The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis.

STUDY DESIGN: Retrospective chart review of 44 cases. OBJECTIVE: To describe the clinical usage of the erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis. SUMMARY OF BACKGROUND DATA: The erythrocyte sedimentation rate is often used to determine the efficacy and duration of treatment in pyogenic vertebral osteomyelitis. Although consensus and anecdotal reports support this notion, no detailed review of the erythrocyte sedimentation rate response in conservative treatment of pyogenic vertebral osteomyelitis has been made, to date. METHODS: For 44 patients with pyogenic vertebral osteomyelitis who had erythrocyte sedimentation rate testing at or before the time of diagnosis and at least twice during the next month, the clinical findings and results of the erythrocyte sedimentation rate testing were reviewed. RESULTS: Of 18 cases with no significant fall in the erythrocyte sedimentation rate during the first month, 9 (50%) failed conservative treatment. Conversely, of the 26 cases with a good erythrocyte sedimentation rate response during the first month, three (12%) were clinical failures. However, a rapid decline of the erythrocyte sedimentation rate (> 50% in the first month) is rarely seen in treatment failure. In addition, approximately 2 weeks after antibiotic treatment, 19 of 32 were actually higher than at the time of diagnosis, but went on to clinical cure without surgery. The erythrocyte sedimentation rate, in combination with the patient's age and immune status, predicted the success of antibiotic treatment, in most cases. The erythrocyte sedimentation rate response alone during the first month was not a clear predictor of success. CONCLUSIONS: Although the erythrocyte sedimentation rate does correlate well with response to treatment as a general rule, care must be taken in interpretation of a persistently elevated or even rising erythrocyte sedimentation rate as an isolated clinical finding.

HIV-1 and HIV-2 Infections Among U.S. Peace Corps Volunteers Returning from West Africa.

Background: The risk of acquiring HIV-1 and HIV-2 infections among expatriates in, and travelers to, West Africa is not known. The objective of the study was to examine the risk of human immunodeficiency virus type 1 and type 2 (HIV-1 and HIV-2) infections among Peace Corps volunteers in West Africa. Methods: A cross-sectional serosurvey was carried out in 18 West African countries. Subjects were 2491 returning Peace Corps volunteers. The main outcome measure was seropositivity for HIV-1 and HIV-2 antibodies. Results: From March 1988 through February 1993, of 2491 study participants, no HIV-2 infections were detected, but three HIV-1 infections were. All three HIV-1-infected persons reported having had unprotected sex with host-country national partners. Conclusions: Results suggest that although persons having unprotected sex with partners from countries with a high prevalence of HIV-1 are at risk for acquiring the infection, casual transmission of HIV-1 or HIV-2 is extremely unlikely.

Human immunodeficiency virus infection among Peace Corps volunteers in Zaire. No evidence for unusual modes of transmission.

A prospective study of US Peace Corps volunteers (PCVs) serving in Zaire, central Africa, was undertaken to determine the risk of human immunodeficiency virus (HIV) and hepatitis B virus infection in an acquired immunodeficiency syndrome-aware expatriate population living in an area of high endemicity for both diseases. Of the 338 PCVs who served in Zaire between October 1985 and May 1988, 282 (83%) were enrolled, representing 7776 volunteer-months of service. Analyses of serum samples for HIV and hepatitis B virus were performed on enrollment and at completion of service. All PCVs received extensive education and counseling regarding HIV and acquired immunodeficiency syndrome throughout their stay in Zaire. There were no documented seroconversions to HIV among 282 PCVs who lived in Zaire for periods ranging from 1 to 81 months, with a mean length of stay of 27.4 months. Of the 14 (6.2%) of 226 PCVs tested who had at least one positive serologic marker for infection with hepatitis B virus, none was documented to have seroconverted during service. During the study period, the rate of all sexually transmitted diseases among PCVs in Africa decreased from 131 to 68 per 1000 study population per year, and there were 52 cases of confirmed malaria among volunteers in Zaire. These data suggest that the risk of acquiring infection with HIV or hepatitis B virus in PCVs in Zaire is very low, and there is no evidence for unusual modes of transmission.

Epidemiological surveillance in Peace Corps Volunteers: a model for monitoring health in temporary residents of developing countries.

In 1985, the US Peace Corps developed a computerized epidemiological surveillance system to monitor health trends in over 5500 Peace Corps Volunteers working in development projects in 62 countries worldwide. Data on 31 health conditions and events are collected monthly from each country; quarterly and annual incidence rates are then calculated, and the analysed data are distributed. In 1987, the most commonly reported health problems were diarrhoea (unclassified), 48 cases per 100 volunteers per year; amoebiasis, 24 per 100 volunteers per year; injuries, 20 per 100 volunteers per year; bacterial skin infections, 19 per 100 volunteers per year; and giardiasis 17 per 100 volunteers per year. Tracking each of these common problems, as well as other selected health conditions, guides design of more specific studies and disease control efforts. Health problems with very low rates (less than 1.0/100 volunteers/year) include hepatitis, schistosomiasis, non-falciparum malaria, and filariasis. The epidemiological surveillance system provides the health data needed to plan, implement, and evaluate health programmes for Peace Corps Volunteers, and provides a model for surveillance in other groups of temporary and permanent residents of developing countries.

The early kinetics of the neutralizing antibody response after booster immunizations with human diploid cell rabies vaccine.

Persons immunized in developing countries were recently shown to have low titers after pre-exposure immunization with human diploid cell rabies vaccine (HDCV). An investigation into the response to HDCV boosters was conducted to determine if immunologic sensitization had occurred and if there was a response difference in persons immunized in and outside of the United States. Intramuscular (im) booster doses of vaccine were administered to 113 persons previously immunized outside the United States and 47 persons immunized in the United States. The post-exposure booster regimen of a single 1.0-ml im booster, as recommended by the World Health Organization for all but the most severe bites, produced a one-dilution (5-fold) rise in antibody titer in 14 (11%) of 123 persons tested 5 days after booster and in 56 (89%) of 63 persons studied 7 days after booster. Persons immunized in the United States and those immunized outside the United States had similar responses. Persons with low pre-booster titers were more likely to exhibit a 5-fold rise in antibody titer 5 days after booster (P = 0.03) than persons with higher pre-booster titers. The post-exposure booster regimen of 2 1.0-ml im doses (one each on days 0 and 3), recommended in the United States, produced a more rapid response than the single booster regimen in only some persons; a 5-fold response occurred in 6 (50%) of 12 persons 5 days after booster.(ABSTRACT TRUNCATED AT 250 WORDS)