George J. Pazin

Prevention of Reactivated Herpes Simplex Infection by Human Leukocyte Interferon after Operation on the Trigeminal Root

Microneurosurgical procedures on the trigeminal-nerve root are often followed by reactivation of herpes simplex virus infection, manifested by herpes labialis or oropharyngeal herpesvirus shedding or both. In a double-blind study of the ability of human leukocyte interferon to prevent this reactivation, patients with a history of herpes labialis were given 7 x 10(4) U of interferon per kilogram of body weight per day or placebo for five days beginning on the day before operation. In 18 patients treated with placebo, herpes labialis developed in 10, and virus shedding in the oropharynx in 15. In 19 patients treated with interferon, lesions developed in five, and shedding in eight. The frequency of reactivation as measured by lesions or positive throat cultures or both was significantly reduced by interferon (P less than 0.05). Of 127 daily throat-wash cultures in the placebo group, 42 per cent were positive for herpesvirus, but of 134 in the interferon group, only 9 per cent were positive (P less than 0.001). We conclude that interferon at a well-tolerated dosage reduces reactivation of latent herpes simplex virus infection after a potent operative stimulus.

Opportunistic Lung Infection Due to Pittsburgh Pneumonia Agent

Eight immunosuppressed patients had pneumonia due to Pittsburgh Pneumonia Agent (PPA), a gram-negative, weakly acid-fast bacterium cultivatable only in embryonated eggs and guinea pigs and distinct from Legionella pneumophila. The diagnosis was established by isolation of the agent from lung or visualization of the organism in lung tissue. The clinical presentations, radiographic abnormalities and pathology were not specific. The most consistent feature associated with the disease was the recent institution of daily high-dose corticosteriod therapy in all patients. Five of the eight patients died despite broad-spectrum antibiotic and antituberculous therapy. Anti-microbial activity against PPA was demonstrated for sulfamethoxazole combined with trimethoprim, for rifampin and for erythromycin with an egg-protection assay. Serologic studies with an indirect fluorescent-antibody technic suggested that seroconversion or high titers may be a sensitive test for PPA disease. PPA appears to be a newly recognized cause of life-threatening bacterial pneumonia in immunosupressed patients.

Herpes simplex infection in acute myelogenous leukemia and other hematologic malignancies: A prospective study

To better define the frequency and clinical characteristics of herpes simplex virus (HSV) infection in adult patients with acute myelogenous leukemia (AML), the authors prospectively studied 29 patients undergoing remission induction chemotherapy with twice weekly throat wash cultures for an average of 25.3 days. Ten seropositive patients (34.5%) shed HSV at least once. Eight patients were asymptomatic. Two episodes of herpes labialis were severe and persistent, but no visceral dissemination was observed. Reactivation of HSV infections in AML patients presumably with marked immunosuppression occurs, but less frequently and more benignly than has been suggested. Daunomycin and cytosine arabinoside, which can inhibit HSV replication, may have accounted for this lower frequency of reactivation.

A Phase I study of subcutaneous recombinant interleukin-2 in patients with advanced Hiv disease while on zidovudine

ObjectiveA Phase I study of subcutaneous recombinant interleukin-2 (rlL-2). DesignSixteen patients with advanced HIV infection receiving 600–1200mg zidovudine per day were divided into three groups, which received sequentially 0.2 x106, 0.7x106 or 2x106 units/m2 per day of rlL-2 subcutaneously for 5 consecutive days. SettingFive-day admission to an academic tertiary care hospital. Patients, participantsSixteen unblinded, non-randomized volunteers. InterventionsSubcutaneous rlL-2. Main outcome measuresTolerance, toxicity, hematologic, immunologic and antiviral responses. ResultsrlL-2 was well-tolerated at the highest dosage, except in two patients who developed significant lymphopenia by the second day of rlL-2 administration, with rebound within 48 h after rlL-2 therapy. The number of eosinophils, CD4+ and CD8+ cells, and percentage of CD16+ (natural killer) cells, remained elevated above baseline for up to 10 weeks. Circulating rlL-2 receptor levels increased transiently during and immediately following rlL-2 administration. A twofold increase in natural killer cell activity against uninfected and HIV-infected targets was observed, but did not persist beyond 10 weeks following rlL-2 administration. There was a transient decrease in blastogenesis to phytohemagglutinin of patients receiving the highest dose of r-IL-2, but no significant change in viral burden. ConclusionsSubcutaneous rlL-2 in advanced HIV-infected patients on zidovudine was tolerated with side-effects similar to intravenous IL-2.

Determination of Site of Infection in Endocarditis

Medical-surgical treatment of antibiotic refractory endocarditis requires determination of the site of infection, which is not always possible with conventional cardiac catheterization. The cases of two patients with right-sided endocarditis who survived after combined medical-surgical therapy are presented. One had persistent Pseudomonas aeruginosa bacteremia and three possible sites of infection. Multiple quantitative blood cultures proximal and distal to each suspected site indicated the pulmonary valve alone was infected. The second had sustained bacteremia with three enteric organisms and no apparent valvular abnormality. Quantitative cultures excluded the abdomen as the continuing source of bacteremia and suggested the tricuspid valve was infected. This was confirmed by a second catheterization using multiple cultures in conjuction with dye dilution studies, intracardiac phonocardiography, and angiography. These bacteriologic and cardiologic techniques may be especially useful in detecting right-sided endocarditis and may also be helpful in detecting concomitant infection of both sides of the heart.

Recombinant interferon alpha-2a for treatment of herpes zoster in immunosuppressed patients with cancer

PURPOSE Acyclovir and high doses of intramuscular leukocyte interferon have been shown to prevent dissemination of herpes zoster in cancer patients with localized herpes zoster. With the availability of recombinant interferon, we decided to conduct a multicenter, placebo-controlled, double-blind trial of intramuscular recombinant interferon alpha-2a to assess its efficacy and safety in the treatment of localized herpes zoster in immunosuppressed patients with cancer. PATIENTS AND METHODS Immunosuppressed cancer patients with localized herpes zoster were randomly assigned to receive placebo, 36 X 10(6) units of recombinant interferon alpha-2a per day, or 68 X 10(6) units of recombinant interferon alpha-2a per day. Due to frequent adverse effects, the 68 X 10(6) unit dose of interferon was discontinued prior to conclusion of the trial. RESULTS Dissemination of herpes zoster occurred in 14 of the 24 patients (58 percent) who received placebo but in only four of 24 recipients (17 percent) of 36 X 10(6) units of interferon per day (p = 0.003). Adverse effects (fever, chills, headaches, gastrointestinal irritability, fatigue, and myalgias) were more common or severe in interferon-treated patients. CONCLUSION These results suggest that interferon modifies the severity of herpes zoster in immunosuppressed patients with cancer but is associated with frequent side effects.

Varicella-zoster virus hepatitis and a suggested management plan for prevention of VZV infection in adult liver transplant recipients

Infection with varicella-zoster virus (VZV) is common, occurring as primary varicella, usually during childhood, and as zoster, following reactivation of latent virus. Although serious VZV infections are infrequent, they can be life-threatening when they occur in susceptible immunosuppressed patients (1, 2). These patients have a high incidence of visceral involvement, including pneumonitis, meningoencephalitis, and rarely, hepatitis. We report here 3 cases of VZV hepatitis in adult liver transplant recipients that occurred in our institution between 1984 and 1989. We describe their clinical presentations and use these cases to illustrate some aspects in diagnosis and prevention of VZV infection after solid organ Tx.

Leukocyte Interferon for Treating First Episodes of Genital Herpes in Women

Abstract Women experiencing their first episodes of genital herpes were treated, beginning within three days of the onset of lesions, with 5 × 104 units of human leukocyte interferon/kg of body weight for 12 doses over 14 days (total, ∼3.6 × 107 units) or with placebo in equivalent volumes. Life-table analysis revealed quicker healing and significant reductions in the duration of shedding of virus in interferon-treated patients. Maximum daily geometric mean titers of virus and total area of unhealed lesions also decreased more quickly. No statistically significant difference in resolution of pain was seen between the two groups. Interferon had no effect on onset or frequency of subsequent recurrences recorded over one year of follow-up. Moderate, transient neutropenia occurred in 13 of 34 interferon-treated patients. A therapeutic effect of human leukocyte interferon on initial genital herpes was documented, but the clinical usefulness of interferon treatment of genital herpes is limited at this time.

Sensitivity and reproducibility of Thayer-Martin culture medium in diagnosing gonorrhea in women

Abstract The Thayer-Martin culture medium was evaluated by culturing specimens from the cervix and rectum of 59 women alleged to have been the source of gonorrhea in men. By testing these women on 3 consecutive days, 50 (85 per cent) were culturally confirmed to have gonorrhea. A single cervical culture detected 89.7 per cent of those infected; repeating a single cervical culture on a subsequent day resulted in a total detection of 96.6 per cent of those infected. The remaining 3.4 per cent in the detection rate was achieved by a single rectal culture. Reproducibility of positive results occurred in 91 per cent of 266 cervical specimens and 89 per cent of 165 rectal specimens. The Thayer-Martin culture medium provides an accurate and reliable means of detecting gonorrhea in women, and its use should be considered for routine screening of high-risk populations.

Reactivation of Type 2 Herpes Simplex Virus by Thoracolumbar Neurosurgery

Excerpt Orofacial Herpes Simplex Virus recurrences after neurosurgery on the trigeminal sensory root (1-5) suggested a relationship between recurrent herpes labialis, herpes simplex virus latency, ...