Biomedical subjects
B B Wray
Publications and source records attributed to B B Wray.
Lack of transmission of human immunodeficiency virus from infected children to their household contacts.
The possibility of transmission of the human immunodeficiency virus (HIV) from infected children to their contacts has been confronted in households, schools, day-care centers, and other child care settings. Cases reported to the Centers for Disease Control and several studies of close contacts of HIV-infected patients suggested that the risk of transmission in these settings is extremely low. However, most of these studies involved infected adults or older children. Younger children, who drool, bite, mouth toys, and are incontinent, may be more likely to transmit HIV in these settings. To assess this possibility, the authors tested 89 members of households in which 25 children with HIV infection, most of whom were preschool-aged, resided. Household members had close personal contact with the infected children. They shared many items likely to be soiled with blood and body fluids, such as toys, toothbrushes, eating utensils, toilets, and bathtubs. Hugging, kissing, sharing a bed, and bathing together were common. Household members were tested no sooner than 4 months after initial contact with the infected child, to allow adequate time for sero-conversion. All 89 participating household members were anti-HIV seronegative, and 78 who were tested were serum p24 antigen negative. It was concluded from this study and other evidence that the risk of transmission from children to their contacts is extremely low and has not been clearly documented in the household setting.
Evaluation of immunocompetency in juvenile laryngeal papillomatosis.
The morbidity from juvenile laryngeal papillomatosis (JLP), a disease process characterized by recurrent growth of multiple epithelial papillomas, has greatly improved with the advent of immunomodulating agents used in combination with the surgical approach of CO2 laser vaporization. In prospectively evaluating the immunologic status of four pediatric patients with this disorder, one patient repeatedly demonstrated IgG2 subclass deficiency. One of two children found to have subnormal functional natural killer (NK) activity received thrice weekly intramuscular administration of 3,000,000 units/m2 body surface area of human leukocyte (alpha) interferon (IFN). Natural killer function normalized, but therapy was discontinued after 4 months; however, no clinical benefits from IFN administration were observed. Further in vitro evaluation of NK function and lymphokine production is needed, in order eventually to offer more effective immunomodulating agents to such patients. A brief review of the literature concerning JLP is also presented.
Mnemonic for treatment of anaphylaxis.
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Use of transfer factor in a pediatric AIDS patient with disseminated Mycobacterium avium intracellulare.
An 8-year-old male with AIDS and disseminated Mycobacterium avium intracellulare infection was treated with transfer factor (TF) prepared from maternal lymphocytes. Subsequent lymphocyte stimulation studies and repeat cultures failed to demonstrate improvement during treatment. His overall clinical status remained unchanged. No adverse effects of TF were noted.
A prospective study: evaluation of the antibody-dependent cell-mediated cytotoxicity assay in chronic active Epstein-Barr syndrome.
Prospective monitoring of active Chronic Epstein-Barr virally infected patients receiving gammaglobulin therapy was performed using the antibody-dependent cell-mediated cytotoxicity assay (ADCC). Efforts were made to analyze and define with respect to clinical course the autologous immunological parameters (cells and sera). Our data demonstrate that the diagnosis and clinical course of this syndrome proved inconsistent with the assays usefulness in predicting suggestive benefits of gammaglobulin therapy.
Effect of interleukin-2 and mitogen on in vitro immunoglobulin production by peripheral blood lymphocytes from patients with selective IgM deficiency.
Immunoglobulin production by mitogen and recombinant interleukin-2-(rIL-2)-stimulated lymphocytes from IgM-deficient patients was studied. The findings were that subnormal serum IgM levels did not necessarily predict defective in vitro IgG or IgM production, lymphocytes from some IgM-deficient patients exhibited defective T cell function, and rIL-2 did not enhance defective in vitro immunoglobulin production.
Terfenadine treatment of fall hay fever.
A double-blind, parallel, multicenter study was undertaken in 215 ragweed skin test positive-patients with fall hay fever. The patients were randomized and treated for seven days with either 60 mg terfenadine twice daily, morning and evening, and a placebo at noon, or with 4 mg chlorpheniramine or placebo three times daily. The severity of nasopharyngeal itching, sneezing, rhinorrhea, nasal congestion, and itchy, watery, red eyes was ranked daily by patients and evaluated before and after treatment by the physician investigators. The patients reported a significant reduction in symptoms within one day. The physician investigators detected moderate to complete relief of symptoms in a greater proportion of the patients treated with terfenadine (70%) and chlorpheniramine (73%) than in the placebo-treated patients (48%). The incidence of sedation with terfenadine treatment (2.5%) was not different from that with placebo (2.4%) and both were lower than with chlorpheniramine (7.6%). We conclude that terfenadine is as effective as chlorpheniramine for the treatment of fall hay fever and that, unlike chlorpheniramine, the incidence of sedation with terfenadine was not different from placebo.
Pediatric acquired immune deficiency syndrome with panhypogammaglobulinemia.
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Effect of an electronic air cleaner and negative ionizer on the population of indoor mold spores.
We evaluated the ability of an electrostatic air cleaner and negative ionizer (Bionaire 1000, Biotech Electronics, Ltd) to cleanse indoor air of mold spores. Significant reductions in the number of mold colonies were observed when the air cleaner was operated alone. We found no significant decrease in the circulating amounts of mold spores over baseline with the additional use of the negative ionizer. Though there were day-to-day variations in the numbers of spores, these changes remained significant.
Seasonal variation in antigens of the imported fire ant Solenopsis invicta.
Eight sequentially collected lots of aqueous extracts of imported fire ant (IFA) front end and abdominal end segments were assayed for phospholipase A (PLA), N-acetyl-beta-glucosaminidase (NAG), and hyaluronidase. Relative potency of each extract lot and pooled venom was measured by RAST inhibition against a venom standard. More than a hundredfold difference in PLA activity was observed. Early summer collections had the highest activity. The May to June collection had more than twice the PLA activity of the next most potent lot. Discordancy in enzyme patterns was noted only in AE extract. NAG levels peaked earlier in the spring and summer and fluctuated less widely. Front end extract had lower activity levels for both enzymes, with no seasonal fluctuation in NAG and a single elevation in PLA activity in the April to May collection. RAST inhibition varied directly with PLA activity (p less than .05) but not with NAG nor hyaluronidase activities. Fifty-one percent of systemic allergic reactions to IFA stings occurred in summer, and 19% occurred in spring. A reported demographic survey demonstrated a higher incidence of IFA stings in the spring (39.9%) with a lower attack rate in the summer (31.9%). These findings suggest that the rate of systemic reactions to stings of the IFA may be related to seasonal variations in allergenic potency, as measured by PLA and RAST inhibition, rather than the sting attack rate.
Sjogren's syndrome in an adolescent.
Sjogren's syndrome is a chronic autoimmune disorder characterized by keratoconjunctivitis sicca, xerostomia, and recurrent enlargement of the salivary glands. Most commonly noted in adults, it rarely affects adolescents. We describe a 15-year-old adolescent with recurrent parotid enlargement as an initial manifestation of this disease.
AIDS in a child 5 1/2 years after a transfusion.
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Congenital X-linked hypogammaglobulinemia and asymptomatic hepatitis B antigen carrier state.
Hepatitis occurring in patients with congenital X-linked or common variable hypogammaglobulinemia has been reported to follow a usual pattern of rapid progression from acute hepatitis to either chronic active hepatitis or death. This article describes a 21-year-old black man with congenital X-linked hypogammaglobulinemia who has been known to be a hepatitis B-associated antigen carrier during a 9-year follow up period. Liver enzyme studies are normal. His immunologic studies demonstrate no impairment of cellular immunity. His brother, who has the same disease and lives in the same household, has remained negative for hepatitis B-associated antigen. This patient demonstrates that not all hypogammaglobulinemia patients invariably have a severe clinical course with hepatitis.
Metabisulfite sensitivity: case report and literature review.
Sulfiting agents have recently been identified as food and drug additives responsible for adverse reactions. These reactions are not rare and may result in life-threatening asthma and anaphylaxis. We report a 34-year-old female with intractable asthma and urticaria. Sensitivity to sulfites was suspected based on exacerbation after restaurant meals and metaproterenol 5% inhalant solution. Bronchial provocation challenge resulted in a 28% decrease in FEV1 and a 34% decrease in FEF25-75 at the 0.01 mg/ml dose. Thirty-two cases of sulfite sensitivity reported in the literature are reviewed. Foods and drugs containing sulfites are listed. The pathogenic mechanism is unknown. The FDA allows the addition of sulfites to foods and drugs without disclosure. Only recently has this potential hazard been recognized. The FDA is considering a labeling requirement on drugs that do contain sulfites.
Malacoplakia associated with vesicoureteral reflux and selective immunoglobulin A deficiency.
A case of malacoplakia involving the lower urinary tract of a young black boy, with associated bilateral vesicoureteral reflux, hydronephrosis and selective immunoglobulin A deficiency is reported. Reflux was caused by the malacoplakia. Reflux and hydronephrosis persisted despite elimination of bacterial infection and malacoplakia by drug therapy. These abnormalities were corrected by a conventional antireflux operation. Malacoplakia appears to be related to immunologic incompetence and diminished levels of intracellular cyclic 3',5' guanine monophosphate. Cholinergic agonists reverse or prevent the pathological changes of malacoplakia.
Chronic urticaria related to sialoadenitis.
A 31-year-old black male experienced severe recurrent urticaria and angioedema during meals. An abnormal sialographic pattern indicated submandibular sialoadenitis, and surgical excision of the gland resulted in complete resolution of the urticaria. This report describes the association of sialoadenitis and urticaria and possible mechanisms involved.
Junctional epidermolysis bullosa. Treatment with phenytoin.
Junctional epidermolysis bullosa (EB) is a rare, heritable, blistering disease of the skin characterized by presence of bullae at birth, lack of scarring of the lesions, and early death. To date there has been no effective treatment for the disease. Phenytoin, which decreases collagenase activity in human skin explants and fibroblast cultures, has been used successfully to treat patients with recessive dystrophic EB. We found a marked decrease in new blister formation in one child with junctional EB during phenytoin therapy.