Immunocompromised Women Research Articles

High frequency of latent and clinical human papillomavirus cervical infections in immunocompromised human immuno-deficiency virus-infected women

In 32 human immunodeficiency virus (HIV)-infected women, routine gynecologic examination was performed with colposcopy and Papanicolaou smear; cervical swabs were collected for human papillomavirus (HPV) DNA screening and typing; and immune status was assessed by CD4 T-cell count. Dot blot analysis was specifically chosen for HPV DNA screening to detect only relatively substantial HPV DNA infections. Polymerase chain reaction analysis was used for precise DNA typing of dot blot-positive samples. The HPV data were assessed for immune status; a subject with a CD4 T-cell count below 200/microL was considered functionally immunosuppressed. The frequency of dot blot positivity was fivefold higher among immunocompromised (nine of ten) than relatively immunocompetent (four of 22) HIV-infected women. Moreover, four immunosuppressed women, compared with no immunocompetent subjects, had evidence of HPV DNA without signs of HPV-associated lesions by cytology or histology (ie, latent HPV infection). Furthermore, four of nine of the immunocompromised, compared with four of 21 immunocompetent, subjects had cervical intraepithelial neoplasia. These frequencies are high compared with those reported in the general population. Finally, HPV 18 was detected in five of the ten women with CD4 T-cell counts below 200/microL and in only one of the 22 with CD4 T-cell counts above that level. These results suggest that the normal immune system suppresses latent and clinical HPV cervical infections and that the efficiency of suppression may be HPV type-specific. Furthermore, impaired immune status, as reflected by CD4 T-cell count, is an important factor increasing the severity of HPV-induced cervical infections in this population.

Prevention of foodborne listeriosis.

Listeria monocytogenes is a Gram-positive, rod-shaped bacterium which, although recognized in the medical literature as an opportunistic pathogen for the past 60 years, has only recently gained prominence as an important foodborne pathogen. Factors which make this organism unique among foodborne pathogens include its ability both to survive in foods under a variety of adverse conditions and to grow at low refrigeration temperatures. The organism is very widespread in the environment and can be found in a wide variety of foods. At least four major outbreaks definitively linked to the consumption of food containing L monocytogenes have occurred. In addition there have been a number of recent sporadic cases of listeriosis linked to the consumption of meat, fish and dairy products. The primary concern of the Health Protection Branch is contaminated foods in which L monocytogenes can grow well, and which would not normally be heated prior to consumption. Worldwide, the disease appears to be increasing in incidence, but definite links to foods are difficult to make. In most cases, individuals who come down with listeriosis include the immunocompromised, the elderly (older than 65 years) and pregnant women and their fetuses. Primary manifestations of the disease include meningitis, spontaneous abortion and septicemia. Mortality rates in foodborne listeriosis outbreaks are approximately 30%. Diagnosis of listeriosis usually requires isolation of the organism from sterile sites such as blood, cerebrospinal fluid, placenta and meconium and gastric aspirates from neonates. The recommended drug of choice is high dose intravenous ampicillin. Advice to physicians concerning measures to prevent foodborne listeriosis in high risk groups is reviewed. Included among these recommendations is avoidance of consumption of potentially hazardous foods such as soft cheese and raw products of animal origin.

Pneumococcal vaccine. Efficacy and associated cost savings

We evaluated the efficacy and cost savings of the pneumococcal pneumonia vaccine in a retrospective cohort study of 762 vaccinated and 1161 randomly selected unvaccinated age-sex matched persons in Blue Cross/Blue Shield of Minnesota using medical and pharmaceutical claims. The pneumonia incidence and the ratio of incidence in the postvaccination to prevaccination periods (rate ratio) were examined in the vaccine group by sex and risk factors. Vaccination significantly reduced pneumonia incidence, with overall efficacy of 69% and higher efficacy in women (86%) than in men (33%). We assigned persons to risk categories based on disease conditions as recorded in the claims by the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnostic codes. In the risk categories, efficacy varied from 50% to 75% and was confounded by sex. Immunocompromised and immunocompetent women had high efficacy (83% to 88%), while immunocompetent and immunocompromised men had lower efficacy (33%). Persons with a precondition of pneumonia exhibited similar vaccine efficacy to the overall cohort relative to the comparison group. Projected costs of pneumonia cases are 3.6 times the observed costs of vaccination and postvaccination pneumonia costs. We conclude that the pneumococcal pneumonia vaccine is efficacious in persons having had pneumonia, persons "at risk" of developing pneumonia, or persons over 50 years of age, and it corresponds to overall savings of $141 per person.