Martin L. Schulkind

Transfer factor in the treatment of a case of chronic mucocutaneous candidiasis

Abstract A girl with a severe case of chronic mucocutaneous candidiasis in whom a partial defect in cell-mediated immunity to C. albicans was demonstrated is described. Chemotherapy with anti-Candida agents afforded only temporary clinical improvement. Although her delayed hypersensitivity skin test response to C. albicans was consistently negative, her lymphocytes underwent blast transformation when cultured in the presence of C. albicans and other mitogens. The addition of exogenous transfer factor to the culture medium increased her lymphocyte blast transformation response to C. albicans. Because of these findings she was treated with transfer factor with the aim of restoring expression of cutaneous hypersensitivity to the antigen, and providing her with clinically significant immunity to the antigen. Following a course of repeated injections of transfer factor given in conjunction with a short course of intravenous amphotericin B, her infection cleared and she has had no recurrence of infection for at least 6 months.

Hypoimmunoglobulinemia with normal T cell function in female siblings

Abstract A distinct syndrome reported here provides evidence for an autosomal recessive counterpart to X-linked (Brutons) hypoimmunoglobulinemia. Two sisters had humoral (B cell) immunodeficiency. One suffered from recurrent infection, the second presented with non septic arthritis. Both had markedly lowered immunoglobulin levels in serum and secretions, deficient antibody production, and absent B-dependent regions in their lymph nodes. They also lacked surface immunoglobulin-bearing peripheral blood lymphocytes. T cell number and cell-mediated immunity were normal; lymphocytes with complement or Fc receptors were present.

A CASE REPORT OF THE SUCCESSFUL TREATMENT OF RECURRENT APHTHOUS STOMATITIS WITH SOME PREPARATIONS OF ORALLY ADMINISTERED TRANSFER FACTOR

A patient with severe disabling recurrent aphthous stomatitis (RAS) was treated with four different preparations of oral human transfer factor (TF), as well as placebo, following a double-blind protocol. Two of the TF preparations had a significant effect upon the course of the patients illness by prolonging the interval between attacks and decreasing the severity of attacks. No side effects attributable to any of the preparations were noted by the patient. Thus, some but not all preparations of human transfer factor given orally are an effective therapy for RAS.

686 CHILDREN AND YOUTH WITH RECURRENT INJURIES

In a study initiated to identify causative factors for recurrent trauma in rural children and youth the charts of 51 patients treated at 3 university affiliated rural health clinics were reviewed. The patients selected had had 3 or more injuries occurring within the previous 5 years.Of these injured children 7.8% were 1-4 years old, 11.8% 6-10, 41.2% 11-15, and 39.2% 16-21. Of the patients, 80.4% were male while 19.6% female; 86.3% were white and 13.7% black. There was a total of 244 incidents of injuries sustained by these patients during the study. Twenty-two injuries were fractures, 6 dislocations, 5 sprains, 11 head injuries, 56 lacerations, 56 contusions, 17 abrasions and 26 were other types including puncture wounds, eye injuries, burns, toxic substance ingestions, exposures to toxic chemicals, gunshot wounds, joint effusions, and ear drum injuries. The injuries occured during these activities: 11 at work, 72 at school, 48 during competitive athletics, 24 in physical education classes, 18 in unsupervised athletic competition, 73 at play, 9 in automobile accidents, 7 in motorcycle accidents, 4 in bicycle accidents, and 23 in activities such as walking, stepping on glass, falling out of non-moving vehicles and windows, fingers caught in doors and windows, dropping objects on extremities, horseback riding and tending a fireplace.A program to prevent recurrent injuries in these children which will include psychosocial as well as general education counseling is being developed.

Transfer factor in the treatment of chronic mucocuataneous candidiasis

The use of “transfer factor” to correct a partial defect in cellular immunity to Candida albicans was studied in an 8-year-old girl with chronic granulomatous mucocutaneous candidiasis.The patient first presented at age 5 years with extensive deforming encrusted lesions on her face, head, trunk and extremities. No evidence of endocrinopathy or antibodies to endocrine tissue was found. Her general humoral immunity was intact. She had a normal complement of granulocytes and lymphocytes. Candida aggregation activity was present in her serum. Her skin test response to C. albicans extract was consistently negative. Her lymphocytes underwent blastogenesis to PHA, diphtheria toxoid and C. albicans extract. However, in the presence of exogenous transfer factor, blastogenesis to candida increased. Transfer factor extracted from her cells did not transfer immunity to non-sensitized cells.Amphotericin B therapy cleared her skin lesions temporarily, but neither fresh frozen plasma injections nor 5-fluorocytosine was effective. Following 2 injections of transfer factor, she developed a positive skin test response to C. albicans extract, and her lymphocytes produced leukocyte inhibition factor (LIF) to candida. After a third injection there was appreciable clearing of the skin lesions.These findings indicate that exogenous transfer factor can restore cellular immunity to candida in a patient with chronic mucocutaneous candidiasis and may be an effective treatment for this disease.

685 ACCIDENTAL INJURIES TO CHILDREN AND YOUTH IN RURAL FLORIDA

In order to develop an accident prevention program for children, a review of injuries occurring in children seeking care at 3 North Florida rural health clinics was made. The clinics are located in 3 medically underserved rural counties and serve as their only medical facilities. The nearest full-service hospital emergency room is 30 miles from one clinic, and over 50 miles from the other two. The records of 230 children treated during the 4-month period were reviewed.Of the 258 injuries or accidents reported, 2 were fatal. The most common non-fatal injuries were lacerations (30%), contusions (16%), sprains (12%), head injuries (10%), fractures (9%), and abrasions (7%). A miscellaneous group of injuries accounted for 18% of the accidents.Accidents occurred more often in males (65%) than females (35%); 2% occurred in 0-1 year olds, 17% in 1-4 year olds, 20% in 5-9 year olds, 41% in 10-15 year olds, and 20% in 16-21 year olds. These accidents occurred most frequently while they were at play (50%); 10% occurred at work, 15% at school, 6% in auto accidents, and 19% of miscellaneous causes. 15% of the accidents resulted from athletic activity; of these 31% occurred in organized sports, 48% in physical education classes, and 21% in unsupervised athletics. A comprehensive accident prevention program will be presented to this selected group of children and youth and their parents for the purpose of reducing injuries.

THE EFFICACY OF GANTRISIN AS COMPARED TO KEFLEX IN THE TREATMENT OF URINARY TRACT INFECTIONS IN COLLEGE COEDS

During, the past three years on 354 occasions college coeds with culture proven acute symptomatic urinary tract infections (2 cultures >100,000 col) were treated with either Gantrisin (123) or Keflex (231) in subgroups of 3, 7, 10, 14 or 21 days.A comparison of the recurrence rates for each of the subgroups within the Gantrisin (G) and Keflex (K) groups were not statistically different. For this reason, all subgroups for each of the drugs were combined in order to compare the combined efficacy of each group.Cantrisin (Total Recurrence Rate Post Theraphy 12.79%) appears to be more effective than Keflex (Total Recurrence Rate Post Therapy 35.4%) in the treatment of urinary tract infections in college coeds. In addition, three days of therapy proved to be as effective as longer courses of therapy in these young women.

PREDICTABILITY OF RECURRENCE RATE OF URINARY TRACT INFECTIONS BASED ON ANTIBODY COATED BACTERIA TESTING

During the past two years on 324 occassions college coeds with symptoms of urinary tract infections were evaluated with at least two urine cultures and a non-invasive test of localization (fluorescent antibody coated bacteria). They were subsequently treated with either Gantrisin (93) or Reflex (231) for periods of 3, 7, 10, 14 or 21 days.The recurrence rate one week post therapy for the separate and combined groups were as follows:It appears that urine demonstrating fluorescent antibody coated bacteria (kidney infection) is not associated with a greater propensity of recurrent infection than is urine with negative testing for fluorescent antibody coated bacteria (bladder infection). Comparable results were obtained utilizing depressed concentrating ability as a test of upper tract infection.

COMPARISON OF A COMBINED QUALITATIVE AND SEMIQUANTITATIVE URINE CULTURE METHOD WITH THE STANDARD CALIBRATED LOOP METHOD

229 urines obtained from college coeds with acute urinary tract infections were examined by comparing the standard calibrated loop culture method with a combination of qualitative Greiss Test (Bac-U-Dip) and a semiquantitative (Bacturcult) method.Analysis of the data demonstrated a small false positive (F.P.) but a marked false negative (F.N.) rate for Bac-U-Dip (BUD). The false negative rate for Bacturcult (B/C) was zero and the false positive rate, when compared to a no-growth culture (NG) was also low (1/70).The combination of Bacturcult and Bac-U-Dip provides both low false positive and false negative rates.

HOME CULTURE PROGRAM FOR CHILDREN WITH RECURRENT BACTERIURIA

One hundred sixty-five children with recurrent bacteriuria were placed on a continuing home culture program with 87% compliance. Parents were taught to obtain clean-catch urines on the first urine of the morning using the urine culture tube technique (Bactercult). They were taught to read the cultures following incubation both at room temperature and in an incubator. Positive cultures (>10 cols./unit area) were repeated. If urines were negative, patients were seen on alternate months; if 2 positive urines were obtained, the patient was returned to clinic for confirmation. Colony counts between 10 and 50 were rarely positive in clinic. When 2 positive urines (>50 cols./unit area) were obtained, confirmation in clinic for significant bacteriuria was 65%. The false positive rate was, therefore, significant. The false negative rate was very low at <4%. There was good agreement between incubator and room temperature for colony growth.A home culture program can significantly reduce office visits; more than 200 visits were avoided for negative cultures. Cultures can be obtained frequently, conveniently, on the first voided urine of the morning and at low cost to parents. Early diagnosis of an asymptomatic recurrence can be made. The epidemiology of bacteriuria can be studied in the family, and a significant advance in the extension of health care to the community can be made.