Imipenem for the treatment of melioidosis

Melioidosis is a protean disease caused by Burkholderia pseudomallei. It is rare in the UK and is generally only seen in patients with a travel history to endemic areas such as Thailand, Singapore and Malaysia. Cases may present with disseminated bacteraemic, non-disseminated bacteraemic, multi-focal bacteraemic or localized disease. Subclinical infections also occur. Following acquisition of the organism a patient may remain asymptomatic for several years before infection becomes clinically apparent. Factors such as diabetes, renal failure or other causes for a decrease in host immunity may precipitate the appearance of overt disease. The current treatment choice for severe melioidosis is parenteral ceftazidime followed by oral amoxycillin-clavulanic acid or a combination of co-trimoxazole, doxycycline and chloramphenicol. We report a case of melioidosis in a 59-year-old male diabetic from Bangladesh who initially responded to piperacillin-tazobactam but was changed to ceftazidime when a definitive diagnosis was made. His condition deteriorated on the latter antibiotic. He subsequently responded to imipenem. The patient's long-term outcome is still not known.

Inhibition of transplant rejection by pretreatment of xenogeneic pancreatic islet cells with anti-ICAM-1 antibodies

Cognate recognition of antigen-presenting cells by antigen-specific T cells is critically dependent on non-cognate adhesive interactions. For instance, several studies have shown that in vivo anti-LFA-1 plus anti-ICAM-1 mAb treatment results in prolongation of allograft survival. We have developed a xenogeneic islet transplant model to investigate the role of various adhesion interactions in the xenogeneic response and study the effect of pretreating donor tissue with immunosuppressive drugs. Pancreatic islet cells were pretreated in vitro with anti-human ICAM-1 mAb, transplanted under the renal capsule of diabetic B6 mice in the absence of systemic immunosuppression and examined for long-term xenograft acceptance. The survival of human islets pretreated with anti-human ICAM-1 was significantly prolonged (MST = 53 days, with 40% of grafts surviving > 100 days). In contrast, the survival of human islets pretreated with the control antibody was similar to those of nontreated islets (MST = 7 days). A massive lymphocyte infiltrate into control xenografts was observed at 5 days post-transplant. In contrast, a lymphocyte infiltrate did not appear in the anti-ICAM-1-treated islets for at least 11 days. Only mAbs specific for the LFA-1 binding epitope of ICAM-1 were found to inhibit a mixed islet/lymphocyte reaction in vitro and block graft rejection in vivo. However, graft prolongation is not accompanied by systemic tolerance. Mice transplanted simultaneously with human islet cells treated with control Ig (left kidney) or anti-ICAM-1 (right kidney) rejected the control islets but not anti-ICAM-1-treated islets. These results suggest that the LFA-1/ICAM-1 interaction is a critical component for xenograft rejection and, more important, that pretreatment of islet tissue with anti-adhesion molecule antibodies can profoundly alter graft recognition and rejection in the absence of any systemic drug therapy. However, graft prolongation is not accompanied by systemic tolerance induction.

Prevention of autoimmune diabetes by treatment with anti-LFA-1 and anti-ICAM-1 monoclonal antibodies

Insulin-dependent diabetes mellitus (IDDM) in humans and mouse models is caused by a T cell-mediated destruction of the beta cells in the islets of Langerhans. The interaction between T cells and their antigens or targets is assisted by adhesion molecules on the surfaces of lymphocytes and counterreceptors on antigen-presenting or other cells. One such pair of molecules thought to be of importance in IDDM is lymphocyte function-related antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) because culture of islet cells with cytokines results in the expression of ICAM-1 on islet cells in vitro. To understand the importance of this interaction in the development of autoimmune diabetes, we have studied the ability of monoclonal antibodies (mAbs) against LFA-1 and/or ICAM-1 to prevent disease in multidose streptozotocin-induced diabetes mellitus (MDSDM). Treatment with both anti-LFA-1 and anti-ICAM-1 mAbs reduced the development of hyperglycemia and insulitis in this model. Treatment with the anti-LFA-1 and anti-ICAM-1 mAbs caused modulation of LFA-1 and ICAM-1 expression on splenocytes, respectively. In mice that were undergoing streptozotocin-induced diabetes, ICAM-1 was found on capillary endothelial cells and on cells surrounding the islets but was not expressed at detectable levels on islet endocrine cells. Thus, interaction between ICAM-1 and LFA-1 is involved in the development of autoimmune diabetes in MDSDM. It is unlikely that ICAM-1 molecules mediate adherence between T cells and islet cells themselves. Our results suggest that treatment with anti-ICAM-1 and anti-LFA-1 mAbs prevents localization of T cells to the islets rather than causing functional impairments of the lymphocytes. The actual sites of interaction between the T cells involved in MDSDM and ICAM-1 are unknown, but may occur on cells that normally express ICAM-1 in the islet or may occur outside the islet itself.

Changes in social support and quality of life: a case study of a man with an enduring psychotic illness

The Government's White Paper on community care has drawn attention to the importance of assessing changes in a person's well-being which occur as a consequence of clinical and social interventions. In the UK the evaluation of the quality of life of people with chronic mental illness is relatively new. This case study demonstrates the use of the 'Lancashire Quality of Life Profile' in routine clinical practice with reference to residential changes in the 'care programme' of a person with a long history of a severely disabling psychotic illness. The formulation and review of his care plan were determined by a network of agencies involved in his long term care.

Cryosurgical treatment of the eyelids and lacrimal drainage ducts of the rhesus monkey. Course of injury and repair

Freezing injuries were produced on the eyelids and lacrimal drainage systems in ten rhesus monkeys. The instrumentation produced both single and double freezing cycles at tissue temperatures of -30 and -60 degrees C. The extent of injury and the course of repair were evaluated by clinical observation and by histologic examination of tissue specimens removed at intervals up to three months after freezing. Both cryosurgical techniques produced necrosis of the tissues, but injury was less with single freezing cycles at -30 degrees C. The course of repair was favorable. Even at the three-month observation period, when healing was complete, there was minimal-clinical or histologic evidence of canalicular obstruction or other periocular complications.