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Biomedical subjects

R H Gilman

Publications and source records attributed to R H Gilman.

197 records · Page 11Linked to original sources
PubMedDate not supplied

Prevalence and symptoms of Enterobius vermicularis infections in a Peruvian shanty town.

The prevalence and symptoms of pinworm infection were determined in a shanty town in Lima, Peru. In 206 families, pinworm infection rates were highest in primary school age children (42%). Approximately one-fourth of pre-school children and secondary school-age children were infected with pinworms. Two examinations detected 74% of patients who were positive after 5 examinations. Symptoms often attributed to pinworm infection, such as perianal itching enuresis, and teeth grinding, occurred in a similar proportion of infected children (15%, 17%, 13%, respectively) and non-infected subjects (11%, 13%, 11%, respectively). Enuresis was more common in primary school-age children with high pinworm egg counts than in their non-infected contemporaries. 52% (28/54) of children under 5 years old became reinfected within 6 months of effective treatment. In a community where water is scarce and hand washing is infrequent, the high rate of perianal itching is probably an important source of faecal-oral contamination. The low morbidity and high reinfection rate make routine treatment of pinworm infection in third world countries a low priority, except when clinically indicated.

Adolescent↗
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A home nutritional rehabilitation programme in a Peruvian peri-urban shanty town (pueblo joven).

In a peri-urban shanty town located in Lima, Peru, a nutritional census of children 0-3 years old revealed a number of second and third degree malnourished children. In order to treat these children a home-based nutritional rehabilitation (HNR) programme was developed utilizing available community health staff. The programme focused on individual and group maternal education, home-based therapy such as oral rehydration solution for diarrhoea, periodic growth monitoring, and a strong trust relationship between mother and health professional. There was one death and four (7%) hospital admissions among the 54 HNR children. These morbidity and mortality rates were similar to those achieved by more traditional programmes in Bangladesh, India, and Guatemala. NHR can provide an inexpensive, reproducible method useful for the treatment of malnourished 'third world' children in peri-urban slums.

Body Height↗
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Serum antigen detection in the diagnosis, treatment, and follow-up of neurocysticercosis patients.

The efficacy of albendazole (ABZ) treatment for human neurocysticercosis (NCC) was assessed by using a monoclonal antibody-based parasite antigen detection ELISA which specifically detects the products of living cysticerci in human serum. The assay displayed 85% diagnostic sensitivity, detecting 39 of 46 NCC cases. Only patients with a single viable cyst or only enhancing lesions (degenerating parasites) were seronegative. Specificity of the assay was 92% (23/25) when tested in healthy Peruvian volunteers. In 'cured' patients, in whom all parasites died after ABZ therapy, parasite antigen levels fell sharply by 3 months post treatment. This pattern was not observed in patients refractory to treatment. The sensitivity of the assay with serum samples, and its ability to identify successfully treated patients, make this monoclonal antibody-based ELISA the test of choice for the follow-up of NCC cases.

Adolescent↗
PubMedDate not supplied

Prevalence, intensity, and fertility of ovine cystic echinococcosis in the central Peruvian Andes.

An abattoir survey of 212 sheep of different ages was undertaken to determine the local epidemiological transmission patterns of Echinococcus granulosus in the central Peruvian Andes. Overall prevalence of the disease in sheep in this survey (which ended in July 1996) was 77.4%, with 96% of sheep aged > or = 6 years being infected. Of 1165 cysts examined, 41.1% were fertile with a mean protoscolex viability of 73.2%. A logistic regression model for the distribution of cyst fertility and type by age, location and size is described. Mathematical modelling also determined that infection pressure on sheep was 0.44 infections per year and that the mean number of cysts increased linearly by 1.28 cysts per year. These data suggest that E. granulosus is in an endemic state in this area and control measures could drive the disease towards extinction.

Animals↗
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Clinical significance of neurocysticercosis in endemic villages. The Cysticercosis Working Group in Peru.

Cerebral cysticercosis is the main cause of late-onset epilepsy in most developing countries. Data on the neuroepidemiology of cysticercosis in endemic populations is scarce. In an endemic village on the northern coast of Peru, 49 individuals with neurological symptomatology (41 epileptic and 8 non-epileptic) were screened for antibodies to Taenia solium, using a serum electroimmunotransfer blot assay. Fifteen subjects were seropositive, 14 (34%) of those with epilepsy but only one (13%) of those who were non-epileptic. A history of passing proglottides was associated with positive serology. Thirteen of the 15 seropositive individuals underwent cerebral computed tomography; only 7 (54%) were abnormal. A randomly selected sample of 20 pigs from the village was also tested, and 6 (30%) were seropositive. This study demonstrated the importance of cysticercosis in the aetiology of epilepsy in endemic villages and the close relationship between porcine and human infection.

Adolescent↗
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Gastric acid secretion and enteric infection in Bangladesh.

In developing countries many enteric infections are caused by acid-sensitive pathogens. Failure of the gastric acid barrier to infection has been reported in cholera but gastric acid secretion has been little studied in other enteric infections. We therefore studied basal and stimulated gastric acid in 185 Bangladeshi men admitted to hospital for the treatment of enteric infection. Patients with dysentery (amoebiasis, n = 24 and shigellosis, n = 19) and culture-negative diarrhoea (n = 69) had similar mean gastric acid levels (basal, 3-5 mmol/h; stimulated, 11-17 mmol/h), which remained stable in those patients studied throughout 12 weeks of convalescence. In contrast, patients with secretory diarrhoea caused by cholera or enterotoxigenic Escherichia coli (ETEC) had low gastric acid levels (P < 0.05 compared with other groups) (cholera, n = 34: basal mean 1.8 mmol/h [SD = 2.2], stimulated mean 7.9 mmol/h [SD = 6.4]; ETEC, n = 39: basal mean 2.7 mmol/h [SD = 2.8], stimulated mean 9.4 mmol/h [SD = 7.5]). Cholera patients' gastric acid level rose during convalescence to similar levels to the dysentery patients'. Low gastric acid level was associated with severe disease in patients with cholera (P < 0.02) or ETEC (P < 0.05). Gastric acid level fell with increasing age (P < 0.007) but this did not account for the differences between groups. Gastric acid levels were not associated with Giardia duodenalis or Strongyloides stercoralis co-infection, fever, use of tobacco, or chewing betel nut. Cholera and secretory diarrhoea caused by ETEC may, therefore, partly result from a reduction in gastric acid level which does not occur during dysentery. Factors which impair gastric acid secretion may predispose to diarrhoeal disease in developing countries.

Acute Disease↗
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A specific antigen-detection ELISA for the diagnosis of human neurocysticercosis. The Cysticercosis Working Group in Peru.

An enzyme-linked immunosorbent assay (ELISA) for the detection of antigen secreted by viable Taenia solium metacestodes (Ag-ELISA) was applied to 43 pre-treatment and 47 follow-up cerebrospinal fluid (CSF) samples from Peruvian patients with neurocysticercosis demonstrated by computed tomography and enzyme-linked immunoelectrotransfer blot assay. The sensitivity of the assay was 86%. Negative pre-treatment results in the Ag-ELISA test were restricted to patients with only a single live cyst or only enhancing lesions. Patients with hydrocephalus had higher levels of circulating antigen. There was no difference between antigen levels in CSF taken before and immediately after treatment (day 14). Levels of parasite antigen were significantly positively correlated with the number of live cysts detected by tomography and were also proportional to the number and intensity of antibody reactions recognized by the immunoblot diagnostic test. In contrast, there was a negative correlation with the number of enhancing lesions revealed by tomography, supporting the hypothesis that enhancing lesions correspond to a terminal, moribund stage of the parasite. The use of antigen-detection tests specific for viable metacestodes has immediate utility in the clinical context, not only providing important information on the viability of the parasites but also leading to an improved understanding of the pathogenesis of neurocysticercosis before and after drug treatment.

Adult↗
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Field diagnosis of Echinococcus granulosus infection among intermediate and definitive hosts in an endemic focus of human cystic echinococcosis.

Human, canine and ovine echinococcosis prevalence was determined in a highland community located in the central Peruvian Andes during 1997 and 1998. Human echinococcosis was determined using portable ultrasonography, chest X-ray examination, and an enzyme-linked immunoelectrotransfer blot (EITB) assay. Canine echinococcosis was determined using microscopy stool examinations and a coproantigen detection enzyme-immunoassay (EIA) for Echinococcus granulosus. Ovine echinococcosis was determined by an EITB assay for sheep echinococcosis and necropsy examination of viscera from domestic slaughtered animals. An abdominal ultrasound, a chest X-ray examination and an EITB for echinococcosis were performed on 214 subjects (45% of the village population). The frequency of presumptive liver/abdominal, lung and liver-lung hydatid cysts was 5.1% (11/214), 3.7% (8/214) and 0.5% (1/214), respectively. The overall prevalence of human cystic echinococcosis was 9.3% (20/214). The frequency of canine echinococcosis was 46% (23/50) and 32% (16/50) by the coproantigen EIA test and arecoline purging, respectively. The frequency of sheep echinococcosis was 65% (22/34) by the EITB and 38% (13/34) by necropsy. We demonstrated a high prevalence of human and animal echinococcosis in this Peruvian village. In remote areas where echinococcosis is endemic, both the coproantigen EIA and arecoline purging may be used for the study of canine echinococcosis; the EITB is useful in establishing the diagnosis of echinococcosis in sheep prior to necropsy.

Adolescent↗
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Hookworm disease: host-pathogen biology.

The hallmark of hookworm infection, a common helminthic disease, is iron deficiency anemia. The development of anemia is dependent on the intensity of infection, the species of hookworm, and the ability of the host to resist infection and to maintain adequate stores of iron. When conditions are appropriate, the incidence of anemia caused by hookworm is high and has a significant economic impact since it results in a reduction of worker productivity. Loss of blood is caused by direct ingestion of red cells and by tissue trauma produced by worm attachment and feeding. This focal trauma may involve multiple villi and is characterized by local hemorrhage, tissue cytolysis, and neutrophilic response. Although focal intestinal lesions are apparent, their significance is questionable since diffuse mucosal changes are absent in intestinal biopsies of patients with heavy hookworm infection. Short-range control measures protecting against hookworm infection have not succeeded. Development of a vaccine against hookworm infection in humans is problematic since functional protective immunity in humans has not yet been demonstrated and no suitable animal model of hookworm infection in humans is available. At present, the most effective method of intervention appears to be supplementation of food staples with iron.

Ancylostomiasis↗
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In vitro and in vivo effects of three bismuth compounds on fermentation by colonic bacteria.

Three bismuth compounds (tripotassium dicitrate bismuthate, bismuth subsalicylate, and bismuth subnitrate) were tested in vitro and in vivo for their effect on fermentation by colonic bacteria. The studies in vitro were done with use of a technique designed to determine the effect of each one of the bismuth compounds on the fermentation of several stool samples that had been mixed with lactose as additional fermentable substrate (fermentation of lactose-enriched stools, FLES). The three bismuth compounds reduced FLES significantly in 47 (81%) of 58 of the stool samples used to test their effect. Bismuth subsalicylate, which reduced FLES in 10 of 10 stool samples, showed the greatest reduction (mean reduction, 74%; P less than .0001). The in vivo studies, done in six flatulent patients, showed significant reduction (P less than .01) of colonic fermentation of ingested raffinose by oral bismuth subnitrate given for 8 days.

Adolescent↗
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The diagnostic importance of species specific and cross-reactive components of Taenia solium, Echinococcus granulosus, and Hymenolepis nana.

Sera from patients infected with Taenia solium, Hymenolepis nana and Echinococcus granulosus were tested against homologous and heterologous parasite antigens using an ELISA assay, and a high degree of cross-reactivity was verified. To identify polypeptides responsible for this cross reactivity, the Enzyme Linked Immunoelectro Transfer Blot (EITB) was used. Sera from infected patients with T.solium, H.nana, and E.granulosus were assessed against crude, ammonium sulphate precipitated (TSASP), and lentil-lectin purified antigens of T.solium and crude antigens of H.nana and E.granulosus. Several bands, recognized by sera from patients with T.solium, H.nana, and E.granulosus infections, were common to either two or all three cestodes. Unique reactive bands in H.nana were noted at 49 and 66 K-Da and in E.granulosus at 17-21 K-Da and at 27-32 K-Da. In the crude cysticercosis extract, a specific non glycoprotein band was present at 61-67 K-Da in addiction to specific glycoprotein bands of 50, 42, 24, 21, 18, 14, and 13 K-Da. None of the sera from patients with H.nana or E.granulosus infection cross reacted with these seven glycoprotein bands considered specific for T.solium infection.

Adolescent↗
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Hospital control and multidrug-resistant pulmonary tuberculosis in female patients, Lima, Peru.

We examined the prevalence of tuberculosis (TB), rate of multidrug-resistant (MDR) TB, and characteristics of TB on a female general medicine ward in Peru. Of 250 patients, 40 (16%) were positive by sputum culture and 27 (11%) by smear, and 8 (3%) had MDRTB. Thirteen (33%) of 40 culture-positive patients had not been suspected of having TB on admission. Six (46%) of 13 patients whose TB was unsuspected on admission had MDRTB, compared with 2 (7%) of 27 suspected cases (p = 0.009). Five (63%) of 8 MDRTB patients were smear positive and therefore highly infective. In developing countries, hospital control, a simple method of reducing the spread of MDRTB, is neglected.

Adolescent↗
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The role of breast milk in protecting urban Peruvian children against cryptosporidiosis.

To test the hypothesis that breast milk of nursing mothers may afford children protection against cryptosporidiosis, a prospective cohort study was carried out in the young peoples' community of San Juan de Miraflores near Lima, Peru. Mothers and newborn children were sorted into cohort groups based on the mothers' breast milk antibody response to Cryptosporidium sporozoites using an antibody-capture enzyme-linked immunosorbent assay to detect parasite-specific immunoglobulin A. Children were monitored for Cryptosporidium infection using an indirect immunofluorescence assay. Of 211 mothers enrolled in the study, 39 (18.5%) had high breast milk antibody titers, 107 (50.7%) had medium titers, and 65 (30.8%) had low titers. Sixty-one episodes of Cryptosporidium infection were detected in 50 children of these mothers. Eleven (22%) had mothers in the high antibody titer group, 20 (40%) had mothers in the medium titer group, and 19 (38%) had mothers in the low titer group. The prevalence of infection within children of each group was 0.17, 0.19 and 0.38 respectively. There was no significant difference in the prevalence or duration of infection among children of the different groups. The data does not support the notion that there is protection from Cryptosporidium infection afforded children whose mothers have demonstrable breast milk antibodies against the parasite.

Adult↗