Persistent Carriage Research Articles

Selection Criteria for PE Tubes versus PE Tubes Plus Adenoidectomy

Source: Nguyen LHP, Manoukian JJ, Yoskovitch A, et al. Adenoidectomy: selection criteria for surgical cases of otitis media. Laryngoscope. 2004;114:863–866.Placement of pressure equalizing tubes (PET) is undoubtedly the most frequent surgical option used for persistent otitis media with effusion (OME) and refractory recurrent acute otitis media (AOM). Researchers from Canada’s McGill University and the University of Kuwait evaluated the efficacy of concomitant adenoidectomy in decreasing the failure rate of PET placement. They evaluated 63 patients, aged 18 months to 18 years and with a history of either: 1) recurrent AOM, defined as more than 3 episodes in the previous 6 months or more than 4 episodes in the preceding 12 months; 2) persistent OME, defined as effusion persisting for more than 3 months or producing a hearing deficit of 30 dB or greater; or 3) both. Study patients were randomly assigned to either PET placement alone or PET with adenoidectomy. In all patients, the adenoids were evaluated during surgery to assess whether they abutted the eustachian tube orifice (ETO). Failure was defined as: 1) 2 episodes of AOM within 6 months or 3 episodes in 1 year not related to water exposure (ie, swimming); 2) OME for greater than 3 months or causing a greater than 30 dB hearing loss; or 3) reinsertion of PET. Of 63 patients, 40 (63%) underwent PET placement alone and 23 (37%) underwent PET placement with adenoidectomy. Thirty-four (54%) of the 63 patients had adenoids abutting the ETO, of which 16 were in the PET group and 18 in the PET plus adenoidectomy group.Failure rates in the adenoidectomy and non-adenoidectomy groups were 21.7% and 42.5%, respectively (P=.096). After stratifying patients by whether or not they had adenoidal abutment, statistically significant differences were found. Adenoidectomy did not decrease failure rates in patients without adenoidal abutment of the ETO (P=.92). However, among patients with adenoidal abutment of the ETO, those who underwent PET placement and adenoidectomy were less likely to have a failure of treatment compared to those who underwent PET placement alone (P<.05).Financial Disclosure: Dr. Willner has disclosed that he has no relationships relevant to this commentary.Financial Disclosure: Dr. Wohl has disclosed that he has no relationships relevant to this commentary.If the results of this small study are replicated by other clinicians in other populations, it may, at long last, provide the basis for a rational approach to the decision about adenoidectomy at the time of PET placement. A previous study found that in patients aged 4 to 8 years, PET placement, with or without adenoidectomy, led to an increased time until recurrence of effusion, and that adenoidectomy was associated with a reduced need for subsequent medical and surgical intervention.1 It was theorized that adenoidectomy provided a long-term benefit by removing persistent nasopharyngeal bacterial carriage. The authors of that study recommended adenoidectomy and bilateral myringotomy in patients of this age with 60 days of effusion refractory to multiple antibiotic courses and with bilateral associated hearing loss. Other investigators have commented that adenoidectomy is associated with more morbidity than PET placement alone.1 A consensus panel recommended that the treatment of each child should be individualized based on the duration of OME, the child’s response to medication and the time of year.2The above study suggested that relieving adenoid abutment at the ETO had a positive effect on PET placement success. Unlike previous studies, the current study included patients with both recurrent AOM and persistent OME as criteria for surgical intervention. Nevertheless, the results suggest that specifically evaluating the adenoids for abutment of the ETO is helpful in determining whether it is reasonable to proceed with adenoidectomy at the time of PET placement, and allows for further individualization of each patient’s care.

Advancing age and the risk of nasal carriage of Staphylococcus aureus among patients on long-term hospital-based hemodialysis.

BackgroundElevated nasal carriage rates of Staphylococcus aureus and ensuing complications among the elderly and in those on long-term hemodialysis (HD) are well recognized. The aim of the present study was to determine the extent to which advancing age is associated with the risk of persistent S. aureus nasal carriage among end-stage renal disease (ESRD) patients on long-term HD.Patients and MethodsThis prospective study involved 205 ESRD patients enrolled for maintenance HD from July 1997 to July 2000. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA) or methicillin-resistant S. aureus (MRSA). Five standardized swabs were taken from the anterior nares of all the patients on long-term HD. S. aureus nasal carriage rates were estimated and compared among ESRD patients of different age groups.ResultsOverall, a prevalence of 38.05% (78/205) for S. aureus nasal carriage was observed, including 27.3% (56/205) for MSSA and 10.7% (22/205) for MRSA. Patients aged 75 to 84 years had the highest (84.6%, 11/13) prevalence of S. aureus nasal carriage (RR, 7.000, 95% CI, 4.350–11.763, P<0.00001). Those aged 65 to 74 years had the next highest (49.0%, 25/51) nasal carriage rates (RR, 4.083, 95% CI, 2.302–7.658, P<0.0001) while patients aged 15 to 24 years (reference group) had the lowest (12.8%, 1/8) prevalence of nasal carriage. The 75 to 84 year age group also had the highest rates of MSSA (46.2%, 6/13), (RR- 3.833, 95% CI, 2.144–7.234, P<0.0001) and MRSA (38.5 %, 5/13) (RR, 6.333, 95%CI, 2.767–16.198, P<0.0001) nasal carriage compared to the reference group.ConclusionsSignificantly higher persistent MSSA and MRSA nasal carriage rates among ESRD patients >75 years of age are suggestive of an elevated risk of potentially serious S. aureus- related complications among the very elderly during long-term HD. These findings might be helpful in the identification of elderly HD patients as a high-risk group for S. aureus-linked vascular access-related septicemia (VRS) and to evolve appropriate preventive strategies.

Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a "culture rule".

To study determinants and risks of Staphylococcus aureus nasal carriage, adequate differentiation between the different S. aureus carrier states is obligatory. We set out to develop a "culture rule" capable of differentiating between persistent and intermittent or noncarriers that uses a minimum of nasal swab cultures. In 51 healthy volunteers (derivation cohort), 12 quantitative nasal cultures were performed to establish S. aureus nasal carriage states. Persons with 11 or 12 cultures positive for S. aureus were classified as persistent carriers, and those with negative results of all cultures were classified as noncarriers. All other persons were classified as intermittent carriers. By means of logistic regression and receiver operating characteristic (ROC) curves, a culture rule was derived. This culture rule was subsequently validated in 106 participants of an ongoing study in 3882 elderly persons, again with the use of 12 quantitative nasal cultures. In both cohorts, the positive predictive value of 2 consecutive positive culture results for persistent carriage was 79%. The model best differentiating between persistent and intermittent or noncarriers used the number of positive culture results combined with the amount of S. aureus in these cultures. By using the outcome of 2 cultures, the areas under the ROC curves were 0.981 (95% confidence interval [CI], 0.949-1.0) for the derivation cohort and 0.936 (95% CI, 0.881-0.990) for the validation cohort. Combining qualitative and quantitative results of 2 nasal swab cultures accurately predicted the persistent S. aureus carriage state with a reliability of 93.6%. Thus, this culture rule can be used in studies of determinants and risks of S. aureus nasal carriage.

LuxS Is Required for Persistent Pneumococcal Carriage and Expression of Virulence and Biosynthesis Genes

Streptococcus pneumoniae causes several diseases, including otitis media, pneumonia, and meningitis. Although little is known about the regulation of or how individual pneumococcal factors contribute to these disease states, there is evidence suggesting that some factors are regulated by a cell-density-dependent mechanism (quorum sensing). Quorum sensing allows bacteria to couple transcription with changes in cell density; bacteria achieve this by sensing and responding to small diffusible signaling molecules. We investigated how the LuxS signaling system impacts the biology of S. pneumoniae. An analysis of the transcriptional profiles of a serotype 2 strain and an isogenic luxS deletion strain utilizing an S. pneumoniae-specific microarray indicated that LuxS regulates gene expression involved in discrete cellular processes, including pneumolysin expression. Contrary to the paradigm for quorum sensing, we observed pronounced effects on transcription in early log phase, where gene expression was repressed in the mutant. Assessing the mutant for its ability to infect and cause disease in animals revealed a profound defect in ability to persist in the nasopharyngeal tissues. Our analysis of an S. pneumoniae transcriptome revealed a function for LuxS in gene regulation that is not dependent upon high cell density and is likely involved in the maintenance of pneumococcal load in susceptible hosts.

The ShdA adhesin binds to the cationic cradle of the fibronectin 13FnIII repeat module: evidence for molecular mimicry of heparin binding.

Introduction of Salmonella enterica serotype Typhimurium into food products results from its ability to persist in the intestine of healthy livestock by mechanisms that are poorly understood. The non-fimbrial adhesin ShdA is a fibronectin binding protein required for persistent intestinal carriage of S. Typhimurium. We further investigated the molecular mechanism of ShdA-mediated intestinal persistence by determining the binding-site of this receptor in fibronectin. Analysis of ShdA binding to fibronectin proteolytic fragments and to recombinant fibronectin fusion proteins identified the (13)FnIII repeat module of the Hep-2 domain as the primary binding site for this adhesin. The (13)FnIII repeat module of fibronectin contains a cationic cradle formed by six basic residues (R6, R7, R9, R23, K25 and R54) that is a high affinity heparin-binding site conserved among fibronectin sequences from frogs to man. Binding of ShdA to the (13)FnIII repeat module of fibronectin and to a second extracellular matrix protein, Collagen I, could be inhibited by heparin. Furthermore, binding of ShdA to the Hep-2 domain was sensitive to the ionic buffer strength, suggesting that binding involved ionic interactions. We therefore determined whether amino acid substitutions of basic residues in the cationic cradle of the Hep-2 domain that inhibit heparin binding also abrogate binding of ShdA. Combined substitution of R6S and R7S strongly reduced ShdA binding to (13)FnIII. These data suggest that ShdA binds the Hep-2 domain of fibronectin by a mechanism that may mimic binding of the host polysaccharide heparin.

Distribution of virulence genes of Staphylococcus aureus isolated from stable nasal carriers

In the present study, we report data on virulence determinants of Staphylococcus aureus from stable nasal carriers, emphasizing on the genes encoding fibronectin ( fnbA, fnbB) and collagen ( cna) adhesive molecules. Of the 44 S. aureus isolates included, 32 isolates (16 pairs) were cultured from the anterior nares of 16 healthy carriers, eight isolates (four pairs) were collected from the nose of four patients with recurrent skin infections and four isolates were obtained from the infection site of these patients. The period between the two nasal swabs taken was 3–5 days. The persistency of carriage could be demonstrated by the indistinguishable genotypic chracteristics of the S. aureus isolates in each pair. This could be shown by determination of gene polymorphisms of coa gene and the X-region and IgG-binding region encoding segments of spa gene. In addition, the isolates within the pairs showed identical toxin patterns. This was determined by PCR amplification of the genes encoding staphylococcal enterotoxins (SEA to SEJ) and TSST-1. The genotypic properties also yielded an identity between persistent nasal carriage isolates and the corresponding skin infection isolates of the four patients. In addition, all S. aureus nasal and skin infection isolates were positive for gene fnbA, fnbB and cna could be found with a high frequency. Among the 44 isolates investigated, 16 isolates (36.7%) harbored gene fnbB and 21 isolates (47.7%) gene cna. The data in the present study showed a relatively wide distribution of the genes fnb and cna among the investigated isolates, indicating that the persistent carriage of strains harboring these virulence determinants may increase the risk for subsequent invasive infections in carriers.

Association of genetic variants of the chemokine receptor CCR5 and its ligands, RANTES and MCP-2, with outcome of HCV infection

The effect of host genetic variation on the outcome of hepatitis C virus (HCV) infection and its treatment is poorly understood. The chemokine receptors CCR5, CCR2, and CCR3 and their ligands, RANTES, MCP-1, MCP-2, and MIP-1α, are involved in the immune responses and the selective recruitment of lymphocytes to the liver in HCV infection. We studied 20 polymorphisms within these genes and investigated their association with persistent carriage of HCV, severity of liver disease, hepatic inflammation, and response to treatment in a large European cohort. Significant associations were found between CCR5-Δ32 and reduced portal inflammation ( P = .011, odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.09-4.84) and milder fibrosis ( P = .015, OR: 1.97, 95% CI: 1.13-3.42). A promoter polymorphism at position −403 in the RANTES gene was associated with less severe portal inflammation ( P = .004). An amino acid change in MCP2, Q46K, was associated with severity of fibrosis ( P = .018, OR: 2.29, 95% CI: 1.14-4.58). In conclusion, our study suggests a possible role of the polymorphisms CCR5-Δ32, RANTES −403, and MCP-2 Q46K in the outcome of HCV infection. (H epatology 2003;38:1468-1476.)

Association of genetic variants of the chemokine receptor CCR5 and its ligands, RANTES and MCP-2, with outcome of HCV infection.

The effect of host genetic variation on the outcome of hepatitis C virus (HCV) infection and its treatment is poorly understood. The chemokine receptors CCR5, CCR2, and CCR3 and their ligands, RANTES, MCP-1, MCP-2, and MIP-1alpha, are involved in the immune responses and the selective recruitment of lymphocytes to the liver in HCV infection. We studied 20 polymorphisms within these genes and investigated their association with persistent carriage of HCV, severity of liver disease, hepatic inflammation, and response to treatment in a large European cohort. Significant associations were found between CCR5-delta32 and reduced portal inflammation (P =.011, odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.09-4.84) and milder fibrosis (P =.015, OR: 1.97, 95% CI: 1.13-3.42). A promoter polymorphism at position -403 in the RANTES gene was associated with less severe portal inflammation (P =.004). An amino acid change in MCP2, Q46K, was associated with severity of fibrosis (P =.018, OR: 2.29, 95% CI: 1.14-4.58). In conclusion, our study suggests a possible role of the polymorphisms CCR5-delta32, RANTES -403, and MCP-2 Q46K in the outcome of HCV infection.

#89-S predictors of group b Streptococcus Colonization in healthy, young men and women

Abstract PURPOSE: Group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in newborns, and increasingly causes infection in pregnant women, and non-pregnant adults with underlying conditions. Risk factors for invasive GBS disease are well described, but little is known about factors associated with asymptomatic colonization. We describe the association of various behaviors with GBS colonization, and report the frequency of colonization among otherwise healthy male and non-pregnant female college students living in a single dormitory. METHODS: We invited 738 students to participate. Students self-collected urine, throat, vaginal and anal orifice specimens, and completed a self-administered questionnaire. RESULTS: 216 men (47%) and 246 women (53%) participated in the study (462/738). 34% (82/241) of women and 20% (43/211) of men were colonized with GBS in at least one site. Women were twice as likely as men to be colonized with GBS at any site (p CONCLUSION: GBS occurs frequently among otherwise healthy college students, and colonization is strongly associated with ever engaging in sexual activity. Direct contact that occurs during cohabitation, however, did not seem to influence GBS colonization, but various food items did. Prospective studies are required to differentiate risk factors for acquisition from those associated with persistent carriage.

THE IMPACT OF NASAL CARRIAGE OF METHICILLIN-RESISTANT AND METHICILLIN-SUSCEPTIBLE STAPHYLOCOCCUS AUREUS (MRSA & MSSA) ON VASCULAR ACCESS-RELATED SEPTICEMIA AMONG PATIENTS WITH TYPE-II DIABETES ON DIALYSIS

Background: Fairly higher nasal carriage rates among type-II diabetics place them at a greater risk of endogenous Staphylococcus aureus linked vascular access-related septicemia (VRS) that is also dependent on the type of vascular access used for hemodialysis (HD). The prevalence of nasal carriage of methicillin susceptible and methicillin-resistant S. aureus (MSSA and MRSA) and its impact on VRS was determined in order to identify most vulnerable group and plan potential prophylactic strategies, accordingly. Methods: Five standardized nasal swab cultures were performed in 208 patients enrolled for long-term HD through July 1996 to July 1999. Persistent nasal carriage was defined by two or more positive cultures for MSSA or MRSA. Peripheral blood cultures were collected on clinical suspicion of septicemia. Results: The prevalence of type-II diabetes of 28.0% with 72.4% of nasal carriage rate and three folds higher S. aureus related VRS (RR-3.19, p<0.0001) than diabetic non-carriers on HD, was observed. Type-II diabetics also had higher MSSA and MRSA nasal carriage rates (53.4% and 19.0%) than non-diabetic nasal carriers (18.6 and 6.0%) yet, carried a comparable (RR-4.0 vs. 4.5) risk of VRS between MSSA and MRSA nasal carriers. Among diabetic type-II S. aureus nasal carriers, central venous catheters (CVCs) carried 35 and 38 times higher collective risk of developing MSSA and MRSA nasal carriage-related VRS respectively than Arterio-venous fistula (AVF). The AVF recorded the lowest risk of developing MSSA and MRSA nasal carriage-related VRS (0.013 and 0.010 episodes/patient-year) in both diabetic type-II MSSA and MRSA nasal carrier groups. Conclusions: Diabetic type-II S. aureus nasal carriers on HD through CVCs make an extremely high-risk group for MSSA and MRSA nasal carriage-related VRS. The incidence of S. aureus nasal carriage-related VRS could reasonably be reduced through a challenging obligation of optimizing AVF prevalence in this high-risk group, while limiting the use of CVCs, at the same time.

Aspects épidémiologiques de Staphylococcus aureus résistant à la méticilline dans un centre hospitalier de taille moyenne

Objective – The aim of this study was to assess the incidence of colonization/infection by methicillin-resistant Staphylococcus aureus (MRSA) in our hospital. Method – For two months, cases of MRSA colonization or infection were monitored prospectively. Antibiotic susceptibility patterns and molecular methods were used to type the isolated strains. Morbidity was determined from the incidence of patients colonized/infected by MRSA, according to the type of ward. Results – The overall incidence of patients colonized/infected by MRSA was 1.22%. Incidence depended on the type of ward; it was 1.56 per thousand days of hospitalization in short-term care wards, and 1.65 per thousand days of hospitalization in long-term care wards. MRSA skin colonization or wound infection was most frequently observed (53.1%). Chromosomal DNA macro restriction analysis, with SmaI by pulsed-field gel electrophoresis, revealed that some epidemic MRSA clones were widespread. Most of the 32 MRSA isolates (78.2%) were closely related, and among these strains, 96% displayed the same antibiotype. Community-acquired MRSA accounted for 25% of the MRSA colonization/infection cases. Nevertheless, when considering significant factors of persistent carriage, true community-acquired MRSA cases only accounted for 6.25% of all cases. Conclusion – Computer-triggered warnings in the patient's file, might contribute to the early detection of previously colonized or infected patients readmitted to the hospital.

Bacterial infections and atopic dermatitis.

Bacterial infections and atopic dermatitis.

Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage.

To investigate persistent carriage of methicillin-resistant Staphylococcus aureus (MRSA), we conducted a prospective 10-month study of MRSA carriage in previous carriers who were readmitted to our hospital. Four screening specimens, 2 from the skin and 2 from the nares, were obtained within 3 days after admission, in addition to diagnostic specimens requested by physicians. Of the 78 patients included in our study, 31 (40%) were persistent carriers of MRSA, with an estimated median time of 8.5 months to MRSA clearance. In the multivariate analysis, the only factor significantly associated with persistent carriage was the presence of a break in the skin at readmission (odds ratio, 4.34; P=.004); however, a trend was found for admission from a chronic-care institution (odds ratio, 3.65; P=.06). Our data confirm that prolonged carriage of MRSA can occur after hospital discharge, support routine screening for MRSA at readmission of previously MRSA-positive patients, and suggest that a particularly high index of suspicion for MRSA carriage should be maintained if these patients have a break in the skin.

Risk Factors for Persistent Carriage of MRSA

Risk Factors for Persistent Carriage of MRSA

Molecular epidemiology of Scedosporium apiospermum infection determined by PCR amplification of ribosomal intergenic spacer sequences in patients with chronic lung disease.

Respiratory tract colonization with Scedosporium apiospermum in patients with chronic suppurative lung disease is a significant concern for lung transplantation candidates, since Scedosporium infections occurring posttransplantation are usually untreatable. Up to 10% of patients with cystic fibrosis attending our respiratory medicine unit have had Scedosporium organisms isolated from sputum samples. We therefore developed a molecular typing method to examine these isolates. Typing by PCR amplification of ribosomal intergenic spacer sequences demonstrated 20 different types from 52 isolates collected from the respiratory medicine unit and elsewhere in Australia. A single common type was isolated from 11 respiratory medicine unit inpatients. Two other types were isolated from more than one source: one from two respiratory medicine unit inpatients and one from two epidemiologically linked nonhuman sources. Multiple isolates were obtained from nine patients. This method demonstrated persistent carriage of isolates of the same type in one patient for 7 months. Two patients showed carriage of isolates with multiple typing patterns within a 3-month period. The high rate of isolation and the predominance of isolates with a single typing pattern from respiratory medicine unit patients may suggest transmission to patients from a source in the unit. There was no epidemiological evidence of direct patient-to-patient spread, and Scedosporium organisms were not isolated from dust, soil, or air samples from the unit. The source and route of transmission have yet to be determined.

Experience with the prevention of invasive Haemophilus influenzae type b disease by vaccination in Alaska: The impact of persistent oropharyngeal carriage

Objectives: To report the epidemiology of invasive Haemophilus influenzae type b (Hib) disease in high-risk Alaska Native infants before and after universal infant Hib vaccination and evaluate an increase in invasive Hib disease in 1996 after changing Hib vaccine type. Study design: Statewide laboratory surveillance for invasive Hib disease has been conducted since 1980. Three cross-sectional Hib carriage studies were conducted in 1997 and 1998. Results: The invasive Hib disease rate in Alaska Natives decreased from 332 cases per 100,000 children <5 years old in 1980-1991 to 17:100,000 in 1992-1995 but increased primarily in rural areas to 57.9:100,000 after a switch in Hib vaccine types. Carriage studies in 5 rural Alaska Native villages showed oropharyngeal Hib carriage as high as 9.3% in children aged 1 to 5 years; in contrast, carriage in urban Alaska Native children was <1%. Conclusions: Although Hib disease has decreased in Alaska, the rate of Hib disease and carriage in rural Alaska Natives did not decrease to the same extent as in non-Natives and urban Alaska Natives. Use of polyribosylribitol phosphate–outer-membrane protein conjugate vaccine for the first vaccine dose is critical to disease control in this population with continued transmission in infants <6 months of age. The ability to eliminate Hib carriage and disease may be affected by population characteristics, vaccination coverage, and Hib vaccine type used. This may pose a challenge to global elimination of Hib. (J Pediatr 2000;137:313-20)

Relationship between asymptomatic carriage of Streptococcus pyogenes and the ability of the strains to adhere to and be internalised by cultured epithelial cells.

This study was undertaken to determine whether the ability of group A streptococci to persist in the throat following antibiotic therapy corresponded with their capacity to adhere to and be internalised by epithelial cells. The study employed a HEp-2 cell model to examine the adherence and internalisation capacities of 42 strains (13 from asymptomatic patients with bacteriological eradication failure and 29 from patients with bacterial eradication). The adherence and internalisation efficiencies of strains from symptomless carriers were significantly higher. The average adherence efficiency of the carriers' strains was 53 (SEM 6)% versus 35 (SEM 5)% in control strains. The average internalisation efficiency of the carriers' strains was 13.4 (SEM 4)% compared with 4.4 (SE 1.6)% in the control group. The results are in agreement with the hypothesis that, in a significant number of cases, streptococcal internalisation might contribute to eradication failure and persistent throat carriage.

Impaired humoral responses to subgenus D adenovirusenovirus infections in HIV-positive patients

HIV-positive patients are at increased risk of developing adenovirus infection, particularly of the gastrointestinal tract and with unusual subgenus D strains. To investigate humoral immunity to these strains of adenoviruses, the humoral immune response was examined in longitudinal samples of serum against isolates collected from a prospective study of HIV-positive patients with subgenus D adenovirus infection. Of 10 HIV-positive patients developing adenovirus infection, 3 had chronic infection (8->27 months) with one serotype, 3 had chronic infection (>/=10 months) with changing serotypes and 4 had acute and self-limiting adenovirus infection (<1 month). Fifty-one sera were tested, and samples collected before adenovirus infection were available in 8 patients. Neutralising assays were performed against the patient's own isolate (adenoviruses 9, 17, 19, 19/23, 19/37, 23, 26, 23/26, 43 and 46) and common circulating strains of adenovirus 1-5. Indirect immunofluorescence tests were carried out against the autologous isolate and complement-fixation tests were undertaken using a standard assay. Immunofluorescence test antibodies were detected (titre >/=160) in all patients, and present to high titre (>/=320) in 8/10 patients. Complement-fixing antibodies were not detected in significant titre. Of particular note, there was no significant neutralising antibody response to the patient's own isolate after acute infection. Neutralising antibody to adenovirus 3 (titre 20) was transiently detected in two patients. In the remaining patients neutralising antibody directed against adenoviruses 1-5 was not detected. Persistent carriage of subgenus D adenoviruses in HIV-positive patients is probably the result of failure of cell-mediated immune responses to clear primary infection. Nevertheless, there is marked impairment of B cell responses resulting in poor neutralising and complement-fixing antibody production even though immunofluorescence test determined antibodies are produced in high titre. These possibly reflect impairment of effective B cell priming mechanisms within the germinal centres of lymph nodes, or the polyclonal activation of B cells driven by HIV infection.

A Longitudinal Study of Human Papillomavirus Carriage in Human Immunodeficiency Virus-Infected and Human Immunodeficiency Virus-Uninfected Women

Abstract OBJECTIVE: We sought to determine the relationship of human immunodeficiency virus serostatus to carriage of oncogenic human papillomavirus. MATERIAL AND METHODS: A total of 268 human immunodeficiency virus–infected and 265 human immunodeficiency virus–uninfected women were seen every 6 months, at which time they had laboratory tests performed including a CD4 count. Human papillomavirus deoxyribonucleic acid was analyzed by polymerase chain reaction. Statistical methods included Kaplan-Meier and Cox's proportional hazard models. RESULTS: The prevalence at baseline of any human papillomavirus type was 73% and 43% among human immunodeficiency virus–seropositive and seronegative women, respectively ( p p 3 ( p p p CONCLUSIONS: Human immunodeficiency virus–seropositive women are more likely to have newly detectable oncogenic types of human papillomavirus at follow-up and to show persistent carriage of oncogenic types of human papillomavirus types. Among human immunodeficiency virus–infected women, those with higher CD4 counts were more likely to have a newly detected oncogenic human papillomavirus during follow-up. (Am J Obstet Gynecol 1998;178:982-6.)

Campylobacter upsaliensis-associated diarrhea in human immunodeficiency virus-infected patients.

Campylobacter upsaliensis was isolated from the feces of 20 human immunodeficiency virus (HIV)-infected patients with diarrhea over a 67-month period, representing 18.5% of fecal Campylobacter isolates from our HIV-seropositive patients. All isolates were recovered from feces by a 0.45-micron-membrane filtration method. Culture on Skirrow's selective medium incubated at 42 degrees C failed to support any growth. The mean CD4 cell count of the patient group was 185/mm3 (range, 0-840/mm3), and all patients had diarrhea for 1-60 days (mean, 19 days). Thirteen had no other enteric pathogen isolated, and three patients (CD4 counts, < or = 70/mm3) had persistent carriage for between 5 weeks and 3 months. All tested isolates were susceptible to erythromycin and doxycycline, but three isolates from two patients were resistant to ciprofloxacin. C. upsaliensis is associated with prolonged diarrhea of mild to moderate severity in HIV-infected patients.