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Infectious Diseases: Annual Review of Significant Publications Postgrad Med J: first published as 10.1136/pgmj.50.586.485 on 1 August 1974. Downloaded from Postgraduate Medical Journal (August 1974) 50, 485-496. ANNUAL REVIEW Infectious diseases: Annual review of significant publications HOBART A. REIMANN M.D. The Hahnemann Medical College and Hospital, Philadelphia, U.S.A. 19102 Introduction transmitting infection. Subtypes may reflect epi- As in previous years, advances in knowledge of demiological features, not biological differences of infections accrued, especially about viruses, the strains.7 Immunity often follows early exposure to diseases they cause and protection against them, and the virus.8 in reactions of immunity in general. Hepatitis and Hepatitis probably is a systemic disease. Therapy herpes viruses claimed much attention, respiratory failed in nine comatose patients. In one, most tract infections less than usual. The relation of EB organs were damaged and HB Ag was present in Protected by copyright. and other viruses to cancer still is obscure. Venereal each.9 Injected heat-inactivated B antigen may diseases continued to increase in incidence. New and meliorate the disease' and eventually a vaccine may expensive antimicrobial drugs were widely used, but be prepared." Radioimmunoassay detected twice as few exceeded the value of older ones. Antimicrobial- many infections with hepatitis B virus as other tests.'2 resistance increased apace. Many reports dealt with Infection was induced experimentally in chimpan- the dangers of iatrogenic and nosocomial infections. zees. 13 Hepatitis A. Further evidence supports the iden- Viral infections tity of a virus recovered from marmosets inoculated Hepatitis with blood from patients with hepatitis A to that of hepatitis A.14 as an Inoculation resulted in characteristic Hepatitis B, occupational hazard, involved evidence of the infection. 15 Convalescent serum from ten hospital employees after exposure to a patient patients neutralized the infectivity of the agent in who had received many blood-transfusions.' Four marmosets. 16 Virus particles appeared in stools of five surgeons were infected during operation on a during the acute of http://pmj.bmj.com/ patient. Three had concurrent arthritis.2 More phase disease.'7 articles on the subject appeared in the July 23 Herpes hominis Journal of the American Medical Association and in Except for pain and tenderness, herpes virus type 2 the July Archives of Internal Medicine. Hepatitis penile lesions may be mistaken for other chancres. occurred in 3000 of 200 drug addicts.3 According to Virus was present in 6% of urethral swabs, in one two articles in the Lancet of June 30, sexual inter- accompanied by T. pallidum."8 Type 1 virus caused course and domestic contact are likely sources of intrauterine infection of an infant. Six instances have infection. Infection with hepatitis B virus seems to been observed resulting in congenital malformations, on September 30, 2021 by guest. be as universal as that of cytomegalovirus or herpes cerebral injury, mental retardation and other de- virus.4 fects.'9 Six adults had herpes hepatitis subsequent to Among more than 2 m blood samples from volun- infection elsewhere chiefly of the oral mucosa. teer donors, 0.10% contained HB Ag. The ratio of Because of its bad prognosis, therapy with cytosine subtype ad to ay was 5-8: 1, and lower in the arabinoside or idoxuridine was recommended. 20 northern U.S.A. Hb Ag was three times higher in Among twenty patients with herpes virus encephali- paid blood donors than in volunteers.6 HB Ag tis treated with idoxuridine, thirteen showed appar- appeared in 79-500 of patients at some time after ent improvement, nine are well and two died. Of exposure to infection. Fifty-six per cent of normal nine untreated patients, six survived but only one donors had subtype ad HB Ag and 7500 of patients recovered completely.2' Herpes hominis virus, the with post-transfusion hepatitis had subtype ay sug- commonest cause of sporadic necrotizing encepha- gesting that healthy carriers present little danger of litis, affected seven patients. Of four treated with 486 Hobart A. Reimann Postgrad Med J: first published as 10.1136/pgmj.50.586.485 on 1 August 1974. Downloaded from idoxuridine, three died. In one instance, as much Rabies. Uncertainty persists about the value of virus was in the brain after a full course as initially. vaccination. Although serious sequelae are rare, the Two treated with cytarabine have chronic disease.22 low incidence of rabies in the U.S.A. makes the risk Labial lesions seemed to respond and recurrences of reaction to the vaccine greater than the risk of were prevented by applying fluorescent light to rabies. Among 116 persons receiving duck-embryo lesions treated with neutral red dye.23 Therapeutic vaccine, all had local reactions, 3300 had constitu- photoinactivation of herpes virus may be hazardous tional symptoms and one had an anaphylactic and lead to changes that result in oncogenesis.24 reaction.45 A human cell culture of rabies vaccine BCG vaccination apparently prevented recurrences evoked antibody without causing an untoward ofgenital herpes type 2 infection incident to menses.25 general reaction.46 Antiserum (Lederle Laboratory) Repeated application of ether or chloroform is is available commercially.47 It may interfere with recommended as the safest treatment for ether- active immunity induced by vaccine.48 sensitive labial herpes. Controversy continues A laboratory worker contracted the infection about the relation of herpes viruses to cancers. A probably by inhaling aerosolized 'fixed' virus.49 latent virus may become active in dysplasic cells.27' 28 Patients with cervical carcinoma had antibody to Viral respiratory tract infections type 2 herpes virus twice as often as in normal Upper respiratory tract viral infections occur in women.29 A recently published book30 and a review the tropics in any season. In Bangkok, parainfluenza in the September 27, October 4 and 11 New England (40°Y), respiratory syncytial (13%) and adenoviruses Journal of Medicine summarize knowledge about (130%) were the chief causes. A2 influenza appeared in herpes and varicella-zoster viruses. August 1965 and dominated for 2 months.50 Else- where, viral infections, especially respiratory syn- Meningoencephalitis cytial and parainfluenza as 3, predominated causes Protected by copyright. Besides measles and smallpox, vaccinia virus also of pneumonia in infants.51 Viral infections often may be a cause of subacute disseminated encephalo- account for exacerbations of chronic bronchitis52 myelitis years after vaccination.31 Measles virus may and do not require antimicrobial therapy. be a cause of multiple sclerosis.32 As yet, no evidence Interferon applied intranasally prevented rhino- of any viral infection has appeared in brain tissue viral infection and viral shedding in inoculated from a patient.33 Measles antigen in infected neurons volunteers.53 Inexplicably, vitamin C reduced the and glial cells may be involved in the cytolysis of severity of colds in girls, but not in boys.54 Sceptical sub-acute sclerosing panencephalitis.34 The increase letters about its value appeared in Lancet of April 28 in the incidence of SSPE in New Zealand may be and in an editorial.55 Both glyceryl guaiacolate and related to vaccination against poliomyelitis. Either terpin hydrate are useless as expectorants.56 Large SV40 or measles virus may have been contaminants.35 dosage of the latter injured the liver.57 Slow viruses were even considered as a cause of Influenza affected three newborn infants. One had schizophrenia.36 Knowledge of conventional and un- bilateral pneumonia on the first day of infection.58 conventional slow viruses was summarized in Science Vaccination of patients who have a demyelinating http://pmj.bmj.com/ of June 29 and July 6. disease is hazardous.59 A new vaccine (1972-73) Powassan virus, present in rodents, caused non- effectively induced serum and nasal antibodies.80 fatal encephalitis in a resident of New Jersey.37 Prophylaxis with amantadine seemed to prevent ECHO virus caused a small outbreak in Britain.38 nosocomial infection61 but resistant strains of virus A Mumps, ECHO 2 and California encephalitis appeared in treated mice.62 The hope of averting viruses were implicated as causes in one child.39 pandemics rests on the improvement of vaccines as The question of anamnestic reaction arises. Califor- discussed in the June 8 and 15 issues of Science. nia arbovirus caused meningoencephalitis in sixty-six on September 30, 2021 by guest. children in Minnesota between 1967 and 1972. All Coxsackie virus survived but 15% had sequelae.40 Type 1 poliomyelitis An outbreak of Coxsackie virus B5 in a boys' in eleven unvaccinated students in October 1972 in summer camp probably had its source in lake water Connecticut emphasized the need for vaccination.41 during bathing. Thirteen boys had pharyngitis. Paralytic poliomyelitis type 3 developed after a Conjunctivitis, pleurodynia, meningitis and dysentery month in an orally vaccinated person in 1963. Ten occurred in one each.63 Evidence of Group B Cox- years later in a suit against the U.S. government, sackie virus infection appeared in fifteen of twenty-one $2 million was awarded because of negligence in children with the haemolytic-uraemic syndrome, and pretesting the vaccine for safety.42 the virus was recovered from two.6i4 Adenovirus type House sparrows andpigeonsprobably disseminated 2 caused haemorrhagic cystitis in seventeen children the St Louis encephalitis virus during an epidemic in and three adults.65 As in the case of mumps, Coxsackie Houston.43 Sparrows also harbour salmonellae.44 B virus caused acute pancreatitis in two patients.66 Infectious diseases: annual review 487 Postgrad Med J: first published as 10.1136/pgmj.50.586.485 on 1 August 1974. Downloaded from Cytomegalovirus usually is invasive when host- measles and varicella pneumonia are recorded. In an resistance is impaired, but it caused nine cases of unusual fatal case in an infant, measles pneumonia heterophil negative mononucleosis in otherwise appeared during varicella pneumonia.
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