Protein Malnutrition and the Febrile Response in the Fischer Rat

We assessed the effect of protein deprivation on the ability of peritoneal macrophages from Fischer rats to produce interieukin‐1 (IL‐1) after in vitro stimulation. Pyrogenic activity of supernatants was measured by an in vivo febrile response assay. Control rats were given a 23% casein diet and protein‐malnourished rats were given an 8% casein diet for 4 weeks. IL‐1‐containing supernatants prepared from peritoneal macrophages were injected into assay rats, whose temperatures were measured for 6 hours (δT6). Rats injected with IL‐1‐containing supernatants derived from peritoneal macrophage cultures of protein‐deprived rats had significantly less fever (δT6 = 0.20 ± 0.09°) than rats injected with IL‐1 containing supernatants derived from peritoneal macrophage cultures of control rats (δT6 = 0.56 ± 0.09°), P < .01. Protein malnutrition leads to diminished pyrogenicity of macrophage culture supernatants and may be at least partly responsible for the decreased febrile response seen in the malnourished animals.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142038/1/jlb0036.pd

Fever of Unknown Origin in the Elderly: Lymphoma Presenting as Vertebral Compression Fractures

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111209/1/j.1532-5415.1994.tb06080.x.pd

Susceptibility of Yeast-Like Fungi to a New Antifungal Agent, LY 121019

LY 121019, a new antifungal antibiotic agent, was tested for activity against 200 clinical isolates of Candida and other yeast-like fungi. LY 121019 had its greatest inhibitory effect on C. albicans , and C. tropicalis. C. glabrata and most other Candida species were not as sensitive. Cryptococcus and other yeast-like fungi, with the exception of a few strains, were not susceptible to LY 121019. Zusammenfassung :  LY 121019, ein neues Antimyzetikum, wurde auf seine AktivitÄt gegen 200 klinische Isolate von Candida und anderen, hefeÄhnlichen Pilzen untersucht. LY 121019 hat seine grÖßte Hemmwirkung gegen C. albicans und C. tropicalis. C. glabrata und die meisten anderen Candida -Arten waren nicht so empfindlich. Cryptococcus und andere, hefeÄhnliche Pilze waren, mit Ausnahme weniger StÄmme, nicht fÜr LY 121019 empfindlich.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73892/1/j.1439-0507.1988.tb04426.x.pd

Opportunistic Infections in Patients with Temporal Arteritis Treated with Corticosteroids

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111238/1/j.1532-5415.1997.tb00949.x.pd

Aging and eliciting agents: Effect on murine peritoneal macrophage monokine bioactivity

Decreased responsiveness of the aged to infection may be associated with a decline in monokine production. Prior studies in macrophages have used different eliciting agents, and results have varied. We assessed the effect of age on interleukin-1 (IL-1), tumor necrosis factor (TNF), and interleukin-6 (IL-6) in unelicited, thioglycollate (TG)-elicited, and complete Freund's adjuvant (CFA)-elicited peritoneal macrophages. Resident macrophages or CFA-elicited macrophages from middle aged or aged mice produced significantly less monokine bioactivity than resident or CFA-elicited macrophages from young mice. Monokine bioactivity from TG-elicited macrophages from aged and middle aged mice was significantly increased when compared with macrophages of young mice. Eliciting agents may alter macrophage populations and interactions with other cells leading to changes in monokine bioactivity with aging.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30935/1/0000605.pd

Monokine Secretion in Aging and Protein Malnutrition

Aged and protein‐malnourished hosta have diminished febrile responses and increased morbidity and mortality from infection that could be due to deficiencies in the production of certain monokines. In this study, the ability of peritoneal macrophages from aged and protein‐malnourished rats to produce IL‐1 and TNF was explored. Aged rats fed a standard diet produced less IL‐1 and TNF, as measured by the thymocyte proliferation and L929 cytotoxicity assays, than young and middle‐aged rats. Monokine production was not diminished by protein malnutrition in any age group. No synergistic decline in IL‐1 or TNF production was seen with increasing age in malnourished rats. Diminished IL‐1 and TNF production may partially explain the severity of infection seen in the elderly patient, but not the malnourished host. The role of other cytokines such as IL‐6 and cytokine inhibitors in aging and malnutrition should be explored.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141681/1/jlb0510.pd

Hepatosplenic candidiasis: Successful treatment with fluconazole

To determine if fluconazole is effective treatment for hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine treatment. Six patients (ages 3 to 44) with acute leukemia and hepatosplenic candidiasis who did not respond to prior antifungal therapy were treated with fluconazole. All six patients had fever and three had nausea and vomiting, computed tomographic (CT) scan showed lucencies in the liver in six, lucencies in the spleen in five, and lucencies in the kidneys in three. Prior therapy with 1.6 to 4 g of amphotericin B in the five adults and 526 mg of amphotericin B in the child (with the addition of flucytosine in four) failed to improve clinical symptoms or lucencies in the liver, spleen, and kidneys seen on CT scan. Fluconazole was given at a dose of 200 to 400 mg daily (70 to 100 mg in the child) for 2 to 14 months. All patients had resolution of fever and other symptoms in 2 to 8 weeks. Improvement of the lesions noted on CT scan was seen in 4 to 8 weeks in all patients. Total resolution of lesions noted on CT scan occurred by 4 weeks in two patients, but took 4 to 5 months for three patients and 13 months for one patient. Three patients had relapse of their acute leukemia and two died, presumably cured of their candidiasis. Two patients underwent successful bone marrow transplantation without relapse of their candidiasis. Fluconazole appears to be useful in the treatment of hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29188/1/0000241.pd

Accuracy of the direct agglutination test for diagnosis of visceral leishmaniasis: a systematic review and meta-analysis

Background:Parasitological investigation of bone marrow, splenic or lymph node aspirations is the gold standard for the diagnosis of visceral leishmaniasis (VL). However, this invasive test requires skilled clinical and laboratory staff and adequate facilities, and sensitivity varies depending on the tissue used. The direct agglutination test (DAT) is a serological test that does not need specialised staff, with just minimal training required. While previous meta-analysis has shown DAT to have high sensitivity and specificity when using parasitology as the reference test for diagnosis, meta-analysis of DAT compared to other diagnostic techniques, such as PCR and ELISA, that are increasingly used in clinical and research settings, has not been done. Methods: We conducted a systematic review to determine the diagnostic performance of DAT compared to all available tests for the laboratory diagnosis of human VL. We searched electronic databases including Medline, Embase, Global Health, Scopus, WoS Science Citation Index, Wiley Cochrane Central Register of Controlled Trials, Africa-Wide Information, LILACS and WHO Global Index. Three independent reviewers screened reports and extracted data from eligible studies. A meta-analysis estimated the diagnostic sensitivity and specificity of DAT. Results: Of 987 titles screened, 358 were selected for full data extraction and 78 were included in the analysis, reporting on 32,822 participants from 19 countries. Studies included were conducted between 1987–2020. Meta-analysis of studies using serum and DAT compared to any other test showed pooled sensitivity of 95% (95%CrI 90–98%) and pooled specificity of 95% (95%CrI 88–98%). Results were similar for freeze-dried DAT and liquid DAT when analysed separately. Sensitivity was lower for HIV-positive patients (90%, CrI 59–98%) and specificity was lower for symptomatic patients (70%, CrI 43–89%). When comparing different geographical regions, the lowest median sensitivity (89%, CrI 67–97%) was in Western Asia (five studies). Conclusions: This systematic review and meta-analysis demonstrates high estimated pooled sensitivity and specificity of DAT for diagnosis of VL, although sensitivity and specificity were lower for different patient groups and geographical locations. This review highlights the lack of standardisation of DAT methods and preparations, and the lack of data from some important geographical locations. Future well-reported studies could provide better evidence to inform test implementation for different patient populations and use cases. PROSPERO registration: CRD4202124083

Randomized Trial to Reduce Air Particle Levels in Homes of Smokers and Children

Introduction Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children. Design A randomized trial with two groups—intervention and control. Setting/participants A total of 298 participants from predominantly low-income households with an adult smoker and a child aged \u3c14 years. Participants were recruited during 2012–2015 from multiple sources in San Diego, mainly Women, Infants and Children Program sites. Intervention The multicomponent intervention consisted of continuous lights and brief sound alerts based on fine particle levels in real time and four brief coaching sessions using particle level graphs and motivational interviewing techniques. Motivational interviewing coaching focused on particle reduction to protect children and other occupants from elevated particle levels, especially from tobacco-related sources. Main outcome measures In-home air particle levels were measured by laser particle counters continuously in both study groups. The two outcomes were daily mean particle counts and percentage time with high particle concentrations (\u3e15,000 particles/0.01 ft3). Linear mixed models were used to analyze the differential change in the outcomes over time by group, during 2016–2017. Results Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p\u3c0.001). Intervention homes’ average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p\u3c0.001). Conclusions Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles. Trial registration This study is registered at www.clinicaltrials.gov NCT01634334

Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages

Abstract Influenza causes substantial morbidity and mortality annually, particularly in high-risk groups such as the elderly, young children, immunosuppressed individuals, and individuals with chronic illnesses. Healthcare-associated transmission of influenza contributes to this burden but is often under-recognized except in the setting of large outbreaks. The Centers for Disease Control and Prevention has recommended annual influenza vaccination for healthcare workers (HCWs) with direct patient contact since 1984 and for all HCWs since 1993. The rationale for these recommendations is to reduce the chance that HCWs serve as vectors for healthcare-associated influenza due to their close contact with high-risk patients and to enhance both HCW and patient safety. Despite these recommendations as well as the effectiveness of interventions designed to increase HCW vaccination rates, the percentage of HCWs vaccinated annually remains unacceptably low. Ironically, at the same time that campaigns have sought to increase HCW vaccination rates, vaccine shortages, such as the shortage during the 2004-2005 influenza season, present challenges regarding allocation of available vaccine supplies to both patients and HCWs. This two-part document outlines the position of the Society for Healthcare Epidemiology of America on influenza vaccination for HCWs and provides guidance for the allocation of influenza vaccine to HCWs during a vaccine shortage based on influenza transmission routes and the essential need for a practical and adaptive strategy for allocation. These recommendations apply to all types of healthcare facilities, including acute care hospitals, long-term-care facilities, and ambulatory care settings