Suppression of frequently recurring genital herpes. A placebo-controlled double-blind trial of oral acyclovir.

We studied 35 otherwise healthy adults with frequently recurring genital herpes (greater than or equal to 1 episode per month), in a double-blind trial comparing oral acyclovir with placebo capsules for suppression of recurrent infection. The patients were treated for 125 days unless herpes recurred. Among 32 evaluable patients, there were significantly fewer recurrences during acyclovir treatment (4 of 16) than during placebo treatment (16 of 16, P less than 0.001). The mean duration of therapy was significantly longer for patients receiving acyclovir than for those receiving placebo (114.9 vs. 24.8 days, P less than 0.001). Of 19 patients who had recurrences in the blind trial, only 2 had recurrences when given acyclovir in a second, open-study phase. All patients had recurrences after completing acyclovir treatment. The therapy was well tolerated, with minimal gastrointestinal upset and one hypersensitivity reaction. Studies of the viral isolates demonstrated that lesions developing in patients receiving acyclovir contained drug-resistant virus. Later recurrences in these patients were associated with drug-sensitive virus. We conclude that oral acyclovir suppresses genital herpes in patients with frequent recurrences, but the potential for problems with drug resistance and the long-term safety need to be more fully explored.

Intraerythrocytic parasitosis in humans with Entopolypoides species (family Babesiidae). Association with hepatic dysfunction and serum factors inhibiting lymphocyte response to phytohemagglutinin.

We have observed two cases of human infection with intraerythrocytic protozoa. The organisms appeared to be in the Entopolypoides group, which had not previously been associated with human infection. One patient was asplenic. Both patients had hepatic dysfunction, and their serum samples contained blocking factors that interfered in vitro with the stimulation of normal lymphocytes by phytohemagglutinin. It appears that in humans, as well as in experimental animals, host factors are important in resistance to infection by intraerythrocytic parasites. These factors include the presence of a spleen and cell-mediated and humoral immunities. Possibly similar infections will be observed in patients with other impairments of T-cell function, such as those induced by malignancy, thymic dysfunction, or immunosuppressive drugs.

Some epidemiologic features of disasters in guatemala.

Epidemiological procedures can be organised under disaster conditions by means of a simple surveillance system and with few personnel. In the aftermath of the 4 February 1976 earthquake in Guatemala, an information system was organized by which the requisite information for decision-making was obtained with adequate speed and promptness. The initial epidemiologic informution was based on reports collected during the early days on symptoms observed at hospitals and health centers and in localities and villages in the stricken area. At a second, post-emergency stage a more elaborate surveillance system was instituted to provide guidance in the investigntwn of outbreaks, evaluate the health activities and establish basic criteria for preventive and control measures.

Pneumocystis carinii pneumonia and primary immune deficiency diseases.

During a 3-year period, 50 cases of Pneumocystis carinii pneumonia in children less than 5 years old were reported to the Parasitic Disease Drug Service, Center for disease Control. Primary immune deficiency diseses constituted the most frequent underlying diseases in patients less than 1 year old (24/29 cases, 83%), whereas acute lymphatic leukemia was the most common underlying diseases in children 1-4 years old (17/21 cases, 81%). Severe combined immunodeficiency was the most common type of immune deficiency disease (15/25 cases, 60%). Six (24%) of the immunodeficient patients each had a sibling who died during infancy of an immunologic deficiency disease and P. carinii penumonia. Although the pathogenesis of the association between immune deficiency and P. carinii pneumonia is poorly understood, defects in both humora and cellular immunity appear to be operative.--Natl Cancer lst Monogr 43: 65-72, 1976.

Acute morbidity and physical growth in rural Guatemalan children.

The relationship between morbidity and physical growth increments was investigated in 716 Guatemalan children ranging in age from 15 days to 7 years. The growth variables investigated were semestral and yearly increments in total body length and weight. The number of days ill with diarrhea, fever, and respiratory illnesses per semester or year was used as an indicator of morbidity. The morbidity data were collected through bi-weekly retrospective interviews of mothers. Children less ill with diarrhea had substantially larger increments in length and weight than children who were ill with diarrhea a greater percentage of the time. In contrast, fever and respiratory illnesses did not affect growth rates. These findings highlight the fact that diarrhea is a major public health problem in developing nations.

Failure of pentamidine isethionate to provide chemoprophylaxis against Pneumocytis carinii infection in rats.

Latent Pneumocystis carinii infections were exacerbated in 54 adult male Sprague-Dawley rats by administration of alternating subcutaneous doses of hydrocortisone-21-phosphate and of cortisone acetate three times a week, plus 0.5% chlortetracycline in their drinking water, until death or the termination of the experiment at 120 days. Twenty-eight of the rats were also given pentamidine isethionate (4mg/kg) intramuscularly daily for 14 days. Pentamidine-treated animals that died within the 120 days of the experiment survived longer than control animals. At necropsy, however, every animal in both groups had P. carinii in the lungs. The intensity of the infection was the same in the pentamidine-treated and control groups. Pentamidine isethionate administered in this standard regimen does not exert a significant chemoprophylactic effect against proliferation of P. carinii in rats. The study provides little encouragement for use of pentamidine as a prophylactic agent against P. carinii in high-risk patients.