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Biomedical subjects

A P Roome

Publications and source records attributed to A P Roome.

At least 19 recordsLinked to original sources
PubMed1998

Acyclovir-resistant herpes simplex virus infections in a bone marrow transplant population.

Over a 3-month period, four patients who had received unrelated donor (UD) bone marrow transplants (BMT) presented with severe mucocutaneous herpes simplex virus (HSV) infection while receiving acyclovir (ACV) prophylaxis. Sensitivity testing of the isolates revealed three to be acyclovir-resistant and in one patient the infection was also characterised by a marked failure to respond to foscarnet (phosphonoformic acid). The emergence of ACV-resistant HSV infections in themselves is a new and challenging problem, and yet a far greater problem will become evident if these infections develop resistance to non thymidine kinase dependent therapy.

Acyclovir↗
PubMed1998

Cytomegalovirus infection in recipients of related and unrelated donor bone marrow transplants: no evidence of increased incidence in patients receiving unrelated donor grafts.

Recent reports suggest an increased incidence of cytomegalovirus (CMV) infection in recipients of unrelated donor (UD) bone marrow transplantation (BMT). In this study we have collated the incidence of CMV infection and disease in sequential UD (n = 119) and related donor (RD; n = 79) BMT performed in a single institution over a 7-year period. Low-risk patients (CMV seronegative recipient and donor) accounted for 51% of UD BMT (n = 61) and 62% of RD BMT (n=49), with CMV excretion documented in one RD BMT only. The remaining high-risk patients received identical prophylaxis regimens with aciclovir and intravenous immunoglobulin (IVIG). Two groups consisting of 58 UD BMT (median age 9.0 years, range 0.7-45.3 years) and 30 RD BMT (median age 13.6 years. range 1.6-47.6 years) were analysed. CMV reactivation/re-infection was documented in 15 UD BMT (26%) and 10 RD BMT (33%) (P = 0.72), and CMV disease in four UD BMT (8%) and four RD BMT (13%) (P = 0.533). In this series the risk of CMV excretion and disease following UD BMT was similar to that following RD BMT.

Acyclovir↗
PubMed1997

Control of varicella-zoster infection on renal and other specialist units.

The introduction of chickenpox onto our renal unit recently raised several issues surrounding the management of patient and staff contracts. This paper describes the action taken and makes various recommendations for future management of similar cases. Guidelines are proposed for the management of patients and staff as well as the role of the infection control team in handling a chickenpox problem. Future developments, including the use of VZ vaccine for patient and staff, are also discussed.

Chickenpox↗
PubMed1993

Comparison of enhanced chemiluminescence and microparticle enzyme immunoassay for the measurement of hepatitis B surface antibody.

Two commercially available immunoassays for the quantitative measurement of antibodies to hepatitis B surface antigen (HBsAg) were compared. The Amerlite enhanced chemiluminescence assay (ECL), which utilizes capture antigen obtained from HBsAg-positive donors bound to microtitre wells, was compared with the Abbott Laboratories microparticle enzyme immunoassay (IMx), which uses a recombinant antigen coated on to microparticle carriers. A total of 310 specimens, 116 from naturally infected patients (group A), 93 from patients vaccinated with a human plasma-derived vaccine (group B) and 101 patients vaccinated with a recombinant vaccine (group C), were tested in both assays undiluted and diluted 1:11. Samples that showed discordant results were also tested in a conventional quantitative enzyme immunoassay (Sorin). The results show significant differences in the level of anti-HBsAg in patient sera using the two technologies. In general, IMx gave significantly higher values than ECL for all three patient categories tested. These differences may lead to conflicting reports being issued by laboratories who change their assay system or when a sample from one patient is tested by different laboratories using different assays.

Adolescent↗
PubMed1993

Cytomegalovirus pneumonitis and bone marrow transplantation: identification of a specific high risk group.

AIMS: To study the association between cytomegalovirus (CMV) excretion and interstitial pneumonitis in allogeneic bone marrow transplant (BMT) recipients, with reference to donor and recipient CMV antibody response. METHODS: The incidence of CMV excretion was prospectively studied in 62 allogeneic bone marrow transplantations performed on adults and children. All recipients received CMV seronegative blood products. Prophylaxis with high dose acyclovir and CMV immune globulin was given to high risk patients (donor or recipient, or both, CMV seropositive). RESULTS: CMV excretion was detected in eight of 26 (31%) high risk patients but in only one of 36 low risk patients (donor and recipient both CMV seronegative). Five of the eight (63%) excretors in the high risk category developed CMV, of whom four (80%) belonged to the seropositive recipient/seronegative donor group, and included the three CMV seropositive recipients whose CMV complement fixation antibody titres were 64 or greater before transplantation. CONCLUSIONS: These findings suggest that there is a subgroup of patients at especially high risk of developing CMV.

Adolescent↗
PubMed1992

An assessment of sputum induction as an aid to diagnosis of respiratory infections in the immunocompromised child.

Sputum induction using nebulised hypertonic saline was performed in two groups of immunocompromised children, one group with symptoms of respiratory infection and one group without. The asymptomatic group were bone marrow transplant (BMT) recipients, all seropositive for cytomegalovirus infection (CMV). Organisms were identified in three of 14 induced sputum specimens obtained from the symptomatic group (CMV N = 1, Haemophilus influenzae N = 2), but in none of 12 specimens from the asymptomatic group. Adverse effects encountered were minor. Four symptomatic patients with negative induced sputum samples underwent bronchoalveolar lavage, and no further organisms were identified. Sputum induction can be a useful adjunct to the diagnosis of respiratory pathogens in this group of patients.

Adolescent↗
PubMed1990

Congenital rubella after previous maternal immunity.

Two mothers who had asymptomatic rubella infection in pregnancy gave birth to severely affected infants. In both, the presence of preexisting antibody was well documented, although it could not be established whether it was the result of vaccine or natural infection.

Adult↗
PubMed1990

Sputum induction as an aid to diagnosis of active cytomegalovirus infection following bone marrow transplantation.

An 8-year-old boy received an allogeneic bone marrow transplant (BMT) for relapsed T cell acute lymphoblastic leukaemia. Because he was seropositive for cytomegalovirus (CMV), serial virological specimens were taken throughout the transplant period, and included those obtained by sputum induction. Sixty-one days following BMT he became unwell, and was found to have mild tachypnoea and reduced oxygen saturations. All investigations were negative, apart from that obtained by sputum induction, which was positive for CMV. He received appropriate therapy with good response. We conclude that the technique of sputum induction can be applied to aid diagnosis of active CMV infection following BMT.

Bone Marrow Transplantation↗
PubMed1989

Comparison of intradermal and intramuscular hepatitis B vaccination in university students.

Antibody levels following intradermal and intramuscular hepatitis B vaccination were compared in a group of university students matched for age and sex. Intradermal vaccination gave satisfactory antibody levels in females, but much lower levels than by the intramuscular route and an unacceptable failure rate in men. The cost implications of introducing a selective vaccination policy in health care workers are discussed.

Adult↗
PubMed1986

The detection of respiratory syncytial virus in nasopharyngeal aspirates: assessment, formulation, and evaluation of monoclonal antibodies as a diagnostic reagent.

Comparisons were made between standard methods of cell culture, indirect immunofluorescence (IF) using hyperimmune respiratory syncytial virus (RSV) antiserum, and indirect IF using mouse monoclonal antibodies directed against various epitopes of RSV for the detection of RSV in nasopharyngeal aspirates. The monoclonal antibodies were used singly and in pools of different specificities which in turn were tested in both direct and indirect IF. In a preliminary study, aspirates from 227 infants were examined for RSV by standard methods. The results were compared with the detection of RSV in these aspirates using nine separate monoclonal antibodies and a pool consisting of five monoclonal antibodies. Respiratory syncytial virus was detected in 64 (28%) by cell culture, in 68 (30%) by indirect IF using bovine polyclonal antibody (BPA), and in 75 (33%) by indirect IF using the monoclonal antibody pool. The nine individual monoclonal antibodies when tested separately were less sensitive, detecting between 8 and 77% of all aspirates found to be positive by culture. After statistical analysis of the results obtained in the preliminary study, a refined monoclonal antibody pool was prepared and in a further study was tested by both direct and indirect IF in parallel with our two standard methods. Slides prepared from 303 nasopharyngeal aspirates collected between 1981 and 1984 and either tested the same day or stored at -20 degrees C were used to evaluate these reagents. Overall agreement between the four tests was found in 274 (90%) specimens. Cell culture detected RSV in 68 (22%) specimens, indirect IF with BPA in 67 (22%), indirect IF with monoclonal antibody in 72 (24%), and direct IF with monoclonal antibody in 79 (26%). The pool of monoclonal antibodies used in direct or indirect IF was thus more sensitive than our standard methods for the detection of RSV in nasopharyngeal aspirates, and direct IF tests could be completed in 40 minutes.

Adult↗
PubMed1986

Adenovirus type 8 keratoconjunctivitis--an outbreak and its treatment with topical human fibroblast interferon.

An outbreak of keratoconjunctivitis is described which involved at least 186 people; adenovirus type 8 was identified in 50 of the cases. Topical human fibroblast interferon was assessed in a double-blind, placebo-controlled study in which 34 patients participated. Seventeen of the 34 trial patients yielded adenovirus type 8; three were infected with adenovirus type 7. The outbreak was curtailed by control of infection measures: principally careful hand-washing by medical personnel between cases and by discouraging attendance of new cases at the Eye Infirmary. Consequently the trial numbers are small. In addition there was a wide interpatient variation in the severity of infection. Therefore it was not possible to make any statistically valid conclusions concerning the recovery rate of patients receiving interferon or placebo.

Adenoviridae Infections↗