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Biomedical subjects

R B Kohler

Publications and source records attributed to R B Kohler.

At least 37 records · Page 2Linked to original sources
PubMed1985

Cross-reactive urinary antigens among patients infected with Legionella pneumophila serogroups 1 and 4 and the Leiden 1 strain.

A solid-phase radioimmunoassay was developed to detect antigens of Legionella pneumophila serogroup 4. The assay detected antigen in urine from four of seven patients with pneumonia caused by L. pneumophila serogroup 4, two of two patients with L. pneumophila Leiden 1 strain (proposed new serogroup), and 26 of 55 patients with L. pneumophila serogroup 1 (proven by culture or direct fluorescent-antibody assay). The antigen of two patients with serogroup 4, one with Leiden 1 strain, and 49 with serogroup 1 infections could be detected in a previously described assay for antigens of L. pneumophila serogroup 1. Serogroup specificity of the assays could be demonstrated if serial dilutions of urine were tested. None of 347 urine specimens used as controls were positive in the radioimmunoassay. We conclude that antigens are excreted in the urine of at least some patients with Legionnaires' disease caused by serogroup 4 and Leiden 1 strain. The urinary antigens in patients with serogroup 4 and Leiden 1 strain infections, although different from those in patients with serogroup 1 infections, serologically contain cross-reactive components.

Antigens, Bacterial↗
PubMed1984

Prevention of infections of skin and skin structures.

Treatment of nasal carriers of coagulase-positive staphylococci with a wide variety of topical systemic antibiotics suppressed these organisms only during treatment. Treatment of methicillin-sensitive or methicillin-resistant staphylococci with oral rifampin plus cloxacillin, vancomycin, fusidic acid, or trimethoprim-sulfamethoxazole eradicated the colonizing Staphylococcus aureus in approximately 80 percent of studies. An alternative approach is replacement of virulent S.aureus with the 502 A S. aureus strain. The latter approach has aborted epidemics of staphylococcal diseases in newborn nurseries and has prevented recurrent furunculosis.

Adult↗
PubMed1984

Cavitary histoplasmosis occurring during two large urban outbreaks. Analysis of clinical, epidemiologic, roentgenographic, and laboratory features.

We have compared risk factors for cavitary histoplasmosis in 62 patients with that manifestation of the infection and in 679 patients with other forms of histoplasmosis, and we have evaluated the clinical and laboratory findings in 45 patients with cavitary histoplasmosis who were cared for at the Indiana University Medical Center hospitals during two large histoplasmosis outbreaks. Chronic obstructive lung disease and old age were the strongest risk factors for cavitary histoplasmosis but male sex, white race and immunosuppression were also important in certain patient groups. Fever, sweats, weight loss, productive cough, anemia, lymphopenia, and alkaline phosphatase elevation were common findings. The patients were occasionally incorrectly treated for presumed class 3 tuberculosis. Cultures were positive in 58% of patients, with sputum samples providing the highest yield (61%). Histoplasmal serologic tests provided useful clues to the diagnosis, positive in over 90% of cases. About one-third of patients recovered spontaneously while another 35% improved following treatment. About 4% developed chronic untreated cavitary histoplasmosis characterized by clinical and roentgenographic exacerbations and remissions. Of the deaths in four patients with untreated disease, one was caused by disseminated histoplasmosis while three died of other causes. Ketoconazole appeared effective in three of seven patients while its effect in three additional patients was uncertain. Toxicity precluded completion of ketoconazole therapy in one patient. Only amphotericin B has been proven to be effective therapy for cavitary histoplasmosis.

Adolescent↗
PubMed1984

Onset and duration of urinary antigen excretion in Legionnaires disease.

The purposes of this study were to determine whether antigen is excreted by patients with Legionnaires disease early enough after the onset of symptoms to be useful for making therapeutic decisions and whether antigen excretion ends when successful treatment is concluded. Specific antigen was detected in the urine of 14 (88%) of 16 patients with Legionnaires disease during days 1 to 3 of symptoms, 33 (80%) of 41 patients during days 4 to 7, 25 (89%) of 28 patients during days 8 to 14, and 11 of 11 patients after day 14, by solid-phase immunoassays for serogroup 1 Legionella pneumophila antigen. Antigen excretion persisted for 42 days or longer after the onset of treatment in at least 15 patients. The longest documented duration of excretion was 326 days. We conclude that antigen can be detected approximately as often early after symptoms begin as later, allowing meaningful therapeutic decisions to be made, but that prolonged antigen excretion may negate the diagnostic value of urinary antigen detection for relapsing or recurrent L. pneumophila pneumonia.

Antigens, Bacterial↗
PubMed1984

Commercially available (ENDO-STAPH) assay for teichoic acid antibodies. Evaluation in patients with serious Staphylococcus aureus infections and in controls.

We have evaluated the clinical usefulness of a commercially available teichoic acid antibody assay (ENDO-STAPH). Teichoic acid antibody titers up to a 1:2 serum dilution were observed in 20% of normal subjects, thus, titers of 1:4 or more were considered positive. Of patients with Staphylococcus aureus infections, 16 of 23 with endocarditis, 12 of 20 with complicated bacteremia, three of 17 with uncomplicated bacteremia, and ten of 20 with nonbacteremic infections had positive titers. Only four of 70 controls had positive titers. Results agreed with those using our standard assay in 130 of 151 specimens. Results were reproducibly positive or negative in 17 of 18 specimens that were retested. Results were also reproducible in ten specimens retested using a different lot of standardized antigen. The ENDO-STAPH assay should broaden the clinical applications of assays for TAA.

Antibodies, Bacterial↗
PubMed1983

Legionella pneumophila pericarditis proved by culture of pericardial fluid.

Serogroup 1 Legionella pneumophila was isolated from the pericardial fluid of a nonimmunosuppressed patient with pulmonary infiltrates, cardiac tamponade, and histologic evidence of pericarditis. This is the first reported case in which the association of L. pneumophila infection and pericarditis has been proved by growth of the organism from pericardial fluid. Physicians caring for patients with pericarditis of unknown cause should consider L. pneumophila in their differential diagnosis because special diagnostic efforts and relatively specific therapy are required for its optimal management.

Adult↗
PubMed1983

Antibody response to peptidoglycan during staphylococcal infections.

Levels of antibodies to peptidoglycan were measured by solid-phase radioimmunoassay in 76 patients with Staphylococcus aureus infections and 44 patients with infections caused by other bacteria. Levels of IgM antibodies to peptidoglycan were elevated in 24% of the patients with endocarditis or complicated bacteremia caused by S. aureus, 21% of those with serious infections caused by other gram-positive cocci, none of those with less serious infections caused by S. aureus or gram-negative bacilli, and 5% of the normal controls. Levels of IgG antibodies to peptidoglycan were elevated in 50% of the patients with endocarditis or complicated bacteremia caused by S. aureus, 3% of those with less severe infections caused by S. aureus, 17% of those with infections caused by other gram-positive cocci, 20% of those infections caused by gram-negative bacilli, and 5% of the normal controls.

Antibodies, Bacterial↗
PubMed1983

Recurrent urban histoplasmosis, Indianapolis, Indiana, 1980-1981.

In January 1981, informal surveillance of acute histoplasmosis in Indianapolis, Indiana, revealed a marked increase in disease activity for the last quarter of 1980. Fifty-one patients with onset of acute histoplasmosis during this period were identified through review of hospital admissions, emergency room visits, and serologic records at Indianapolis hospitals and the Indiana State Board of Health. In a retrospective case-control study, the authors found a significant association between developing acute histoplasmosis during this period and working or attending classes in a 2 sq mi (5.2 sq km) area encompassing the Indiana University-Purdue University campus (p = 0.015, Fisher's exact test). A review of construction activities on or near the campus during the epidemic period suggested that the probable source of infection was excavation activity for a large new indoor swimming complex (natatorium). Skin tests and serosurveys of students on campus by a newly developed radioimmunoassay for histoplasmal immunoglobulin M antibodies supported the association of infection with exposure to this site (p less than 0.05).

Disease Outbreaks↗
PubMed1983

Pericarditis as a manifestation of histoplasmosis during two large urban outbreaks.

During two histoplasmosis outbreaks in Indianapolis 45 patients presented with pericarditis. The pericarditis occurred as a late complication in individual patients and during the outbreak. Risk factors for this complication included young age, immunocompetence, and male sex in persons between 20 and 39 years old. Intrathoracic adenopathy was present in 66% of cases. Since cultures were uniformly negative, including pericardial fluid or tissue from nine patients, serologic studies provided the basis for diagnosis. Although the course was usually benign, nine patients presented with tamponade and another with constrictive pericarditis. Prompt response to antiinflammatory medications and failure to identify H. capsulatum in the pericardial fluid or tissue support a noninfectious, inflammatory mechanism for this complication. Of 20 patients reexamined 1 year later, none had evidence of constriction but three had pericardial thickening by echocardiography. Histoplasmosis should be considered in patients with pericarditis from endemic areas, particularly when associated with intrathoracic adenopathy.

Cardiac Tamponade↗
PubMed1983

Rapid diagnosis of Legionnaires' disease by latex agglutination.

We developed a latex agglutination test to detect antigen(s) of serogroup 1 Legionella pneumophila in urine and evaluated its ability to diagnose legionnaires' disease. Antigen was detected in 46, or 70%, of 66 patients with serogroup 1 legionnaires' disease but in none of 51 patients with various bacteremic infections nor 60 with urinary tract infections. One of 50 patients with other pulmonary infections was antigen-positive, an immunosuppressed patient with Pneumocystis carinii infection. Seven other patients infected with P. carinii were negative. When compared with radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) using serial dilutions of a single antigen-containing urine, latex agglutination was 16-fold less sensitive. However, 82% of RIA- or ELISA-positive specimens were positive by latex agglutination. Latex agglutination is simpler and more rapid than ELISA or RIA, and it should prove valuable in situations where ELISA or RIA are unavailable or unaffordable.

Antigens, Bacterial↗
PubMed1983

Immunoglobulin M and G histoplasmal antibody response in histoplasmosis.

Radioimmunoassays for IgM and IgG histoplasmal antibodies were developed and proved to be specific for their respective immunoglobulin classes, sensitive, and reproducible. Elevated IgM antibodies were detected in 59.8% of patients with histoplasmosis and 7.9% of control subjects. Elevated IgG antibodies occurred in 80.4% of patients with histoplasmosis but in only 12.9% of control subjects. Radioimmunoassay was nearly twice as sensitive as complement fixation for identifying patients with mild, presumably asymptomatic, infection. Of 13 patients with serologic follow-up at least 1 yr later, elevated IgM antibodies cleared, whereas IgG antibodies persisted in 7. In an epidemiologic investigation of a recurrent histoplasmosis outbreak, only the radioimmunoassay was able to prove the hypothesis that construction for a swimming complex was the source of exposure. These assays promise to be useful for clinical and epidemiologic investigations.

Antibodies, Fungal↗
PubMed1983

Legionnaire's disease in postoperative neurosurgical patients.

Legionella pneumophila postoperative pneumonia may be an important cause of morbidity and mortality in selected surgical patients. This report presents five postoperative neurosurgical patients in whom the diagnosis of Legionnaires' disease was made. Their clinical course and treatment are presented. Clinical manifestations, methods of diagnosis, and treatment of L. pneumophila pneumonia are discussed. It is pointed out that neurosurgical patients who have received high doses of corticosteroids and who develop nosocomial postoperative pneumonias should be suspected of having Legionnaires' disease.

Adrenal Cortex Hormones↗
PubMed1983

Diagnostic and therapeutic significance of staphylococcal teichoic acid antibodies.

Alpha- or beta-acetylglucosamine are major antigen determinants of ribitol teichoic acids of the cell walls of coagulase-positive staphylococci. Teichoic acid antibodies have been detected by quantitative immunoprecipitation methods, agar-gel diffusion, counterimmunoelectrophoresis, crossed immunoelectrophoresis, radioimmunoassay and enzyme-linked immunosorbent assay. Almost all adults have detectable antibodies if a sufficiently sensitive method is used. Elevated concentrations of teichoic acid antibodies result from a recent staphylococcal disease such as endocarditis, bacteremia with metastatic foci of abscesses in which drainage and/or antibiotic therapy is delayed, but increases in teichoic acid antibodies are infrequent in transient staphylococcal bacteremia such as from infected intravascular cannulae or abscesses in patients who are treated early. Detection of high concentrations of teichoic acid antibodies may allow a specific bacteriological diagnosis earlier than cultures, when cultures are negative as in partially treated endocarditis, and when cultures are difficult to obtain or evaluate such as deep seated abscesses, drainage from osteomyelitis or pneumonias. In addition, elevated concentrations of teichoic acid antibodies in patients with staphylococcal bacteremia are strong presumptive evidence for endocarditis, metastatic foci, or abscesses.

Abscess↗
PubMed1983

Recent advances in the diagnosis of serogroup 1 L. pneumophila pneumonia by detection of urinary antigen.

ELISA and radioimmunoassay were analyzed for their ability to detect antigen in urine from patients with serogroup 1 Legionnaires' disease. The sensitivity of the two assays is approximately 80 percent, and the specificity is estimated to be 99 percent or better. Assay predictive values, determined on 1,239 specimens, were 76 percent for positive, and 99 percent for negative results. Antigen was detected nearly as often during the first three days of symptoms as later. Antigen excretion lasted from four to 327 days. A latex agglutination test detected antigen in 82 percent of patients positive by the other immunoassays.

Antigens, Bacterial↗
PubMed1982

Rapid diagnosis of Legionnaires' disease by urinary antigen detection. Comparison of ELISA and radioimmunoassay.

An enzyme-linked immunosorbent assay was developed to detect urinary antigen excreted by patients with Legionnaires' disease. Of 47 patients tested, antigen was detected in 39. Of these 39 specimens, 35 gave clearly positive results by visual analysis; four others required spectrophotometric verification of positive results. Antigen was not detected in any of 178 urine specimens from patients with other pulmonary, bacteremic or urinary tract infections after a quick and simple confirmatory test. The assay required more time to perform than a previously described radioimmunoassay but was of equivalent sensitivity and specificity and did not require expensive equipment or contract with radioactive reagents. We conclude that enzyme-linked immunosorbent assay is a rapid, sensitive and specific means for rapidly diagnosing legionnaires' disease that can be performed in clinical laboratories unwilling or unable to use radioisotopes.

Antigens, Bacterial↗
PubMed1982

Immunoglobulin M antibody titers in the diagnosis of Legionnaires disease.

The purpose of this study was to determine whether measurement of immunoglobulin M (IgM) antibodies against Legionella pneumophila serogroup 1 can aid in the diagnosis of Legionnaires disease. On the basis of measurements of antibody levels in 1,942 control sera, we used an IgM titer of 1:256, observed in 2.3% of the controls, as presumptive evidence of Legionnaires disease. Measurement of IgM titers permitted us to presumptively or definitively diagnose Legionnaires disease in 13 of 34 patients earlier than we would have if only IgG titers had been measured. Of the 13 patients, 5 were diagnosed serologically only by IgM antibody determination. IgM titers were presumptively diagnostic in week 1 of clinical symptoms in 4 of the 13 patients. We conclude that conjugates used for antilegionella indirect fluorescent-antibody tests should be capable of detecting IgM antibodies so that the value of serological results in diagnosing and managing Legionnaires disease will be maximized.

Fluorescent Antibody Technique↗