeal secretions of 137 children with acute otitis media. The following were found: (1) an epidemic of infection with respiratory syncytial virus (RSV) caused a significant increase in the occurrence of acute otitis media. (2) Fifteen percent of the children had RSV antigens in middle ear fluid, and in 7% RSV was the sole pathogen found. Adenovirus antigens were found in the middle ear fluid of 3% of the children. (3) Bacteriologic findings in otitis media related and unrelated to viral (RSV) infection were similar. These findings indicate that some episodes of otitis media are associated with viral infection and that the disease may be solely due to viral infection. Thus, at least during an epidemic of respiratory virus infections, treatment failures--e.g., fever and earache unresponsive to antimicrobial therapy--may be due to a viral etiology of acute otitis media.
Serum chloramphenicol levels were evaluated in 52 children with severe infection treated intravenously with chloramphenicol succinate and orally with chloramphenicol palmitate, chloramphenicol monostearoylglycolate or chloramphenicol in capsules. Effective serum levels were recorded with all chloramphenicol preparations. The variability was largest with chloramphenicol monostearoylglycolate. In a case of neonatal Escherichia coli meningitis good serum levels of chloramphenicol were achieved with chloramphenicol palmitate orally, supporting the view that oral chloramphenicol palmitate can be used to treat serious infections in this age group. Our data and those in the literature show that monitoring of serum chloramphenicol levels in neonates is necessary. After the neonatal period monitoring of serum chloramphenicol levels is useful in avoiding too high concentrations. On the other hand, toxic effects of high concentrations can be recognized from reticulocyte and haemoglobin, neutrophil and platelet counts, which should be performed every three to four days.
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IgM, IgA and IgG antibodies to lymphocytosis promoting factor and fimbriae were measured by enzyme-linked immunoassay in seropositive and/or culture-positive patients without symptoms of pertussis, culture-negative patients with typical whooping cough symptoms, and culture-positive patients with typical symptoms. The culture-negative patients with typical symptoms had higher antibody levels in the first specimens and stronger responses to these antigens than the other patients. Antibody levels in the first specimens and antibody responses did not correlate with patients' age and duration of symptoms before taking of the first specimens. Thus, no correlation occurred between the symptoms of pertussis and antibody levels or antibody responses to fimbriae or lymphocytosis promoting factor. Bacteria were less likely to be isolated from those with strong antibody responses and this stresses the need of using both isolation and serology in the diagnosis of pertussis.
Serum opsonic capacity against Bordetella pertussis was studied by using quantitative chemiluminescence (CL) which is known to have several advantages over conventional methods in the evaluation of opsonization and phagocytosis. For opsonization, sera from whooping cough patients or from controls were incubated with killed B. pertussis cells at 37 degrees C for 30 min. Polymorphonuclear leukocytes, mononuclear cells or unfractionated leukocytes, all from healthy blood donors, were added to the opsonization mixture and CL emission was measured. Bacteria opsonized in diluted sera of whooping cough patients caused the activation of leukocytes manifested as a CL emission and no CL emission was observed when unopsonized B. pertussis was incubated with leukocytes. The opsonins could be detected by using any type of leukocyte preparation. Sera from adults vaccinated with DTP in the childhood gave rise to a large CL emission. Sera from whooping cough patients produced CL responses in more dilute solutions than those from vaccinated controls and sera from unvaccinated infants did not contain opsonins against B. pertussis. In unvaccinated infants suffering from whooping cough no opsonins were detectable in sera collected one week after the onset of the disease. However, the development of the opsonic capability against B. pertussis was observed in follow-up sera of all patients. The CL assay is simple, rapid, and reproducible offering new possibilities to evaluate humoral immune mechanisms and phagocytosis in whooping cough.
The clinical findings for 105 children hospitalized with adenoviral infection were studied prospectively. In 82 children, the diagnosis was based on the detection of adenovirus antigen in the nasopharyngeal specimens and in 17 children in the feces. In the remaining six patients, findings from nasopharyngeal specimens were negative but a significant increase in CF (complement fixation) titers was detected. The clinical picture of adenoviral infection was characterized by high-grade (mean 39.4 degrees C) and prolonged fever (mean duration 5.4 days). Tonsillitis, otitis, and gastroenteritis were the most common illnesses. In 17% of the patients, no identifiable focus of infection could be demonstrated; nine children with no identifiable focus of infection had febrile convulsions. The WBC count and ESR varied from normal values to values seen in bacterial infections; thus it was difficult to distinguish adenoviral disease from a bacterial disease. Forty-five children were referred to the hospital due to infection unresponsive to antimicrobial therapy. The rapid detection of adenovirus antigen in nasopharyngeal specimens or feces proved to have a great clinical value in the diagnosis of adenoviral infections.
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Direct detection of viral antigen in nasopharyngeal secretion by radioimmunoassay was compared with serology by IgG antibody enzyme immunoassay for diagnostic efficacy in 77 children with clinically suspected respiratory syncytial virus (RSV) infections. Antigen detection gave a positive diagnosis in 26 of 33 (79%) children in whom RSV infection was diagnosed by any of the two methods. The diagnostic efficacy of antigen detection was dependent upon the interval after onset at which specimens were collected; 88% of specimens taken during the first 5 days and 50% of specimens taken 6-10 days after onset of illness were positive. It was also dependent on the age of the patients, the diagnostic efficacy being 88 and 76% in children under and over 6 months of age, respectively.
Immunoglobulin class-specific enzyme immunoassay (EIA) was used for determination of antibody responses in sera collected from 26 children with acute primary respiratory syncytial virus (RSV) infections. All 26 patients had IgG antibody responses with a significant titer increase in 24 (92%); an IgM antibody response was detected in 19 of the 26 (73%). From patients aged 6 months or less only 5 of 8 produced detectable IgM antibodies, whereas all patients aged 1-2 years did so. IgM antibodies appeared within 1 week after onset of illness and persisted from 20 days to 2-3 months. An IgA antibody response was observed in 20 of 26 (77%) patients with a significant titer increase detected in 17 of 26 (65%) patients. In some patients the persistence of IgA antibodies followed that of the IgM antibodies, but in others the IgA antibody titers remained stable up to the end of the follow-up. The most sensitive assay system for serological diagnosis of acute RSV infection in children was the determination of titer increases by IgG antibody.
Adenovirus antigen was detected by radioimmunoassay in the nasopharyngeal specimens of 30 of 74 children with febrile exudative tonsillitis. In the other 44 children, the cause of tonsillitis was identified in 16 (beta-hemolytic streptococci or Epstein-Barr, parainfluenza, or herpes simplex viruses). The clinical picture of adenoviral tonsillitis was difficult to differentiate from that of streptococcal disease; 20 of the patients had originally been given antibiotics. In 68% of patients without complications, the serum concentration of C-reactive protein was less than 20 mg/L, suggesting a viral disease. No other hematologic test was found helpful in identifying the adenoviral tonsillitis. The rapid detection of adenovirus antigen permitted withdrawal of unnecessary and ineffective antibiotic treatment in most patients.
During a local outbreak of pertussis mainly involving school-children and adults, 71 patients with suspected whooping cough and 25 of their household contacts were studied in the course of 1 day so as to compare enzyme-linked immunosorbent assay (ELISA) with bacterial isolation in the diagnosis of pertussis. Serum samples and two nasopharyngeal swabs were collected from all persons. Five different culture media were used. Twenty-eight cases were diagnosed within 2 days by measuring IgM- and IgA-class antibodies to Bordetella pertussis in the first serum samples of patients. Fifty cases were identified when paired serum samples were used. Cultures were positive in only nine patients. The results show that ELISA is a valuable aid in the diagnosis of pertussis in patients with negative cultures.