Stephen T. Green

Propionibacterium acnes Endocarditis in a Native Valve Complicated by Intraventricular Abscess: A Case Report and Review

Propionibacterium acnes is a constituent of the normal skin flora. It has been described as causing infection on prosthetic valves but very rarely on native valves. We describe a case of aggressive P. acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortic root abscess and review the literature.Propionibacterium acnes is a constituent of the normal skin flora. It has been described as causing infection on prosthetic valves but very rarely on native valves. We describe a case of aggressive P. acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortic root abscess and review the literature.

Prison experience of injecting drug users in Glasgow

Five hundred three injecting drug users in Glasgow recruited by a multisite and citywide sampling strategy were questioned regarding their drug-taking behaviour during episodes of custody over the six months prior to interview. Fifty-two percent had been in custody during the past 6 months, 16% of these had injected while in custody. Of these 73% borrowed injecting equipment and 78% handed on used equipment to others. All those who shared, cleaned their injecting sets before use. Over half of those who injected had a source of new sets. While the potential exists for spread of HIV among drug users while in custody there is clear understanding among them of the route by which the virus is spread and also the will to prevent it.

Use of ciprofloxacin in developing countries.

BACKGROUND The demographic and subsequent economic pressures in developing nations have contributed to the increasing levels of antibiotic resistance among both commensal flora and pathogenic bacteria. As empirical options are diminishing daily, the role of ciprofloxacin in pediatric infections is becoming increasingly significant. OBJECTIVE The levels of resistance among various enteric pathogens are described, and the efficacy and safety of ciprofloxacin in treating infections such as shigellosis, cholera and Escherichia coli gastroenteritis are discussed. The findings of a large study of invasive salmonellosis in children in rural Africa are briefly presented, including the role of ciprofloxacin in multiresistant invasive disease. In addition the role of ciprofloxacin as a chemoprophylactic agent in the control of meningococcal disease is discussed. RESULTS The efficacy and safety of ciprofloxacin in children were found to be similar to those observed in adults for gastrointestinal infectious diseases. Overall the data presented confirm that ciprofloxacin is a safe and efficacious agent for use in children in the developing world. CONCLUSION Ciprofloxacin has been shown to be safe and efficacious in children in developing countries. Subsequently a priority for both the pharmaceutical industry and regulatory authorities in developing nations is to prevent fluoroquinolone misuse and development of antibiotic resistance.

Plasmodium falciparum malaria in pregnancy: a review

The prevalence of Plasmodium falciparum malaria in the United Kingdom has risen steadily over the last decade with over 1000 cases reported in 1986 (Phillips-Howard et al. 1988). This has been attributed to the increased number of travellers to Africa exposed to the infection, and to greater risk of breakthrough as a result of the spread of chloroquineresistant P. fakiparum malaria (McGregor 1964). Although there has been no corresponding increase in deaths related to P. falciparum infection, the majority of deaths occurred in Britons who were likely to be non-immune. Non-immune pregnant women are particularly prone to falciparum malaria infection. Infection in the second or third trimester carries a bad prognosis (Warrell 1989). Complications include miscarriage, intrauterine death, preterm delivery and low birthweight (McGregor et al. 1983; Menon 1972). The principal maternal complications are severe hypoglycaemia, acute pulmonary oedema, anaemia, preterm labour and death (Warrell et al. 1990). In the recent recommendations for the prevention of malaria among travellers, women who are pregnant or likely to become so were advised to avoid travel to areas with chloroquine resistant P. falciparum because alternatives to chloroquine chemoprophylaxis, either mefloquine or doxycycline, are not currently licensed for chemoprophylaxis in pregnancy (CDC 1990). We review the current management of Plasmodium falciparum malaria occurring in pregnancy as well as the problems of antimalarial chemoprophylaxis.

HIV testing among injecting drug users in Glasgow

The use of saliva rather than blood for epidemiological studies of HIV prevalence, especially among injecting drug users, has several practical advantages. In a cross-sectional, behavioural and prevalence study among drug users in Glasgow during 1990, salivary samples were therefore obtained by the use of salivettes. Such samples were requested for anonymous anti-HIV testing from 498 persons in locations varying from residential rehabilitation centres to the open streets. Of this number, 35 refused to give a sample, resulting in a compliance rate of 93%. Of the 463 salivettes received by the laboratory, eight were found to be dry. Of the remaining 455 specimens, eight were found to be positive for HIV-1 antibody by means of an IgG antibody capture ELISA, so giving a prevalence rate of 1.8%. The results of testing saliva and blood spot samples collected at the same time on filter paper from 98 persons for HIV-1 antibody were 100% concordant. The study confirms the experience of others that specimens of saliva are easy to collect under variable conditions by non-medical staff and demonstrates that the salivette can provide an HIV antibody test result the same as that obtained from a blood spot. The prevalence of HIV antibody determined in this study is similar to that of other studies taking place in the city during the same period of time.

'Now and Again It Really Hits Me': The Impact of an HIV-positive Diagnosis upon Psychosocial Well- being.

Quantitative and qualitative data were gathered from a sample of 66 seropositive and 67 seronegative men and women about the impact of an HIV diagnosis upon psychosocial well-being. No significant differences between seropositives and seronegatives were found on any of the psychosocial measures except hopelessness. Nor was there significant variation by disease progression (but this may be due to the restricted size of the sample). The qualitative data are used to illustrate these findings and explore their meaning. It is concluded that, with the exception of a hopeless future orientation, psychosocial disturbance of seropositives tends to be episodic and short-lived and thereby difficult to measure.

Estimates of HIV infection among injecting drug users in Glasgow, 1985-1990.

ObjectiveTo use research and surveillance studies in Glasgow (Scotland, UK) to estimate the number of current injectors infected with HIV, the total number of injectors infected up to the end of 1990 and the recent incidence of infection. Design(A) Prevalence of injecting drug use was estimated using log-linear modelling. (B) Prevalence of HIV infection was determined from voluntary testing of a community-wide sample of injectors

Tideline and turn: possible reasons for the continuing low HIV prevalence among Glasgow's injecting drug users

This is an early report of data from an on-going, repeated, cross-sectional study of a community sample of Glasgow injecting drug users. Although HIV was first detected among Glasgows drug injectors in 1985, data from the first two years of our annual samples (1990 and 1991) indicate that HIV prevalence continues to be low in this population, in the order of 1 or 2 per cent. Possible reasons for this apparent continuing low prevalence are examined. It is suggested that substantial risk reduction – reductions in injection equipment-sharing, reductions in numbers of sharing partners and restrictions in social circles of sharing partners – may have been sufficient reasons, in conjunction with limited contributions to near-stabilisation from the disproportionate attrition of the numerator population through death and cessation of injecting.

Successful use of Fendrix in HIV-infected non-responders to standard hepatitis B vaccines

decrease of pertussis in the French armed forces. Our estimation of VE appears to be in the range of that estimated in other studies of recent vaccination against pertussis. In light of the waning of protection against pertussis during the years following the last dTaP-IPVadministration, themilitary vaccination schedule could be modified in the near future to recommend more than one booster dose during adulthood.

Mobility of Scottish injecting drug users and risk of HIV infection

Nine hundred and nineteen injecting drug users (IDUs) were interviewed in Glasgow, Scotland during 1990 and 1991, as part of a wider study of HIV risk behaviour, about their injecting and sexual behaviour outside the city in the previous two years. Forty-five percent of respondents injected outside Glasgow, 6% shared needles and syringes (n/s) and 20% had sexual intercourse. Much activity occurred outside Scotland but mainly within the UK, particularly London. Predictors of n/s sharing outside Glasgow during the previous two years included current injecting with and passing on of used n/s and sexual intercourse with casual partners. Predictors of sexual behaviour outside Glasgow included passing on used n/s, having sexual intercourse with casual partners and, for females, engaging in prostitution. Glasgow IDUs are a highly mobile group and although HIV prevalence remains low within this population, considerable potential for importation/ exportation of HIV and other bloodborne and sexually transmitted infections exists. Further work is required to establish why IDUs travel to, and engage in high-risk activities in locations outside their home environment, and detailed data about activities such as frequency of condom usage and n/s cleaning practices need to obtained. While there is a widespread network of services for IDUs in the UK, information provided usually relates to local services and may not fully address the needs of this mobile population. Therefore, we recommend that IDUs be provided with details of facilities such as n/s exchange schemes and drug-treatment establishments in centres to where they most commonly travel.