ABSTRACT
Plasma viral load from 71 HIV-1-infected neonates was measured by using Amp-RT, an ultrasensitive quantitative reverse transcriptase (RT) assay and by nucleic acid sequence-based amplification (NASBA), an RNA-based quantitative assay. Results were then compared with those obtained from detection of proviral DNA in peripheral blood mononuclear cells (PBMCs) by polymerase chain reaction (PCR) using Turnbull analysis. At 5 days of life, 50% of neonates were positive by Amp-RT, 30% were NASBA positive, and 20% were DNA-PCR positive. Through the first 12 days of life, Amp-RT was more sensitive than either NASBA or DNA-PCR in detecting HIV-1 infection. Amp-RT values correlated well with NASBA RNA values, with an overall Pearson's r = 0.63 (95% confidence interval [CI], 0.40-0.78). In proportional hazards analysis of infants aged 14 to 61 days (N = 31), a one-log increase in RNA-based viral load was associated with a > fivefold risk of disease progression when using the U.S. Centers for Disease Control and Prevention (CDC) clinical Category C (CDC-C) or death as an endpoint (p =.014). Kaplan-Meier analysis of these data found that RNA viral loads were able to predict disease progression using CDC-C/death as an endpoint (p = .013). Early quantitative viral load measurements may assist clinicians in diagnosing HIV-1 infection, stratifying risk of disease progression, and implementing a treatment plan using highly active antiretroviral therapy for infants within the first few weeks of life.
Subject(s)
DNA, Viral/blood , HIV Infections/congenital , HIV Infections/diagnosis , HIV Reverse Transcriptase/blood , Infant, Newborn, Diseases/diagnosis , RNA, Viral/blood , Black or African American , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Birth Weight , Centers for Disease Control and Prevention, U.S. , Demography , Disease Progression , Female , HIV Infections/blood , HIV Infections/drug therapy , HIV Infections/virology , HIV Reverse Transcriptase/metabolism , HIV-1/enzymology , HIV-1/genetics , HIV-1/isolation & purification , HIV-1/physiology , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/blood , Infant, Newborn, Diseases/drug therapy , Infant, Newborn, Diseases/virology , Infant, Premature , Male , Polymerase Chain Reaction , Prognosis , Proportional Hazards Models , Sensitivity and Specificity , Survival Rate , United States , Viral LoadABSTRACT
Pseudomonas stutzeri is a rare pathogen, and its recovery is often associated with colonization and contamination. We report a case that, to our knowledge, is the first of community-acquired P. stutzeri vertebral osteomyelitis in a previously healthy patient, and we review the literature regarding infections with this uncommon organism. Of the 29 previously reported cases of P. stutzeri infection cited in the literature, only two resulted in death, reflecting the relatively low degree of virulence of this organism. Predisposing risk factors for P. stutzeri infection can be categorized as follows: (1) previous surgery or procedure (implying probable nosocomial acquisition), with or without a foreign body; (2) immunocompromise (an underlying predisposition to infection by an organism with low virulence); (3) immunocompromise and a previous procedure; and (4) previous trauma or superficial infection, with or without possible nosocomial contamination. Our patient lacked any known risk factors for either pyogenic vertebral osteomyelitis or P. stutzeri infection.
Subject(s)
Lumbar Vertebrae/pathology , Osteomyelitis/diagnosis , Osteomyelitis/microbiology , Pseudomonas Infections/microbiology , Pseudomonas/isolation & purification , Acute Disease , Adult , Anti-Bacterial Agents , Drug Therapy, Combination/therapeutic use , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Osteomyelitis/drug therapy , Pseudomonas Infections/diagnosis , Pseudomonas Infections/drug therapy , Treatment OutcomeABSTRACT
Over a six-month period women attending a general practice surgery for contraceptive pill prescriptions were asked whether they had had rubella and if they would give a blood sample to test for immunity. Of 459 interview, 104 (23%) did not want any more children and 69 (15%) had been vaccinated or had been shown to be immune by serotesting. Only three refused to give a blood sample, and 283 patients (62%) had their antibody concentrations checked. Two hundred and twenty-five (79-5%) could be reassured that they were immune, and the rest were offered rubella vaccination. It is thus quite feasible, and would add little to the work load, to screen the susceptible women in a practice and offer rubella vaccination to those needing it.
