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Biomedical subjects

C R Lucas

Publications and source records attributed to C R Lucas.

At least 19 recordsLinked to original sources
PubMed2000

Liver function and hepatitis markers in carriers of hepatitis B virus in New Zealand.

AIMS: The Hepatitis Foundation has identified many chronic carriers of hepatitis B virus (HBV) in community surveys of schools and family contacts. This study reports the characteristics of carriers and the relationship between hepatitis markers and liver function. METHODS: Demographic data from confirmed chronic carriers of HBV in the North Island were correlated with liver function and hepatitis markers. Longitudinal data were obtained by following a cohort for two years with regular blood tests. RESULTS: Of 2778 confirmed carriers of HBV most were children or young adults and 56% were male. Sixty percent were Maori and 26% Pacific Island people. Loss of HBsAg occurred at less than 1% per year compared to 9% for HBeAg. Mean ages for 50% loss of HBeAg were 14 years for children of HBV negative mothers and 19 years for those of HBV carrier mothers. Fewer adult males than females were HBeAg positive. Alanine aminotransferase levels above 50 IU/L were found in 16% of HBeAg positive and 6% HBeAg negative cases. Other factors significantly associated with raised alanine aminotransferase were male gender (OR 1.8) and age more than 15 years (OR 2.0). Thirty five percent of HBeAg positive carriers with raised alanine aminotransferase levels spontaneously seroconverted to HBeAg negative in two years. However, raised alanine aminotransferase in HBeAg negative carriers was persistent in most cases and 38% had HBV-DNA detectable in serum. CONCLUSIONS: HBV carriage is less benign in adults than children, even after loss of HBeAg. It is recommended that all HBV carriers have regular checks of liver function. Those with persistent abnormality should be strongly advised to restrict alcohol and be assessed for possible antiviral treatment.

Adolescent↗
PubMed1996

Hepatitis B infection in households of HBsAg positive New Zealand children.

AIMS: To determine, from data obtained in a school-based hepatitis B vaccination programme, the prevalence of hepatitis B virus (HBV) infection in household contacts of children found to be hepatitis B surface antigen (HBsAg) positive. METHODS: Children who were HBsAg positive were visited in their homes 6 months or more after their initial blood test. Blood was drawn to confirm HBsAg status, and to ascertain HBeAg status. Their household contacts were tested for HBV seromarkers. RESULTS: Visits were made to homes of 931 children initially found to be HBsAg positive. Nine hundred and seven of these children (97.4%) were still HBsAg positive and thus confirmed to be chronic HBsAg carriers. The testing of 2957 household contacts of HBsAg positive schoolchildren revealed that 719 (24.3%) were HBsAg positive, a rate many times higher than that in the schoolchildren initially tested. Total HBV seromarker rates were highest in Asian households, and lowest in Europeans where 57% had been infected and 12% were HBsAg positive. Ethnic differences were largely accounted for by variation in maternal HBsAg status, reflecting different rates of perinatal infection. CONCLUSIONS: All family and household contacts of individuals identified as presumptive HBsAg carriers should be tested for HBV seromarkers as a routine. It is particularly important to ensure full prophylaxis against perinatal infection.

Adolescent↗
PubMed1994

Kawerau revisited: hepatitis A and B seroprevalence in 1984 and 1993.

AIMS: To determine if protection against hepatitis B is maintained in a cohort of children nine years after primary vaccination; To compare the prevalence of hepatitis B infection in 1984, before the introduction of hepatitis B vaccine, with that in 1993; To compare the prevalence of hepatitis A antibody (anti-HAV) in children in 1984 and 1993. METHODS: Serum samples collected from children attending Kawerau Intermediate School in 1993 were tested for hepatitis B markers and anti-HAV, and the results were compared with those in children attending the same school in 1984. RESULTS: Antibody to hepatitis B surface antigen (anti-HBs) was detected in 91.8% of children documented to have received hepatitis B vaccine in 1984. Seroconversion for antibody to hepatitis B core antigen (anti-HBc) had occurred in 5%. None had suffered a clinical illness. No vaccinee had a positive test for hepatitis B surface antigen (HBsAg). The prevalence of hepatitis B infection had fallen from 71.7% in 1984 to 24.2% in 1993. The prevalence of hepatitis A was 29.6% in 1984 and 0.4% in 1993. CONCLUSIONS: Protection against clinical disease and chronic hepatitis B infection is maintained nine years after primary vaccination. Hepatitis A has virtually disappeared among children in Kawerau.

Adolescent↗
PubMed1993

Tuberculous meningitis: a 30-year review.

Tuberculous meningitis remains an important illness that can be difficult to diagnose in a timely fashion and carries significant morbidity. We present a retrospective review of the cases of tuberculous meningitis diagnosed and treated at a single institution. Fifty-eight cases were identified and stratified according to stage of disease at presentation. Four patients (7%) died; three (5%) developed severe neurological sequelae. Poor outcomes were largely confined to cases presenting in an advanced stage and at the extremes of age. Corticosteroids were administered to 56 patients and may have contributed to the comparatively good outcome in these cases.

Adrenal Cortex Hormones↗
PubMed1992

Hepatitis B vaccination in children: five year booster study.

AIM: to demonstrate that appropriate doses of hepatitis B vaccines would be protective for at least five years in children. This would be shown by administering booster doses and measuring the response. METHODS: 2 micrograms intramuscular (IM) doses of Merck Sharp and Dohme (MSD) recombinant DNA vaccine (rDNAV) were given to 318 children who had received age appropriate doses of MSD plasma derived vaccine (PDV) five years earlier. Sera were tested for hepatitis B virus (HBV) seromarkers pre- and postbooster. RESULTS: all children who had responsed to primary immunisation demonstrated an anamnestic response. The geometric mean titre (GMT) of antibody to hepatitis B surface antigen (antiHBs) rose from 89 to 4777 IU/L. AntiHBs was detected in 94% of vaccinees just prior to the five year booster, and 96.5% a mean of 10 days later. CONCLUSION: when initial vaccine seroconversion is satisfactory, protection of responders persists for at least five years, assuming that the response to vaccine boosters mimics the response to wild virus. Therefore, for population control of hepatitis B in children in endemic areas, booster doses are not required for at least five years.

Antibodies, Viral↗
PubMed1992

Clinical effects and in vitro studies of trifluorothymidine combined with interferon-alpha for treatment of drug-resistant and -sensitive herpes simplex virus infections.

Three AIDS patients with severe cutaneous herpes simplex virus (HSV) infection refractory to therapy with acyclovir and foscarnet (2 patients) were treated with a topical preparation of trifluorothymidine (TFT) and interferon-alpha. Complete healing of lesions occurred in 1 patient; a second had significant regression of the infected area. In the third, the lesion was stabilized twice after application of the preparation and reduced in size after a subsequent treatment. In vitro studies confirmed that isolates from these patients were acyclovir- or acyclovir/foscarnet-resistant. In addition, they revealed strong synergy between TFT and interferon-alpha for these isolates and for strains with wild-type drug sensitivity profiles. Topical TFT/interferon-alpha may be of benefit in the therapy of mucocutaneous HSV infections, especially when they are resistant to treatment with systemic antiviral agents.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Use of ribosomal RNA gene restriction patterns to investigate two outbreaks of Campylobacter enteritis in Melbourne, Australia.

The analysis of ribosomal RNA (rRNA) gene patterns (ribotyping) has been used to differentiate strains within bacterial species. We used this method to investigate two outbreaks of campylobacter enteritis that occurred recently in Melbourne, Australia. The first outbreak involved seven patients although isolates from only five patients were available for typing. The second outbreak consisted of three patients infected with human immunodeficiency virus (HIV) on the same ward of a hospital. Analysis of the rRNA gene patterns revealed identical patterns for the isolates from five patients in the first outbreak, suggesting that these isolates were from the same source. However, ribotyping of the four isolates from the second outbreak showed three distinct ribotypes indicative of contact with unrelated sources. This study demonstrated that ribotyping is a useful, reliable and convenient typing scheme for epidemiological purposes.

Australia↗
PubMed1992

Oral dapsone versus nebulized pentamidine for Pneumocystis carinii pneumonia prophylaxis: an open randomized prospective trial to assess efficacy and haematological toxicity.

OBJECTIVE: To compare the haematological toxicity and efficacy of oral dapsone and nebulized pentamidine as Pneumocystis carinii pneumonia (PCP) prophylaxis in HIV-infected patients receiving zidovudine. DESIGN: Randomized, prospective. SETTING: Infectious diseases hospital with participants drawn from both inpatient and outpatient departments. PATIENTS: Those eligible were starting treatment with zidovudine, needed PCP prophylaxis (CD4+ count < 200 x 10(6)/l or < 20% total lymphocyte count or previous episode of PCP), and had a normal glucose-6-phosphate dehydrogenase screen. Of the 98 patients enrolled, 96 returned for follow-up. INTERVENTIONS: Fifty patients received dapsone (100mg orally twice weekly) and 46 pentamidine (400 mg nebulized monthly). Follow-up was for a median of 18 months. MAIN OUTCOME MEASURES: The development of PCP, transfusion requirements, monthly complete blood cell counts, serious adverse reactions and death were recorded. RESULTS: Nine (18%) dapsone and eight (17%) pentamidine recipients developed PCP. There was no significant difference in number of patients transfused (12 dapsone and nine pentamidine recipients) or transfusion-free survival. At exit from the study, mean haemoglobin (11.7 versus 12.4 g/dl), white blood cell (3.9 versus 3.7 x 10(9)/l) and platelet (195 versus 184 x 10(9)/l) counts did not differ for the dapsone and pentamidine arms, respectively. There was no significant difference in the occurrence of serious adverse reactions (six in the dapsone and eight in the pentamidine arm). CONCLUSIONS: Dapsone can be recommended in preference to pentamidine as PCP prophylaxis on the basis of equivalent efficacy, absence of excessive haematological toxicity, low cost and ease of administration.

AIDS-Related Opportunistic Infections↗
PubMed1991

Antibodies to gp41 and nef in otherwise HIV-negative homosexual man with Kaposi's sarcoma.

A homosexual man with histologically confirmed Kaposi's sarcoma remained seronegative for HIV-1, HIV-2, and HTLV-1 on conventional tests over a 4-year period. HIV cultures were also negative on thirteen separate occasions. However, serum antibodies to synthetic peptide analogues of the gp41 and nef regions of HIV-1 were consistently detected on an enzyme immunoassay. Tests with the polymerase chain reaction with primers directed to the gag and env regions were negative. The antigens to which the antibodies were produced might have come from a defective HIV mutant, another retrovirus, or a hitherto unknown "agent of Kaposi's sarcoma" with similar antigenic epitopes.

Genes, nef↗
PubMed1991

Specific syphilis serological tests may become negative in HIV infection.

The diagnosis of syphilis is frequently dependent upon the results of serological tests, but the reliability of syphilis serology in patients with HIV-1 infection has been questioned. We examined specific antibody to Treponema pallidum (TP) using the TP haemagglutination (TPHA) and fluorescent treponemal antibody-absorption (FTA-ABS) tests in AIDS patients and HIV-antibody-negative controls with a history of syphilis. Tests were carried out on two sera separated by an interval of at least 3 years from each patient. Twelve out of 29 AIDS patients compared with four out of 29 controls showed significant falls in titres of specific antibody as measured by the TPHA, FTA-ABS, or by both the TPHA and FTA-ABS (P = 0.02). Furthermore, in three out of 29 (10%) of the AIDS patients with past syphilis infections both the TPHA and FTA-ABS became non-reactive. We conclude that negative specific serology does not exclude a past syphilis infection in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The increased risk of fatal liver disease in renal transplant patients who are hepatitis Be antigen and/or HBV DNA positive.

To determine whether active viral replication is associated with increased morbidity and mortality in chronic carriers of hepatitis B virus (HBV) undergoing renal transplantation, we reviewed 23 years of experience at our hospital. Over the period 1966-1989, 42 chronic carriers of hepatitis B surface antigen (HBsAg) received renal transplants, 32 of whom had functioning grafts for 12 months or longer. Stored sera were tested for markers of hepatitis B virus, hepatitis C virus (HCV), and hepatitis delta virus (HDV) infection, and the serologic findings were correlated with clinical and biochemical data. The presence of HBV DNA and/or hepatitis Be antigen (HBeAg) in serum samples collected prior to transplantation was associated with an increased probability of death from liver disease. Whereas 5 of 10 patients in this group died of chronic liver disease, only 1 of 15 patients who were HBV DNA and/or HBeAg negative prior to transplantation died of liver disease. This difference is highly significant (P less than 0.02). No difference in outcome was attributable to age at transplantation, gender, country of birth, or the presence of abnormal hepatic transaminase levels prior to transplantation.

Adolescent↗
PubMed1991

Low frequency maintenance ganciclovir for cytomegalovirus retinitis.

45 patients on maintenance ganciclovir for treated cytomegalovirus (CMV) retinitis were reviewed retrospectively. Treatment was given at 30 mg/kg/week in 3 divided doses: Monday, Wednesday, Friday. The median time to clinical relapse was 5.4 months. This is similar to that reported with higher frequency maintenance regimens. The high degree of immunodeficiency (median CD4 count 16 cells/microliters) and poor prognosis (median survival 8.2 months) associated with CMV retinitis were confirmed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons.

Infection with the human immunodeficiency virus (HIV) results in progressive depletion of the CD4 subset T-lymphocytes and the development of opportunistic infections and certain malignancies. Charts were reviewed for 185 HIV-infected individuals with 265 AIDS-defining illnesses (ADIs) who had T-lymphocyte subset analyses performed within 2 months prior to or 1 month following the diagnosis. Also included were 22 HIV-infected patients with oral candidiasis and 20 with asymptomatic infection. Significant differences in CD4 lymphocyte numbers were observed between the 12 ADIs, oral candidiasis, and asymptomatic infection, allowing them to be grouped into five general categories, based on mean CD4 count: (a) asymptomatic infection, CD4 greater than 500/mm3; (b) oral candidiasis and tuberculosis, range 250-500/mm3; (c) Kaposi's sarcoma, lymphoma, and cryptosporidiosis, range 150-200/mm3; (d) Pneumocystis carinii pneumonitis, disseminated Mycobacterium avium complex, herpes simplex ulceration, toxoplasmosis, cryptococcosis, and esophageal candidiasis, range 75-125/mm3; (e) cytomegalovirus retinitis, less than 50/mm3. Our data concur with clinical impressions and provide a basis for interim treatment and prophylaxis recommendations.

Adult↗
PubMed1990

Cytomegalovirus cultures during maintenance DHPG therapy for cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS).

Nine patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis on maintenance therapy with ganciclovir: 9(1,3-dihydroxy-2-propoxymethyl) guanine (DHPG) at high dose (30 mg/kg/week) or low dose (20 mg/kg/week) were tested every 1-2 weeks for CMV isolation from blood, saliva, and urine. Duration of therapy ranged from 1.5 to 12 months (average 5.3 months). During pretreatment and low-dose and high-dose maintenance therapy, CMV was isolated from 48/59 (81%), 90/211 (43%), and 40/290 (14%) of specimens, respectively. Three patients with progressive retinitis had viraemia more frequently than did six patients with stable retinitis, CMV being isolated from 29/47 (62%) and 17/121 (14%) of blood samples, respectively.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Primary dapsone chemoprophylaxis for Pneumocystis carinii pneumonia in immunocompromised patients infected with the human immunodeficiency virus.

During a 12-month period from August 1, 1986 to July 31, 1987, a study of primary chemoprophylaxis with dapsone for Pneumocystis carinii pneumonia was undertaken in immunodeficient patients who were infected with the human immunodeficiency virus. One attack of P. carinii pneumonia occurred among 16 patients who received chemoprophylaxis immediately that a T-helper (CD4) lymphocyte count of less than 0.2 x 10(9)/L was recorded compared with 16 attacks in the historical control group of 46 similar patients who did not receive chemoprophylaxis (log-rank test, chi 2(1) = 3.72; P = 0.05).

AIDS-Related Complex↗
PubMed1989

The gastrointestinal and hepatic manifestations of the acquired immunodeficiency syndrome.

Eighty-five patients with the acquired immunodeficiency syndrome (AIDS) were treated at Fairfield Infectious Diseases Hospital between April 1984 and June 1987. Sixty per cent of patients suffered gastrointestinal symptoms during the period of study, and in a further 15% of patients, abnormalities of the gastrointestinal tract were found incidentally. The principal manifestations were oropharyngeal ulceration, dysphagia/odynophagia, abdominal pain, diarrhoea, gastrointestinal bleeding, and perianal lesions. Opportunistic diseases involving all parts of the gastrointestinal system were encountered, the most prevalent being infections that were caused by Candida spp., cytomegalovirus, Mycobacterium avium-intracellulare and herpes simplex, and Kaposi's sarcoma. Abnormal liver-function test-results were found in 41 patients; most commonly, these were attributable to minor drug reactions, and cytomegalovirus or Myco. avium-intracellulare infection. Only one patient became jaundiced clinically. We conclude that involvement of the gastrointestinal tract is common in patients with AIDS, and that gastrointestinal lesions are an important cause of morbidity and mortality in these patients.

Acquired Immunodeficiency Syndrome↗