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Biomedical subjects

S H Gillespie

Publications and source records attributed to S H Gillespie.

104 records · Page 6Linked to original sources
PubMed1988

Detection of circulating parasite antigen and specific antibody in Toxocara canis infections.

Serological surveys, measuring humoral antibody responses, have indicated significant levels of human infection with the zoonotic nematode Toxocara canis, and raised concern about the resultant risk of ocular and neurological damage. Such measurements do not distinguish with certainty current infection from past exposure. Thus, we have developed a test for circulating Toxocara antigen released by parasites in the host. This monoclonal antibody-based two-site 'sandwich' assay discriminates between T. canis and the related feline ascarid T. cati, and has been used, in tandem with the standard ELISA, to examine experimental and human infections. In experimental animals, antigen is transiently detectable, disappearing when immunocomplexed with host antibody. Antigen was also found in sera from UK patients diagnosed with visceral or ocular toxocariasis, and in four asymptomatic Papua New Guinean children. In the latter population, individuals positive for parasite antigens were not necessarily positive for antibody, implying that some infected cases may be negative in the current diagnostic ELISA. The antibody test was also adapted to measure host antibody directed to single monoclonal antibody-defined epitopes, revealing evidence of differential temporal regulation of distinct antibody specificities.

Animals↗
PubMed1988

Meningitis in an Irish community.

A series of 26 cases of meningitis occurring in one year in a defined area is presented. The clinical features, and complications are reviewed. Neisseria meningitidis occurred twice as commonly as Haemophilus influenzae, suggesting that the pattern of infection differs from that reported in England and Wales. An incidence of 4.6/100,000 for N. meningitidis is reported exceeding rates of infection in previous UK "epidemics".

Child↗
PubMed1986

Malaria in Northern Ireland.

The clinical features, parasitology and prophylactic history of 67 patients who imported malaria to Northern Ireland between 1974 and 1983 are reported. P. falciparum infections were encountered more frequently than anticipated from current United Kingdom experience. The clinical implications of these findings are discussed.

Adolescent↗
PubMedDate not supplied

A new micronized formulation of halofantrine hydrochloride in the treatment of acute Plasmodium falciparum malaria.

The current formulation of halofantrine hydrochloride has poor absorption and bioavailability. A newly developed micronized formulation was evaluated for efficacy, safety and tolerance in the treatment of acute Plasmodium falciparum malaria. The study was conducted at a plantation hospital in northern Tanzania, where chloroquine resistance is common. Sixty in-patients with mild or moderate malaria were treated with 375-750 mg micronized halofantrine hydrochloride given in 3 equal doses, 6 h apart. Patients were followed up for 28 d after therapy. Treatment was associated with rapid parasite clearance (mean clearance time = 34.8 h), fever clearance (mean time = 20 h), and clinical improvement (70% of patients were free of all presenting symptoms within 2 d). The formulation was well tolerated clinically, although 3 patients (5%) developed mild pruritus after treatment which may have been drug-related. Haematological and biochemical studies did not indicate any significant toxicity. One patient, whose immediate recovery was uneventful, was found to have a headache and low parasitaemia 3 weeks after treatment. He was readmitted to the study and treated as before. Parasitaemia, fever and headache cleared rapidly and he remained aparasitaemic for 28 d.

Acute Disease↗
PubMedDate not supplied

Restriction fragment length polymorphism analysis of Mycobacterium tuberculosis isolated from patients with pulmonary tuberculosis in northern Tanzania.

Isolates of Mycobacterium tuberculosis from 88 patients with pulmonary tuberculosis in northern Tanzania were subjected to IS6110 restriction fragment length polymorphism (RFLP) analysis. Of 88 isolates, 73 fell into 11 groups of which 9 contained 2-5 isolates. Of 2 large homology groups one, group H (20 isolates), was isolated only from patients resident in the Kilimanjaro region, whereas 79% of isolates from other groups came from this region. A significant association (P = 0.023) was found between another group, M (24 isolates) and isolation from patients of the Masai tribe. The data from this pilot study support the idea that IS6110 RFLP analysis provides information which may be of value in the control of tuberculosis in Africa.

Adolescent↗
PubMedDate not supplied

Nutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania.

We assessed nutritional status in 200 adult Tanzanian patients with smear-positive pulmonary tuberculosis before, during, and after 6 months of tuberculosis treatment; 148 patients (74%) were successfully followed for 12 months. Marked nutritional impairment was present on admission: 77% of males and 58% of females had a body mass index (BMI) below 18.5; approximately one-fifth had BMI < 16.0. The length of hospital stay and gender, rather than microbiological response, were the major determinants of weight gain during treatment. Patients infected with human immunodeficiency virus (HIV) gained more weight than uninfected patients. Most patients lost weight after completing treatment and returning home. At 12 months, 32% of male and 19% of female patients considered cured of tuberculosis had BMI < 18.5. It is concluded that patients with tuberculosis from this area of Tanzania frequently have evidence of malnutrition both before and after treatment for tuberculosis. Weight gain during therapy appeared to be an unreliable indicator of overall treatment response. However, the results also demonstrated that nutritional rehabilitation can be successfully achieved even in HIV-positive tuberculosis patients and in patients with a suboptimal response to therapy.

Adult↗
PubMedDate not supplied

Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial.

BACKGROUND: No trials of co-trimoxazole (trimethoprim-sulfamethoxazole) prophylaxis for HIV-infected adults or children have been done in areas with high levels of bacterial resistance to this antibiotic. We aimed to assess the efficacy of daily co-trimoxazole in such an area. METHODS: We did a double-blind randomised placebo-controlled trial in children aged 1-14 years with clinical features of HIV infection in Zambia. Primary outcomes were mortality and adverse events possibly related to treatment. Analysis was by intention to treat. FINDINGS: In October, 2003, the data and safety monitoring committee recommended early stopping of the trial. 541 children had been randomly assigned; seven were subsequently identified as HIV negative and excluded. After median follow-up of 19 months, 74 (28%) children in the co-trimoxazole group and 112 (42%) in the placebo group had died (hazard ratio [HR] 0.57 [95% CI 0.43-0.77], p=0.0002). This benefit applied in children followed up beyond 12 months (n=320, HR 0.48 [0.27-0.84], test for heterogeneity p=0.60) and across all ages (test for heterogeneity p=0.82) and baseline CD4 counts (test for heterogeneity p=0.36). 16 (6%) children in the co-trimoxazole group had grade 3 or 4 adverse events compared with 18 (7%) in the placebo group. These events included rash (one placebo), and a neutrophil count on one occasion less than 0.5x10(9)/L (16 [6%] co-trimoxazole vs seven [3%] placebo, p=0.06). Pneumocystis carinii was identified by immunofluorescence in only one (placebo) of 73 nasopharyngeal aspirates from children with pneumonia. INTERPRETATION: Our results suggest that children of all ages with clinical features of HIV infection should receive co-trimoxazole prophylaxis in resource-poor settings, irrespective of local resistance to this drug.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Sexually transmitted diseases in prostitutes in Moshi and Arusha, Northern Tanzania.

Sexually transmitted diseases are thought to be important in facilitating transmission of HIV in sub-Saharan Africa. This study reports the prevalence of several sexually transmitted diseases in 106 prostitutes in Arusha and Moshi Northern Tanzania. The seroprevalence of HIV was 73% compared with 3% for local blood donors. Over half (51%) of the subjects had evidence of N. gonorrhoeae infection. Seventy-four per cent had a positive TPHA and 27% a positive RPR. Of 47 subjects tested 12 (25%) had Chlamydia trachomatis antigen detected in endocervical swabs. No significant statistical association was found between the presence of any of the STDs investigated and HIV seropositivity.

Adolescent↗
PubMedDate not supplied

Clinical features and serum beta 2-microglobulin levels in HIV-1 positive and negative Tanzanian patients with tuberculosis.

Serum beta 2-microglobulin (beta 2M) rises in the later stages of HIV disease and has therefore been used to monitor progression to AIDS. However, little work has been done on patients co-infected with HIV and tuberculosis. We studied clinical features and serum beta 2-M in 35 Tanzanian patients treated for pulmonary tuberculosis (9 HIV-positive, 26 HIV-negative). The provisional WHO clinical definition of AIDS for use in Africa was fulfilled by 89% of the HIV-positive and 65% of the HIV-negative patients. Median serum beta 2-M on admission was slightly higher in HIV-positive (3.17 mg/l) than in HIV-negative (2.85 mg/l) patients. Serum beta 2-M fell during treatment in 17/24 (71%) of HIV-negative and 3/7 (43%) HIV-positive patients followed up for 6 months. We conclude that serum beta 2-M is frequently raised in active tuberculosis, and is therefore an unreliable indicator of the stage of HIV disease in co-infected patients. The WHO clinical definition of AIDS also proved unreliable in patients with tuberculosis.

AIDS-Related Opportunistic Infections↗