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Biomedical subjects

P H Rothbarth

Publications and source records attributed to P H Rothbarth.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Hepatitis B in children in 4 university centers in The Netherlands].

OBJECTIVE: To evaluate the prevalence and the natural course of hepatitis B infection in children. DESIGN: Retrospective longitudinal. SETTING: Four university pediatric centres. METHOD: To explore the possibility of starting a trial with interferon alpha, data of viral and biochemical tests and biopsies of children younger than 16 years were studied. RESULTS: In a period of 10 years (1980-1990) 145 patients, of whom 74% were not of original Dutch descent, were found positive for HBsAg. The data of 142 patients could be analysed. Seroconversion was seen in 27 patients and 42 were already anti-HBe positive at the time of presentation. Chronic hepatitis, representing the category which could benefit from interferon alpha treatment, was found in 24 patients. Severe complications of the hepatitis were found in 4% of the children, including hepatocellular carcinoma and cirrhosis. Follow-up was insufficient so the seroconversion rate could only be estimated at 12% for the first year following the diagnosis. CONCLUSION: As a result of this study the authors present a proposal for a therapeutic trial with interferon alpha. This is a national protocol under the auspices of the section for pediatric gastroenterology of the Nederlandse Vereniging voor Kindergeneeskunde (Netherlands Pediatric Association).

Adolescent↗
PubMed1993

The significance of complete serological testing for hepatitis B in heart valve banking.

Allograft heart valves obtained from donor hearts have been cryopreserved in the Heart Valve Bank in Rotterdam for transplantation purposes. In contrast to hepatitis B screening of organ donors, which consists of only a rapid HBV surface antigen (HBsAg) assay, tissue donors can be screened more completely for hepatitis B virus (HBV) by HBsAg and antibodies against HBV core antigen (anti-HBc) tests, and when necessary, anti-HBs and HBV-DNA tests. The value of this complete HBV screening was investigated by evaluation of the HBV screening results of 676 donor sera. HBsAg was positive in 1 serum. Anti-HBc was positive in 63 sera, of which 52 also had positive antibodies against HBV surface antigen (anti-HBs) tests (no risk of transmission) and 10 had negative anti-HBs tests. In 3 cases with a negative anti-HBs test the HBV-DNA test was positive (risk of transmission). In 3 cases not enough serum was available to perform all tests, resulting in a total of 7 rejected donors. Single HBsAg testing would have resulted in the rejection of only 1 donor. In the presented group of selected donors, approximately 0.5% of the HBsAg-negative donors were lower-level chronic carriers of hepatitis B. Complete HBV screening decreases the risk of transmission of hepatitis B in allograft heart valve transplantation.

DNA, Viral↗
PubMed1993

Prospective application of reverse transcriptase polymerase chain reaction for diagnosing influenza infections in respiratory samples from a children's hospital.

A prospective clinical evaluation of the reverse transcriptase polymerase chain reaction (RNA PCR) for detection of influenza viruses was carried out with specimens from 342 patients of a children's hospital in The Netherlands. The RNA PCR, carried out directly on the specimens without an organic extraction, showed a sensitivity and specificity which are superior to those of direct immunofluorescence and comparable to those of cell culture combined with immunofluorescence (culture/IF). Negative results can be obtained within 2 days by the RNA PCR but may take up to 14 days by culture/IF. Because culturing is the standard technique for the detection of respiratory viruses, at this moment there are no strong arguments to replace culture/IF with RNA PCR for the detection of influenza A virus.

Base Sequence↗
PubMed1991

[Non-Hodgkin lymphoma in patients with an HIV-infection].

In the period 1985-1990, 111 patients with AIDS were treated in the University Hospital Rotterdam-Dijkzigt. In 8 out of 111 patients malignant non-Hodgkin lymphoma developed. The unusual and bizarre representation is highlighted by several clinical histories and a review of literature. HIV-related non-Hodgkin lymphoma is characterized by widespread extranodal disease, often at unusual sites, and high grade B-cell malignancy. The therapeutic outcome and survival in these cases has been disappointing. Prognosis is better for patients without a prior AIDS diagnosis, higher total CD4 cell counts, good performance score and absence of an extranodal site of disease. Treatment should be tailored to individual patients based upon a variety of prognostic features.

Adult↗
PubMed1991

Reliability of two new test kits for rapid diagnosis of respiratory syncytial virus infection.

Two new rapid enzyme immunoassays (EIAs) for detecting respiratory syncytial virus (RSV), Directigen (Becton Dickinson Microbiology Systems) and TestPack (Abbott Diagnostics) were compared with virus isolation and direct immunofluorescence by using fresh specimens. The sensitivities of both EIAs were low (72 to 73%), but when initial specimens were used, TestPack had a high sensitivity (92%) in contrast to that of Directigen (76%). Because of its high sensitivity and specificity, TestPack can be used for diagnosis of RSV in acute disease.

Culture Techniques↗
PubMed1990

Congenital mumps pneumonia: a rare cause of neonatal respiratory distress.

A case of a fullterm infant with severe neonatal respiratory distress due to mumps infection is reported. Pregnancy was complicated by a self-limited febrile illness of the mother about two weeks before birth. Foetal heart rate patterns and delivery were normal. Immediately after birth the infant needed mechanical ventilation. Bacterial infections, as well as congenital cardiac or pulmonary malformations were excluded. The infant showed serologic evidence of mumps infection: IgM antibodies to mumps virus were highly positive. He expired on the 9th day of life due to bilateral pneumothoraces and pneumopericardium. Post-mortem examination showed interstitial pneumonia with intra-alveolar multinucleated giant cells, suggesting viral disease. This case demonstrates, that mumps pneumonia should be included in the differential diagnosis of severe neonatal respiratory distress in fullterm neonates.

Female↗
PubMed1990

Cytomegalovirus seronegative heart transplant recipients. Prophylactic use of anti-CMV immunoglobulin.

Thirty-two CMV seronegative heart transplant patients received prophylactic anti-CMV immunoglobulin during the first three posttransplant months. One of the 16 recipients of a heart from a seronegative donor acquired CMV infection and developed CMV disease. In eight of the 16 recipients of a heart from a seropositive donor, CMV infection was observed. Viremia was diagnosed in seven of them, but only two of these patients developed CMV disease. The incidence of CMV infection and of CMV disease in the globulin-treated CMV seronegative recipients of a heart from a seropositive donor was comparable to the incidence of CMV infection and of CMV disease in 31 nonglobulin-treated CMV seropositive recipients. This was significantly lower (percentage difference 69 percent, 95 percent CI 42-97 percent, p less than 0.001) than expected on the basis of the data from the literature and indicates that passive immunization with anti-CMV immunoglobulins induces the same protection against CMV disease as natural acquired anti-CMV resistance. This protective effect was temporary, as one patient developed symptomatic CMV infection four months after transplantation at a time when the anti-CMV immunoglobulin levels had decreased to pretransplantation values.

Cytomegalovirus↗
PubMed1990

[Congenital cytomegalovirus infection].

Until recently, prevention and treatment of congenital cytomegalovirus infection was not possible. However, several studies on the epidemiology of congenital CMV infection and the development of vaccines, diagnostic tests and antiviral drugs such as ganciclovir may improve the perspectives for patients with congenital CMV disease. In this article we will discuss several of those developments that may offer new approaches for prevention and treatment of congenital CMV disease.

Cytomegalovirus↗
PubMed1990

[Hepatitis B in children].

Central to immunization programmes is that hepatitis B virus infection in infancy is much more likely to result in the chronic carrier state than if infection occurs in adulthood. In areas of high endemicity like south-eastern Asia most infections occur when chronically infected women transmit hepatitis B virus to their newborns or when chronically infected children transmit the virus to other children. In the Netherlands, the endemicity is considered low; seroprevalence studies showed that 0.8% of the pregnant women are HBsAg-positive. To prevent mother to child transmission of hepatitis B a national immunization program has recently been implemented to prevent perinatal infection in approximately 450 neonates each year. Horizontal transmission of hepatitis B virus also seems possible in children since persistent carriers are found in (medical) centres and institutions for mentally handicapped. Since hepatitis B infections acquired during early childhood are likely to progress to chronicity and liver disease in adult life some risk factors for children in the Netherlands to contract hepatitis B infection are described and the immunization strategy is discussed.

Child↗
PubMed1990

[HIV infections in childhood].

After the presentation of 3 case histories of children who became infected with HIV through different modes of transmission the disease is further discussed. Special attention is paid on epidemiology, transmission pathways, pathophysiology, making the diagnosis, clinical symptoms, therapy and prognosis of HIV infected children.

Adolescent↗
PubMed1990

Acute ulcerative proctocolitis associated with primary cytomegalovirus infection.

The case is reported of a 39-year-old pregnant woman who presented with fever, abdominal complaints, and diarrhea. Laboratory investigation revealed mononucleosis in the peripheral blood. All microbiological studies were negative, with the exception of finding cytomegalovirus (CMV). Seroconversion was documented; the virus was cultured from urine and subsequently was demonstrated to be present in the inflamed mucosa of the rectum and distal sigmoid, which was found at sigmoidoscopy. This woman was delivered of a neonate with congenital CMV infection but without apparent malformations. The patient experienced recurrences of the bowel disease, in the first of which CMV could still be cultured from a biopsy specimen. In the follow-up period, an otherwise aspecific chronic inflammatory bowel disease remained present. No immunological abnormalities were found, and antibodies to human immunodeficiency virus were negative. This case demonstrates that inflammatory bowel disease can develop as a result of primary infection with CMV.

Acute Disease↗
PubMed1990

Selection of asymptomatic HIV carriers for antiviral therapy.

In order to find suitable markers for selection and monitoring of antiviral therapy in asymptomatic HIV-infected patients, we evaluated 18 anti-HIV positive individuals at three monthly intervals by HIV culture, HIV antigen, and core (p24) antibody testing as well as by measurement of lymphocyte subsets. Consistent results were obtained with HIV antigen, p24 antibody testing and T4 cell enumeration, whereas results of virus detection were variable. Therefore cumbersome and expensive virus culture is not of use in selecting patients for antiviral therapy. On the basis of our results and recent literature we currently propose using absence of p24 antibodies, presence of HIV antigen and low or falling T4 cells as eligibility criteria for antiviral therapy in asymptomatic infected individuals.

Antiviral Agents↗
PubMed1989

[An infant with AIDS].

A four-month-old girl was hospitalized with pneumococcal sepsis from which she recovered. Subsequently she developed various other infectious diseases, including chronic diarrhoea caused by Cryptosporidium. After a period with neurological symptoms, later sagittal sinus thrombosis and cerebral atrophy, she died at age 13 months. It was found that the child suffered from AIDS. The mother was seropositive and the virus had probably been transmitted via the placenta. Rapid recognition of infants and young children with AIDS is necessary, for in the near future more cases of this disease will occur. Antiviral treatment may bring about improvement in children as well.

Acquired Immunodeficiency Syndrome↗
PubMed1989

An improved immunocytochemical method for the detection of human cytomegalovirus antigens in peripheral blood leucocytes.

A recently described immunoperoxidase method for the detection of nuclear human cytomegalovirus (HCMV) immediate early antigen (IEA) directly on peripheral blood leucocytes suffers from the drawback that the antigen is vulnerable to endogenous peroxidase inactivation procedures. To solve this problem a procedure is developed in which endogenous peroxidase is inactivated after binding and immobilization of the primary antibody with 4% formaldehyde. In combination with this procedure, three types of inactivation were investigated: glucose/glucose oxidase, hydrochloric acid and methanol/H2O2. Of these three, the first gives optimal results, especially in combination with methanol/acetic acid (20/1 v/v) as the primary fixative. This procedure results in preparations which allow for a more objective evaluation and enable automated examination using bright field microscopy. As a second improvement we developed a simple adherence method in order to diminish the risk of infection for the laboratory staff during processing of unknown blood samples. The protocol described shows great clinical potential for the diagnosis of HCMV infections.

Antigens, Viral↗
PubMed1989

Prevention of cytomegalovirus-related death by passive immunization. A double-blind placebo-controlled study in kidney transplant recipients treated for rejection.

In a double-blind placebo-controlled study, the value of prophylactic anti-CMV immunoglobulin administration was evaluated in 39 kidney transplant recipients treated for rejection with rabbit antithymocyte globulin. Passive immunization completely prevented CMV-related death, although it did not reduce the incidence of CMV isolation, viremia, or disease. The effect of passive immunization was exclusively observed in CMV-seronegative recipients of a CMV-seropositive kidney donor. It could be demonstrated even when instituted when antirejection therapy was started. Seropositive recipients did not benefit from immunoglobulin treatment. Moreover, CMV-seronegative recipients of a kidney from a seronegative donor were not at risk for CMV infection at all. Therefore passive immunization should be restricted to seronegative recipients of seropositive allograft donors treated for rejection.

Antibodies, Viral↗