Biomedical subjects
Publications and source records attributed to D E Peterson.
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OBJECTIVE: (1) To assess factors associated with the occurrence of multiple false-positive viral enzyme-linked immunosorbent assays (ELISAs) for human immunodeficiency virus (HIV), human T-cell lymphotrophic virus type 1 (HTLV-1), and hepatitis C virus (HCV) among individual blood donors and (2) to determine the frequency and time course of this phenomenon. DESIGN: Case-control study. SETTING: A regional blood center. PARTICIPANTS: Blood donors found to have multiple false-positive viral ELISAs (case donors) and randomly selected seronegative controls (control donors) who donated between October 31, 1991, and December 15, 1991. An additional random sample of 262 donation records was reviewed to calculate the proportion of donors who received influenza vaccine. MAIN OUTCOME MEASURES: Multiple false-positive viral ELISAs, receipt of influenza vaccination formulated for the 1991-1992 influenza season, and follow-up ELISA results on serum samples obtained from case donors. RESULTS: Among 17,941 donors, 10 case donors were identified. Nine of the 10 case donors received influenza vaccine, compared with three of 30 control donors (odds ratio [OR] = 81; 95% confidence interval [CI], 6 to 3670; P less than .001). Among nine case donors, the mean time between vaccination and blood donation was 26 days (range, 9 to 68 days). Follow-up ELISAs of serum samples from seven case donors obtained 52 to 130 days (mean, 75 days) after vaccination demonstrated reversion to HIV and HTLV-1 seronegativity in all but one specimen, with persistence of positive HCV ELISAs in four specimens. We estimate between 0.6% and 1.7% of blood donors who received influenza vaccine this season had multiple false-positive viral ELISAs. CONCLUSIONS: The occurrence of multiple false-positive viral ELISAs among blood donors was associated with influenza vaccination, but was infrequent among vaccinees. This phenomenon is of short duration for HIV and HTLV-1, but may persist longer for HCV. We recommend influenza vaccinees not be deferred from blood donation. Blood donors with multiple false-positive viral ELISAs should be considered for future reentry as blood donors.
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Capnocytophaga is a gram-negative, capnophilic, facultatively anaerobic bacillus that normally inhabits the oral cavity. We report the case of a patient who developed capnocytophaga bacteremia following autologous bone marrow transplantation for Hodgkin's disease, and we review other reported cases of capnocytophaga bacteremia in immunocompromised patients. In our case infection followed pretransplantation conditioning and was associated with severe oral mucositis and neutropenia. Antibiotic therapy resulted in clinical resolution of infection. Capnocytophaga bacteremia should be included in the differential diagnosis of febrile neutropenia in immunocompromised patients (e.g., those undergoing bone marrow transplantation) especially in the presence of mucositis and gingival bleeding.
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We evaluated the effect of state cigarette tax increases on cigarette sales in the 50 states for the years 1955 to 1988. State cigarette tax increases were associated with an average decline in cigarette consumption of three cigarette packs per capita (about 2.4%). Larger tax increases were associated with larger declines in consumption. Raising state cigarette taxes appears to be an effective public health intervention that can reduce cigarette consumption and its associated health consequences.
This article has reviewed selected oral complications that can develop in the myelosuppressed or head and neck radiation cancer patient. Many of these complications can be prevented by treating diseased oral sites prior to initiation of cancer therapy. Further, cancer treatment often causes changes in oral tissues that require long-term management. The dentist thus can play an important role in the overall care of many cancer patients.
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Candida spp. can frequently cause oral infections in the elderly. A number of factors, including yeast virulence factors and compromised host defenses, contribute to outcomes of clinical disease. Precise mechanisms that determine the varied clinical appearances of oral candidiasis have not been delineated fully. Oral candidiasis should be suspected at the clinical level when oral mucosal lesions consistent with the various presentations of candidiasis are observed in patients at risk. Culture remains the gold standard for assessment, although results may be equivocal. Topical or systemic antifungal therapy may result in resolution of symptoms and lesions, but lesions may recur if underlying risk factors remain.
Oral mucositis and hepatic veno-occlusive disease (HVOD) are common complications after bone marrow transplantation (BMT). Forty-seven patients were prospectively examined for development of ulcerative oral mucositis (UOM) and HVOD after allogeneic BMT. In 17 patients (36%) UOM developed between 2 days before and 18 days after transplant (median 4 days after BMT). In seven patients (15%) HVOD developed with onset between 3 and 21 days after transplant (median 18 days after BMT). In a time-dependent analysis, in patients given busulfan plus cyclophosphamide or busulfan, etoposide, and cyclophosphamide UOM was 19 times more likely to develop than in patients treated by cyclophosphamide plus total body irradiation or by cyclophosphamide alone (p less than 0.001). Patients in whom UOM developed were 6.5 times more likely to develop HVOD than those in whom UOM did not develop (p less than 0.03). The sensitivity (86%), specificity (73%), and negative predictive value (97%) of UOM to predict HVOD were high, but the positive predictive value (35%) was low. The association of UOM and HVOD support the concept that both are toxic effects of treatment. Patients with hepatic abnormalities but without UOM are unlikely to have HVOD, and other causes of the hepatic dysfunction should be investigated.
Human polymorphonuclear cell (PMN) viability, morphology, adherence, chemotaxis, oxidative metabolism, degranulation and phagocytosis were evaluated following treatment with sanguinarine (SANG). SANG was noncytotoxic to PMNs at all concentrations tested (0.31-200 microM). SANG entered the PMNs rapidly without altering the membrane fluidity and localized in the nuclear matrix. SANG (1.56-6.21 microM) inhibited chemotaxis, chemokinesis and adhesion in a dose-dependent manner, with a complete inhibition at 6.2 microM concentration. Concentrations of SANG up to 1.56 microM did not affect PMN oxidative burst; however, higher concentrations were found to inhibit basal as well as PMA-induced superoxide anion generation. The effect of SANG was time- and dose-dependent, and could be reversed if the PMNs were exposed to 12.5 microM or lower concentrations of SANG for less than 5 min. Autologous serum increased the tolerance of PMNs to SANG. Exogenous Ca2+ or Mg2+ did not alter the SANG-mediated inhibition of PMN functions. Treatment of PMNs with 3.12 microM or higher concentrations of SANG also resulted in inhibition of PMN degranulation and phagocytosis. The results suggest that SANG-mediated inhibition of PMN functions, without cytolysis or resultant release of inflammatory mediators, may have clinical implications.
It will take the cooperation of many people to address the issue of lead poisoning. The recent death has dramatized the problem of high dose exposures. But a larger challenge is posed by the fact that most preschool children in Wisconsin are not screened for lead and as a result many asymptomatic children without signs of pica behavior will experience subtle neurological damage as a result of low to moderate elevations of lead in blood. Because many of these cases occur in children without recognized pica behavior, doctors need to expand screening, especially during well child visits, to identify children with elevated blood lead levels. Additionally, the public health community and property owners need to evaluate and control sources of lead. Major efforts are needed to address the lead hazards which now impair hundreds of Wisconsin children each year.
Risk for acute infection increases as granulocyte levels decrease secondary to myelosuppressive chemotherapy in patients with acute nonlymphocytic leukemia (ANLL). Acute exacerbations of concomitant inflammatory periodontal diseases can result in systemic infections in these patients. However, host-oral bacterial relationships in the periodontium in patients with ANLL are not well understood. Twenty-one adult patients with ANLL with periodontal disease ranging from gingivitis to severe periodontitis were studied. Supragingival and subgingival plaque specimens were collected before chemotherapy (prechemotherapy), and at a defined midpoint of myelosuppression (midchemotherapy; day 14). All specimens were extensively cultured both aerobically and anaerobically. Data were submitted to a partial correlational analysis, controlling for covariation relation to oral hygiene intervention and antibiotic administration. Levels of total yeast exhibited a significant association with Staphylococcus sp. at supragingival sites midchemotherapy (r = 0.68, p less than or equal to 0.05). Levels of total yeast also correlated positively with Pseudomonas aeruginosa at subgingival sites both prechemotherapy (r = 0.70, p less than or equal to 0.01) and midchemotherapy (r = 0.61, p less than or equal to 0.05). Significant correlations of levels of Veillonella sp. with Neisseria sp. and gram-negative enteric bacilli were observed in both supragingival (r = 0.95, 0.77, p values less than or equal to 0.01) and subgingival (r = 0.69, 0.61, p values less than or equal to 0.05) plaque specimens midchemotherapy but not prechemotherapy. These data suggest that potentially pathogenic bacteria occur in plaque simultaneous with granulocytopenia in these patients. Multiple mechanisms, including intergeneric coaggregation and other symbiotic relationships, may influence infectivity of the mixed plaque flora and thus contribute to the oral ecology observed in these patients.
This study analyzed factors associated with acute oropharyngeal herpes simplex virus (HSV) infection in 627 patients who had undergone allogeneic bone marrow transplantation for leukemia, lymphoma, or aplastic anemia. HSV infection developed in 233 (37%) of the patients; all but two were seropositive for HSV before transplant. Sixty-two percent of the seropositive patients had at least one episode of HSV reactivation during the first 100 days after transplant. Other factors that placed patients at increased risk for HSV infection were a pretransplant diagnosis of leukemia, being in remission at the time of transplant, and/or having been conditioned for transplant with chemoradiotherapy. Recognition of factors that may predispose patients to HSV infection helps determine those transplant recipients who might benefit most from antiviral prophylaxis or other approaches to prevention of HSV reactivation.
In vitro coaggregation between Candida species isolated from immunosuppressed bone marrow transplant recipients and oral bacteria was investigated. Each Candida strain showed a different pattern of coaggregation with the 22 bacterial strains studied. Two strains of Lactobacillus amylovorus isolated from separate bone marrow transplant patients and Fusobacterium nucleatum (VPI 10197) coaggregated with all Candida strains. Ten bacterial strains showed no coaggregation with the Candida strains. A variety of inhibition patterns were observed when coaggregating strains were first incubated with various sugars or subjected to heat treatment. Positive and negative results were generally consistent with all Candida strains. On the basis of the culture characteristics of the oral rinse specimens, relationships between the colonization of bacteria and yeasts and in vitro coaggregation were suggested.
It is important to understand the pathogenesis of acute oral infections in patients with chemotherapy-induced myelosuppression in order to develop strategies to prevent such complications. Four distinct oral sites that can either be acutely infected or contribute to acute systemic infection are the oral mucosa, dental pulp and periapical tissues, periodontium, and salivary glands. Many cytotoxic drugs can be directly stomatotoxic to replicating oral mucosa. Once mucosal integrity is affected, secondary acute infection can occur. Even without clinical ulceration, deleterious shifts in the oral microbial population can develop. Gram-negative bacilli have been identified as frequent colonizers of myelosuppressed patients, although coagulase-negative staphylococci are being recovered with increasing frequency. Strategies to prevent oral mucosal infection include reducing trauma and preventing proliferation of organisms. Dental pulpal infection is most commonly caused by extensive dental caries. Most pulpal infection is of bacterial origin and can progress to involve the periapical tissues of the involved tooth if not treated. Specific endodontic interventions will usually stabilize or eliminate the source of the infection until the patient's hematologic status returns to normal and definitive pulpal therapy can be provided. In part because acute pulpal complications in the myelosuppressed cancer patient are relatively infrequent, research on the causative organisms and the appropriate therapy of acute, systemic infection of pulpal origin has been limited. Many adults have chronic, asymptomatic periodontal disease. In its advanced stages, extensive ulceration may be present that is not clinically observable. In patients with reduced host defenses, exacerbation of preexistent periodontal disease can have systemic sequelae and is associated with elevated levels of periodontopathic organisms or pathogens typically associated with systemic infection in myelosuppressed cancer patients. Mechanical and chemical antimicrobial techniques are available to reduce prevalence and improve patient comfort and oral hygiene. Dental extractions may be indicated to eliminate the nidus of infection of either pulpal or periodontal origin in patients who are scheduled to receive myelosuppressive chemotherapy. Data indicate that such procedures may be performed without undue risk. Unlike patients who undergo bone marrow transplantation or radiotherapy, patients who receive chemotherapy do not commonly experience subjective salivary gland dysfunction. Occasionally, a transient xerostomia may occur; this condition is frequently attributed to the patient's oral habits, such as breathing through the mouth. The dessicating effect of breathing through the mouth can contribute to oral mucosal injury during function as well as provide a setting for acute infection of commensal origin. More research is needed on the effects of chemotherapy on salivary host defenses.
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