Chemotherapy and the Immune Response in Protozoal Infections1

Available evidence indicates that many of the antiprotozoal drugs currently in use significantly modify the immune response of the host. The effect depends on both the drug and the host. Some drugs enhance the immune response, some are immuno-suppressants, and others enhance some types of immune mechanisms while suppressing others. Future efforts in the development of antiprotozoal drugs should consider their effects on both the parasite and the immune response of the host. Also in the chemotherapy of protozoal infections consideration should be given to the combined usage of immunoenhancing agents and antiprotozoal drugs.     

Interferon and Interferon Inducers in Protozoal Infections

Several interferon inducers (Newcastle disease virus, statolon, and poly rI:poly rC) as well as exogenous mouse interferon protect mice from sporozoite-induced Plasmodium berghei malaria, as long as they are administered before the end of the preerythrocytic phase of development of the parasite. The protective effect of the interferon inducers was related to their interferon-inducing effect; the protective effect of the interferon preparations was related to the interferon titer of the preparations, and it exhibited other attributes of interferon such as species specificity. In contrast to sporozoite-induced infection, blood forms-induced P. berghei malaria was only weakly susceptible to the protective effect of interferon inducers. This difference may provide an approach to study the mechanism of protection. The growth in cell cultures of another intracellular protozoon, Toxoplasma gondii, is also inhibited by interferon (22). The fact that P. berghei and T. gondii (as well as another group of intracellular parasites susceptible to interferon, the Chlamydia) have their own ribosomes raises questions, concerning the role of host cell ribosomes in the host cell-parasite relationship of these intracellular parasites and in the mechanism of interferon action against them, that can be approached experimentally. The possibility of therapeutic or prophylactic application of interferon or of its inducers to certain protozoal diseases of man and of other animals is still remote, but it has to be considered for long range planning.     

Further Studies in the Chemotherapy of Plasmodium hexamerium Infections in Ducks

Five standard antimalarial drugs have been tested, in the present study, against trophozoite-induced Plasmodium hexamerium infections in ducks; namely, chloroquine, proguanil (paludrine), pyrimethamine (daraprim), pentaquine and isopentaquine. (Four others were used previously.) Two doses daily were given for a treatment period of 7 days. The effectiveness of treatment was measured in terms of its ability to suppress parasitemia and to completely prevent relapse ( i.e. to achieve sterilization). Of the five drugs, the two pentaquines were about equally effective. They rapidly cleared the blood of parasites, and completely aborted the infection in nearly all cases. The other three drugs failed to sterilize any of the cases treated, and were not even effective as suppressants.
The pentaquines, however, proved quite toxic to the host and, even in the dosages used, retarded the normal rate of weight gain. Pyrimethamine had a similar effect, and in addition interfered with normal feathering. Neither of these effects, whether due to pentaquines or pyrimethamine, was recovered from after treatment stopped.     

The Importance of Bacterial and Viral Infections Associated with Adult Asthma Exacerbations in Clinical Practice

Background

Viral infection is one of the risk factors for asthma exacerbation. However, which pathogens are related to asthma exacerbation in adults remains unclear.

Objective

The relation between various infections and adult asthma exacerbations was investigated in clinical practice.

Methods

The study subjects included 50 adult inpatients due to asthma exacerbations and 20 stable outpatients for comparison. The pathogens from a nasopharyngeal swab were measured by multiplex PCR analysis.

Results

Asthma exacerbations occurred after a common cold in 48 inpatients. The numbers of patients with viral, bacterial, or both infections were 16, 9, and 9, respectively. The dominant viruses were rhinoviruses, respiratory syncytial virus, influenza virus, and metapneumovirus. The major bacteria were S. pneumoniae and H. influenzae. Compared to pathogen-free patients, the patients with pathogens were older and non-atopic and had later onset of disease, lower FeNO levels, lower IgE titers, and a higher incidence of comorbid sinusitis, COPD, or pneumonia. Compared to stable outpatients, asthma exacerbation inpatients had a higher incidence of smoking and comorbid sinusitis, COPD, or pneumonia. Viruses were detected in 50% of stable outpatients, but a higher incidence of rhinovirus, respiratory syncytial virus, and metapneumovirus infections was observed in asthma exacerbation inpatients. H. influenzae was observed in stable asthmatic patients. Other bacteria, especially S. pneumoniae, were important in asthma exacerbation inpatients.

Conclusion

Viral or bacterial infections were observed in 70% of inpatients with an asthma exacerbation in clinical practice. Infection with S. pneumoniae was related to adult asthma exacerbation.     

Clinical Importance of Infections due to Bacteroides fragilis and Role of Antibiotic Therapy

Out of 200 infections due to Bacteroides fragilis occurring over a period of three years 133 were related to the intestinal tract, 55 to the genitourinary tract, and the remainder were in bedsores and ulcers; 56% occurred in patients undergoing major intestinal surgery.B. fragilis was isolated in pure culture from 56% of the infections. In mixed culture it was most commonly associated with Klebsiella and Enterobacter species. Other anaerobic bacteria were isolated in 9% of the mixed cultures.Altogether 131 (65·5%) of the patients recovered without antibiotic therapy or further surgery, but 59 (29·5%) developed complications and 10 (5%) died. The commonest complication was abscess formation, and the incidence was highest with infections associated with malignancy (44%) and lowest with obstetric infections (5%). The mortality was 5% overall but in the presence of bacteraemia it rose to 33%.Only 43 patients received appropriate chemotherapy. Clindamycin was the most effective antibiotic, having a recovery rate of 78%, but this rate was little better than in untreated patients (65%). The role of prophylactic antibiotic therapy in preventing bacteroides infection remains to be studied.The incidence of the isolation of bacteroides from wound infections after major intestinal surgery rose from 13% in 1970 to 81% in 1973. This increase was due to both the accurate collection and care of specimens while in transit to the laboratory and the use of selective media for the isolation of bacteroides in laboratory culture. The importance of these precautions is emphasized.