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Lymphocytes are white blood cells that are made in lymphoid tissues throughout the body. When exposed to interleukin-2 (a protein, or lymphokine, produced by the immune system), lymphocytes develop the ability to kill tumor cells. These lymphocytes are called lymphokine-activated killer cells (LAK cells). In preliminary studies, LAK cells were reported to have beneficial effects in 25 patients with advanced cancer. In other clinical studies, combinations of interleukin-2 and LAK cells were administered to cancer patients with renal carcinoma, malignant melanoma and colorectal carcinoma. In August 1986, two cases of hepatitis A virus (HAV) infection were identified in patients treated with interleukin-2 and LAK cells at the New England Medical Center. Blood testing revealed five more cases of HAV infection. This prompted an investigation into the mode of HAV transmission. Between July and September of 1986, six different clinical centers reported outbreaks of HAV infection. These infections occurred in cancer patients that had been treated with interleukin-2 and LAK cells. Upon further investigation it was found that the human serum used to make the LAK cells may have been the cause of the HAV outbreak. HAV infection was associated with two different batches of human serum, called X and Y, that were used to prepare the LAK cells. HAV infection was reported in 85 percent of the patients treated with LAK cells made from batch X serum, in 62 percent of patients treated with LAK cells from batch Y, and in 50 percent of the patients exposed to both batches of serum. None of the 24 patients treated with LAK cells prepared from other batches of serum had HAV infection. Batch X and batch Y sera were prepared from the blood of 20 donors. Twelve of the 20 donors were tested for HAV and found to be negative. It is possible that one of the other donors had HAV infected serum that was used in both batches of LAK cells. It is concluded that treatment of patients with LAK cells made using human serum represents a new mode for HAV transmission. (Consumer Summary produced by Reliance Medical Information, Inc.)

The only confirmed outbreak of acute hemorrhagic conjunctivitis in the continental United States during 1982 occurred in Brainerd, Minnesota. The disease first appeared in a 27-year-old woman during a trip to Tahiti. The patient's two daughters (8 months old and 3 years old) developed mild conjunctivitis two days later. Although the symptoms of all three had completely resolved before they arrived in Brainerd, illness compatible with acute hemorrhagic conjunctivitis developed in five other individuals who shared a house with them there. Symptoms appeared within two days in four of the five and within three days in the fifth. All five had high neutralizing antibody titers to enterovirus 70 (1:128, 1:32, 1:32, 1:128, and 1:256) and one had high antibody titers to coxsackievirus A24 which may cause similar symptoms (<1:4 in all cases). The symptoms resolved without sequelae in all five patients within five days.

We report three unrelated outbreaks of acute pulmonary histoplasmosis associated with cutting and gathering firewood in Minnesota. Clinical symptoms and laboratory findings from nine patients are reported. All recovered without treatment. This report emphasizes that physicians must consider cutting and gathering wood, especially decayed wood, as a potential risk for acute pulmonary histoplasmosis even in areas of the country where histoplasmosis is not considered prevalent.

Between September 1978 and December 1985, 450 case reports of serious respiratory and cardiovascular events and 32 case reports of death attributed to ophthalmic timolol were received by the United States Food and Drug Administration and the National Registry of Drug-Induced Ocular Side Effects. Two hundred sixty-seven patients (55%) experienced a cardiac arrhythmia or a bronchospasm-related event. The median age was 68 years (n = 365). Fifty-five percent of the patients were women and 45% were men (n = 41). Of the 212 persons for whom medical history was provided, 129 (61%) had respiratory disease, 65 (31%) had cardiovascular disease, 13 (6%) had other illnesses, and five (2%) had no underlying illness. Of the 318 patients for whom data on duration of drug use were available 106 (33%) experienced their adverse event within one week of beginning timolol therapy: 73 (23%) had their events on the first day of therapy. Of 192 patients for whom information was available 177 (92%) improved after the drug was discontinued.

A confirmed case of human babesiosis was identified in August 1983 in a 54-year-old asplenic Wisconsin resident. Babesia microti was identified as the causative agent by blood smear morphology and hamster inoculation techniques. The patient's wife had clinically confirmed Lyme disease in 1981 and had serologic evidence (immunofluorescent antibody to a B microti titer of 1:1,024) of recent Babesia infection in August 1983. Mice (Peromyscus species) trapped on the patients' property and elsewhere in their Wisconsin county of residence were infected with B microti. Lyme disease and babesiosis have the same tick vector and animal reservoir; serum samples from 116 Wisconsin and Minnesota residents with clinically confirmed Lyme disease between 1980 and 1983 were tested, and none were found to have concurrent Babesia infection. This area of Wisconsin is identified as a new focus for babesiosis transmission, but the risk of transmission seems to be low.(JAMA 1985;253:2675-2678)

To examine the utility of dermatology subspecialty reporting of adverse drug reactions for early detection of unusual reactions, reports of five drug-induced adverse reactions are reviewed: Fansidar and severe skin reactions, isotretinoin and spontaneous abortion and teratogenesis, isotretinoin and pseudotumor cerebrii, ketoconazole and fatal hepatic necrosis, and Piroxicam and photosensitivity. Reports from the registry are analyzed for completeness and timeliness and compared with reports received by the FDA's Spontaneous Reporting System (SRS). Reports from both systems proved to be comparable in terms of completing nine data elements examined on the adverse reaction reporting form. Registry reports, however, were received later than FDA reports.

Serum angiotensin-converting enzyme (SACE) levels were measured in 44 subjects six weeks after acute pulmonary histoplasmosis. All patients were infected in a common-source outbreak of histoplasmosis which occurred on one day. All patients had both strictly defined clinical and serologic evidence of infection. The SACE activity was elevated at six weeks compared to normal controls, and seven of the 44 had levels more than 2 SD above the normal mean. SACE levels were also measured at three and 24 weeks after acute infection in a smaller number of the same subjects. Serial observations demonstrated that all subjects (including those with normal and elevated SACE at six weeks) had a rise and fall in SACE activity following symptomatic acute pulmonary histoplasmosis. Our findings suggest that elevated SACE does not reliably separate sarcoidosis from histoplasmosis, although elevations in histoplasmosis are much less common and may occur only briefly following acute pulmonary histoplasmosis. More important, it seems that SACE activity rises acutely in all patients with symptomatic acute histoplasmosis and then falls gradually toward baseline over several months, coinciding temporally with the granulomatous response.

AbstractEight cases of sternal/mediastinal infection due to Enterobacter species were seen in postoperative cardiac patients during 1980 to 1981. The attack rate was 14.5% (8/55), compared to 3.7% (2/54) for an identical period in 1979 to 1980 (p<0.05). Cases varied in severity from fulminant, acute bacteremic infections (one death) to less severe wound infection. Late complications or recurrences were not seen. There was a hospital-wide increase, relative to all other gram-negative bacillary isolates, in Enterobacterlaboratory isolations, but no increased rate of infection in any other specific surgical condition.No personnel, materials, or techniques were associated with the outbreak, and all but two environmental cultures were negative. Case-control analysis suggested that surgical complications and prophylactic cephalosporins were associated with infection. Prospectively, an additional 85 cardiac surgery patients had increased Enterobacterskin/wound colonization following perioperative prophylaxis with cephalosporin antibiotics. After introduction of barrier isolation and restriction of contacts no further mediastinitis occurred in 100 subsequent cardiac surgery patients. This study indicates that Enterobactermay be major pathogens causing post-cardiac-surgery infection not prevented by cephalosporin prophylaxis.