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1.
N Engl J Med ; 339(4): 216-22, 1998 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-9673299

RESUMO

BACKGROUND: Lyme disease is a multisystem inflammatory disease caused by infection with the tick-borne spirochete Borrelia burgdorferi and is the most common vector-borne infection in the United States. We assessed the efficacy of a recombinant vaccine consisting of outer-surface protein A (OspA) without adjuvant in subjects at risk for Lyme disease. METHODS: For this double-blind trial, 10,305 subjects 18 years of age or older were recruited at 14 sites in areas of the United States where Lyme disease was endemic; the subjects were randomly assigned to receive either placebo (5149 subjects) or 30 microg of OspA vaccine (5156 subjects). The first two injections were administered 1 month apart, and 7515 subjects also received a booster dose at 12 months. The subjects were observed for two seasons during which the risk of transmission of Lyme disease was high. The primary end point was the number of new clinically and serologically confirmed cases of Lyme disease. RESULTS: The efficacy of the vaccine was 68 percent in the first year of the study in the entire population and 92 percent in the second year among the 3745 subjects who received the third injection. The vaccine was well tolerated. There was a higher incidence of mild, self-limited local and systemic reactions in the vaccine group, but only during the seven days after vaccination. There was no significant increase in the frequency of arthritis or neurologic events in vaccine recipients. CONCLUSIONS: In this study, OspA vaccine was safe and effective in the prevention of Lyme disease.


Assuntos
Antígenos de Superfície/imunologia , Proteínas da Membrana Bacteriana Externa/imunologia , Vacinas Bacterianas , Grupo Borrelia Burgdorferi/imunologia , Lipoproteínas , Doença de Lyme/prevenção & controle , Vacinas Sintéticas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Vacinas Bacterianas/administração & dosagem , Vacinas Bacterianas/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Esquemas de Imunização , Doença de Lyme/imunologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/efeitos adversos
2.
Medicine (Baltimore) ; 74(4): 191-200, 1995 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-7623654

RESUMO

A prospective, observational study of 110 patients with serious infections due to Enterococcus spp. in 6 university and community teaching hospitals in Connecticut was conducted to define the epidemiology of community and nosocomial serious enterococcal infections and to determine risk factors, including antibiotic resistances, that contribute to outcome. Serious community and nosocomial enterococcal infections involved a variety of sites, and antibiotic resistance was common. Types of infection by major organ system were cardiovascular, 54% (catheter-related bacteremia 28%, primary bacteremia 18%, endocarditis 6%, septic thrombophlebitis 1%); intra-abdominal, 13% (including cholangitis, 6%); renal, 13%; skin and soft tissue, 5%; bone and joint, 4%; pleuropulmonary, 4%; central nervous system, 3%; deep surgical wound, 3%; and endometritis, 2%. Sixty-one percent of infections were nosocomial; 48% of these occurred in the intensive care unit. Enterococcus faecium was responsible for 20% of all infections. Antibiotic resistances among the infections included high-level gentamicin resistance (26%), ampicillin resistance (10%), and vancomycin resistance (8%). Clinical cure was achieved in 64% of patients; 6.8% of patients relapsed, 6.8% had recurrence of the infection with a different pathogen, and overall mortality was 23%. Ampicillin resistance and a high acute physiology and chronic health evaluation (APACHE) II score were highly predictive of lack of cure.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/epidemiologia , Enterococcus , Infecções por Bactérias Gram-Positivas/epidemiologia , Adolescente , Adulto , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Criança , Pré-Escolar , Connecticut/epidemiologia , Resistência Microbiana a Medicamentos , Empiema Pleural/epidemiologia , Empiema Pleural/microbiologia , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Enterococcus/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/microbiologia , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
Surgery ; 103(3): 383-5, 1988 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3278407

RESUMO

Rubber band ligation is a commonly employed office procedure for the eradication of symptomatic internal hemorrhoids. Since 1980 increasingly frequent reports of an often fatal complication--"pelvic cellulitis"--have appeared. Death has been avoided for some of these patients by early recognition and treatment. One such survivor is reported here, in a case report that illustrates the value of early recognition of symptoms and appropriate diagnostic and therapeutic intervention.


Assuntos
Infecções por Bacteroides , Celulite (Flegmão)/etiologia , Infecções por Escherichia coli , Hemorroidas/cirurgia , Adulto , Antibacterianos/uso terapêutico , Bacteroides fragilis , Celulite (Flegmão)/tratamento farmacológico , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Masculino , Pelve
5.
Arch Dermatol ; 123(2): 213-5, 1987 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3813594

RESUMO

The development of transient bacteremia during simple surgical excision of cutaneous neoplasms was studied. Of 35 patients undergoing surgery on eroded, but not clinically infected, cutaneous tumors, one developed a transient bacteremia, whereas none of 15 patients developed bacteremia during surgery on cutaneous neoplasms with intact skin surfaces. The low incidence of bacteremia associated with surgery on eroded skin neoplasms suggests that, for this commonly performed surgery, prophylactic antibiotics be administered perioperatively only to patients with prosthetic heart valves and not to other patients at risk for endocarditis. This recommendation would be in keeping with the American Heart Association guidelines for prophylaxis for other surgical procedures associated with low incidences of transient bacteremia.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Sepse/epidemiologia , Neoplasias Cutâneas/cirurgia , Antibacterianos/uso terapêutico , Endocardite Bacteriana/prevenção & controle , Humanos , Pré-Medicação , Neoplasias Cutâneas/microbiologia , Neoplasias Cutâneas/patologia
6.
J Infect Dis ; 152(5): 946-53, 1985 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-3900240

RESUMO

An inhibition enzyme-linked immunosorbent assay (ELISA) capable of detecting 10 ng of aspergillus carbohydrate antigen/ml of serum was developed. When retrospectively applied to the sera of 19 patients with invasive aspergillosis, the ELISA detected antigen in 11 patients. None of 14 healthy controls or 28 patients with a variety of other infections were positive for circulating antigen. A rabbit model of invasive aspergillosis was also developed. Daily fungal cultures of blood were negative in the rabbits, as in human disease, but antigen was detected in increasing amounts up to the time of death. This ELISA is a sensitive, specific, and easily performed assay for circulating aspergillus antigen that should facilitate early diagnosis of invasive aspergillosis, heretofore, seldom made without invasive tests.


Assuntos
Antígenos de Fungos/análise , Aspergilose/diagnóstico , Aspergillus/imunologia , Adolescente , Adulto , Idoso , Animais , Anticorpos Antifúngicos/análise , Aspergilose/imunologia , Aspergillus fumigatus/imunologia , Carboidratos/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coelhos , Estudos Retrospectivos
7.
Med Clin North Am ; 69(2): 333-44, 1985 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3990438

RESUMO

The pathogenesis, clinical signs and symptoms, laboratory manifestations, and laboratory diagnosis of cryptococcal infection of the central nervous system are reviewed, as well as the interaction between the organism and the immune system of the host. In addition, based on our own experience and that of others, the therapy and prognosis of cryptococcal meningitis are discussed.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Criptococose/diagnóstico , Meningite/diagnóstico , Anfotericina B/uso terapêutico , Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/tratamento farmacológico , Doenças do Sistema Nervoso Central/fisiopatologia , Criptococose/líquido cefalorraquidiano , Criptococose/tratamento farmacológico , Criptococose/fisiopatologia , Flucitosina/uso terapêutico , Humanos , Meningite/tratamento farmacológico , Prognóstico
8.
Am J Surg Pathol ; 8(7): 529-38, 1984 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-6742314

RESUMO

Infantile myofibromatosis is a distinct clinicalpathologic entity occurring primarily in neonates and infants either as a single nodular lesion or as a multicentric form. We have recently studied two cases of this disorder in neonates, and a third involving the father of one of these infants, all documented by biopsy. Evidence in support of an autosomal-dominant mode of inheritance for infantile myofibromatosis and of its potential to recur after a long period of quiescence is presented.


Assuntos
Neoplasias Ósseas/genética , Leiomioma/genética , Neoplasias Primárias Múltiplas/genética , Neoplasias Cutâneas/genética , Neoplasias de Tecidos Moles/genética , Adulto , Neoplasias Ósseas/patologia , Feminino , Humanos , Recém-Nascido , Leiomioma/patologia , Masculino , Metástase Neoplásica , Ombro , Neoplasias Cutâneas/patologia , Neoplasias de Tecidos Moles/patologia
9.
Ann Intern Med ; 100(5): 677-80, 1984 May.
Artigo em Inglês | MEDLINE | ID: mdl-6546844

RESUMO

Hypocalcemia occurs in patients with psoriasis vulgaris, pustular psoriasis of von Zumbusch, and impetigo herpetiformis. In most cases hypocalcemia is caused by accompanying hypoalbuminemia, yet reductions in ionized serum calcium concentrations due to hypoparathyroidism or malabsorption have been reported. We report the case of a patient with surgical hypoparathyroidism in whom hypocalcemia precipitated typical pustular psoriasis of von Zumbusch. The psoriasis rapidly cleared on two occasions when the patient's serum calcium was corrected by therapy with oral calcium and vitamin D or its analogues, and reappeared when treatment was discontinued. The patient's psoriasis cleared on a third occasion when her serum calcium level returned to normal with a calcium infusion. Hypocalcemia can precipitate pustular psoriasis of von Zumbusch in susceptible persons. These psoriatic flares are due not to abnormal circulating levels of parathyroid hormone or vitamin D metabolites but to hypocalcemia.


Assuntos
Hipocalcemia/complicações , Psoríase/etiologia , Calcitriol/uso terapêutico , Cálcio/uso terapêutico , Feminino , Febre/etiologia , Humanos , Hipocalcemia/tratamento farmacológico , Hipocalcemia/metabolismo , Psoríase/patologia , Psoríase/terapia , Síndrome
10.
Arch Intern Med ; 144(2): 397-9, 1984 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-6607716

RESUMO

Community-acquired Pneumocystis carinii pneumonia developed in a young adult patient with dyskeratosis congenita. His hospitalization ended fatally with disseminated candidiasis. Evaluation during the admission showed evidence of cellular immune dysfunction as indicated by skin test anergy and absent lymphocyte proliferation in an in vitro mixed lymphocyte culture. Treatment with transfer factor failed to reverse the cutaneous anergy or affect the clinical course. Dyskeratosis congenita is a rare multisystem disorder with prominent dermatologic manifestations; bone marrow failure or malignant neoplasm are common fatal outcomes. Immune system abnormalities are not classically considered a part of the disease complex. Serial evaluation of our patient's condition over several years suggests that depressed immune function, especially of the cellular limb, may evolve as a feature of clinical importance in these patients.


Assuntos
Candidíase/etiologia , Síndromes de Imunodeficiência/complicações , Transtornos da Pigmentação/congênito , Pneumonia por Pneumocystis/etiologia , Dermatopatias/congênito , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Humanos , Imunidade Celular , Síndromes de Imunodeficiência/imunologia , Masculino , Unhas Malformadas , Transtornos da Pigmentação/complicações , Transtornos da Pigmentação/imunologia , Pneumonia por Pneumocystis/imunologia , Dermatopatias/complicações , Dermatopatias/imunologia , Síndrome
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