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Biomedical subjects

G Slutkin

Publications and source records attributed to G Slutkin.

At least 19 recordsLinked to original sources
PubMed1994

Risking everything? Risk behavior, behavior change, and AIDS.

Inquiry into the determinants of risk-related sexual behavior is important for the development of interventions to reduce the incidence of new cases of human immunodeficiency virus infection. Recent social and behavioral research has revealed much about the individual and social factors influencing risk-taking. Findings from these studies have been important in the development of new educational and community-based interventions for communities at risk in the developed and developing worlds.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The validity of acid-fast smears in the diagnosis of pulmonary tuberculosis.

The acid-fast smear remains an important tool in the diagnosis of tuberculosis. Some reports have questioned the validity of this stain in situations of low prevalence. We examined the relationship between prevalence and predictive value of sputum smears in one laboratory during periods of both low and high laboratory prevalence of Mycobacterium tuberculosis. Smears were examined by fluorescence and confirmed by Kinyoun stain. The number of samples positive for mycobacteria increased from 128 (4.3%) of 2956 during the 1975 through 1978 study period to 197 (8.4%) of 2347 during the 1979 through 1982 study period. Of 47 positive smears during the first study period, only one was a false-positive. None of 96 positive smears during the second period was a false-positive. The positive predictive value of acid-fast microscopy was 97.9% and 100% for the two periods examined. We have demonstrated in practice the small effect of a shift in prevalence on the positive predictive value of an acid-fast smear when specificity is maintained.

Humans↗
PubMed1989

Tuberculosis and human immunodeficiency virus infection.

Progressive human immunodeficiency virus infection eventually leads to activation and dissemination of a wide variety of microorganisms normally held in check by the cellular immune system. Mycobacterium tuberculosis is one of these pathogens, and the disease caused by it has become a common presenting infection in the patient with AIDS. Dr. Richard E. Chaisson and Dr. Gary Slutkin have studied tuberculosis in the United States and worldwide, respectively. In this AIDS Commentary they address the unique nature of this infection, its diagnosis, and its treatment in the patient with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings.

We analyzed the outcome of therapy for 139 patients who were treated for a presumptive diagnosis of pulmonary tuberculosis based on radiographic abnormalities. Patients who had acid-fast bacilli seen on sputum smears and patients who had received adequate therapy for tuberculosis in the past were excluded from the analysis. Accuracy of the diagnosis was determined by comparison of clinical and radiographic findings after 3 months of isoniazid, rifampin, and ethambutol, as well as the results of sputum cultures. Of 139 patients started on therapy presumptively, 66 (48%) were determined to have current tuberculosis (16 had positive cultures, 43 because of improvement in their chest films, and 7 because of clinical improvement). Adverse reactions requiring change of therapy occurred in six of 72 (8.3%) patients determined to have inactive tuberculosis. One patient had both tuberculosis and carcinoma found at bronchoscopy after 3 months of therapy. For purposes of comparison, chest radiographs of 59 patients documented by culture to have current tuberculosis were reviewed. Of these, 45 (70%) were improved at 3 months. Presumptive therapy is of benefit in that it stops progression of the disease at an early stage and decreases the potential for spread of tuberculous infection. In addition, such therapy coupled with systematic reevaluation of patients substantiates the diagnosis or indicates that further evaluation is needed. These benefits must be weighed against the adverse reactions and costs of overtreating patients with inactive disease. Determining the appropriateness of presumptive therapy must be based on local factors including prevalence of tuberculosis and available resources.

Antitubercular Agents↗
PubMed1988

Evaluation of a third sequential tuberculin skin test in a chronic care population.

To evaluate factors that might influence the accuracy of tuberculin tests in identifying elderly persons recently infected with Mycobacterium tuberculosis, we performed as many as 3 sequential administrations of 5 tuberculin units of purified protein derivative in 1,726 persons residing in chronic care facilities. Significant reactions (greater than or equal to 10 mm of induration) to 1 of 3 tests were found in 702 (40.7%) persons. Of these, 68% were found with Test 1, 22.5% with Test 2, and 9.5% with Test 3. Of 1,146 persons with nonsignificant reactions to Test 1, 13.8% had significant reactions on Test 2, and of 769 persons with nonsignificant reactions to Tests 1 and 2, 8.7% had significant reactions on Test 3. Males, nonwhites, and persons between 50 and 79 yr of age had a greater proportion of significant reactions for each of the first 2 tests but not for the third test. These data indicate that continued boosting of the tuberculin reaction occurs in a substantial number of persons who receive a third sequential test. Marked increases in the size of reactions caused by boosting may explain high apparent conversion rates found in facilities where the third test is delayed for one year.

Adolescent↗
PubMed1988

Conversion and reversion of tuberculin reactions in nursing home residents.

To assess the consistency of tuberculin reactions over time, we performed tuberculin tests in a cohort of 495 nursing home residents in both 1982 and 1985. Significant reactions (greater than or equal to 10 mm of induration to 5 TU PPD) were found in 258 (52.1%) and 209 (42.2%) residents in 1982 and 1985, respectively. Males, nonwhites, and persons younger than 80 yr of age had a greater proportion of significant reactions (all, p less than 0.01). Of the 237 persons with nonsignificant reactions in 1982, 15 (6.3%) had a significant reaction in 1985. None of the 15 converters was found to have current tuberculosis. Tuberculin reversions occurred in 64 (24.8%) of 258 persons who had significant reactions in 1982. Of the patients who had a significant reaction only after boosting in 1982, 16 of 21 (76.2%) had nonsignificant reactions with up to 3 tests in 1985. Tuberculin reactions in nursing home residents may vary over time and may not be recalled by boosting, boosted reactions may be transient, and apparent conversions may be due to an extension of the booster phenomenon.

Age Factors↗
PubMed1988

The results of 9-month isoniazid-rifampin therapy for pulmonary tuberculosis under program conditions in San Francisco.

The outcome of treatment for pulmonary tuberculosis using isoniazid and rifampin for 9 months supplemented by ethambutol for the initial 2 months was evaluated in a cohort of 233 patients. All patients had sputum cultures positive for Mycobacterium tuberculosis sensitive to isoniazid and rifampin. Of the 233 patients, 200 completed the regimen without change. Four patients had adverse reactions necessitating discontinuation and four became pregnant and had ethambutol substituted for rifampin. All eight were treated successfully with altered regimens. Ten patients were lost to follow-up, seven died, and eight were transferred to other jurisdictions. No patients failed to convert their sputum during therapy. At completion of therapy, three patients (1.5%) were found to have positive sputum. Follow-up 6 months after completion of treatment in 174 successfully treated patients revealed four (2.3%) with positive sputum. No further relapses were detected on evaluation 12 months after treatment was completed. All seven patients who failed therapy or relapsed were retreated successfully using the same regimen. These data provide a reference standard against which newer treatment regimens, such as the 6-month regimen currently in use, can be compared. In addition, the value of routine evaluations in detecting relapses at the time treatment is completed and 6 months later was substantiated, but 12-month follow-up was not useful.

Adolescent↗
PubMed1986

Identification of Mycobacterium tuberculosis antigens in Seibert fractions by immunoblotting.

Seibert fractions prepared from Mycobacterium tuberculosis culture filtrates were evaluated by immunoblotting with a serum pool from patients with active pulmonary tuberculosis. Antibody activity was observed primarily with antigens in the polysaccharide II and A protein fractions; these fractions were further evaluated by immunoblotting with sera from individual patients with tuberculosis, from individuals without tuberculosis and positive for the purified protein derivative antigen skin test, and from individuals negative for the purified protein derivative antigen skin test. The antigens identified in the protein A fraction, a 32,000-molecular-weight antigen and a heterogeneous high-molecular-weight antigen, reacted with antibody found in sera from all patients with tuberculosis and with antibody from over 25% of the control individuals. A 10,000-molecular-weight antigen, a 30,000- to 44,000-molecular-weight antigen, and a heterogeneous high-molecular-weight antigen were observed in the polysaccharide II fraction; these antigens reacted with serum antibody from 70% or more of the patients with tuberculosis and with antibody from 20 to 70% of the control individuals. One of the antigens, with a molecular weight ranging from 17,000 to 28,000 in the polysaccharide II fraction, reacted with antibody in 64% of the sera from patients with tuberculosis but with only 1 of 15 control normal sera. This antigen may elicit an antibody response specifically associated with tuberculosis.

Antigens, Bacterial↗
PubMed1986

Time course and boosting of tuberculin reactions in nursing home residents.

To determine the optimal strategy for tuberculin testing in elderly persons, we examined two aspects of the test: (1) the concordance between tuberculin skin test readings 2 and 7 days after application, and (2) the frequency of boosting of nonsignificant reactions. Four hundred eleven nursing home residents (mean age 74.5 yr) were tested. Significant reactions (greater than or equal to 10 mm of induration to 5TU PPD) were found in 133 (32%) subjects on day 2. Men, nonwhites, and persons younger than 75 yr of age had an increased proportion of significant reactions (p less than 0.01). Tuberculin reactivity steadily declined in persons between 75 and 90 yr of age but was increased among persons age 90 to 101 yr of age. Of 380 subjects with readings on both day 2 and day 7, 96 (25%) had significant reactions on both, 23 (6%) had indurations greater than or equal to 10 mm on day 2 only, and 20 (5%) had indurations greater than or equal to 10 mm on day 7 only. Repeat testing found an additional 14 subjects whose reactions increased from less than 10 mm to greater than or equal to 10 mm (booster effect). This evaluation indicates that the most sensitive and efficient strategy for tuberculin testing consists of a single reading at day 7 followed by a second test with a reading in 48 h for persons with reactions less than 10 mm.

Aged↗
PubMed1986

Tuberculin reactivity in United States and foreign-born Latinos: results of a community-based screening program.

Because of the concern that we were underestimating the prevalence of tuberculosis within the Latino community in San Francisco, we undertook a community-based screening program directed largely towards recent immigrants. Of 1,871 intermediate-strength (5 TU) tuberculin tests applied and read, 37 per cent of the reactions were greater than or equal to 10 mm. Significant reactions were found in 53 per cent of foreign-born persons compared to 7 per cent of those born in the United States. Persons older than 20 years of age were more likely to have significant reactions compared to younger Latinos. Among the foreign-born, the frequency of significant reactions was not influenced by the length of stay in the US or a history of BCG (bacille Calmette-Guérain) vaccination. Two foreign-born children were found to have current tuberculosis. The prevalence of tuberculin reactors among US-born Latino children was 3 per cent, which suggests that undetected transmission of tuberculosis may be occurring. We conclude that Latino immigrants should be systematically screened for tuberculosis.

Adolescent↗
PubMed1986

The benefits of evaluating close associates of child tuberculin reactors from a high prevalence group.

To determine the efficacy of evaluating persons (associates) in close contact to children with significant tuberculin reactions, we prospectively evaluated 831 associates of 297 children younger than eight years who had significant (greater than or equal to 10 mm) tuberculin reactions. Eighty-seven per cent of the index reactors were foreign-born, as were 84 per cent of the associates. All associates were evaluated by tuberculin skin testing; chest roentgenograms and sputum cultures were obtained if indicated. Four hundred sixty-one (55 per cent) of the associates had significant tuberculin reactions, and 15 had current tuberculosis. However, only three of these cases were newly discovered (total case rate: 1.81/100, new case rate: 0.36/100). Two of the three new cases were detected in the associates of children younger than three years of age. In addition, 338 candidates for isoniazid (INH) preventive therapy were found. We conclude that although the yield of new cases was low, the evaluation of associates did provide a convenient, high yield method of identifying candidates for INH preventive therapy. Moreover, it served as a useful mechanism for monitoring the adequacy of other case-finding activities.

Adolescent↗