PubMed Health⌕ Search

Biomedical subjects

C F von Reyn

Publications and source records attributed to C F von Reyn.

At least 55 records · Page 3Linked to original sources
PubMed1993

Endemic giardiasis in New Hampshire: a case-control study of environmental risks.

Giardiasis is the most frequently reported diarrheal disease in northern New England. A case-control study of endemic giardiasis and environmental risk factors among residents of New Hampshire involved 273 cases from the state's 1984 disease registry and 375 controls. Giardiasis was associated with a shallow dug well as a residential water source (odds ratio [OR] = 2.4; 95% confidence interval [CI], 1.3-47.0), a recent history of drinking untreated surface water (OR = 3.4; CI, 2.1-5.5), a history of swimming in a lake or pond (OR = 4.6; CI, 2.4-86.0) or swimming in any natural body of fresh water (OR = 4.0; CI, 2.3-70.0), contact with a person thought to have giardiasis (OR = 2.3; CI, 1.4-36.0), and recent contact with a child in day care (OR = 1.5; CI, 1.0-2.1). Multivariate modeling supported these associations. Shallow wells, relatively common in New Hampshire, have not previously been established as important sources of giardiasis.

Adolescent↗
PubMed1993

Evidence of previous infection with Mycobacterium avium-Mycobacterium intracellulare complex among healthy subjects: an international study of dominant mycobacterial skin test reactions.

Skin tests with 0.1 mL of intermediate-strength Mycobacterium tuberculosis purified protein derivative (PPD) and 0.1 mL of Mycobacterium avium sensitin were conducted on 484 healthy subjects from diverse geographic sites. Reactions of > or = 5 mm to one antigen that exceeded the reaction to the other by > or = 3 mm were considered M. avium- or PPD-dominant. PPD-dominant reactions were more frequent at sites where routine Bacille Calmette-Guérin immunization is done or where there are high rates of tuberculosis: New Hampshire, 2%; Boston, 7%; Finland, 14%; Trinidad, 26%; and Kenya, 28%. However, rates of M. avium-dominant reactions ranged from 7% to 12% at all sites. Analysis of dominant reactions based on a more stringent 10-mm minimum reaction size showed similar trends. These data suggest that exposure to MAC is similar in developed and developing countries but that broad mycobacterial immunity is greater in developing countries and may contribute to the lower rates of disseminated MAC infections in AIDS in these areas.

Adult↗
PubMed1993

Isolation of Mycobacterium avium complex from water in the United States, Finland, Zaire, and Kenya.

Disseminated infection with organisms of the Mycobacterium avium complex (MAC) is a common complication of AIDS in the United States and other developing countries, but it is rare or absent in sub-Saharan Africa. To assess the comparative likelihood of exposure to MAC in these geographic areas, we used a standard protocol to culture 91 water samples from environmental sites and piped water supply systems in the United States, Finland, Zaire, and Kenya. MAC was isolated from all geographic areas and from 22 of 91 (24%) samples. Isolation rates were 13 of 47 (28%) for environmental samples and 9 of 44 (20%) for water supply samples. Overall isolation rates were 18 of 52 (35%) samples in the United States and Finland, whereas they were 4 of 39 (10%) samples in Zaire and Kenya (P = 0.015). MAC isolation rates from water supply systems were 8 of 25 (32%) samples in the United States and Finland and 1 of 19 (5%) samples in Zaire and Kenya (P = 0.056). MAC was isolated from hospital water in the United States and Finland but not in hospital water in Zaire and Kenya. Serovar determinations showed that six of eight isolates from the United States were serovar 4 or 8. One MAC isolate from Zaire was identified as an "X" mycobacterium. These data suggest that exposure to MAC in water is likely in diverse areas of the world, but that the likelihood of human exposure to the organism in water may be slightly less in sub-Saharan Africa than in developed countries in the Northern Hemisphere.

AIDS-Related Opportunistic Infections↗
PubMed1992

Continuous infusion of intrathecal morphine to control acquired immunodeficiency syndrome-associated bladder pain.

A 36-year-old man with acquired immunodeficiency syndrome had incapacitating dysuria and vesical pain secondary to interstitial cystitis. When medical management and suprapubic urinary diversion failed to control the symptoms the patient was started on subarachnoid morphine sulfate. Bupivacaine was added 1 year later via an implanted Therex M-3000 implantable continuous infusion pump, which has continued successfully for more than 18 months. We believe that subarachnoid narcotics and other analgesic agents, such as clonidine, bupivacaine hydrochloride and baclofen, may prove equally valuable in the treatment of bladder spasm and pain. Furthermore, implanted intrathecal ports and pumps may have less associated risk of infection than the percutaneous vascular access catheters presently used for the continuous delivery of medications in immunosuppressed patients.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Infections in HIV-infected travelers: risks and prevention.

OBJECTIVE: To review risks for infection and to outline strategies to protect the health of travelers infected with human immunodeficiency virus (HIV). DATA SOURCES: Original reports and summaries of the geographic distribution and frequency of infections as well as of special risks these infections impose on HIV-infected persons. The recommendations incorporate guidelines published by the Centers for Disease Control (CDC) and the World Health Organization. STUDY SELECTION: Sources containing the most recent, pertinent information. DATA SYNTHESIS: Infections of the gastrointestinal tract are common in all travelers to developing countries and are likely to be more frequent, severe, and difficult to treat in HIV-infected persons. Prominent among the respiratory tract infections that pose special risks to HIV-infected travelers are influenza, measles, and fungal infections with geographically focal distributions. The most common vector-borne infection, malaria, appears to present relatively little, if any, incremental risk to the HIV-infected traveler. Persons with HIV infection respond less vigorously to vaccines and have a higher frequency of adverse reactions to antimicrobial agents. Nevertheless, immunizations and chemoprophylaxis can reduce the risk for many travel-related infections. Additionally, there are protective measures that travelers can take to minimize exposure to pathogens. CONCLUSIONS: By understanding the risks for disease in different destinations, assessing patients' HIV status, counseling patients about travel plans and personal protective measures, appropriately using vaccines and chemoprophylaxis, as well as instituting early treatment of infection, physicians can help HIV-infected patients to preserve their health during travel.

Gastrointestinal Diseases↗
PubMed1991

Effect of delays in processing on the survival of Mycobacterium avium-M. intracellulare in the isolator blood culture system.

Concentrations of Mycobacterium avium-M. intracellulare ranging from 10(-1) to 10(3) CFU/ml were added to blood, placed in Isolator tubes, and held at room temperature for intervals ranging from 4 h to 56 days before being processed (centrifugation and culture on Middlebrook 7H10 agar). At all concentrations tested, M. avium-M. intracellulare was recovered after hold times ranging from 4 h to 7 days; the number of final CFU actually increased progressively for hold times of 8 h or more. Hold times of up to 7 days did not increase the time from processing to the first appearance of visible colonies. At an inoculum of 10(2) CFU/ml, M. avium-M. intracellulare was recovered from Isolator tubes processed 56 days after inoculation. Two Isolator blood cultures were drawn from a patient with AIDS; M. avium-M. intracellulare was recovered from the sample processed immediately and from the sample processed after a hold time of 7 days. Since M. avium-M. intracellulare survives for prolonged periods in Isolator tubes, blood cultures may be collected in outpatient settings or in hospitals without mycobacterial culture facilities and shipped to reference laboratories for processing without loss of viability.

Acquired Immunodeficiency Syndrome↗
PubMed1990

International travel and HIV infection.

Although human immunodeficiency virus (HIV) infection is a worldwide problem, its prevalence and pattern vary from country to country. Accordingly, the risk to international travellers of acquiring HIV infection also varies widely in different parts of the world, and depends principally on their behaviour. The risk of sexual acquisition of HIV infection can be virtually eliminated by avoiding penetrative sexual intercourse with intravenous drug users and persons who have had multiple sexual partners (such as prostitutes) or reduced by the use of condoms. The risk of parenteral exposure to HIV can be reduced by avoiding parenteral drug use and behaviour that is likely to lead to injury (with its attendant risk of requiring blood transfusion) and by seeking medical facilities with adequate capabilities to screen blood donors for HIV and to sterilize instruments. HIV screening of international travellers is an ineffective, costly, and impractical public health strategy for limiting the worldwide spread of HIV infection. Travellers infected with HIV require specialized advice regarding health precautions, prophylactic medications, and immunization.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Human immunodeficiency virus infection and routine childhood immunisation.

Current experience with the safety and efficacy of vaccines in infected children and adults is reviewed to examine the basis for decisions about routine immunisations of children infected with the human immunodeficiency virus (HIV). No adverse reactions to inactivated vaccines have been noted, but complications with live vaccines have been recorded with both BCG and smallpox. Limited experience with live poliomyelitis and measles vaccines in HIV-infected children has not yet shown any severe complications from these vaccines. Theoretical concerns that immunisation might accelerate the course of HIV infection are not supported by available data. Serological response to most inactivated and live vaccines is reduced in HIV-infected persons, and is related to the degree of immunosuppression present. Preliminary evidence suggests that the severity of some vaccine-preventable diseases is increased in HIV-infected children. This review finds general support for recommendations on immunisation of HIV-infected children that have been developed by the World Health Organisation.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Nosocomial endocarditis.

We analyzed 14 cases of nosocomial infective endocarditis which occurred over a seven-year period at the Beth Israel Hospital in Boston, and compared them with 90 cases of community-acquired endocarditis. Patients with nosocomial endocarditis were older, more often female, and had a greater incidence of underlying valvular heart disease and bacteremia precipitating invasive procedures (93% v 50%, p less than .05). Forty-three percent of patients had infection at the site of prosthetic valves or intracardiac prosthetic material. The disease carried a significantly higher mortality than community-acquired endocarditis (43% v 11%, p less than .01). The clinical presentation was acute and the infecting organisms reflected the site of origin of bacteremia, with staphylococci from skin and enterococci from urinary sources. Half of the cases in this series may have been prevented by the application of currently recommended preventive and therapeutic practices. Nosocomial endocarditis occurs in a definable sub-population of hospitalized patients and is potentially preventable.

Catheters, Indwelling↗
PubMed1977

Epidemiologic and clinical features of an outbreak of bubonic plague in New Mexico.

An outbreak of seven cases of bubonic plague in New Mexico was investigated. Clinical features were studied and correlated with field studies in an attmept to determine the source of infection in patients with indefinite histories of exposure. Most patients presented with fever, malaise, and an acute painful lymphadenitis (bubo). One death occurred in a patient with bubonic-septicemic plague complicated by meningitis due to Yersinia pestis. All patients lived in rural or semirural areas, and most had been in the general vicinity of their usual residence during the six days prior to onset of symptoms. The outbreak was associated with probable epizootics in rodents in two different areas of the state. One case was traced to direct hand contact with plague-infected rabbits. One patient developed insect bites after sleeping in the same bed with a flea-infested cat. Three of the other five patients had insect bites, presumably flea bites, but none of the five recalled contact with rodents or rabbits. Four of the five, however, had been in contact with dogs or cats that were later shown to have titers of antibody to Y. pestis. These findings provide further support for the hypothesis that contact with domestic dogs and cats may result in direct or indirect transmission of Y. pestis to humans.

Adult↗
PubMed1977

Epidemiologic investigation of echinococcosis in American Indians living in Arizona and New Mexico.

Ten cases of echinococcosis diagnosed in American Indians in Arizona and New Mexico between 1972 and 1975 were investigated as part of a regional epidemiologic study. Patients were visited at home to discover factors associated with local parasite transmission, to detect possible additional cases among family members, and to perform diagnostic tests on dogs. Six patients were Navajo, 2 Zuni, and 2 Santo Domingo Indians. An additional case in a Navajo man was detected by serologic testing of patients' family members; this was the 20th case diagnosed in the region since 1965. Dogs owned by three of the Navajo patients were infected with Echinococcus granulosus. Arecoline-purge testing of 110 dogs in the Zuni pueblo demonstrated echinococcosis in a single stray dog. The findings at slaughter of Navajo-owned sheep indicate that the infection is enzootic in this intermediate host. The epidemiologic findings suggest that humans were infected from dogs which contracted their infections from two sources. The first was sheep raised locally in rural areas of the Navajo Reservation where the infection is enzootic in the dog-sheep cycle; transmission was apparently facilitated by the widespread practice of home butchering. A second source of human infection was dogs which became infected by eating viscera of sheep of off-reservation origin; these sheep were purchased and butchered by individual families in urban areas of the Navajo Reservation and in the Zuni and Santo Domingo pueblos.

Animals↗
PubMed1976

Bubonic plague from exposure to a rabbit: a documented case, and a review of rabbit-associated plague cases in the United States.

A 62-year-old woman developed bubonic plague with an epitrochlear bubo one to two days after skinning two cottontail rabbits. The implicated rabbits were later recovered from the patient's freezer, and Yersinia pestis was isolated from marrows of both rabbits. Although human plague cases in the United States have occasionally been traced to exposure to wild rabbits, this is the first documentation of plague infection in the actual rabbits to which the patient was exposed. All reported cases of rabbit-associated plague in the United States were then reviewed. Eight cases were characterized by direct exposure to rabbit tissues. Seven of the eight cases occurred in adult males who had hunted rabbits during winter months in plague-endemic areas. These patients had upper extremity buboes, and the case-fatality ration for the group was 50%. Three other cases in which rabbit exposure was indirect or its role less clear, were also analyzed.

Animals↗