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Biomedical subjects

A L Reingold

Publications and source records attributed to A L Reingold.

At least 55 records · Page 3Linked to original sources
PubMed1995

Mycobacterium avium complex in water, food, and soil samples collected from the environment of HIV-infected individuals.

As part of an epidemiologic study of Mycobacterium avium complex (MAC) infection in San Francisco, water, food and soil samples were collected from the home environment of 290 persons with human immunodeficiency virus (HIV) infection and cultured for mycobacteria. Isolates recovered from the environment were compared with isolates cultured from study patients. Although mycobacteria were recovered from numerous environmental samples, isolates reactive with MAC-specific DNA probes were recovered from only four of 528 (0.76%) water samples and one of 397 (0.25%) food samples. The species M. avium was recovered from one water (0.19%) and one food sample. In contrast, MAC was recovered from 55% and M. avium from 27% of soil samples taken from potted plants in patients' home. Speciation of 76 MAC isolates from study patients showed all isolates belonged to the species M. avium. With use of serotype and multilocus enzyme electrophoresis analysis, some of the soil isolates were found to be similar to isolates recovered from study patients. The results of this study suggest that soil, rather than water, may be a significant reservoir of organisms causing MAC infection in San Francisco.

Bacteriological Techniques↗
PubMed1995

Screening for active tuberculosis in HIV testing centre.

In industrialised nations HIV-seropositive individuals can be offered skin testing for tuberculosis (TB) and isoniazid prophylaxis, but this approach is neither practicable nor affordable in most developing countries. In Santo Domingo, Dominican Republic, we offered skin testing and a brief clinical examination for active TB to people requesting HIV testing at one centre. 200 newly detected HIV-positive individuals and 200 age and sex-matched HIV-negative ones were compared. 39 (9.7%) of the 400 individuals seeking HIV testing had active TB; 29 were HIV positive and 10 were HIV negative (adjusted odds ratio 3.3, 95% CI 1.3-8.7; p = 0.01). In multivariate analysis, the strongest independent predictors of active TB were 10 mm or more of induration on skin testing, a history of chronic cough, lymphadenopathy, and HIV infection. Of the patients diagnosed with TB, 85% had one or more symptoms readily ascertainable in a brief screening questionnaire. Screening for TB at HIV-testing sites could be an effective approach to early detection of active TB among not just HIV-positive but also HIV-negative people. Integrating screening for TB into HIV testing schemes could help to reduce the spread of TB and allow patients with TB to be diagnosed and treated earlier.

Adolescent↗
PubMed1995

Routine hepatitis B vaccination in a clinic for sexually transmitted diseases.

Patients were assigned to one of two vaccine schedules to assess the feasibility of vaccinating a sexually transmitted disease clinic population against hepatitis B virus. Of 1386 patients entering an inner-city clinic between June and July 1990, 611 (44%) accepted a first dose of vaccine. Twenty-one percent of all susceptible patients received at least two doses of vaccine. Annualizing these findings shows that an ongoing program could prevent 636 hepatitis B virus infections per year. Although a significant proportion of sexually transmitted disease clinic patients can be successfully vaccinated, strategies for preventing hepatitis B virus infections in this high-risk population must consider patient behavior as well as vaccine efficacy.

Adolescent↗
PubMed1994

The use of serologic tests for Lyme disease in a prepaid health plan in California.

OBJECTIVE: To determine the reason(s) why serologic tests for Lyme disease are performed, who initiates the test requests, and how the test results are used in a clinical setting. DESIGN: Retrospective cohort. SETTING: Prepaid health plan in northern California. PATIENTS: Consecutive sample of 117 patients for whom at least one serologic test for Lyme disease was performed during a 3-month period. MAIN OUTCOME MEASURES: Reason for ordering and result of the serologic test, differential diagnoses, and treatment. RESULTS: One of 117 patients had antibodies to Borrelia burgdorferi. Fifty-six percent of test requests were initiated by the physician and 35% by the patient. Of 66 tests ordered by the physician, 20% were performed because of suspected early Lyme disease, 6% as follow-up of a tick bite, 2% to confirm a prior history of Lyme disease, 14% as a workup for arthritis, and 60% as one of a battery of laboratory tests for vague symptoms. Of 41 tests initiated by the patient, 51% were performed because of a history of a tick bite. The reasons for ordering 10 tests were undetermined. CONCLUSION: Only 19% of all serologic tests for Lyme disease were performed because the physician suspected Lyme disease in the patient. Particularly in light of the low probability of contracting Lyme disease in California, it appears that this serologic test is being overused. Indiscriminate testing increases health care costs and does not appear to affect treatment decisions. Education is needed regarding the limitations of this serologic test.

California↗
PubMed1994

Predicting Mycobacterium avium complex bacteremia in patients infected with human immunodeficiency virus: a prospectively validated model.

In cases of advanced infection with human immunodeficiency virus, mycobacterial blood cultures are frequently used to diagnose disseminated infection with the Mycobacterium avium complex (MAC). However, no prospectively validated guidelines exist for the use of such cultures. In this study, a two-part model for predicting MAC bacteremia was developed and then validated prospectively. First, a CD4+ cell count of < or = 50/microL was used to predict bacteremia. Then, among patients with < or = 50 CD4+ cells/microL, the documentation of fever on more than 30 days during the preceding 3 months, a hematocrit of < 30%, or a serum albumin concentration of < 3.0 g/dL was used to predict bacteremia. This model had a sensitivity of 89% and positive and negative predictive values of 30% and 98%, respectively, for the identification of patients with bacteremia. Had the model been applied to patients in this study, the number of blood cultures performed would have decreased by 61%, but 11% of the positive cultures would have been missed. In short, this model can predict MAC bacteremia and can potentially guide the use of mycobacterial blood cultures.

AIDS-Related Opportunistic Infections↗
PubMed1994

The impact of Mycobacterium avium complex bacteremia and its treatment on survival of AIDS patients--a prospective study.

It is currently recommended that patients with AIDS and Mycobacterium avium complex (MAC) bacteremia receive antimycobacterial treatment. However, no study has prospectively evaluated the impact of this infection and its treatment on survival. This study prospectively followed a cohort of 367 AIDS patients with < or = 50 CD4+ cells/microL and found that MAC bacteremia was independently associated with an increased risk of death (relative hazard [RH] = 1.8, 95% confidence interval [CI] = 1.3-2.4, P < .001). Patients with MAC bacteremia who were treated had a longer median survival than those who were not (263 vs. 139 days, P < .001); treatment was independently associated with a lower risk of death (RH = 0.45, 95% CI = 0.23-0.89, P < .001). However, 23% of patients with bacteremia died within 28 days of that diagnosis; few were treated. MAC bacteremia contributes to the death of patients with AIDS, and treatment increases survival. However, many patients will not survive long enough to receive treatment. These results underscore the importance of early diagnosis and chemoprophylaxis for MAC bacteremia.

AIDS-Related Opportunistic Infections↗
PubMed1994

Lyme disease in northwestern coastal California.

To determine the incidence of physician-diagnosed Lyme disease in an endemic area of California, an active surveillance program was implemented in Lake, Mendocino, Sonoma, and southern Humboldt counties. More than 200 medical care providers were called monthly for their list of suspected cases of Lyme disease. Pertinent information was abstracted from the medical record of each patient. Of 153 cases of possible early Lyme disease ascertained from July 1991 to December 1992, 37% consisted of physician-diagnosed erythema migrans. Only 58% of erythema migrans rashes were at least 5 cm in diameter. An additional 43 patients had suspicious rashes not classified as erythema migrans. Of 166 patients with possible late-stage Lyme disease, 31% had specific clinical symptoms and 75% had a positive serologic test. With an incident case defined as physician-diagnosed erythema migrans of at least 5 cm in diameter, the annual incidence of Lyme disease in northwestern coastal California according to active surveillance only was 5.5 per 100,000. The rate of Lyme disease in California is substantially lower than that in the Atlantic northeastern United States. Many suspected cases of Lyme disease in this endemic area do not meet surveillance criteria, which are intentionally restrictive. Although some of the illnesses not meeting surveillance criteria may be due to infection with Borrelia burgdorferi, it appears that Lyme disease is being overdiagnosed in this area.

Adolescent↗
PubMed1993

Hepatitis C virus infection among patients attending a clinic for sexually transmitted diseases.

OBJECTIVE: To evaluate the association between hepatitis C virus (HCV) infection and sexual behavior in a sexually active population. DESIGN: Cross-sectional study. SETTING: Inner-city clinic for sexually transmitted diseases. SUBJECTS: The study included 1292 patients attending the clinic for care during a 1-month period and having syphilis serologic tests performed. OUTCOME MEASURES: Antibody to HCV (anti-HCV) positivity as defined by a repeatedly-reactive enzyme immunoassay and a positive neutralization enzyme immunoassay (Abbott Laboratories, Chicago, Ill). RESULTS: Of 1292 patients screened for anti-HCV, 99 (7.7%) were positive. Logistic regression analysis found that patients who reported intravenous drug use, were positive for antibody to hepatitis B core antigen, reported a history of a blood transfusion, were black, or reported crack cocaine use were more likely to be anti-HCV-positive. Forty-five percent of patients who were anti-HCV-positive reported intravenous drug use. Sex with an intravenous drug user and a history of gonorrhea and syphilis were associated with anti-HCV positivity in a univariate analysis, but after controlling for confounding variables, no such associations remained. While having multiple sexual partners in the previous 3 months, being homosexual or bisexual, and engaging in receptive anal intercourse were associated with being positive for antibody to hepatitis B core antigen, those behaviors were not associated with anti-HCV positivity. CONCLUSIONS: While these results cannot exclude a role for the sexual transmission of HCV, they do suggest that, in this sexually active population, the sexual transmission of HCV occurs infrequently and that HCV is largely associated with intravenous drug use.

Adult↗
PubMed1993

Comparison of four decontamination methods for recovery of Mycobacterium avium complex from stools.

The presence of Mycobacterium avium complex (MAC) in stool specimens may be a predictor of disseminated MAC infection, yet the methods for decontaminating stools have not been evaluated for their usefulness in recovering MAC organisms. In the present study, four decontamination methods commonly used to recover acid-fast bacteria from respiratory specimens were compared for their utility in recovering MAC from stool specimens. Ten strains of MAC were used at a level of 10(4) to 10(6) CFU to seed the stool specimens. Specimens were divided into four portions and were decontaminated by using the following treatments: (i) N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH), (ii) cetylpyridinium chloride-sodium chloride (CPC-NaCl), (iii) oxalic acid, or (iv) benzalkonium chloride-trisodium phosphate (BC-TSP). The specimens were then plated onto a total of five pieces of selective and nonselective egg- and agar-based media. The oxalic acid method yielded the greatest number of MAC CFU from seeded stool samples; this was followed by NALC-NaOH, BC-TSP, and CPC-NaCl. The difference between the oxalic acid method and each of the other methods was statistically significant (analysis of variance at the 95% significance level). Although more MAC CFU was recovered from seeded stool samples by using oxalic acid than NALC-NaOH, no difference in culture positivity rates was observed when the two methods were used to test 368 clinical stool specimens processed with either oxalic acid (164 specimens) or NALC-NaOH (204 specimens) (P = 0.07) or 67 specimens processed by both methods (P = 0.77). The oxalic acid and NALC-NaOH decontamination methods both appear to be useful for the recovery of MAC organisms from stool specimens.

AIDS-Related Opportunistic Infections↗
PubMed1992

Invasive Haemophilus influenzae infections in men with HIV infection.

OBJECTIVE: To determine the incidence of invasive Haemophilus influenzae disease in men with the acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection and the proportion of disease due to serotype b. DESIGN: Population-based, active surveillance. SETTING: San Francisco (Calif) Department of Health. PARTICIPANTS: All men 20 to 49 years of age with invasive H influenzae disease. RESULTS: The cumulative incidences of invasive H influenzae disease in men 20 to 49 years of age with AIDS and in HIV-infected men 20 to 49 years of age without AIDS were 79.2 and 14.6 per 100,000, respectively, but only 33% of cases were due to serotype b. The corresponding rates for invasive H influenzae b disease were 11.3 and 7.6 per 100,000. CONCLUSIONS: Men with AIDS or HIV infection are at increased risk of invasive H influenzae infections, including H influenzae b, but such infections are still infrequent in this population.

AIDS-Related Opportunistic Infections↗
PubMed1992

Role of foods in sporadic listeriosis. I. Case-control study of dietary risk factors. The Listeria Study Group.

OBJECTIVE: To identify dietary risk factors for sporadic listeriosis. DESIGN: Case-control study with blinded telephone interviews. SETTING: Multistate population of 18 million persons, November 1988 through December 1990. PARTICIPANTS: One hundred sixty-five patients with culture-confirmed listeriosis and 376 control subjects matched for age, health care provider, and immunosuppressive condition. RESULTS: The annual incidence of invasive listeriosis was 7.4 cases per million population; 23% of the infections were fatal. Cases were more likely than matched controls to have eaten soft cheeses (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4 to 4.8; P = .002) or food purchased from store delicatessen counters (OR, 1.6; 95% CI, 1.0 to 2.5; P = .04); 32% of sporadic disease could be attributed to eating these foods. Sixty-nine percent of cases in men and nonpregnant women occurred in cancer patients, persons with the acquired immunodeficiency syndrome, organ transplant recipients, or those receiving corticosteroid therapy. Among these immunosuppressed patients, eating undercooked chicken also increased the risk of listeriosis (OR, 3.3; 95% CI, 1.2 to 9.2; P = .02). CONCLUSIONS: Foodborne transmission may account for a substantial portion of sporadic listeriosis. Prevention efforts should include dietary counseling of high-risk patients and continued monitoring of food production.

Case-Control Studies↗
PubMed1992

Detection of meningitis epidemics in Africa: a population-based analysis.

Portions of sub-Saharan Africa are subject to major epidemics of meningococcal meningitis that require early detection and rapid control. We evaluated the usefulness of weekly meningitis rates derived from active surveillance data in Burkina Faso for detecting a meningitis epidemic. By analysing the rates of disease in 40 x 40km2 areas within a study region of Burkina Faso, we found that a threshold of 15 cases/100,000/week averaged over 2 weeks was 72-93% sensitive and 92-100% specific in detecting epidemics exceeding 100 cases/100,000/year. During epidemic periods, the positive predictive value of this threshold approached 100% for detecting local epidemics. Additionally, meningitis incidence was proportional to village size, with villages greater than 8000 having the highest disease rates during a major group A meningococcal epidemic in 1983-1984. Despite the rudimentary nature of surveillance data available in many developing countries, these data can be used to detect the early emergence of meningitis epidemics. Additional studies are needed to determine the relevance of this approach for detecting epidemics.

Burkina Faso↗
PubMed1991

Randomised, controlled trial of effectiveness of ampicillin in mild acute respiratory infections in Indonesian children.

The recommended treatment for mild acute respiratory infections (ARI) in children is supportive care only, but many physicians, especially in developing countries, continue to prescribe antibiotic treatment because they believe it prevents progression to more severe ARI. To find out whether ampicillin treatment conferred any benefit over supportive care alone, a randomised, controlled trial was carried out among 889 children (under 5 years) with mild ARI in Indonesia. 447 were randomly allocated ampicillin (25-30 mg/kg body weight three times daily for 5 days) plus supportive care (continued breastfeeding, clearing of the nose, and paracetamol to control fever); 442 were allocated supportive care only. The treatment groups were almost identical after randomisation in terms of age, sex, level of parental education, history of measles immunisation, and fever. After 1 week the percentages cured were nearly identical (204 [46%] ampicillin; 209 [47%] control), as were the percentages of cases progressing to moderate ARI (56 [13%] vs 53 [12%]). The effect of treatment was not modified by age, sex, measles immunisation status, or the educational level of the parents. At the 2-week follow-up, the percentages cured were 62% (277) in the ampicillin group and 58% (256) in the control group; 14% of both groups had progressed to moderate ARI; and 24% (107) and 28% (123), respectively, still had mild ARI. None of the differences in outcome between the ampicillin and control groups was statistically significant. Thus, ampicillin plus supportive care offers no benefit over supportive care alone for treatment of mild ARI in young Indonesian children.

Acute Disease↗
PubMed1991

Toxic shock syndrome: an update.

Since late 1979 to early 1980, when toxic shock syndrome achieved notoriety, a substantial body of data has demonstrated that vaginal Staphylococcus aureus infections, particularly those occurring during menstruation, account for most cases of toxic shock syndrome in women of reproductive age. Among those patients with onset during menstruation, tampon use has been identified as the most important risk factor. Although menstrually associated cases have been observed among users of all brands and styles of tampons, the use of selected "super absorbent" brands and styles has been associated with an increased risk of toxic shock syndrome. Although the tampon characteristics responsible for the associated risk of toxic shock syndrome remain poorly understood, both absorbency and chemical composition appear to be important variables in this relationship. In response to studies demonstrating this relationship and legal pressures, tampon manufacturers have removed chemical constituents previously used to enhance absorbency, such as polyester foam, carboxymethylcellulose, and polyacrylate rayon, and have markedly reduced tampon absorbency. Coinciding with these changes, the reported number of menstrually related cases of toxic shock syndrome has dropped substantially, although they continue to account for 50% to 70% of all cases of toxic shock syndrome in women of reproductive age.

Female↗
PubMed1991

Recent trends in the incidence of toxic shock syndrome in northern California.

The incidence of toxic shock syndrome in women members of a large prepaid medical care program in Northern California was 1.5 cases per 100,000 in a period after removal of tampons containing polyacrylate rayon and reductions in tampon absorbency. This rate was lower, but not significantly lower, than the rate of 2.2 per 100,000 in the prior interval. It was higher, but not significantly higher, than the rate of 0.4 per 100,000 in the era before "superabsorbent" materials were introduced into tampons. The incidence in men has been stable at about 0.1 cases per 100,000 for the 15-year period from 1972 though 1987.

Adolescent↗
PubMed1990

Risk factors associated with a school-related outbreak of serogroup C meningococcal disease.

An outbreak of Neisseria meningitidis sero-group C disease occurred in four eighth grade students and in a younger sibling of another eighth grade student attending an intermediate school (seventh and eighth grades) in Santa Clara County, CA. Four cases had onset within 3 days in January, 1989, with the fifth case occurring approximately 10 days later. A case-control study was performed to determine risk factors associated with serogroup C meningococcal infection (disease or carriage) in this eighth grade class. Students were more likely to be infected if they had had a preceding viral-like respiratory illness characterized by fever (odds ratio (OR) 5.3, P = 0.03) or cough (OR 5.1, P = 0.048). A ski trip (OR 6.3, P = 0.01) and a poster-making session for a school dance (OR 3.7, P = 0.08) were identified as possible settings for a common exposure. Spending time with two specific students during lunchtime or outside of school was associated with an increased risk of infection (OR 7.0, P = 0.054; OR 5.8, P = 0.04).

Adolescent↗
PubMed1988

Failure of gloves and other protective devices to prevent transmission of hepatitis B virus to oral surgeons.

A survey of 434 oral surgeons was conducted to examine risk factors for hepatitis B virus (HBV) infection. Overall, 112 (26%) of the participants demonstrated serologic evidence of past or current infection with HBV. Seropositivity was significantly associated with age, number of years in practice, and year of graduation from dental school but not with other variables examined, such as the number of patients seen annually or the number of patients seen who were at high risk of HBV infection. The strong correlation between years in practice and seropositivity was unaffected by reported use of gloves, face masks, or eye shields. The use of gloves and other protective devices does not appear to offer substantial protection against HBV exposure in oral surgeons, and all oral surgeons should receive HBV vaccine.

Adult↗