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Biomedical subjects

R C Brunham

Publications and source records attributed to R C Brunham.

143 records · Page 8Linked to original sources
PubMed1982

Therapy of cervical chlamydial infection.

The treatment of cervical Chlamydia trachomatis infection in nonpregnant women was evaluated in a double-blind randomized study. Objective criteria were used to assess the response of cervicitis to therapy. Fifty patients were treated with tetracycline hydrochloride, 500 mg orally four times daily, and 50 patients were treated with rosaramicin, 250 mg orally four times daily, both for 7 days. Both agents were highly effective in eradicating C trachomatis. Both produced significant improvement in objective signs of cervicitis: eliminating mucopurulent endocervical discharge and edema of ectopy, and decreasing the clinical severity score of cervicitis. This trial shows that the 1-week course of tetracycline hydrochloride currently recommended for treatment of chlamydial urethritis in men is also highly effective for the treatment of chlamydial cervical infection in women. Rosaramicin, a macrolide antibiotic, was equally effective but produced a higher rate of gastrointestinal side effects.

Chlamydia Infections↗
PubMed1981

Cellular immune response during uncomplicated genital infection with Chlamydia trachomatis in humans.

A lymphocyte transformation (LT) assay for the study of the cellular immune response to Chlamydia trachomatis in humans is described. Subjects studied included 9 newborns whose mothers were C. trachomatis culture negative, 16 seronegative, sexually inexperienced adults, and 107 patients seen at a sexually transmitted disease clinic, including 31 men presenting with acute nongonococcal urethritis and 76 women with known or suspected uncomplicated gonorrhea or with uncomplicated C. trachomatis genital infection. LT stimulation indices (SI) were less than 3.5 in newborns and normal adults, as well as 11 of 12 seronegative, isolation-negative sexually transmitted disease clinic subjects. LTSI greater than 3.5 was found only with subjects who were sero- or culture positive for C. trachomatis. Among men with nongonococcal urethritis, the LTSI correlated better with culture than with antibody. Among women, the LTSI correlated better with antibody than with culture. LTSI decline significantly 3 to 4 weeks after curative therapy in men with nongonococcal urethritis, suggesting that LT response is short-lived and that the LTSI may be an indicator of acute C. trachomatis infection. The sensitivity, specificity, and predictive value of a positive LT assay and of serum and local antibody tests, in terms of C. trachomatis infection defined as positive isolation, were also compared. The predictive value of a positive LTSI for C. trachomatis infection was generally low in the sexually transmitted disease clinic patients: 62% in men with nongonococcal urethritis and 37% in women. However, this study did show the LT assay to be a useful specific test for monitoring the cellular immune response to C. trachomatis infection.

Antibodies, Bacterial↗
PubMedDate not supplied

Human immunodeficiency virus-associated progressive multifocal leukoencephalopathy: apparent response to 3'-azido-3'-deoxythymidine.

We present the case of a 26-year-old human immunodeficiency virus-seropositive man who developed progressive multifocal leukoencephalopathy as the initial manifestation of AIDS. He appears to have responded dramatically to therapy with 3'-azido-3'-deoxythymidine (AZT). His neurologic status deteriorated shortly after an AZT dose reduction. He has stabilized since resuming his previous AZT dose. Although it remains unclear whether AZT is useful in the treatment of JC virus infection, we think that all AIDS patients with progressive multifocal leukoencephalopathy should be offered treatment with AZT, especially in light of recent reports describing a possible potentiation of human immunodeficiency virus infection of the central nervous system in this setting.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Treatment of concomitant Neisseria gonorrhoeae and Chlamydia trachomatis infections in women: comparison of trimethoprim-sulfamethoxazole with ampicillin-probenecid.

Sixty-nine women with known or suspected uncomplicated gonorrhea were treated randomly either with a single dose of 3.5 g of ampicillin plus 1 g of probenecid or with four doses of trimethoprim-sulfamethoxazole (TMP-SMZ) in two double-strength tablets (160 mg of TMP plus 800 mg of SMZ) twice daily for two days. Overall, 56 (81%) of the women had gonococcal infections, 26 (38%) had chlamydial infections, and 23 (33%) had coexisting Chlamydia trachomatis and Neisseria gonorrhoeae infections. Among the women with genital or anal gonorrhea, two (9%) of 23 treated with TMP-SMZ and three (12%) of 25 treated with ampicillin and probenecid remained infected. TMP-SMZ cured four of four pharyngeal gonococcal infections. C. trachomatis was isolated at the first posttreatment visit significantly more often after treatment with ampicillin and probenecid (10 of 11 times) than after treatment with TMP-SMZ (1 of 10 times; P = 0.003). However, at the second follow-up visit, C. trachomatis was isolated from 30% of the women treated with TMP-SMZ. The area of ectopic columnar epithelium (ectopy) on the ectocervix and edema of this area were highly correlated with the presence of C. trachomatis, and persistence of C. trachomatis was associated with persistent edema of ectopy and with friability. TMP-SMZ is as effective as ampicillin-probenecid for the treatment of uncomplicated genital gonorrhea in women and may be more effective for the treatment of pharyngeal gonorrhea. The optimal dose and duration of TMP-SMZ therapy for C. trachomatis infection requires further study.

Adolescent↗
PubMedDate not supplied

Human immune response and Chlamydia trachomatis infection.

Chlamydia trachomatis is a prevalent pathogen in human populations in both developing and developed areas of the globe. Disease burden is heavy, since both acute and chronic complications can arise from infection. Emerging knowledge of the immune response to infection suggests that many of the complications of chlamydial infection are accompanied by important alterations in immunoregulation; new information suggests that both antibody-mediated and cell-mediated immune effectors may be significant in eliminating or limiting chlamydial infection. Further studies of the pathophysiologic mechanisms of host defense and the ways in which C. trachomatis escapes these defenses are needed. Elucidation of the immune response may provide the information necessary to redevelop a vaccine approach to disease control.

Antibodies, Bacterial↗
PubMedDate not supplied

Gonococcal recidivism, diversity, and ecology.

Gonococcal infections are frequently recurrent and are sustained in human populations by core groups, composed of very sexually active individuals, that have a high incidence and prevalence of infection. Recent advances in typing of gonococci have documented extreme strain heterogeneity, and epidemiologic studies have shown that gonococci vary widely between different geographic regions, within different population groups in a region, and within a given human population over time. The hypothesis of strain-specific immunity to gonococcal infection explains the diversity, dynamics, and recidivism so well-recognized for this organism. If true, this hypothesis will have some bearing on vaccine development and will suggest alternate strategies for disease control.

Africa, Eastern↗
PubMedDate not supplied

Parents of infants with ophthalmia neonatorum: a high-risk group for sexually transmitted diseases.

One hundred forty-nine mothers and 74 fathers of infants who presented at the Special Treatment Clinic (Nairobi) with ophthalmia neonatorum were evaluated. Neisseria gonorrhoeae was isolated from 60 (40%) of 149 mothers and Chlamydia trachomatis was isolated from 31 (21%). Twenty-six mothers (17.5%) had clinical evidence of endometritis or pelvic inflammatory disease. Mothers with endometritis and/or pelvic inflammatory disease were more often infected with N. gonorrhoeae (65%) than were mothers without these conditions (24%) (P less than or equal to .001). N. gonorrhoeae was isolated from ten (14%) and C. trachomatis from three (9%) of 32 fathers, and nongonococcal urethritis was diagnosed in an additional 21 fathers (28%). Seven of ten men with gonococcal urethritis and 18 of 21 with nongonococcal urethritis had no symptoms. These data confirm that the presence of ophthalmia neonatorum in a neonate should be considered as a strong indicator of sexually transmitted disease in the parents. Although most infections in fathers were asymptomatic, the mothers were at high risk for complications.

Adult↗
PubMedDate not supplied

Single-dose ceftriaxone therapy of gonococcal ophthalmia neonatorum.

Ceftriaxone (125 mg) given as a single intramuscular dose without topical therapy was evaluated in seven infants with smear-positive gonococcal ophthalmia neonatorum. Neisseria gonorrhoeae was isolated from the eyes of six infants, and four of these isolates were penicillinase-producing N. gonorrhoeae. Two infants had concomitant ocular infection with Chlamydia trachomatis. All seven infants, when seen at follow-up, showed marked clinical improvement. Conjunctivitis resolved completely in four infants. One infant was lost to subsequent follow-up, while two infants had persistent ophthalmia due to C. trachomatis. Follow-up eye cultures for N. gonorrhoeae were all negative.

Ceftriaxone↗
PubMedDate not supplied

Etiology of nonvesicular genital ulcers in Winnipeg.

Twenty-eight patients with recent onset of nonvesicular ulcerative genital lesions were studied prospectively to define the microbial etiology. Causative agents identified included herpes simplex virus (HSV), Chlamydia trachomatis, Haemophilus ducreyi, and Treponema pallidum. Three women and 25 men (seven of whom were homosexual) were studied. Ten patients did not have an etiology identified. Nine patients had syphilis, six had genital herpes, one had chancroid, one had granuloma inguinale, and one had a human bite injury. Six of seven homosexual men had syphilis, as compared with one of eight heterosexual men (P less than .002). Among heterosexual men, five had atypical HSV infections, three with extensive balanoposthitis and two with chancroidal ulcers. Of the clinical characteristics examined, induration of the ulcer base and tenderness on palpation were predictive of etiology, whereas numbers of ulcers and regional lymphadenopathy were not. H. ducreyi was not a common cause of genital ulcers in Winnipeg, and it was not found as a commensal or superinfecting organism in ulcers caused by other agents.

Adolescent↗
PubMedDate not supplied

Chlamydia trachomatis, infertility, and population growth in sub-Saharan Africa.

In sub-Saharan Africa, Neisseria gonorrhoeae and Chlamydia trachomatis are common infections. These pathogens are also the major causes of post-salpingitis tubal infertility, and infertility is a frequent problem in this region. A mathematical model, recently devised to estimate the effect of gonococcal infection on population growth, was used to estimate the potential effect of chlamydial infection on population growth. The model predictions for chlamydial infection were compared with those previously reported for gonococcal infection. The model predicts that both infections may be exerting severe effects on population growth at realistic prevalence rates of infection. The model also predicts that N. gonorrhoeae produces a steeper reduction in population growth than does C. trachomatis because its transmission dynamics result in a higher force of infection (incidence rate) at any given prevalence of infection. Large scale changes in the epidemiology of these infections can be expected to occur in sub-Saharan Africa because of improved sexually transmitted disease (STD) diagnosis and treatment services as a component of AIDS prevention. Changes in the epidemiology of gonococcal and chlamydial infection are predicted to result in accelerated population growth unless STD control programs are linked to effective contraception programs.

Africa↗
PubMedDate not supplied

Ophthalmia neonatorum in a trachoma endemic area.

BACKGROUND AND OBJECTIVES: Chlamydia trachomatis can be directly transmitted by sexual or perinatal contact and indirectly transmitted by flies or fomites. Whether distinct epidemiologic forces among human populations or biologic characteristics of the organism are responsible for the different routes of transmission is uncertain. STUDY DESIGN: To determine if ophthalmia neonatorum and trachoma are linked epidemiologically, 38 infants with ophthalmia and 277 children with trachoma were studied for evidence of C. trachomatis infection using culture, antigen and DNA detection tests. The study was performed in a trachoma endemic area of central Kenya. RESULTS: Of infants with ophthalmia neonatorum, 8% to 9% had microbiologic evidence of ocular C. trachomatis infection. Of the children with trachoma, 31% had evidence of chlamydial infection. Ninety-two percent of the 59 identified strains causing trachoma belonged to the classic trachoma serovars (A, B, Ba and C). Neither of the two chlamydial strains recovered from infants with ophthalmia was a trachoma serovar. Mothers rarely (3%) had cervical C. trachomatis infection. CONCLUSION: This study does not support a major role for perinatally transmitted C. trachomatis infection in trachoma epidemiology.

Adolescent↗
PubMedDate not supplied

Estimating the effective rate of sex partner change from individuals with sexually transmitted diseases.

BACKGROUND AND OBJECTIVES: The effective rate of partner change is an important variable for determining whether an epidemic of a sexually transmitted disease (STD) occurs. It is essential for understanding the transmission dynamics of STDs. GOAL OF THIS STUDY: The problem of estimating the effective rate of partner change is addressed. RESULTS: Under certain conditions the mean rate of partner change in STD patients estimates the effective rate of partner change in the general population. CONCLUSION: To estimate the effective rate of partner change in a population, the use of surveys of patients with STD provides a simpler and less costly alternative to population surveys of sexual behavior.

Bias↗
PubMedDate not supplied

Estimating the basic reproductive rates of Neisseria gonorrhoeae and Chlamydia trachomatis: the implications of acquired immunity.

BACKGROUND AND OBJECTIVES: The basic reproductive rate of and STD is an important parameter from which the success of intervention strategies can be predicted. GOAL OF THE STUDY: To evaluate different methods to estimate the basic reproductive rate. RESULTS: Two different methods of estimating the basic reproductive rates of Neisseria gonorrhoeae and Chlamydia trachomatis yielded discrepant results. One of the methods, which is based on the assumption of the absence of acquired immunity, yielded unrealistically low estimates of the basic reproductive rates. CONCLUSION: In conjunction with other epidemiologic evidence, we infer that some form of acquired immunity to these pathogens must exist and discuss its implication for control.

Antibody Formation↗
PubMedDate not supplied

Chlamydiae as pathogens: new species and new issues.

The recognition of genital chlamydial infection as an important public health problem was made first by the recognition of its role in acute clinical syndromes, as well as in serious reproductive and ocular complications, and secondly by our awareness of its prevalence when diagnostic tests became widely accessible. The recent availability of effective single dose oral antimicrobial therapy and sensitive molecular amplification tests that allow the use of noninvasive specimens for diagnosis and screening is expected to have a major impact in reducing the prevalence of disease in the next decade. Clinical manifestations associated with Chlamydia pneumoniae infection continue to emerge beyond respiratory illness. In particular, its association with atherosclerosis deserves further investigation. Chlamydia pecorum, a pathogen of ruminants, was recently recognized as a new species. The continued application of molecular techniques will likely elucidate an expanding role for chlamydiae in human and animal diseases, delineate the phylogenetic relationships among chlamydial species and within the eubacteria domain, and provide tools for detection and control of chlamydial infections.

Anti-Bacterial Agents↗
PubMedDate not supplied

Persistence of Mycoplasma hominis after therapy: importance of tetracycline resistance and of coexisting vaginal flora.

In past studies Mycoplasma hominis has persisted after treatment with placebo, penicillins, or rifampin in 88-97% of women and 49-77% of men with infections of the lower genital tract. Among women with nonspecific vaginitis, M. hominis persisted in only a third of those treated with metronidazole as compared with at least 70% of those treated with ampicillin (P = 0.01), even though M. hominis is resistant in vitro to metronidazole and to its acid and hydroxy metabolites. Persistence of M. hominis after treatment with metronidazole was significantly associated with persistence of Bacteroides species in the vagina (P = .03). These results suggest that colonization of the vagina with M. hominis is partly dependent on other components of the vaginal microbial flora. In prior studies, M. hominis has persisted in zero to 50% of women and in zero to 30% of men after treatment with tetracycline or lincomycin, but the role of tetracycline resistance in treatment failure was not defined. The susceptibility of M. hominis to tetracycline is bimodal; and the minimal inhibitory concentration (MIC) of tetracycline for strains isolated before or soon after treatment was greater than or equal to 16 micrograms/ml for seven (78%) of nine that did persist and for two (17%) of 12 that did not persist after tetracycline therapy for cervicitis in women (P = .002). The MIC of tetracycline was greater than or equal to 16 micrograms/ml for two (12%) of 17 isolates from women in Seattle in 1972-1973, as compared with 27 (34%) of 79 isolates from Seattle men and women in 1979-1982.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗