Pseudomonas cepacia: an emerging pathogen in chronic granulomatous disease.
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Adolescent↗
Biomedical subjects
J F Modlin
Publications and source records attributed to J F Modlin.
Serial cardiac function tests in myocarditis.
Sixteen patients (mean age 27 years, range 16 to 39 years) with the diagnosis of myopericarditis established by strict clinical criteria were evaluated following recovery 0.7 to 4.0 years (mean 2.7 years) later. Evidence of an acute viral infection was present in 44%. During the acute illness, the major clinical manifestations consisted of pericarditis in 10 patients, acute myocardial infarction in 5, right ventricular dysfunction in 5, bundle branch or hemiblock in 4, ventricular arrhythmias in 3, congestive heart failure in 3 and cardiogenic shock and inappropriate sinus tachycardia in one patient each. Holter monitoring, echophonocardiography and radionuclide ventriculography results were abnormal in 57, 67 and 64% of patients respectively. At follow-up, these tests were abnormal in 67, 7 and 73%. Focal wall motion abnormalities were present in five. Seventy-five percent of patients had one or more abnormal tests at last follow-up. Although 8 patients had improved by a scoring system, 5 patients had an increase in the number of abnormal tests, including one who died. These findings indicate that persistent abnormalities following recovery from myopericarditis are not rare and support the hypothesis that the syndrome of dilated cardiomyopathy may be a sequel of myopericarditis.
Acute Disease↗
A controlled comparison of joint reactions among women receiving one of two rubella vaccines.
While transient rheumatic side-effects are not uncommon in women receiving any of the attenuated rubella virus vaccines yet developed, few comparative data are available on the only rubella vaccine currently available in the United States - the RA 27/3 vaccine. In this study, the frequency and severity of joint reactions were compared among seronegative women receiving HPV77DE5 vaccine (n = 59) or RA 27/3 vaccine (n = 53), and in seropositive vaccinees receiving either vaccine (n = 60). The proportions of vaccinees developing arthralgia/arthritis were similar (29 per cent and 26 per cent, respectively) in the seronegative groups, and were significantly higher than in the seropositive control group (3%). The onset of symptoms was earlier and their duration was briefer in those receiving RA 27/3 vaccine compared to the HPV77DE5 vaccine recipients. No chronic or recurrent symptoms were observed. These data, along with previous studies, suggest that while transient rheumatic reactions following rubella vaccination are not uncommon, they are not associated with serious disability and should not interfere with ongoing immunization programs.
Adult↗
Coxsackievirus B infection in pregnant mice and transplacental infection of the fetus.
Direct instillation of coxsackievirus B1 into the gastrointestinal tracts of albino mice caused viremia in more than 85% of the animals within 1 day. In pregnant mice infected early in gestation (7 days), the geometric mean titer of virus in the blood was lower (P = 0.02) and the duration of viremia was shorter (P = 0.07) than in nonpregnant female mice, but infection of the heart, liver, and uterus did not differ on each of 5 days after infection. Although transplacental infection of the placenta or fetus or both occurred, the high spontaneous abortion rate (48%) obviated comparison of transplacental infection in these mice with mice infected later in gestation. Pregnant mice infected in the third trimester had significantly greater geometric mean titers of virus in the blood, heart, liver, and uterus, and infection persisted longer than in nonpregnant mice (P = 0.04). A very high geometric mean titer of virus was recovered from the uteri of these mice for 3 days after infection, whereas simultaneous geometric mean titers of virus in the placentas and fetuses were lower. In the majority of third trimester pregnant mice, virus was found in low titers in the fetuses at 2 and 3 days after maternal infection, and virus was not detected after day 3. We conclude that coxsackievirus B1 infection in late gestational pregnant mice is more severe than in mice at earlier gestational stages and in nonpregnant mice and that transplacental infection of the fetus occurs transiently during maternal infection. This model will prove useful in the study of perinatal enterovirus infection and in examination of the numerous factors that may influence outcome of infection of perinatally infected newborn infants.
Animals↗
Epidemiology of subacute sclerosing panencephalitis.
The Subacute Sclerosing Panencephalitis Registry has compiled data from 453 instances of SSPE occurring in the United States from 1960 through 1976. The mean annual incidence during this period was 3.5 per 10 million persons under 20 years of age, 2.3 times higher for males than females, and 4.0 times higher for whites than blacks. Although the long-term pattern of incidence is unknown, the incidence of reported SSPE declined dramatically from 1970 to 1976. There are marked geographic variations of SSPE activity within the United States and also a higher incidence for children from farms (9.4 per 10 million persons under 20) compared with children from other rural domiciles (3.7 per 10 million), suburban children (2.9 per 10 million), and inner-city children (1.6 per 10 million). Available epidemiologic evidence suggests that some extrinsic factor, unrelated to measles or measles vaccine, is important in the pathogenesis of the disease.
Adolescent↗
From the Center for Disease control: current status of measles in the United States, 1973--1977.
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Age Factors↗
Clinical trials of bivalent A/New Jersey/76-A/Victoria/75 influenza vaccines in high-risk children.
Various doses of two whole-virus and one split-product bivalent influenza A/New Jersey/76-A/Victoria/75 vaccines were administered to 253 children aged six to 18 years. There were no statistically significant differences in either reactivity or humoral antibody response among the 167 children in seven chronic disease categories and 86 healthy children. The whole-virus vaccines were associated with unacceptably high rates of reaction when given in sufficiently antigenic initial doses but were relatively nonreactive when used for booster immunization. Split-product vaccines were no more reactive than placebo. All vaccine preparations induced adequate seroconversion rates and protective titers of antibody to A/Victoria virus after one dose and to A/New Jersey virus after two doses.
Adolescent↗
Response of children with cardiac disease to the bivalent influenza A vaccines.
During the recent nationwide trials of influenza vaccine, 121 children with cardiac disease, aged three to 18 years, were evaluated with respect to their immune response and reaction rate after administration of a whole-virus or split-virus bivalent influenza A/New Jersey/76-A/Victoria/75 vaccine given as a single dose or two divided doses. The serologic response of the cardiac children did not differ significantly from that of the total group of high-risk children or normal children who recived the same vaccine. The major reaction to the vaccines was fever, which occurred in one-fourth to one-half of children receiving the whole-virus vaccines. The split-virus vaccines were generally well tolerated. The reaction index of the cardiac children was slightly lower than that of the normal children receiving the same vaccine during the single-dose trial but higher during the two-dose trial. The second dose was generally better tolerated than the first dose. Reactions in the children with cardiac disease could not be adequately evaluated according to specific diagnoses or functional disabilities.
Adolescent↗
Multicenter two-dose trials of bivalent influenza A vaccines in asthmatic children aged six to 18 years.
Data from all of the vaccination centers that immunized asthmatic children six to 18 years old with bivalent influenza A/New Jersey/76 and A/Victoria/75 vaccines were analyzed. Systemic reaction indexes were somewhat higher in asthmatic children receiving the first dose of whole-virus vaccines than in similar vaccinees without asthma. Antibody levels after immunization, while different in some instances, did not show any significant trends toward either hypo- or hyperresponsiveness in the asthmatic children.
Adolescent↗
Current status of rubella in the United States, 1969-1975.
Implementation of the rubella immunization policy in the United States has resulted in marked decreases in the number of reported cases of both rubella and CRS. Emphasis on immunization of one- to 12-year-old children has resulted in a dramatic reduction in reported rubella in this age group. Accordingly, the proportion of reported cases occurring in adolescents and young adults has increased. Therefore, it seems appropriate to place more emphasis on immunizing susceptible adolescent and adult females as an adjunct to routine immunization in early childhood. This joint strategy should result in a further decrease in the incidence of rubella and CRS.
Adolescent↗
Epidemiologic studies of measles, measles vaccine, and subacute sclerosing panencephalitis.
Histories obtained in 350 of 375 clinically cofirmed cases of subacute sclerosing panencephalitis (SSPE) reported to a national registry showed that 292 patients had measles and 58 had no history of measles. Forty of the latter patients received live, attenuated measles virus vaccine. In patients with a history of measles, measles illness occurred before age 2 years in 46%, and a mean of 7.0 years before onset of SSPE. In contrast, there was no relationship of SSPE with age at vaccination in 35 of the 40 patients historically associated with measles vaccine, and SSPE occurred a mean of 3.3 years after vaccination. Based on estimated national measles morbidity data and national measles vaccine distribution data, the risk of SSPE following measles vaccination (0.5 to 1.1 cases/106) appears to be less than the risk following measles (5.2 to 9.7 cases/106). Because live measles vaccine is highly effective in preventing measles illness and a high proportion of children in the United States have received measles vaccine, these data are consistent with the observed downward trend in SSPE incidence since 1969.
Adolescent↗
Risk of congenital abnormality after inadvertent rubella vaccination of pregnant women.
The risk to a fetus after rubella vaccination of its mother is unknown. The Center for Disease Control has compiled information from the pregnancies of 343 women inadvertently given rubella vaccine shortly before or after conception. The pregnancies of 145 women were terminated by therapeutic abortion, and rubella vaccine virus was recovered from the products of conception of nine women, including six of the 28 known to be seronegative to rubella at the time of vaccination. None of the 172 infants carried to term had either clinical or serologic evidence of rubella infection, including 38 infants of women known to be susceptible and 12 additional women estimated to be susceptible at the time of rubella vaccination. On the basis of the binomial distribution, the maximum risk of fetal infection after maternal rubella vaccination is between 5 and 10 per cent. The actual risk is probably less.
Abortion, Therapeutic↗
Serologic response to revaccination with two rubella vaccines.
Three years after receiving rubella vaccine, 1,060 elementary school children living on the island of Maui, Hawaii, were revaccinated with either HPV-77 DE-5 or RA 27/3 rubella vaccine given subcutaneously or intranasally in order to compare the effectiveness of these two vaccines in raising antibody titers. RA 27/3 was the more effective booster vaccine, producing fourfold or greater titer rises in 20.1% of recipients, including 80% of children with hemagglutination-inhibiting antibody titers less than or equal to 1:40 at the time of revaccination, intranasal revaccination was not significantly more effective than subcutaneous revaccination, although it did elicit higher titers in children who responded. Responses differed according to the vaccine that children had received three years earlier. Because antibody titers have persisted in vaccinated children, routine administration of a second dose of rubella vaccine is not currently recommended.
Administration, Intranasal↗
A review of five years' experience with rubella vaccine in the United States.
National morbidity figures show a decline in reported rubella and congenital rubella syndrome since 1969, concurrent with widespread use of rubella vaccine. In addition, no nationwide outbreak, such as the 1963-1964 epidemic, has occurred, though on the basis of long-term secular trends, one would be expected between 1970 and 1974. Recent rubella outbreaks have occurred in unimmunized students in high schools and universities, and there appears to have been a slight upward shift in the age-specific incidence of rubella in the United States since the beginning of widespread immunization. Currently available vaccines have provided durable protection to date, and, although reinfection is known to occur following vaccination, it has not proven a risk to the pregnant woman. There is a small but significant incidence of adverse reactions and a potential risk to the woman who is vaccinated during pregnancy. These data indicate that rubella vaccines are safe and effective. They also imply that rubella vaccines, as they are currently applied, have been successful in reducing the morbidity of congenital rubella syndrome, although continued surveillance will be necessary to confirm this trend.
Abortion, Spontaneous↗
Surveillance of the congenital rubella syndrome, 1969-1973.
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Age Factors↗
Subacute sclerosing panencephalitis.
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Child, Preschool↗
Mediastinitis after cardiovascular surgery.
Postoperative mediastinitis complicated 21 (3.4%) of 616 median sternotomy procedures at Beth Israel Hospital (Boston, Mass.) between 1975 and 1979. These cases were analyzed by means of a case control study to identify host and operative risk factors and to characterize the clinical features of mediastinitis. Eighteen patients with mediastinitis (86%) had serious underlying noncardiac diseases, as compared with 14 (33%) of 42 noninfected controls (P = .001). Reoperation was positively associated with infection (P = .03). All patients had abnormal sternal wounds and fever; sternal instability and mediastinal widening were unusual. Twelve patients (57%) were bacteremic. Twenty-four organisms were recovered from the 21 patients with mediastinitis; 13 of the isolates were gram-positive, and 11 were gram-negative. Infections due to gram-negative bacteria appeared earlier and were more likely to be bacteremic (70%). All gram-negative isolates and five of six isolates of Staphylococcus epidermidis were resistant to the antimicrobial agent used perioperatively. Patients were treated with extensive debridement and appropriate antibiotics. The mortality rate was 24% (five of 21). Long-term complications in survivors were not seen.
Cardiac Surgical Procedures↗