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Biomedical subjects

R J Rice

Publications and source records attributed to R J Rice.

At least 19 recordsLinked to original sources
PubMed1998

Transmission of Chlamydia trachomatis and Neisseria gonorrhoeae among men with urethritis and their female sex partners.

Transmission of Chlamydia trachomatis and Neisseria gonorrhoeae among infected men and their female sex partners was examined using a design enhancing the likelihood that spread was directed from men to women. Chlamydia culture-negative specimens were examined using DNA amplification tests. Infection rates in women exposed to male sex partners with Chlamydia only were 65% (20/31) and with gonorrhea only were 73% (33/45). Infection of women by either agent was not influenced by the number of sexual exposures to or coinfection in men. There was a 98% (40/41) concordance of N. gonorrhoeae isolates among partners by auxotype and serovar. Chlamydia isolates were serotyped using ELISA and immunofluorescence testing and confirmed by nested polymerase chain reaction: 50% (6/12) of men and 57% (8/14) of women yielded mixed serovars. Sixty-four percent of pairs (9/14) were infected with identical serovars and an additional 28% shared at least one serovar. Multiple serovars of C. trachomatis, but not of N. gonorrhoeae, were common in sex partners and exchanged frequently.

Boston↗
PubMed1997

Receipt of recommended prenatal interventions and birth weight among African-American women: analysis of data from the 1988 National Maternal and Infant Health Survey.

OBJECTIVES: While the importance of exploring and better measuring elements of prenatal care have been noted in the public health literature, the components and timing of such services have been poorly examined for the overall pregnant population and specifically for African-Americans, who traditionally have had higher rates of low birth weight and premature delivery. This study explores the association between patient receipt of selected recommended prenatal care interventions and infant birth weight in a nationally representative sample of African-American women, while controlling for the influence of low birth weight risk indicators. METHOD: This is a retrospective case-control analysis using survey data of women who delivered normal birth weight, moderate low birth weight, and very low birth weight newborns in 1988. A sample of 3905 African-American women who responded to the 1988 National Maternal and Infant Health Survey is examined based on maternal recall of receipt of six clinical screening procedures and seven health-promotion recommendations. Birth weight measures were obtained from linked 1988 birth certificate data. RESULTS: The initial results indicated that women who do not receive all of the recommended health-promotion advice are more likely to deliver very low birth weight infants than women who receive all of the advice in the content of their prenatal care, after controlling for low birth weight risks (OR = 1.28; 95% CI = 1.01, 1.7). However, when breast-feeding advice is removed from the aggregation of health-promotion advice, the significant effect of advice on very low birth weight is negated. No other significant group variations in the receipt of clinical screening procedures or health-promotion advice for women who gave birth in the remaining birth weight categories are observed. CONCLUSIONS: Nationally recommended initial clinical screening procedures and health-promotion advice in prenatal care content do not appear to be associated with a reduction in low birth weight for African-American women. More research is needed to better assess the impact of other antenatal interventions, particularly those given to women with a higher prevalence of poor birth outcomes.

Adolescent↗
PubMed1996

Maternal hypertension and associated pregnancy complications among African-American and other women in the United States.

OBJECTIVE: To characterize maternal hypertension and related pregnancy complications among African-American and other women in the United States. METHODS: Using data from the National Hospital Discharge Survey, we analyzed the incidence and clinical spectrum of maternal hypertension among African-American women who delivered in hospital during 1988-1992. Maternal hypertension consisted of pregnancy-induced hypertension and chronic hypertension preceding pregnancy, including pregnancy-aggravated hypertension. Pregnancy-induced hypertension included preeclampsia, eclampsia, and transient hypertension. Incidence rates (per 1000 deliveries) and 95% confidence intervals (CI) were calculated by type of hypertension and demographic characteristics. Risk ratios and 95% CIs for adverse pregnancy outcomes among women with hypertension were also calculated. RESULTS: The overall incidence of all causes of maternal hypertension was 64.2, and of chronic hypertension preceding pregnancy it was 25.0 per 1000 deliveries among African-American women, an excess of 15.6 and 14.5 cases per 1000 deliveries, respectively, compared with rates for other women. The risks of preterm delivery and inadequate fetal growth were similarly increased for all hypertensive women, regardless of race. However, hypertensive African-American women were at a threefold greater risk of pregnancies complicated by antepartum hemorrhage, an association that was not observed, in other women. Development of preeclampsia and eclampsia irrespective of race was about four times higher among women with chronic hypertension preceding pregnancy than among those without chronic hypertension. CONCLUSION: The excess incidence of maternal hypertension, particularly chronic hypertension, may contribute to adverse maternal and fetal pregnancy outcomes and the disparity in outcomes observed between African-American and other women in the U.S. These findings provide a specific focus for further clinical outcomes research and assessment of prenatal management in African-American women.

Adolescent↗
PubMed1995

Pathology of the umbilical cord in congenital syphilis: analysis of 25 specimens using histochemistry and immunofluorescent antibody to Treponema pallidum.

Identification of Treponema pallidum in the placenta is important for diagnosis of congenital syphilis; however, spirochetes are difficult to observe in chorionic villi. To determine the sensitivity of umbilical cord examination for T pallidum, and the association of spirochetes with cord pathology, placentas were prospectively obtained from 25 women with untreated syphilis. The most common finding using hematoxylin-eosin staining was a normal-appearing umbilical cord (48%); necrotizing funisitis was the most frequent pathological lesion (36%). Spirochetes were detected using silver and immunofluorescent staining in 89% of cords, including 92% of histologically normal and 84% of abnormal cords. Three specimens showed subamnionic aggregates of spirochetes, consistent with amniotic fluid infection. Necrotizing funisitis was strongly associated with umbilical artery infection by spirochetes (P = .008). There was a 100% correlation between results of silver and immunofluorescent staining. The umbilical cord is a sensitive site for morphological confirmation of T pallidum; it is significant for the pathologist that spirochetes may often be detected in the absence of overt tissue inflammation or necrosis.

Antibodies, Bacterial↗
PubMed1995

Proposed criteria for interpretation of susceptibilities of strains of Neisseria gonorrhoeae to ciprofloxacin, ofloxacin, enoxacin, lomefloxacin, and norfloxacin.

The susceptibilities of 45 strains of Neisseria gonorrhoeae, including 25 strains susceptible to ciprofloxacin (MICs, < or = 0.06 microgram/ml) and 20 strains exhibiting decreased susceptibilities to ciprofloxacin (MICs, > or = 0.125 microgram/ml), to ciprofloxacin, ofloxacin, enoxacin, lomefloxacin, norfloxacin, and nalidixic acid were determined by agar dilution and disk diffusion. On the basis of theoretical calculations of predicted susceptibilities at which infections may fail therapy (supported by observed failures of infections to respond to the therapeutic doses of enoxacin and ciprofloxacin), the Centers for Disease Control and Prevention has adopted the following agar dilution breakpoints for interpretation of resistance to these agents: MICs of > or = 1.0 microgram of ciprofloxacin, enoxacin, and norfloxacin per ml and MICs of > or = 2.0 micrograms of ofloxacin and lomefloxacin per ml. The corresponding disk diffusion breakpoints for these agents were as follows: ciprofloxacin, < or = 29 mm; ofloxacin, < or = 24 mm; enoxacin, < or = 31 mm; lomefloxacin, < or = 26 mm; and norfloxacin, < or = 32 mm. The Centers for Disease Control and Prevention recommends two strains as interim quality control strains for susceptibility testing of ciprofloxacin and ofloxacin. These are N. gonorrhoeae CDC-10,328 (MIC of ciprofloxacin, 0.125 to 0.25 microgram/ml [inhibition zone diameter range, 30 to 34 mm]; MIC of ofloxacin, 0.5 microgram/ml [inhibition zone diameter range, 27 to 32 mm]) and N. gonorrhoeae CDC-10,329 (MIC of ciprofloxacin, 1.0 to 2.0 micrograms/ml [zone inhibition diameter range, 21 to 26 mm]; MIC of ofloxacin 2.0 micrograms/ml [inhibition zone diameter range, 18 to 21 mm]).

Anti-Infective Agents↗
PubMed1995

Susceptibilities of Chlamydia trachomatis isolates causing uncomplicated female genital tract infections and pelvic inflammatory disease.

The in vitro susceptibilities of 45 recent clinical isolates of Chlamydia trachomatis obtained from women with asymptomatic genital tract infection, mucopurulent cervicitis, or pelvic inflammatory disease to doxycycline, azithromycin, ofloxacin, and clindamycin were determined. In addition, susceptibilities of 12 isolates to amoxicillin and trimethoprim-sulfamethoxazole were also determined. Isolates also were serotyped with a panel of monoclonal antibodies specific for chlamydial major outer membrane protein; 24 of 45 (53%) belonged to serovars Ia and E. For all isolates, the MIC range of doxycycline was 0.008 to 0.06 micrograms/ml, for trimethoprim-sulfamethoxazole it was 0.03 to 0.25 micrograms/ml, for azithromycin it was 0.125 to 2.0 micrograms/ml, for ofloxacin it was 0.5 to 1.0 micrograms/ml, for clindamycin it was 0.25 to 2.0 micrograms/ml, and for amoxicillin it was 0.25 to 4.0 microgram/ml. The ranges of minimum chlamydiacidal concentrations were generally 1 to 4 dilutions above the MICs of most agents, with a rank order similar to those of the MICs. Comparing the minimum chlamydiacidal concentrations for 90% of isolates tested, isolates causing asymptomatic infection belonged to a greater variety of serovars and were relatively more susceptible to doxycycline and azithromycin than isolates causing mucopurulent cervicitis or pelvic inflammatory disease; these differences in susceptibility were not detected among the other study agents. These data indicate that additional studies are needed to better define the apparent association of certain chlamydial serovars with the clinical severity of disease and the in vitro susceptibilities to certain antimicrobial agents.

Anti-Bacterial Agents↗
PubMed1995

Trends in susceptibility of Neisseria gonorrhoeae to ceftriaxone from 1985 through 1991.

The antimicrobial susceptibilities of 16,441 gonococcal isolates from Seattle-King County were determined for ceftriaxone, cefoxitin, penicillin G, and tetracycline. From 1985 to 1989, ceftriaxone, in combination with doxycycline, was increasingly used for treatment of gonorrhea, and by 1989, it was used as therapy for > 80% of cases in Seattle-King County. MICs of ceftriaxone correlated significantly (P < 0.001) with those of the other beta-lactam antibodies included in this study. Geometric mean MICs of penicillin G for isolates that did not produce beta-lactamase increased from 1985 to 1991. The geometric mean MICs of cefoxitin, ceftriaxone, and tetracycline began to decline in 1987 but increased in 1990 and 1991. The percentage of strains with decreased susceptibility to ceftriaxone (MIC, 0.06 to 0.25 microgram/ml) rose from 0.3% in 1985 to 5.3% in 1987 but subsequently declined steadily to 2.6% in 1991, despite increased use of ceftriaxone as routine therapy for gonorrhea. Changes in patterns of antimicrobial susceptibility may be related not only to antimicrobial selection pressures but also to less well understood population shifts among Neisseria gonorrhoeae strains within a community.

Ceftriaxone↗
PubMed1995

In vitro activity of a new fluoroquinolone, CP-99,219, against strains of Neisseria gonorrhoeae.

The susceptibilities of 216 strains of Neisseria gonorrhoeae to a new fluoroquinolone, CP-99,219 were determined. For strains for which the MICs of ciprofloxacin were < or = 0.06 microgram/ml, the MICs at which 90% of the isolates are inhibited (MIC90s) of CP-99,219, ciprofloxacin, and ofloxacin were 0.008, 0.015, and 0.03 microgram/ml, respectively. For strains for which the MICs of ciprofloxacin were 0.125 to 0.5 microgram/ml, the MIC90s of CP-99,219, ciprofloxacin, and ofloxacin were 0.06, 0.25, and 0.5 microgram/ml, respectively. For strains for which the MICs of ciprofloxacin and ofloxacin were 2.0 micrograms/ml, the MIC of CP-99,219 was 0.25 microgram/ml.

Anti-Infective Agents↗
PubMed1994

Syphilitic endometritis causing first trimester abortion: a potential infectious cause of fetal morbidity in early gestation.

This report describes a 30-year-old woman with a history of prostitution and "crack" cocaine use during pregnancy. After an incomplete abortion at 11 weeks' gestation, a suction dilatation and curettage of uterine contents was done. Histopathologic examination revealed lymphoplasmacytic deciduitis and decidual necrosis, as well as rare first trimester chorionic villi. Silver staining using the Steiner technique showed numerous spirochetes, morphologically consistent with Treponema pallidum, in the decidualized endometrial tissues. This case of syphilitic endometritis, which appears to be the first reported, suggests that treponemal infection can cause fetal morbidity during early gestation.

Abortion, Spontaneous↗
PubMed1994

Antimicrobial susceptibilities of Neisseria gonorrhoeae strains representing five distinct resistance phenotypes.

The susceptibilities of 109 strains of Neisseria gonorrhoeae to penicillin G, tetracycline, amoxicillin-clavulanic acid, cefotetan, cefoxitin, ceftriaxone, ciprofloxacin, and fleroxacin were determined. The activities of cefmetazole, cefuroxime, cefixime, and ofloxacin were also determined against 62 of these strains. Strains represented penicillin-susceptible (Pen(s)) N. gonorrhoeae; penicillinase-producing N. gonorrhoeae (PPNG) possessing 2.9-, 3.05-, 3.2-, or 4.4-MDa beta-lactamase plasmids; strains with high-level, plasmid-mediated tetracycline resistance (TRNG); strains with plasmid-mediated resistance to penicillin and tetracycline; and strains with chromosomally mediated resistance to penicillin and tetracycline (CMRNG). Ceftriaxone, cefixime, and ciprofloxacin were the most active agents tested against all strains. Pen(s), TRNG, and PPNG strains possessing a 3.2-MDa beta-lactamase plasmid were more susceptible to amoxicillin-clavulanic acid, extended- and broad-spectrum cephalosporins, and quinolones than were either PPNG strains possessing a 2.9-, a 3.05-, or a 4.4-MDa beta-lactamase plasmid or CMRNG strains.

Anti-Bacterial Agents↗
PubMed1994

Susceptibility of Neisseria gonorrhoeae associated with pelvic inflammatory disease to cefoxitin, ceftriaxone, clindamycin, gentamicin, doxycycline, azithromycin, and other antimicrobial agents.

We determined the susceptibilities, by the agar dilution method, of 84 recent clinical isolates of Neisseria gonorrhoeae obtained from women with pelvic inflammatory disease in the United States to the following antimicrobial agents: penicillin, cefoxitin, cefotetan, ceftriaxone, ceftizoxime, cefixime, tetracycline, doxycycline, ciprofloxacin, ofloxacin, erythromycin, azithromycin, clindamycin, and gentamicin. Twenty-five percent of the isolates were resistant to penicillin and 20% were resistant to tetracycline. In comparison, doxycycline was more active than tetracycline and azithromycin was more active than erythromycin in vitro. Ceftriaxone, ceftizoxime, and cefixime were equally active against penicillin-susceptible isolates, but they had different in vitro activities against gonococcal isolates possessing chromosomally mediated resistance to penicillin. Overall, cefoxitin was slightly more active than cefotetan and ciprofloxacin was more active in vitro than ofloxacin, especially against N. gonorrhoeae with chromosomally mediated resistance. Criteria for the interpretation of susceptibility data for N. gonorrhoeae are not available for clindamycin or gentamicin, but for at least half of all isolates, including penicillin-susceptible isolates, at least 4 micrograms of clindamycin or gentamicin per ml was required to inhibit growth in vitro.

Anti-Bacterial Agents↗
PubMed1994

Persistence of Neisseria gonorrhoeae strains with decreased susceptibilities to ciprofloxacin and ofloxacin in Cleveland, Ohio, from 1992 through 1993.

Twenty-five isolates of beta-lactamase-negative strains of Neisseria gonorrhoeae exhibiting decreased susceptibilities to ciprofloxacin (MIC, > or = 0.125 microgram/ml) were isolated from men with uncomplicated gonococcal urethritis in Cleveland, Ohio, from January 1992 through June 1993. The strains belonged to three auxotype-serovar classes: Pro-IB-1 (2 isolates), Pro-IB-2 (21 isolates), and Pro-IB-3 (2 isolates). MICs for strains were in the intermediate or resistant categories for penicillin, the intermediate or susceptible categories for tetracycline (with the exception of one strain that had acquired the 25.2-MDa TetM-containing plasmid) and cefoxitin, and the susceptible categories for ceftriaxone and cefixime (MICs, < or = 0.25 microgram/ml) and spectinomycin (MIC, < or = 256 micrograms/ml). MICs for strains were also in the susceptible category for ofloxacin (MIC, 0.25 microgram/ml) and in categories higher than susceptible for ciprofloxacin (MICs, 0.125 to 0.25 microgram/ml) and ofloxacin (MIC, 0.5 microgram/ml). The diameters of zones of inhibition for these strains ranged from 31 to 39 mm for ciprofloxacin to 28 to 35 mm for ofloxacin. The persistence of these strains over an 18-month period supports the need for routine sentinel surveillance and monitoring of gonococcal isolates, particularly posttreatment isolates, for resistance to quinolones when these agents are used for the primary therapy of uncomplicated gonorrhea.

Ciprofloxacin↗
PubMed1994

Emerging in vitro resistance to quinolones in penicillinase-producing Neisseria gonorrhoeae strains in Hawaii.

The susceptibilities of 37 penicillinase-producing strains of Neisseria gonorrhoeae (PPNG), isolated in Hawaii from December 1991 through January 1994, were determined to ciprofloxacin and ofloxacin, fluoroquinolone agents currently recommended by the Centers for Disease Control and Prevention as alternative regimens for the treatment of uncomplicated gonorrhea. Nine isolates (24.3%) exhibited decreased susceptibilities (MICs, > or = 0.06 microgram/ml) to ciprofloxacin and ofloxacin. Ciprofloxacin MICs for three isolates (8.1%) were 2.0 micrograms/ml; these isolates belonged to the auxotype/serovar class Pro/IB-7 and possessed the 3.2-MDa beta-lactamase and the 24.5-MDa conjugative plasmids. Six strains for which ciprofloxacin MICs were 0.06 to 0.125 microgram/ml belonged to a variety of gonococcal phenotypes. Strains for which ciprofloxacin MICs were 2.0 micrograms/ml were isolated from persons who had traveled to, or were sexual contacts of persons who had recently traveled to, Southeast Asia. Persons infected with these isolates had been treated with ceftriaxone (250 mg intramuscularly, single dose); therefore, none of these cases were associated with clinical failure following the use of fluoroquinolone therapy. Further studies are needed to confirm the clinical and public health significance of increased in vitro resistance to ciprofloxacin and ofloxacin in N. gonorrhoeae.

Ciprofloxacin↗
PubMed1994

Flow cytometric analysis of peripheral blood lymphocyte immunophenotypes in persons infected with Treponema pallidum.

To characterize the human immune response to syphilis, we determined the effect of infection with Treponema pallidum on the percentage of the various lymphocyte subpopulations in the peripheral blood of infected and uninfected persons. Monoclonal antibodies labeled with either fluorescein isothiocyanate or phycoerythrin were used to perform dual color analysis on a FACScan with the following markers: CD3 for total T cells, CD4 for T helper cells, CD8 for T suppressor cells, CD19 for B cells, and CD16 plus CD56 for natural killer cells. Lymphocyte immunophenotype results were analyzed by the stage of untreated syphilis and by gender. Although they were within the ranges of the normal distribution of immunophenotypes, the percentages of CD4+ cells were significantly lower (P < 0.001) and those of CD8+ cells were higher (P = 0.03) in patients with syphilis than in the uninfected population. For infected versus uninfected subjects, both women and men, the differences in the mean percentages of CD3+ and CD4+ cells were significant (P < or = 0.05). Significant differences were noted between the sexes in secondary syphilis only in the mean percentages of cells positive for CD3, CD4, CD8, and CD16 plus CD56. Gender had no effect on lymphocyte subpopulations in subjects with primary or latent syphilis. In the control population, significant differences due to gender were observed in the percentages of cells positive for CD3, CD4, and CD16 plus CD56.

B-Lymphocytes↗
PubMed1994

Potential for bias in studies of the influence of human immunodeficiency virus infection on the recognition, incidence, clinical course, and microbiology of pelvic inflammatory disease.

As the human immunodeficiency virus (HIV) epidemic affects more women, clinicians are increasingly observing pelvic inflammatory disease (PID) in HIV-infected women. The extent to which PID is a factor in the recognition of HIV or HIV is a factor in the recognition of PID is unknown. Even less is known about how HIV infection influences the development, clinical course, and microbiology of PID. The paucity of existing data largely results from difficulties in designing studies that are free of bias. Several biases may distort studies of the effect of HIV on the recognition, incidence, clinical presentation and course, and microbiology of PID. Selection bias, diagnostic bias, and confounding bias are the most likely causes of invalid conclusions in studies of the influence of HIV infection on these aspects of PID, for three major reasons: Factors that determine patients' health care seeking behavior may be related to HIV status; the diagnosis of PID tends to be imprecise; and extraneous factors that cause or prevent PID may be distributed differently in HIV-infected and HIV-uninfected women. Appropriate study design and analytic techniques can eliminate, reduce, or estimate the magnitude and direction of these biases, thereby yielding more valid conclusions. To interpret properly existing and future studies of the influence of HIV infection on PID, clinicians must consider several biases that may distort results.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Clinical and serologic evaluation of neonates for congenital syphilis: a continuing diagnostic dilemma.

Neonates born to women with reactive serologic tests for syphilis were studied; the total of 116 included 18 who were symptomatic, 60 asymptomatic but possibly infected, and 38 asymptomatic and probably uninfected. The fluorescent treponemal antibody-absorption (FTA-ABS) 19S IgM test and an IgM capture ELISA for Treponema pallidum, both treponema-specific assays, and the reverse enzyme-linked immunospot (RELISPOT), which detects immunoglobulin-secreting cells and is a nonspecific indicator of infection, were evaluated. Sensitivities among symptomatic neonates were 88% (IgM ELISA), 73% (FTA-ABS), and 78% (RELISPOT). Specificities ranged from 97% to 100%. A major problem has been the inability to identify which asymptomatic but possibly infected neonate is really uninfected. Among 41 such babies who had all three tests done, 93% were negative by all assays, suggesting they were uninfected or recently infected. Strategies to accurately identify the truly uninfected asymptomatic newborn would prevent the unnecessary hospitalization of all at-risk infants, resulting in improved quality of care and reduced costs.

Adult↗