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S P Adler

Publications and source records attributed to S P Adler.

At least 19 recordsLinked to original sources
PubMed1992

Cytomegalovirus and pregnancy.

Cytomegalovirus remains the most common congenital infection worldwide, with approximately 1% of all newborns infected in utero. Of those infected in utero, approximately 10% will have signs and symptoms of cytomegalovirus infection at birth and develop sequelae, especially mental retardation, hearing deficit, or both. Recent data indicate that more than 90% of symptomatic infections or infections causing sequelae occur following a primary maternal infection during pregnancy. The overall risk of delivering an infant who will develop significant handicaps following a primary maternal infection is between 10% and 20%. Between 1% and 2% of seronegative women may acquire a primary cytomegalovirus infection during pregnancy, but seronegative women at high risk include day-care workers, who have a 10% to 20% annual infection rate, and the seronegative mothers of infected children under 2 years of age, 50% of whom will acquire cytomegalovirus annually from their children. Adolescents are another group who may have a high infection rate during pregnancy. Although a cytomegalovirus vaccine is still many years from introduction, these observations strengthen the need and feasibility for a cytomegalovirus vaccine. Pending vaccine development and evaluation, several possible strategies for intervention to prevent primary infection for high-risk pregnancies are suggested.

Adolescent↗
PubMed1991

Culture confirmation of cytomegalovirus and herpes simplex virus by direct enzyme-labeled DNA probes and in situ hybridization.

Using probes consisting of horseradish peroxidase (HRP) directly attached to DNA, scrapings or trypsinized cells from 217 adequate clinical samples were cultured and analyzed in 3 blind studies by in situ hybridization for the presence of cytomegalovirus (CMV) and herpes simplex virus (HSV). Sixty samples were judged inadequate due to insufficient cell numbers; however, this problem was significantly decreased during the course of the study. One hundred and eighteen samples were found positive and 70 samples were found negative for CMV. Scrapings of cultured cells from 29 clinical samples revealed 9 samples which were positive and 20 samples which were negative for HSV. Forty-two additional samples, containing either uninfected cells or cells infected with various strains of CMV, were analyzed for the ability of the HRP-DNA CMV probe to detect such isolates. Twenty samples were positive and 22 negative for CMV. No false-negatives or false-positives were observed for either CMV or HSV. In addition to the specificity noted above neither the CMV nor the HSV DNA probe hybridized to potential contaminants found in clinical specimens.

Cell Line↗
PubMed1991

Cytomegalovirus and child day care: risk factors for maternal infection.

To determine the rates and factors affecting cytomegalovirus transmission from children infected in day care to their seronegative mothers, we prospectively monitored 96 seronegative mothers. Of 46 seronegative mothers without infected children, 2 seroconverted. Among 50 mothers with infected children, 19 seroconverted and of these 19, 9 shed cytomegalovirus and all 9 shed the same isolate as their child. The annual seroconversion rate for these women was 30%, significantly higher than the 3% rate for mothers without infected children (P less than 0.001; relative risk, 10.2; 95% confidence interval, 2.4, 43.8). Maternal infection was not associated with maternal age, race, duration of observation, duration of viral shedding by their children or the DNA pattern of each isolate but was associated with the age when a child's infection was identified. Only 3 of the 19 mothers who seroconverted had children older than 20 months of age (26, 28 and 28 months). Sixteen (57%) of 28 mothers with infected children 20 months of age or younger became infected compared with only 3 (13%) of 22 mothers with infected children more than 20 months (P less than 0.007), Fisher's exact test, two tailed; relative risk, 3.9; 95% confidence interval, 1.3, 11.8). For mothers with infected children younger than 20 months of age the interval between identification of her child's infection and maternal infection ranged from 1 to 26 months (8 +/- 6 (SD) months). Survival estimates revealed that mothers of infected children younger than 20 months of age acquired cytomegalovirus significantly more rapidly than mothers of older children (chi square, 9.34; P less than 0.0022).

Age Factors↗
PubMed1991

Molecular epidemiology of cytomegalovirus: a study of factors affecting transmission among children at three day-care centers.

To account for the wide variations in the prevalence of cytomegalovirus infections among day-care centers we serially tested 309 children at three day-care centers for 3 years. Based on the DNA restriction endonuclease pattern of each isolate, the rate of infection for children differed significantly (P less than 0.001) among centers: at Center 1, 50% (46 of 93) of children acquired cytomegalovirus in day care; at Center 2, 62% (64 of 104); and at Center 3, 25% (21 of 84). Infection rates were associated with the number of infants enrolled, and half or more of infected children were younger than 24 months of age. Six of 7 new isolates were introduced by children 18 months of age. Based on DNA patterns the prevalent isolates at Centers 1 and 2, although different, were shed for an average of 22 and 23 months, respectively, compared with an average of 15 months for other isolates (P less than 0.001). Reinfections with the prevalent isolates were observed for 2 of 34 children tested. The most important factors affecting day-care center transmission are the number of infants enrolled and prolonged viral shedding, possibly enhanced by reinfection.

Age Factors↗
PubMed1990

Manifestations and treatment of human parvovirus B19 infection in immunocompromised patients.

We diagnosed infections from human parvovirus B19 in three patients by using dot-blot hybridization and a polymerase chain reaction to detect B19 DNA and using an enzyme immunoassay to detect IgG and IgM to B19. For 5 months a 5-year-old boy with acute lymphoblastic leukemia in remission had anemia without reticulocytes or bone marrow erythrocyte precursors. His serum lacked IgG and IgM to B19 but contained B19 DNA. He received gamma globulin intravenously (0.4 gm/kg/day for 5 days); his viremia promptly cleared and reticulocytosis developed. A 14-year-old boy with acute lymphoblastic leukemia in remission had fever, rash, neutropenia (less than 300 leukocytes/mm3), and a hemophagocytic syndrome lasting 3 weeks. His serum contained IgM to B19 and B19 DNA. Without therapy, IgG to B19 developed; although low levels of B19 DNA persisted, the leukocyte count returned to normal. In a 19-year-old patient with systemic lupus erythematosus and hemolytic anemia, an aplastic crisis lasted 2 weeks. Her serum lacked IgG and IgM to B19 but contained B19 DNA. Without therapy, IgG and IgM to B19 appeared, viremia diminished, and reticulocytosis occurred. These patients illustrate the varied manifestations of chronic B19 infections, the importance of DNA detection for diagnosis, and the possible efficacy of gamma globulin therapy.

Adolescent↗
PubMed1990

Detection of human parvovirus B19 DNA by using the polymerase chain reaction.

The polymerase chain reaction (PCR) was investigated for detecting human parvovirus B19 (B19) DNA in sera. Three pairs of oligonucleotides were evaluated as primers. The best oligonucleotide pair spanned 699 nucleotides, including the region common to VP1 and VP2. After PCR amplification of B19 DNA in serum, a 699-nucleotide DNA fragment was detected on agarose gels. This DNA fragment was B19 DNA, because after Southern transfer it hybridized to a 19-nucleotide internal probe and contained a single PstI cleavage site. Dot blot hybridization with a radiolabeled cloned portion of the B19 genome as a probe was compared with PCR. PCR was 10(4) times more sensitive than dot blot hybridization and, with an internal radiolabeled probe, 10(7) times more sensitive than dot blot hybridization. Of 29 serum specimens from 18 patients with proven B19 infections, 24 were PCR positive. None of 20 serum samples from uninfected controls were positive. Of 22 serum samples positive for immunoglobulin M to B19, PCR detected B19 DNA in 17. Seven serum samples lacking immunoglobulin M were PCR positive. PCR detected B19 DNA in urine, amniotic fluid, pleural fluid, ascites, and leukocyte extracts. PCR is a rapid and simple method for diagnosing infections with human parvovirus B19 but must be combined with serologic tests for immunoglobulin M to B19, especially when testing only a single serum sample.

Base Sequence↗
PubMed1990

Comparative analysis of human cytomegalovirus a-sequence in multiple clinical isolates by using polymerase chain reaction and restriction fragment length polymorphism assays.

The human cytomegalovirus (HCMV) a-sequence (a-seq) is located in the joining region between the long (L) and short (S) unique sequences of the virus (L-S junction), and this hypervariable junction has been used to differentiate HCMV strains. The purpose of this study was to investigate whether there are differences among strains of human cytomegalovirus which could be characterized by polymerase chain reaction (PCR) amplification of the a-seq of HCMV DNA and to compare a PCR method of strain differentiation with conventional restriction fragment length polymorphism (RFLP) methodology by using HCMV junction probes. Laboratory strains of HCMV and viral isolates from individuals with HCMV infection were characterized by using both RFLPs and PCR. The PCR assay amplified regions in the major immediate-early gene (IE-1), the 64/65-kDa matrix phosphoprotein (pp65), and the a-seq of the L-S junction region. HCMV laboratory strains Towne, AD169, and Davis were distinguishable, in terms of size of the amplified product, when analyzed by PCR with primers specific for the a-seq but were indistinguishable by using PCR targeted to IE-1 and pp65 sequences. When this technique was applied to a characterization of isolates from individuals with HCMV infection, selected isolates could be readily distinguished. In addition, when the a-seq PCR product was analyzed with restriction enzyme digestion for the presence of specific sequences, these DNA differences were confirmed. PCR analysis across the variable a-seq of HCMV demonstrated differences among strains which were confirmed by RFLP in 38 of 40 isolates analyzed. The most informative restriction enzyme sites in the a-seq for distinguishing HCMV isolates were those of MnlI and BssHII. This indicates that the a-seq of HCMV is heterogeneous among wild strains, and PCR of the a-seq of HCMV is a practical way to characterize differences in strains of HCMV.

Base Sequence↗
PubMed1989

Cytomegalovirus and child day care. Evidence for an increased infection rate among day-care workers.

To determine whether day-care workers acquire cytomegalovirus infection from the children they care for, we studied 610 women employed at 34 day-care centers over two years. Forty-one percent of the caretakers were seropositive for cytomegalovirus. After adjustment for the effects of race, marital status, and age on seropositivity, the women who cared for children younger than two years of age had a significantly higher seropositivity rate (46 percent) than the women who cared for children older than two years of age (35 percent) (relative risk, 1.29; 95 percent confidence interval, 1.05 to 1.57; P less than 0.02). Of 202 initially seronegative caretakers (observed for an average of 305 days per woman), 19 seroconverted, for an annual seroconversion rate of 11 percent. This rate was significantly higher than the 2 percent annual rate of seroconversion among 229 seronegative women (11 of whom seroconverted) in a comparison group of female hospital employees observed for an average of 781 days per woman (relative risk, 5.0; 95 percent confidence interval, 2.4 to 10.5; P less than 0.001). At three day-care centers in which the children were also studied, seven of the nine women shed isolates of cytomegalovirus in their saliva or urine that had EcoRI and BamHI DNA-digestion patterns identical to the DNA patterns of isolates shed by one or more children in their care. We conclude that workers in day-care centers may acquire cytomegalovirus infection from the children in their care and that this risk is significantly greater among those who care for children less than two years of age.

Adult↗
PubMed1989

Cytomegalovirus infections in seropositive patients after transfusion. The effect of red cell storage and volume.

Antibody responses to cytomegalovirus (CMV) after red cell (RBC) transfusion were studied in 84 seropositive surgery patients and 82 seropositive oncology patients. The surgery patients were randomized to receive RBCs stored either 3 to 8 or 20 to 42 days after donation. Of 38 patients receiving RBCs stored 8 days or less, 3 developed a rise in titer (4-fold increase) of IgG antibody to CMV 8 to 12 weeks after transfusion. This rate of response (8%) did not differ significantly (p = 0.23) from that (16%) in the 46 patients receiving RBCs stored 20 to 42 days. Seropositive oncology patients were randomized to receive RBCs from seronegative or random donors. Five (19%) of 27 oncology patients receiving seronegative RBCs and 13 (23%) of 55 patients receiving random RBCs (mean, 2 seropositive RBC units/patient) developed a rise in titer of antibody to CMV. No CMV morbidity occurred in either patient group. For both patient groups, a rise in titer of antibody to CMV was associated with the number of transfused RBC units. These results confirm that CMV-seronegative RBCs are unnecessary for infrequently transfused seropositive patients. They also suggest that multiple transfusions of stored RBCs are as immunosuppressive as multiple transfusions of RBCs used within a few days after donation.

Adult↗
PubMed1989

Immunologic evidence for frequent age-related cytomegalovirus reactivation in seropositive immunocompetent individuals.

Immunoblot analysis using mouse monoclonal antibody to human IgM detected IgM to cytomegalovirus (CMV)-specific proteins (150, 42, 38, 32, and 28 kDa) in 74 (38%) of 197 seropositive serum samples from 197 individuals in three subject groups: 43 surgical patients, 31 patients with solid tumors, and 123 healthy individuals. Logistic regression analysis revealed that the presence of IgM to CMV proteins was not associated with a specific subject group but was associated with age (P less than .0001), gender (P less than .005), and IgG titer (P less than .03). The rate of IgM positivity increased from 15% (8 of 54) for those less than 20 y to 63% (37 of 59) for those greater than 60 y. Twenty-three (29%) of 80 males were IgM-positive compared with 49 (44%) of 111 females. Immunoglobulin G titers to CMV were significantly associated with age, gender, and IgM positivity. These data suggest that CMV reactivation in immunocompetent seropositive individuals may occur frequently and increase with age.

Adult↗
PubMed1989

Human parvovirus B19 infections in women of childbearing age and within families.

Human parvovirus B19 (B19) crosses the placenta causing fetal death. We used an indirect capture enzyme immunoassay to measure IgG to B19 in sera of 845 subjects from 2 groups. The first group included 405 women (mean age, 30 years) composed of 85 pediatric nurses and 130 other female hospital employees, 122 women employed caring for preschool children and 68 mothers of preschool children enrolled in day care. Twenty-eight percent of all these women were seropositive. Seropositivity was unrelated to occupational group. Four of 235 women observed between 1983 and 1987 for a mean of 435 days/woman acquired B19 infections (an annual seroconversion rate of 1.5%). We investigated intrafamilial associations of B19 infection in a second group of 440 subjects from 111 families. Seropositivity of parents was not associated with seropositivity of their children. Seropositivity of one spouse was not associated with seropositivity of the cospouse. However, of 47 seropositive older siblings, 32 (68%) of their younger siblings were seropositive, compared to 20 (18%) seropositive younger siblings of 112 seronegative older siblings (P less than 0.001). B19 infections increased with age from 19% for those younger than 10 years to 67% for those older than 49 years. For all ages females had a higher rate (51%) of B19 infection than males (38%). These data suggest that children may be more susceptible to B19 than adults and B19 infections occur infrequently among women younger than 40 years of age. However, during local outbreaks the B19 infection rate for susceptible pregnant women remains unknown.

Adolescent↗
PubMed1988

Molecular epidemiology of cytomegalovirus: viral transmission among children attending a day care center, their parents, and caretakers.

This 26-month prospective study monitored 104 children from one day care center (DCC), and their families, for cytomegalovirus (CMV) infections. Among the children, 14 different strains of CMV were identified by restriction endonuclease analysis of the viral DNA of isolates. Three of these strains infected 44 DCC children and apparently were transmitted within the DCC environment. Only children younger than 3 years of age acquired the DCC-associated CMV strains. Of 75 seronegative children in this age group, 34 acquired DCC-associated CMV strains, and four were infected with unique strains. Among 23 children older than 3 years of age, none acquired the DCC-associated strains, although six were infected with unique strains. Of 18 seronegative mothers, six acquired CMV infections within 3 to 7 months after their children became infected; the strains were identical to those isolated from their children and were DCC associated. Four fathers, three seropositive mothers, and two caretakers also shed DCC-associated strains of CMV. None of the 31 mothers whose children were not infected shed CMV. There was no apparent CMV-associated morbidity. These results prove the frequent transmission of CMV within the DCC environment and from DCC children to their parents. They further suggest that caretakers do acquire CMV from DCC children.

Child Care↗
PubMed1988

Seroepidemiology of cytomegalovirus and herpes simplex virus in twins and their families.

To determine the importance of intrafamilial transmission of cytomegalovirus and herpes simplex virus (types 1 and 2), the authors investigated the presence of immunoglobulin G antibody to one or both of these viruses in the sera collected between 1976 and 1985 from 1,115 members of 301 kinships from Virginia consisting either of juvenile twins and their parents or of adult twins, their spouses, and offspring. The sample included 486 children and 629 adults, aged 1-68 years. Among the 125 couples in whom the wives were seropositive, 78 (62%) of the husbands were found to be seropositive. Among 77 couples in whom the wives were seronegative, only 32 (42%) of the husbands were seropositive (p less than 0.01). Of 105 couples in whom the wives were seropositive for herpes simplex virus, 81 (77%) husbands were seropositive compared with 20 (47%) of 43 husbands with herpes simplex virus-seronegative wives (p less than 0.001). In families with cytomegalovirus-seropositive mothers, 54 (25%) of 213 children were seropositive for cytomegalovirus compared with 13 (8%) of 168 children in families with seronegative mothers (p less than 0.001). Childhood cytomegalovirus infections showed no association with infection in the father. In contrast, among families in which both parents were seropositive for herpes simplex virus, 48 (31%) of 156 children were seropositive compared with only two (4%) of 48 children without herpes simplex virus-seropositive parents (p less than 0.001). Among all siblings, there were strong associations for both herpes simplex virus and cytomegalovirus infections. These data are consistent with the venereal transmission of cytomegalovirus in married couples, provide evidence for the intrafamilial spread of herpes simplex virus, and confirm the importance of the maternal-child transmission of cytomegalovirus.

Adolescent↗