Biomedical subjects
Publications and source records attributed to D C William.
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A 38-year-old man with AIDS presented with fever of unknown origin, splenomegaly, anemia, and thrombocytopenia. Admission laboratory data revealed a positive toxoplasmosis titer in the blood. The initial chest x-ray showed small bilateral pleural effusions, a normal cardiac silhouette, no infiltrates, and no interstitial edema. Ga-67 imaging revealed markedly abnormal uptake in the myocardium. A diagnosis of toxoplasmosis myocarditis was made based on laboratory and imaging data. The patient was treated for toxoplasmosis. No myocardial uptake of tracer was demonstrated on a follow-up Ga-67 scan, performed after completion of treatment for toxoplasmosis.
42 homosexual or bisexual men with persistent generalised lymphadenopathy not attributable to an identifiable cause have been followed longitudinally since February, 1981. Lymphadenopathy was accompanied by fatigue, low-grade fever and/or night sweats (57%), splenomegaly (29%), leucopenia (40%), hypergamma - globulinaemia (76%), and diminished proportion and absolute numbers of helper T cells (95%). Of the 26 patients who had lymph node biopsy, all showed benign reactive hyperplasia. After 15-30 (median 22) months, 8 patients have met criteria for the diagnosis of acquired immunodeficiency syndrome (AIDS). This outcome was associated with previous heavy nitrite inhalant use, with the presence of night sweats, with leucopenia, and with the triad of constitutional symptoms, splenomegaly, and leucopenia. In addition, a lower mean absolute helper T cell count and an increased frequency of anergy to mumps intradermal antigen and of herpes simplex virus isolation distinguished these patients from those remaining in the cohort, who seem to be stable and in some cases to have improved.
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The cases of 20 male homosexuals with Kaposi's sarcoma and the acquired immunodeficiency syndrome were compared with those of 40 age- and race-matched male homosexual controls. Patients with Kaposi's sarcoma had lower OKT4/OKT8 (T-helper/T-suppressor) ratios than controls, due to smaller numbers of OKT4 cells. Serum IgG concentrations and antibody titers to cytomegalovirus in patients exceeded those in controls, but patients had lower antibody titers to Epstein-Barr virus. Logistic regression analysis comparing patients with controls showed significant relative risks for Kaposi's sarcoma associated with the number of partners per month in receptive anal-genital intercourse, occasions per month of " fisting ," and cytomegalovirus antibody titers. Cytomegalovirus titers also were inversely correlated with OKT4 cell concentrations in the control group. Significantly greater OKT4 cell concentrations were found at diagnosis in HLA-DR5-positive patients than in HLA-DR5-negative patients. Patients who have HLA-DR5 may express disease at lesser degrees of immunodeficiency than HLA-DR5-negative patients.
An investigation of 20 homosexual men with histologically confirmed Kaposi's sarcoma and 40 controls revealed significant associations between Kaposi's sarcoma and use of a number of drugs (amyl nitrite, ethyl chloride, cocaine, phencyclidine, methaqualone, and amphetamine), history of mononucleosis, and sexual activity in the year before onset of the disease. Patients with Kaposi's sarcoma also reported substantially higher rates of sexually transmitted infections than did controls. Multivariate analysis indicated independent significant associations for amyl nitrite and sexual activity and showed use of phencyclidine, methaqualone, and ethyl chloride to be non-significant. Evaluated at the median exposure for patients, the analysis yielded risk-ratio estimates of 12.3 for amyl nitrite (95% confidence limits 4.2, 35.8) and 2.0 for sexual activity (95% confidence limits 1.3, 3.1).
A method for a rapid (within three minutes) detection of Neisseria gonorrhoeae in a urethral exudate from male patients without the use of a Gram stain or culture, was evaluated in 201 patients. Analyses of the data obtained from the study indicate no difference with respect to sensitivity and specificity compared to the Gram stain. The use of the Gonodecten test kit as a differential diagnostic tool would decrease materially the time necessary to determine if a urethritis is gonococcal or nongonococcal while the patient is still in the office. The ability to diagnose rapidly gonococcal urethritis at the time of the patient's examination should contribute substantially to improved disease control, especially in the private sector. The Gonodecten test kit provides a diagnostic tool for the clinician who does not have a laboratory or qualified personnel to carry out the necessary tests for making a presumptive diagnosis of gonorrhea.
The clinical findings in eight young homosexual men in New York with Kaposi's sarcoma showed some unusual features. Unlike the form usually seen in North America and Europe, it affected younger men (4th decade rather than 7th decade); the skin lesions wee generalised rather than being predominantly in the lower limbs, and the disease was more aggressive (survival of less than 20 months rather 8-13 years). All eight had had a variety of sexually transmitted diseases. All those tested for cytomegalovirus antibodies and hepatitis B surface antigen of anti-hepatitis B antibody gave positive results. This unusual occurrence of Kaposi's sarcoma in a population much exposed to sexually transmissible diseases suggests that such exposure may play a role in its pathogenesis.
We examined the prevalence of enteric protozoan and helminthic infections and the associations between infection and gender, sexual preference, and sexual practices in 180 consecutive patients at a venereal-disease clinic. Of 163 men, 29 were infected with one or more enteric parasites. None of the 17 women had an enteric infection. The prevalence of infections with Entamoeba histolytica or Giardia lamblia (or both) was 21.5 per cent in homosexual men, 6.2 per cent in bisexual men, and 0 in heterosexual men. There were significant associations between oral-anal sex and infection with E. histolytica (P less than 0.01) or with helminths (P less than 0.05). Homosexuality and oral-anal sex were the most important risk factors in E. histolytica, G. lamblia, and helminthic infections. We conclude the "hyperendemic" enteric protozoan infection rates in homosexual men are related to three factors: the original endemic level in the general population; the prevalence of sexual acts that facilitate transmission; and the frequency of exposure to an infected person.
This paper focuses on the growing incidence of the "new" sexually transmitted parasitic enteric diseases: amebiasis and giardiasis. Two major behavioral factors influence transmission of these diseases in the gay community: 1) oral-rectal and oral-genital sexual contact and 2) multiple sexual partners. Pathogenesis, clinical signs and symptoms and complications associated with these diseases are also discussed. Although many patients present with severe symptoms, approximately 50 percent of infected patients are asymptomatic. The diagnostic procedures include a fresh purged stool examination, nonpurged warm stool examinations, and/or cold stool specimens. The serologic tests (serum precipitin and hemagglutination) are of value only in severely symptomatic invasive disease. Different treatment regimens and their side effects are discussed. Drugs used in the treatment of the enteric diseases include diiodohydroxyquin, metronidazole, furamide, and paromomycin. Only 60 to 70 percent of patients with the disease are cured, and 30 to 40 percent of patients require multiple courses of therapy. Test-of-cure examinations, ideally consisting of one or two purged stool specimens, are necessary in follow-up management.
We assessed the efficacy of an inactivated hepatitis B vaccine in a placebo-controlled, randomized, double-blind trial in 1083 homosexual men known to be at high risk for hepatitis B virus infection. The vaccine was found to be safe and the incidence of side effects was low. Within two months, 77% of the vaccinated persons had high levels of antibody against the hepatitis B surface antigen. This rate increased to 96% after the booster dose and remained essentially unchanged for the duration of the trial. For the first 18 months of follow-up, hepatitis B or subclinical infection developed in only 1.4 to 3.4% of the vaccine recipients as compared with 18 to 27% of placebo recipients (P < 0.0001). The reduction of incidence in the vaccinees was as high as 92.3%; none of the vaccinees with a detectable immune response to the vaccine had clinical hepatitis B or asymptomatic antigenemia. A significant reduction of incidence was already seen within 75 days after randomization; this observation suggests that the vaccine may be efficacious even when given after exposure.
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Of 126 homosexual men in a selected population in New York City, 31.7% were infected with Entamoeba histolytica, 18.3% with Giardia lamblia, and 39.7% with one or both on a single stool examination. Of 5885 clinic and hospital patients examined in the same laboratory by the same methods, 1.3% were infected with E. histolytica, 2.1% with G. lamblia, and 3.3% with one or both. Evidence indicates that an epidemic of intestinal protozoan infection exists in the homosexual male population in New York City. The difficulty in making a diagnosis, inadequate therapy, failure to alert potential victims, and official neglect of the epidemic have combined to create a dangerous situation.
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Stool specimens from 89 high-risk, sexually active homosexual men were screened for enteric protozoal cysts. Patients whose specimens contained nonpathogenic cysts were investigated further by examination of fresh purged specimens. A total of 27 of the initial specimens (30%) contained protozoal cysts. Twenty-three patients (26%) harbored pathogens. There were 18 cases (20%) of amebiasis and 11 cases (12%) of giardiasis. Six men (7%) had concurrent amebiasis and giardiasis. The presence of infections correlated with a history of anilingus but not with place of birth, travel, or history of symptoms. The exceptionally high rate of prevalence of intestinal protozoal infection in this population suggests that enteric protozoal infections are important among sexually transmitted diseases.
The authors conducted a retrospective study of 125 male patients treated for anal gonorrhea with 4 g of spectinomycin in a social hygiene clinic. Of those treated, nine (7.2%) still had cultures positive for Neisseria gonorrhoeae when tested again five to 14 days after treatment.