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Comparison of cervicovaginal humoral immunity in clinically asymptomatic (CDC A1 and A2 category) patients with HIV-1 and HIV-2 infection.

Paired sera and cervicovaginal secretions (CVS) from 11 HIV-1- and 11 HIV-2-infected women, all clinically asymptomatic (CDC A1 and A2 categories), were analyzed for total IgG, IgA, albumin (HSA), IgG, and IgA antibodies to env-encoded surface glycoproteins of HIV-1 (gp160) and of HIV-2 (gp105), by comparison to 15 age-matched healthy controls. Secretion rates of IgG and IgA into CVS were evaluated by calculation of their relative coefficients of excretion (RCE) by reference to HSA. Cervicovaginal production of anti-HIV antibodies was evaluated by comparison between specific antibody activities of IgG and of IgA to HIV in CVS were, respectively, 6- and 4-fold increased, whereas the secretion rate of total IgG was 2.1-fold increased and that of total IgA was 2.5-fold reduced. In contrast, total IgG and IgA as well as their secretion rates were normal in HIV-2-infected women. In HIV-1- but not in HIV-2-infected women, HSA levels in cervicovaginal washings were twofold increased, demonstrating alteration of the mucosal barrier in HIV-1 infection. In HIV-1-infected patients, IgG and IgA to gp160 were detected in all sera and CVS. In HIV-2-infected patients, IgG to gp105 was detected in all sera and CVS, whereas IgA to gp105 could be detected in only half of sera and one-third of CVS. Cross-reactivity by IgG and/or IgA to HIV-1 or HIV-2 against the surface glycoprotein of the other HIV type was observed in sera as well as in CVS, and more frequently in HIV-2- than in HIV-1-infected women. Finally, the mean specific activities of IgG and of IgA to gp160 or gp105 were higher in CVS than in sera, evidencing a possible local synthesis of both isotypes in HIV-1 as well as in HIV-2 infections. As early as the asymptomatic stages, HIV-1 affects the cervicovaginal mucosa more than HIV-2 does, suggesting higher viral replication within the female genital tract in HIV-1 infection than in HIV-2 infection.

Adult↗

Peritonitis with CDC group IVc-2 bacteria in a patient on continuous ambulatory peritoneal dialysis.

A case of CDC group IVc-2 peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD) is described. To the authors' knowledge, this is the first case reported of CAPD peritonitis in which a member of this unusual group of bacteria was isolated as the sole microorganism. As this microorganism is usually resistant to most antibiotics commonly used to treat peritonitis in patients on CAPD, microbiological investigations with identification and antimicrobial susceptibility tests are mandatory.

Gram-Negative Aerobic Bacteria↗

Corynebacterium CDC group A-4 native valve endocarditis.

A patient with endocarditis caused by Corynebacterium CDC Group A-4 is described. This is the first case in the literature of endocarditis caused by this bacteria, and is unique in that the patient was immune competent and the infection occurred on a native valve. This case illustrates that corynebacteria cannot be considered a contaminant and that the exact pathogen should be identified.

Aged↗

Phenotypic differentiation of Cardiobacterium hominis, Kingella indologenes and CDC group EF-4.

Eleven strains of Cardiobacterium hominis, two strains of Kingella indologenes and six strains of CDC group EF-4 were characterized. Since all three taxa are oxidase-positive, fastidious gram-negative rods with relatively few positive reactions, they may be easily confused in the microbiological laboratory. Common characteristics are acid production from glucose, aerobic growth in semi-solid agar and very slow anaerobic growth. Group EF-4 is distinguished from the other two species by its capacity to produce catalase and its lack of indole production. Cardiobacterium hominis can be distinguished from Kingella indologenes by its ability to ferment mannitol and sorbitol and by differences in enzyme production. The three taxa also differ considerably with regard to morphological and cultural characteristics.

Aerobiosis↗

Cognitive behavior in asymptomatic (CDC stage II and III) HIV--seropositive intravenous drug users (IVDUs).

To evaluate cognitive impairment in the early stages of HIV infection in intravenous drug users (IVDUs) we have studied 39 consecutive HIV-infected subjects (CDC stage II-III) whose only known risk factor for the infection was intravenous heroin addiction. The control group was represented by 30 seronegative IVDUs. All subjects were tested with an extensive neuropsychological battery assessing general intellectual abilities and single cognitive functions. The patients differed from controls only for tests of attention and visual-motor abilities: 20% of asymptomatic seronegative and PGL patients showed alterations in two or more cognitive tests, as opposed to 3% of controls (p < 0.001). Our findings suggest that cognitive deficits seem to be present in a substantial percentage of IVDUs with asymptomatic HIV infection. Cognitive damage at this stage seems to selectively involve attention and visual-motor abilities, sparing general intellectual performances.

Adult↗

Up-regulation of cell division cycle (cdc) 2 kinase in neurons with early stage Alzheimer's disease neurofibrillary degeneration.

The major component of Alzheimer's disease (AD) neurofibrillary tangles (NFTs) is abnormally hyperphosphorylated tau aggregated as paired helical filaments (PHFs). Cell division cycle (cdc) 2 kinase is one of the main candidate kinases that phosphorylates normal tau in vitro at several sites seen in PHF-tau. Using brains staged according to Braak and Braak criteria, we investigated the role of cdc2 in neurofibrillary changes in the hippocampal formation, and the entorhinal and temporal cortices. Neurons with tangle-like inclusions positive for active cdc2 were found to appear first in the Pre-alpha layer of the entorhinal cortex, and then extend to other brain regions co-incident with the progressive sequence of neurofibrillary changes. This predictable progressive pattern is not associated with amyloid. The intraneuronal accumulation of active cdc2 appeared to precede the deposition of PHF-tau phosphorylated at Ser 202/Thr 205 sites. These data are consistent with the notion that cdc2 might be involved in the abnormal hyperphosphorylation of tau and consequently aggregation of tau into PHF at an early stage and that increased cdc2 activity is not consequent to the deposition of beta-amyloid in AD brain.

Adult↗

Isolation and characterisation of glutamate dehydrogenase from Mycobacterium smegmatis CDC 46.

Glutamate dehydrogenase (L-glutamate:NADP+ oxidoreductase (deaminating), EC 1.4.1.4) has been purified from Mycobacterium smegmatis CDC 46 using (NH4)2SO4 precipitation, negative adsorption on DEAE-cellulose, 2',5'-ADP-Sepharose affinity chromatography and Sephadex G-200. The enzyme was purified 1041.6-fold and the preparation was found to be homogeneous on column chromatography, polyacrylamide gel electrophoresis and SDS-polyacrylamide gel electrophoresis. Alanine and threonine were identified as the N- and C-terminal amino acids of glutamate dehydrogenase from M. smegmastis. The enzyme kinetics and regulation of glutamate dehydrogenase activity by different nutritional factors has been studied. Initial velocity plots showed that the reaction mechanism of glutamate dehydrogenase from M. smegmatis followed an ordered sequential ter-bi mechanism.

Electrophoresis, Polyacrylamide Gel↗

Selecting, implementing, and evaluating teen pregnancy prevention interventions: lessons from the CDC's Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

PURPOSE: To summarize 13 communities' experiences with selecting, implementing, and evaluating teen pregnancy prevention interventions within the CDC Community Coalition Partnership Programs for the Prevention of Teen Pregnancy. The study focuses on decision-making processes and barriers encountered in five categories of interventions: reproductive health services, reproductive health education, parent-child communication, male involvement, and programs for pregnant and parenting teens. METHODS: Telephone interviews were conducted with program directors, lead evaluators, and community coalition chairpersons in each of the 13 communities. The descriptive analysis explored factors that influenced community decisions to develop or not to develop interventions. These factors were analyzed by type of intervention. RESULTS: Each community implemented an average of six interventions and operated them with a variety of funding sources. Interventions were selected on the basis of need, and the community needs and assets assessment process was "very important" for most reported interventions. Decision-making was influenced most often by project staff, the coalition, or related work groups. Teens were infrequently viewed as primary decision-makers in the selection of interventions. Communities with family planning services as hub agencies were more likely to address reproductive services and reproductive health education. Communities with child advocacy or youth-serving agencies were more likely to focus on other intervention categories. About two-thirds of the interventions were evaluated by either process or outcome measures, or by both. CONCLUSIONS: This study highlights important lessons learned that should be considered in examinations of the overall effectiveness of this community coalition approach to the prevention of teen pregnancy.

Adolescent↗

Lowering standards of clinical waste management: do the hazardous waste regulations conflict with the CDC's universal/standard precautions?

Clinical waste is a costly and troublesome commodity. Comprising the detritus of medical care, the foremost hazard is the risk of infection from micro-organisms present in these wastes. Infection commonly occurs through penetrating injury, the so-called 'sharps' or 'needlestick' injury, although contamination of non-intact skin or splashes to the eye may transmit infection. Bloodborne viruses (hepatitis B, hepatitis C, human immunodeficiency virus) are the most serious threat, although respiratory, soft tissue and enteric infections are not unknown. The European Hazardous Waste Directive, that harmonizes the categorization and control of wastes, permits downregulation of clinical wastes where the risk of infection may be low. Although strengthened by the requirement for risk assessment in waste classification, UK regulatory guidance promoting classification of some clinical wastes as non-hazardous completely ignores the Centers for Disease Control and Prevention's Universal Precautions for the prevention of transmission of human immunodeficiency virus, hepatitis B virus and other bloodborne pathogens in healthcare settings, which seek to prevent bloodborne virus infection in healthcare workers and others, and the more extensive Standard Precautions that extend these principles to the prevention of healthcare-associated infections and the environmental spread of nosocomial pathogens. By creating a potent cost driver encouraging downregulation of some clinical wastes, UK legislation based on the European Hazardous Waste Directive conflicts with the CDC's Universal/Standard Precautions.

Animals↗

Comparison of three assays for the quantification of Candida biomass in suspension and CDC reactor grown biofilms.

A common assay to measure yeast metabolic activity in biofilms is based on the reduction of the tetrazolium salt XTT {2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide} to a colored formazan. However, a recent report, also confirmed by our own findings about the shortcomings of the chromogenic XTT assay, has prompted us to investigate alternative methods for yeast biomass quantification. To this end, two fluorogenic assays using fluorescein diacetate (FDA) and SYTO 9 as well as the XTT assay were comparatively evaluated with regard to the linear range of Candida albicans and Candida parapsilosis cell number-response curves, precision and intra- and interspecies variability. Reading of fluorescence and absorbance was carried out in a multilabel microtiter plate reader. All three assays were adequate for the determination of planktonic yeast biomass, but the FDA and SYTO 9 assays present practical advantages. When applied to the quantification of yeast biofilm biomass obtained in the CDC biofilm reactor, the FDA assay proved superior.

Biofilms↗

A hard lesson for Europeans: the ASEAN CDC.

Despite the growing threat of major pandemics, the European Union is planning no more than a meager surveillance agency staffed with 70 people on the 2007 horizon: the new European Centre for Disease Control. I argue that an effective structure should be much larger and include a strong research activity. Asian countries, inspired by the US CDC, are now taking this concept in hand and creating an ASEAN Center For Disease Control, with sophisticated laboratory facilities to be included. This is a tough lesson for us Europeans, and our avarice in this domain could have tragic consequences in the future.

Asia↗

Further validation and reliability testing of the Attitudes and Beliefs about Living with Epilepsy (ABLE) components of the CDC Epilepsy Program Instrument on Stigma.

The aim of this study was to conduct additional validation and reliability testing of the Attitudes and Beliefs about Living with Epilepsy (ABLE) components of the CDC Epilepsy Program Instrument on Stigma. Thirteen items were tested using a representative sample of U.S. adults (n=4345). Confirmatory factor analyses confirmed two underlying constructs as hypothesized that accounted for 61% of the variance in the factor analysis: Negative Stereotypes (alpha=0.86) and Risk and Safety Concerns (alpha=0.88). As expected, participants differed on scale scores by demographic characteristics. Test-retest reliability was acceptable. The results of these analyses extend those from our previous study suggesting that the negative stereotypes and risk and safety concern scales demonstrate acceptable validity and reliability, and can be used to measure attitudes toward epilepsy related to these two domains.

Adolescent↗

Reduction of hypercholesterolemic atherosclerosis by CDC-flaxseed with very low alpha-linolenic acid.

Flaxseed (Type I flaxseed) with 51-55% alpha-linolenic acid in its oil and richest source of plant lignans, has been shown to reduce hypercholesterolemic atherosclerosis by 46% without lowering serum lipids. Antiatherogenic activity was claimed to be due to its alpha-linolenic acid and/or lignan content. If alpha-linolenic acid component of flaxseed is responsible for antiatherogenic activity, then, CDC-flaxseed (Type II flaxseed) which has similar oil and lignan content but has very little (2-3% of the total oil) alpha-linolenic acid would have no antiatherogenic effect. An investigation, therefore, was made of Type II flaxseed on high cholesterol diet-induced atherosclerosis and serum lipids [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C)] in rabbits. Rabbits were assigned to four groups: Group I, Control; Group II, Type II flaxseed diet (7.5 g/kg orally daily); Group III, 1% cholesterol diet; Group IV, 1% cholesterol diet supplemented with Type II flaxseed (7.5 g/kg orally daily). Blood samples were collected before (0 time) and after 4 and 8 weeks of experimental diets for measurement of serum lipids. Aorta was removed at the end of 8 weeks for assessment of atherosclerotic plaques. Serum TC, LDL-C, TC/HDL-C, and LDL-C/HDL-C were lower in Group IV as compared to Group III by 14 and 31%, 17 and 32%, 28 and 34% and 24 and 32%, respectively, at 4 and 8 weeks. HDL-C was not affected by Type II flaxseed in hypercholesterolemic rabbit. TG and VLDL-C were markedly increased in Group IV as compared to Group III. Type II flaxseed reduced the development of atherosclerosis by 69%. Histological changes in the atherosclerotic regions were qualitatively similar in Groups III and IV. Results indicate that reduction in hypercholesterolemic atherosclerosis by Type II flaxseed is due to a decrease in serum TC and LDL-C. In conclusion, antiatherogenic activity of Type II flaxseed is not due to alpha-linolenic acid.

Animals↗

Status of practice guidelines in the United States: CDC guidelines as an example.

BACKGROUND: Clinical practice guidelines have proliferated in the past several decades, starting with only a handful in the 1980s to over 1000 approved through The National Guideline Clearinghouse in 2002. METHODS: The purposes of this article to review research related to guideline adoption and impact and to make recommendations for assessing the outcomes of guidelines, using the CDC guideline process as an example. RESULTS: Despite the national movement toward standardization of evidence-based practice, few studies have been conducted to assess the costs of guideline development and implementation, and some practice guidelines have been implemented without concomitant assessment on patient outcomes and costs and benefits of changes in care. CONCLUSIONS: An immediate mandate is to ensure that when guidelines are promulgated, they include an evaluation plan, developed by the implementer of the guideline, which takes advantage of existing qualitative and quantitative data and programs (e.g., patient-centered care, quality assurance, risk management) not limited to expensive and sophisticated clinical trials.

Centers for Disease Control and Prevention, U.S.↗

Potential effect of revising the CDC surveillance case definition for AIDS.

The Centers for Disease Control (CDC) revised the surveillance case definition for acquired immunodeficiency syndrome (AIDS) in August, 1987. To determine the impact of this revision, information was extracted from the medical charts of the 630 patients receiving comprehensive medical care as of 1980 at 6 haemophilia treatment centres, and who were therefore likely to have been infected with human immunodeficiency virus (HIV). 38 (6%) and 47 (7%) met the 1985 and 1987 case definitions, respectively (22% increase). Of the cases added by use of the 1987 case definition, 3 patients had HIV dementia, 3 had Pneumocystis carinii pneumonia (2 of whom were presumptively diagnosed and 1 who had been receiving steroids and immunosuppressives), and 3 had HIV wasting syndrome. These data suggest that the revision of the AIDS case definition will have a substantial impact on future AIDS surveillance trends in persons with haemophilia and perhaps in other risk groups.

Acquired Immunodeficiency Syndrome↗

Intravenous line infection due to Ochrobactrum anthropi (CDC Group Vd) in a normal host.

Ochrobactrum anthropi, formerly known as Achromobacter species (CDC group Vd), is an aerobic, gram-negative bacillus widely distributed in aquatic environments. Most important, it has been implicated as a cause of intravenous line infection in immunocompromised hosts with solid tumors or hematologic malignancies. Trimethoprim-sulfamethoxazole and aminoglycosides are usually active against O. anthropi, but this organism is usually resistant to beta-lactam antibiotics. Because O. anthropi is a low-virulence organism, patients with intravenous-line infections have been cured without removal of the intravenous catheter. We describe a case of intravenous-line infection in a normal host that was successfully resolved alter catheter removal.

Catheterization, Central Venous↗

Threats in bioterrorism. II: CDC category B and C agents.

A variety of agents have potential for use as weapons of biological terrorism. Knowledge of the likely organisms may be useful in preparations to mitigate the effects of a BT event. Recognition of the clinical presentation of these organisms could help physicians identify them quickly, allowing more appropriate management and possible prophylaxis of others who may have been exposed. Although many of these agents do not have specific treatments, it is important to recognize those that do. It is also important to know which infections require isolation because of potential for person-to-person spread. Table 3 summarizes important features of the CDC category B and C agents. The list of agents discussed in this article is by no means exhaustive. It is always possible that some "mad scientist" could modify an existing organism or engineer some new agent for use in biological terrorism. The possibilities are limited only by the ingenuity and depravity of those individuals who would take part in such an attack.

Bacterial Infections↗