Reviews of infectious diseases最新文献

The role of antibody and, in particular, antibody-dependent cellular cytotoxicity (ADCC) antibodies, in preventing or reducing the severity of infection with herpes simplex virus (HSV) in neonates is controversial. We have shown that human and murine neonates, in contrast with adults, are relatively deficient in ADCC leukocyte effector cell function. In an adoptive transfer model, the combination of ADCC-active human leukocytes and antibody to HSV could protect neonatal mice from lethal infection with HSV. Use of cells defective in ADCC function (e.g., from human neonates or patients with the CD11,18 deficiency in cell surface adhesive integrin) could not provide protection in this model. Finally, in human neonates the level of ADCC antibody at the time of infection with HSV was associated with severity of illness. Thus, ADCC is an important host defense against neonatal infection with HSV.

A 36-year-old homosexual man who was infected with human immunodeficiency virus presented with a 2-month history of fever and intermittent diarrhea. Stool cultures were negative for bacterial pathogens, ova, parasites, and acid-fast organisms. An initial blood culture became positive after 5 days for a curved, gram-negative rod that was identified later as Campylobacter cinaedi. The patient received a series of antibiotic regimens, including a 2-week course of erythromycin followed by a 2-week course of tetracycline, but follow-up blood cultures continued to yield C. cinaedi. The patient was then treated with a 2-week course of oral ciprofloxacin; he remained asymptomatic 11 weeks later, at which time a blood culture was negative for C. cinaedi. To the best of our knowledge, this is the first documented case of symptomatic bacteremia due to C. cinaedi that was successfully treated with ciprofloxacin.

Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.

Increased attention is being paid to adenoviruses as expression vectors and as recombinant virus vaccines. Adenovirus serotypes 4 and 7 have been administered orally to large numbers of military recruits as vaccines, and no adverse effects have been noted. We have constructed recombinant adenovirus vectors expressing glycoproteins of herpes simplex virus (HSV) that induce humoral and cellular immunity to HSV. Mice vaccinated with an adenovirus vector expressing HSV glycoprotein B (gB) were protected from a lethal challenge with HSV. Further studies are under way in monkeys to examine the possibility that oral administration of adenovirus vectors can produce protective immunity. In addition, adenovirus vectors have been used to identify viral antigens that are recognized by cytotoxic T lymphocytes and to further characterize these T cell responses. A small region in HSV gB, which acts as a major target for HSV-specific cytotoxic T lymphocytes, was defined with use of adenovirus vectors expressing deleted forms of gB.

We report a case of gonococcemia that was associated with adult respiratory distress syndrome (ARDS). To our knowledge, this is only the third reported case of ARDS associated with gonococcemia. This is the first reported case of ARDS associated with gonococcemia that was documented by positive results of blood cultures and measurements of wedge pressure obtained by a catheter in the pulmonary artery. We also believe that this is the first reported patient who required mechanical ventilation under positive end-expiratory pressure. This patient made a full recovery. Gonococcemia associated with ARDS continues to occur rarely in patients despite the prevalence of disseminated gonococcal infection. The reason for the infrequent occurrence of ARDS with disseminated gonococcal infection remains uncertain.

Case histories recorded by Hippocrates around 400 B.C. describe the clinical manifestations of scarlet fever and rheumatic fever, although the entities are not identified by name. Although the descriptions are not as detailed or complete as they would be today, they strongly suggest the existence of scarlet fever and rheumatic fever at that time. Hippocrates' references to these illnesses were presumably the first to be documented and/or discovered, as a thorough search of the worldwide medical literature revealed no prior descriptions.

Pseudomonas paucimobilis (formerly CDC group IIK, biotype 1) is a strictly aerobic, nonfermenting, oxidase- and catalase-positive, gram-negative bacillus that is widely distributed in water and soil. Its name derives from the difficulty encountered in demonstrating its motility, even in liquid media. This microorganism is responsible for two types of infection in humans: sporadic or community-acquired infections, probably of endogenous or environmental origin (bacteremia, meningitis, urinary tract infection, and wound infection); and outbreaks of nosocomial infection associated with the contamination of sterile fluids employed in hospitals. We present four cases of infection caused by P. paucimobilis (two of bacteremia, one of leg ulcer infection, and one of cervical adenitis). The majority of infections produced by P. paucimobilis have a good prognosis; no deaths related to this entity have been reported in the literature. The published results of susceptibility tests suggest that the aminoglycosides (either alone or in combination with a beta-lactam antibiotic) or the quinolone may be the agents of choice in the treatment of these infections.

The guinea pig model of genital herpes has proved useful for the evaluation of experimental herpes simplex virus vaccines. The model shares many of the features of genital herpes in humans, including a natural route of inoculation that results in self-limiting primary vulvovaginitis. Latent infection is established in sensory ganglia, and animals experience both spontaneous and ultraviolet radiation-induced recurrence of infection. Many humoral, cellular, and cytokine responses to herpes simplex virus type 2 infection in the guinea pig have been characterized. Both inactivated subunit immunogens and live, attenuated virus have been shown to afford some protection against primary disease, although they generally do not prevent acute viral replication or the establishment of latency. Because latently infected guinea pigs experience recurrent infections, this model has been used to explore immunotherapeutic approaches to the control of recurrent disease. With the development of more defined immunologic reagents, this model should prove useful for exploring the immune responses that are important in the control of primary, latent, and recurrent herpes simplex virus type 2 infections.