Reviews of infectious diseases最新文献

Investigation of the immune response to herpes simplex virus (HSV) has progressed rapidly, mainly through the use of various animal models of human disease. Murine models of HSV infection have been explored extensively and have yielded a wide array of insights into the mechanisms of antiviral immunity. Current research has focused on defining the role of individual viral envelope glycoproteins in stimulating a protective B and T cell response, with the ultimate goal of identifying the minimum effective immunization unit. This ongoing dissection of the glycoprotein-specific immune response in the mouse has revealed both the values of an animal model that mimics human infection and the limitations inherent in defining the immunopotential of specific viral proteins and peptides in an unnatural host. This article reviews the results of murine studies evaluating the mechanisms of protection against HSV infection and the protective potential of immunization with the viral envelope glycoproteins.

To reassess the epidemiology and treatment of listeriosis in the United States, we reviewed greater than 120 cases of listeriosis from four medical centers in three geographically separated cities: Los Angeles County-University of Southern California Medical Center (LAC-USCMC); Rush-Presbyterian-St. Luke's Hospital, Chicago; the University of Illinois Hospital, Chicago; and Vanderbilt University Hospital, Nashville, Tennessee. The epidemiological pattern at LAC-USCMC was relatively narrow; more than two-thirds of the cases occurred during the perinatal period. Cases at Vanderbilt University Hospital represented the opposite end of the spectrum; the majority of these occurred in nonpregnant, older adults who had received organ transplants. An intermediate pattern of cases was observed at the two medical centers in Chicago. Potential risk factors included pregnancy, neonatal status, organ transplantation, renal failure, malignancy, systemic lupus erythematosus, steroid therapy, and AIDS (two cases). Antimicrobial agents noted to be effective were, as expected, penicillin and ampicillin; the cephalosporins were ineffective. The mortality associated with listeriosis occurred mainly among premature infants and stillbirths delivered from infected pregnant women and was markedly less among neonates and adults.

Different cause-and-effect relationships between hemolytic and infectious processes are categorized in a clinically useful manner as follows: infections causing hemolysis by invasion of red blood cells (RBCs), by hemolysins, or by immune mechanisms; oxidative damage to RBCs during infections; hemolysis secondary to infection-induced pathologic processes; hemolytic effects of antimicrobial therapy; and predisposition of an individual to infection caused by an underlying hemolytic disorder or therapy for that disorder. The mechanisms of these interrelationships are discussed in detail.

A 16-year-old girl developed multiple subcutaneous abscesses, osteomyelitis, and severe colitis. On the patient's second admission, a single blood culture--and, subsequently, a specimen of pus--yielded Brucella melitensis biovar 1. A second set of serologic tests, including the rose bengal test, the standard tube agglutination test, the CF test, and Coombs' test, were all negative for Brucella on the patient's second admission and 1 month later. However, a lymphocyte proliferation assay with extracted antigen of Brucella was markedly positive. Thus, this case illustrates that patients with B. melitensis infection may have a unique clinical presentation and that the lymphocyte proliferation assay is an important diagnostic tool for patients whose serologic test results are negative but for whom brucellosis is suspected.

We describe 10 new cases of bacteremia due to Stomatococcus mucilaginosus and review eight other cases that have been described in the literature. The most common clinical presentations were endocarditis, catheter-related infection, and septicemia. Commonly associated risk factors were intravenous drug abuse, cardiac valve disease, the presence of foreign bodies (especially indwelling vascular catheters), and immunocompromised states. S. mucilaginosus bacteremia is readily treatable with antibiotics. This organism is of low virulence, but appears to be an emerging pathogen. Infection due to S. mucilaginosus is likely to be underreported because the organism may be easily misidentified and information on it is not included in the databases of many automated microbiologic identification systems.

A brief overview is presented concerning the membrane-associated antigens of herpes simplex viruses (HSV). Aspects discussed include certain properties and functional roles of the HSV-specific glycoproteins. In addition, recent findings of an association between certain immediate-early proteins of HSV-1 and the tegument of virions as well as the plasma membrane of virus-infected cells are discussed.

We report a case of presumed cryptococcal endophthalmitis that occurred in a patient with severe disseminated cryptococcosis and AIDS. Multiple small, spherical lesions appeared bilaterally on the surface of the retina 2 weeks after cryptococcal meningitis was diagnosed; the lesions were associated with multiple blind spots, blurred vision, and the perception of flaring of light. Over the next week, many more lesions with adjacent hemorrhages appeared. Therapy with itraconazole over the next 3 months resulted in complete resolution of the lesions. Cryptococcal endophthalmitis is a rare disease. Fewer than 20 cases, including five in patients with AIDS, have previously been reported. None of these patients regained normal vision.

Cancer of the uterine cervix is one of the most common malignant diseases worldwide. Although morbidity rates have declined in the past several decades as a consequence of wide-scale screening, the disease remains an important public health problem. The risk of cervical cancer is strongly influenced by sexual behavior, which suggests a causal role for an infectious agent. Certain types of human papillomaviruses (HPVs) seem to be involved in the genesis of the disease. In addition, there is good evidence that herpes simplex viruses may also be implicated. Recently, important epidemiological incoherences have been found with respect to the sexual transmission route of HPV infection in the causal pathway of cervical cancer. HPV infection rates in asymptomatic women do not seem to be related to sexual behavior, and if analyzed simultaneously sexual behavior and HPV infection seem to be independent predictors of cervical cancer risk. If confirmed by further research, these findings could signify that there may be alternative etiologic mechanisms for cervical cancer. Since some researchers have recently proposed public health action because of the acceptance of HPV infection as a necessary cause of cervical cancer, it is imperative that the aforementioned incoherences be immediately resolved by further research.