Infections in the immunocompromised host.
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Lysostaphin, a microbicidal enzyme that lyses Staphylococcus aureus, was introduced to study phagocytosis and ICBA (Tan et al.3) on the presumption that it does not penetrate into the phagocytic cells. It was recently suggested, however, that LS enters the cells and kills ingested bacteria. By using two methods to study phagocytosis and bactericidal activity, the old one based on disruption of PMNs and plating technique and a new one that does not require disruption, we found that LS did not influence phagocytosis or phagocytic index but altered intracellular kill of Staphylococcus. LS eliminated almost completely extracellular bacteria, but centrifugation and washing of PMN at the end of phagocytic assay were almost equally efficient. Since the method of disruption of PMN and plating of bacteria cannot distinguish penetration of LS to the cells from its adherence to the outer wall of PMN, we employed a new, recently described acridine orange/crystal violet method, which can measure simultaneously phagocytosis and ICBA and eliminates completely extracellular microorganisms. This method has shown that in the presence of LS, a significantly higher proportion of staphylococci were killed intracellularly--91% +/- 2.7 vs. 74% +/- 2.9 (p less than 0.001), i.e., that LS either penetrated to the cells or enhanced ICBA. It was also found that trypsin, which was used as an inhibitor of LS, was unable to abolish bactericidal activity of LS. It is suggested that LS should not be used for assessment of ICBA but may be employed for studies of phagocytosis over short incubation periods. A new method based on acridine orange/crystal violet staining was found to be useful for investigation of phagocytosis and ICBA of human PMNs.
The hyper IgE syndrome develops in childhood and leads to repeated infectious episodes, usually of staphylococcus aureus origin and affecting mainly the skin and pulmonary parenchyma. It may be associated with a predominantly facial atypical dermatitis and more rarely with allergic manifestations. Biological tests show mainly an eosinophilia and a hypergammaglobulinemia E alone without modifications in other immunoglobulin types. Disorders of neutrophil and monocyte chemotaxis are inconstant findings. The initial mechanism of the affection appears related to a deficit in suppressive T function selectively acting on the IgE isotype.
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Concerning the total defense of the body the function of granulocytes in the determining parts of phagocytosis (motility, chemotaxis, opsonation, ingestion, microbicidia) are described and the congenital and acquired distrubances of phagocytosis are treated as short survey as well as partly explained by clinical examples. Out of the manifold possibilities of examinations of the function of granulocytes the NBT-test is described as an estimation of the function of granulocytes usable in clinical routine wotk and its application is recommended.
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A 4-year-old boy with recurrent infections and his clinically healthy father showed a severe, isolated defect in bactericidal activity of peripheral neutrophil leukocytes (the mother and the only sister were normal). Lymph nodes, spleen and liver of the child presented a massive infiltration by macrophages. Such infiltration and the segmentary albinism of the hair resemble traits of the Chediak-Higashi syndrome, but some of the most relevant traits of this syndrome are absent, since all other neutrophil functions were normal in our patient.
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Experiments in rats (burns followed by intratracheal infection with a staphylococcus suspension) were used to study association between disorders in phagocytosis of polymorphonuclear leukocytes and alveolar macrophages and histological manifestations of the inflammatory-infectious process in the lungs. Different resistance of micro- and macrophage cells to burn trauma was demonstrated. Disorders in the phagocytic properties of the cells were shown to precede the development of the inflammatory-infectious process documented at the tissue level.
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Job's syndrome is characterized by the clinical features of fair skin, red hair, recurrent cold staphylococcal skin abscesses with concurrent other bacterial infections and skin lesions. This case report chronicles a classic presentation of Job's syndrome. A brief review of the otolaryngological presentations of immune deficiencies is presented. Other than its relationship to the manifestations of other immunological defects, Job's syndrome is of interest to the otolaryngologist because of the head and neck infections represented in its clinical expression. Familiarity with phenotypic and laboratory manifestations of such diseases will enable earlier recognition and treatment of this syndrome.
A bone marrow graft was performed in a 3 1/2 year old boy suffering from chronic granulomatous disease. Donor-recipient matching was complete in the ABO, HL-A and M.L.C. systems. The number of injected cells amounted to 5.4 X 10(9) (3.6 X 10(8) cells/kg body weight). The immunosuppression regimen consisted of cyclophosphamide and A.L.S. before the graft, and methotrexate after it. Neither graft versus host reaction, nor secondary infection developed. The take of the graft was monitored by the Gm allotypes. Rejection, however, occurred after 2 months.