The child with HIV infection.

1. Although incurable, HIV infection is treatable. Advances in antiretroviral therapy, prophylaxis to prevent opportunistic infections, treatment of opportunistic infections, and aggressive nutritional intervention allow for prolonged survival with a reasonable quality of life for many infected children. 2. HIV-infected children tolerate the majority of surgical procedures well; HIV infection alone is not a contraindication to surgery. Because of the multiple laboratory abnormalities that occur in children with HIV, nurses must assess that the appropriate laboratory testing has been completed and that the results have been reviewed. 3. Symptoms in children with HIV result from multiple causes and present in a variety of ways. As the lives of children are extended with better supportive and antiviral treatment, additional manifestations of HIV are being noted.

Simian virus 40 T antigen can transcriptionally activate and mediate viral DNA replication in cells which lack the retinoblastoma susceptibility gene product.

Simian virus 40 T antigen is a multifunctional protein which has recently been shown to form a complex with the retinoblastoma susceptibility gene product (Rb protein) (J.A. DeCaprio, J.W. Ludlow, J. Figge, J.-Y. Shaw, C.-M. Huang, W.-H. Lee, E. Marsilio, E. Paucha, and D.M. Livingston, Cell 54:275-283, 1988; P. Whyte, K.J. Buchkovich, J.M. Horowitz, S.H. Friend, M. Raybuck, R.A. Weinberg, and E. Harlow, Nature (London) 334:124-129, 1988). This interaction may facilitate some of the functions of T antigen. The ability of simian virus 40 T antigen to mediate transcriptional activation and viral DNA replication was tested in human osteosarcoma cell lines U-2OS and Saos-2, which are Rb positive and Rb negative, respectively. Both functions of T antigen were efficient in both cell lines. Hence, these functions can occur in the absence of Rb protein.

Activity of simian virus 40 late promoter elements in the absence of large T antigen: evidence for repression of late gene expression.

We used chloramphenicol acetyltransferase transient expression to examine the activity of the promoter elements of the simian virus 40 late promoter in the absence of large T antigen. Since the experiments were done in permissive CV-1 cells, these conditions mimic the state which exists early in the viral lytic cycle before the onset of replication and T-antigen-mediated trans activation. Our data, using deletion analysis, indicate that removal of the 21-base-pair (bp) repeat region causes as much as a 10-fold increase in activity of the late promoter elements. This result suggests that the 21-bp repeat sequences may be involved in repression of the late promoter elements during the early phase of the lytic infection. This is supported by competition analysis which indicates that increasing amounts of competitor containing only the 21-bp repeat region results in increased activity of the intact promoter. A model for the activity of the late promoter through the course of lytic infection is presented.

Isolation of nontoxigenic Vibrio cholerae O group 1 from a patient with severe gastrointestinal disease.

A nontoxigenic strain of Vibrio cholerae O group 1 was isolated in Florida from the stool of a patient with severe diarrhea. The strain had the same hemolytic and unique phage-sensitivity pattern as all toxigenic isolates from recent cases of cholera in Texas and Louisiana. Identical strains were transiently isolated from sewerage systems in two other Florida communities, suggesting that multiple human infections had occurred. This is the first indication that V. cholerae O1 strains which do not produce cholera toxin may be able to cause gastrointestinal disease in humans. The identification of these strains also raises questions about the relationship between toxigenic and nontoxigenic strains of V. cholerae O1 along the Gulf Coast of the United States.

Detection of precipitating antibodies to Histoplasma capsulatum by counterimmunoelectrophoresis.

The technique of counterimmunoelectrophoresis was evaluated for its usefulness in the detection of precipitating antibodies to Histoplasma capsulatum, designated h and m precipitin bands. Forty-four patients with active histoplasmosis had either m bands or both h and m bands. The h precipitin band occurred primarily in patients with disseminated disease, chronic pulmonary disease, or mediastinal lymphadenopathy of several months' duration; with resolution of the infection, this antibody disappeared. The m band appeared earlier in the course of histoplasmosis and persisted for months to years after resolution of the infection. Antibodies detected by counterimmunoeelectrophoresis were in the immunoglobin G class and were more specific for histoplasmosis than those detected by the complement fixation test. Only one false positive h band occurred in a total of 81 sera tested (specimens from 24 healthy control subjects and 57 patients with other diseases). Counterimmunoelectrophoresis was both more sensitive and quicker than immunodiffusion at detecting h and m antibodies. Combining this assay with standard complement fixation tests and fungal culture methods should lead to the accurate, rapid diagnosis of histoplasmosis.

Pericarditis caused by Histoplasma capsulatum.

Sixteen patients with pericarditis caused by Histoplasma capsulatum were studied. Fourteen were less than 30 years old, and no patient had an underlying illness or was receiving immunosuppressive therapy. All patients experienced a flu-like prodromal illness lasting from 2 weeks to 4 months. Pneumonitis or hilar adenopathy, or both, was found in 12; pleural effusion, uncommon in primary pulmonary histoplasmosis, was found in seven patients. Pericardial fluid, pleural fluid and bone marrow cultures yielded no growth. All patients demonstrated a fourfold or greater change in complement-fixing antibody titers. No patient had disseminated disease, and only one required treatment with ampholericin B. The illness ran a protracted course, and in six patients symptomatic pericarditis recurred. Ultimately all recovered. Ten patients were restudied 6 months to 12 years after recover. Only one patient had pericardial calcification, and none had constrictive pericarditis. This form of granulomatous pericarditis, unlike that caused by Mycobacterium tuberculosis, appears to carry a good prognosis.

Clindamycin concentrations in the central nervous system of primates before and after head trauma.

The authors measured levels of clindamycin, a drug well established as useful in the treatment of various soft-tissue and parenchymal bacterial infections, in serum, cerebrospinal fluid, and brain tissue of 14 rhesus monkeys. Penetration into brain tissue was erratic and concentrations detected were not significant. Cerebrospinal fluid levels, however, averaged 20.5% of paired serum concentrations and were higher than concentrations needed to inhibit most Gram-positive bacteria. Further studies in humans are indicated before this antibiotic may be used routinely.