Ashir Kumar

Acquisition of cytomegalovirus infection in infants following exchange transfusion: a prospective study.

A prospective study of newborn infants who required exchange transfusion was undertaken to evaluate the risk of transmission of cytomegalovirus (CMV). Buffy coat‐, urine‐ and saliva‐saturated throat swabs for viral cultures and serum specimens for CMV complement‐fixing (CF) antibody were obtained from 45 infant‐mother pairs. Buffy coat from the donor blood was cultured and CMV CF titers measured. Viral studies were repeated on infants and mothers at six and 12 weeks after exchange transfusion. Fifteen infants received CMV seropositive blood and 14 infants received CMV seronegative blood. Sixteen infants who did not receive blood or blood products served as controls. Three of 12 antibody‐positive newborns developed infection after getting seropositive blood. One of three antibody‐negative newborns developed infection after getting seropositive blood. The presence of transplacental antibody does not appear to protect the infants. None of the control infants developed CMV infection. None of the infected infants were symptomatic. Although CMV infection in infancy can be acquired by routes other than blood, exchange transfusion with seropositive blood enhances the likelihood of acquiring infection.

Humoral and cell-mediated immune responses to herpesvirus antigens during pregnancy—A longitudinal study

Humoral and cellular immune responses were studied during the second trimester, third trimester, and postpartum periods in 11 pregnant women and in nonpregnant control women. Complement fixing (CF) and indirect hemagglutinating antibody (IHA) titers for herpes simplex type 1 (HSV-1), herpes simplex type 2 (HSV-2), and cytomegalovirus (CMV) were determined. Cellular response was measured by [3H]thymidine uptake by stimulated lymphocytes. Phytohemagglutinin (PHA), HSV-1, HSV-2, and CMV antigens were used as stimulants. No differences in the mean titers of CF and IHA antibodies were found. The cellular response to PHA had a transient decrease (P<0.02) during the third trimester. The cellular response to CMV was significantly lower during the second and third trimesters. A diminished response to HSV-1 antigen was observed during the second and third trimesters; the cellular response to HSV-2, though reduced, was not significantly altered during pregnancy. These data indicate a suppression of cellular responses to various herpesviruses and PHA during pregnancy.

Delayed nerve conduction velocities in children with protein-calorie malnutrition†

Protein-calorie malnutrition in human beings and animals affects the myelination and growth of the nervous system. The effects of PCM on the developing nervous system were evaluated by measuring the nerve conduction velocities in 93 (38 marasmus, 13 kwashiorkor, and 42 control) children in ulnar, median, peroneal, and posterior tibial nerves. The children were divided into three age groups: Group I, six to 12 months; Group II, 13 to 24 months; Group III, 25 to 48 months. All 13 children with kwashiorkor demonstrated irritability, delayed milestones, and muscular wasting; and six also had hypoactive muscle reflexes. Conduction velocities were reduced in each type of malnutrition, with statistically significant differences in the three groups of marasmic children and in Group III kwashiorkor children. Children with kwashiorkor in Group II had significantly reduced velocities only in the nerves of the lower extremities. These data suggest PCM, when it occurs during the development of the nervous system, affects myelination of the peripheral nerves.

Humoral-and cell-mediated immune responses to herpesvirus antigens in patients with cervical carcinoma.

Abstract The humoral and cellular immune responses were studied in 35 patients with cervical carcinoma (Ca Cx) and 32 healthy controls. Complement fixing (CF) and indirect hemagglutinating antibody (IHA) titers for herpes simplex type 1 (HSV-1), herpes simplex type 2 (HSV-2), and cytomegalovirus (CMV), and fluorescent antibody (FA) titers for viral capsid antigen for Epstein-Barr virus (EBV) were determined. Cellular immune response was measured by the technique of [ 3 H]thymidine uptake by stimulated lymphocytes. Phytohemagglutinin (PHA), HSV-1, HSV-2, and CMV antigens were used as stimulants. CF titers (≥ 1:4) to HSV-1, HSV-2, and CMV were present in 34 ( P P P P P P P P

Reversible Neutropenia Associated with Ampicillin Therapy in Pediatric Patients

Hematologic abnormalities associated with penicillin compounds are uncommon, and neutropenia associated with ampicillin is reported even less frequently. Neutropenia developed in three pediatric patients after high-dose (150–400 mg/kg) ampicillin therapy over a period of 3 to 12 days. In all cases, the white blood cell and neutrophil counts returned towards normal within 4 to 11 days after discontinuation of the antibiotic. Bone marrow examination revealed a maturation arrest in one and slight shift to the left in the maturation of granulocytic cells in another. Other marrow components were normal. Red blood cells, reticulocytes, platelets, and hemoglobin did not show any abnormal alteration in any of the patients. Physicians administering ampicillin, particularly in high doses, should be alert to the possible development of neutropenia; however, all reported neutropenias have been reversible.

Value of Leukocyte Alkaline Phosphatase and Other Leukocyte Parameters in Diagnosis of Neonatal Infection

Various leukocyte parameters, i.e., leukocyte alkaline phosphatase (LAP) activity, absolute segmented polymorphonuclear count (segs), absolute band count and bands/segs ratio were studied in 15 full-term newborns with bacterial infections, 15 full-term newborns with bacterial infections, 15 full-term newborns with viral illnesses, and 10 age- and weight-matched control newborns. Mean LAP scores were 87.5 in the control group, 160.3 in newborns with viral illnesses, and 232.7 in newborns with bacterial infections. The differences between each group were statistically significant. The mean band count and bands/segs ratio were 65.6/mm3 and 0.013 in the control group; 842/mm3 and 0.18 in newborns with viral illnesses, and 2,207/mm3 and 0.37 in newborns with bacterial infections. LAP was more sensitive than other parameters in distinguishing the three groups. The data indicate that an LAP score of greater than 200, a band count of greater than 500/mm3 and a bands/segs ratio of greater than 0.3 are highly suggestive of bacterial infection.

Patient compliance to antibiotic regimens. A simple method of evaluation.

Clinicians are often perplexed by patients with bacterial infection who are not responding to oral antibiotic therapy. Since most of the commonly used antibiotics are excreted in the urine, inhibitory activity of urine against susceptible organisms can be used as a measure of patient compliance. To assess the reliability of this technique, we studied 42 hospitalized patients documented to be receiving oral antibiotics. All urine samples from patients receiving oral antibiotics inhibited bacterial growth at a dilution of greater than or equal to 1:32, while none of the specimens from control patients inhibited growth. Subsequent experience in the outpatient clinic has corroborated the reliability and simplicity of this test as a measure of compliance in patients who are receiving antibiotics either for prophylaxis or for therapy of acute infection.

Failure of Marasmus and Kwashiorkor to Affect Distal Latencies in Infancy and Childhood

The effect of protein‐calorie malnutrition on the terminal branches of peripheral nerves and neuromuscular junction was evaluated by studying the distal latency time in ulnar, median, peroneal and posterior tibial nerves in 38 children with marasmus, 13 with kwashiorkor and 42 control children between the ages of six months and four years. All children with protein‐calorie malnutrition demonstrated features of neuromuscular involvement related to malnutrition. Distal latencies were comparable in the individual nerves but were higher in peroneal and posterior tibial than in ulnar and median nerves in all the children. Distal latencies in the malnourished children were similar to those of the controls. These findings indicate that marasmus and kwashiorkor do not alter the electrophysiology of impulse transmission at nerve terminals and neuromuscular junction.

Septic shock—an update

Recognition of patients at risk to gram negative infections and septicemia and the pathogenesis of shock enables one to establish the diagnosis early in the course of the syndrome and institute effective therapy. The early description of septic shock resulting from gram negative bacterial infection came from the observations of Waisbren and Spink. ~ The development and use of variety of antibiotics effective in the control of gram positive infections resulted in an increasing incidence of serious gram negative infections frequently complicated by septicemia3

CELLULAR IMMUNE RESPONSE TO HERPESVIRUS ANTIGENS DURING PREGNANCY

The cellular immune response of lymphocytes was studied in 27 pregnant females and 25 nonpregnant females of child bearing age by the technique of lymphocyte stimulation (LS) as measured by 3H Thymidine uptake (3HThU) in vitro. LS indices (3HThU in stimulated cells/3HThU in unstimulated cells) were measured using phytohemagglutinin (PHA) and different concentrations (undilute, 1/10, 1/100) of Herpes simplex (HS) type 1, HS type II and cytomegalovirus (CMV) antigens (agns) as stimulants. Complement fixing (CF) liters ≥1:4 to CMV, HSI, HSII were present in 22, 22 and 20 pregnant and in 13, 17 and 15 nonpregnant patients (pts) respectively. In antibody positive pts, LS indices of ≥3 to agns were found in 12/22 (CMV), 22/22 (HSI), and 19/20 (HSII) pregnant; and 12/13 (CMV). 14/17 (HSI) and 13/15 (HSII) nonpregnant pts. When the stimulating agn was diluted, the means of LS indices to HSI and CMV were lower in pregnant as compared to non-pregnant pts., eg. means of LS indices to 1/100 dil CMV agn in 12 nonpregnant pts were 3.28 and 9.75 (p=.02); means of LS indices to 1/100 dil of HSI agn in 22 pregnant and 14 nonpregnant pts were 7.66 and 24.88 (p=.004). No differences were found in means of LS indices to HSII agn or PHA regardless of the dilution. These data indicate that there is depression of cellular immune response to certain Herpesvirus agns during pregnancy.