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Biomedical subjects

A W Sturm

Publications and source records attributed to A W Sturm.

At least 73 records · Page 4Linked to original sources
PubMed1996

Pulmonary tuberculosis in a BCG vaccinated area: relationship of disease severity with immunological and hematological parameters and drug resistance patterns.

Clinical hematological and immunological parameters were studied in a group of 145 pulmonary patients with active tuberculosis, from a defined area of Karachi (Kharadar) belonging to the lower socioeconomic strata. Although clinical symptomatology could not differentiate the extent of lung involvement, a majority (69.6%) of the patients were diagnosed radiologically as having moderately advanced pulmonary disease. The peak number of patients were in their second decade of life. No differences were observed in the extent of disease based on age or gender. All hematological parameters for the group were in the normal ranges except for low levels of hemoglobin (9.58 +/- 1.55 SD; normal range 12-14 mg/dl) and a high ESR (90 +/- 31 SD; normal range 0-13 mm/hour). A negative correlation of PPD skin test induration (r = 0.21, p = 0.02), and a positive correlation of total white blood cell (r = 0.20; p = 0.015) was observed with the amount of lung tissue involved. The resistance amongst the strains for the four first line anti-tuberculosis agents was found to be: isoniazid = 27.4%; ethambutol = 14.5%; rifampicin = 11.29% and streptomycin = 12.9%. Multi-drug resistance to the most commonly prescribed combination (rifampicin and ethambutol) was 8.06%. Drug resistance patterns to individual drugs were comparable with resistance patterns observed in strains from greater Karachi at The Aga Khan Hospital during the same period. Such studies should provide improved rationale for patients diagnosis and treatment.

Adolescent↗
PubMed1995

Epidemic Shigella dysenteriae type 1 in Natal.

Since its first isolation in South Africa in 1994, Shigella dysenteriae type 1 has now spread to cause an epidemic outbreak in Natal Kwazulu, resulting in a steep rise in admissions for dysentery and the haemolytic uraemic syndrome in children. We report on the epidemic as it has evolved so far. A large outbreak is to be expected in South Africa in view of large scale poverty, lack of housing, and adequate water and sanitation, unless urgent public health measures are taken.

Child↗
PubMed1995

Sexually transmitted diseases including HIV infection in women with Bartholin's gland abscesses.

OBJECTIVES: The aim of this study was to establish the prevalence of sexually transmitted infections including human immunodeficiency virus (HIV) infection in women with Bartholin's gland abscess. SETTING: Gynaecology Clinic of King Edward VIII Hospital, a large urban, referral hospital for the province of Kwa-Zulu Natal, serving an underprivileged population. METHODS: Thirty consecutive women presenting with unruptured Bartholin's gland abscesses were studied. Prior to surgical drainage, aspirates from the abscess cavity and swab specimens from the vagina and endocervix were collected for microbiological investigations. In addition peripheral venous blood samples were obtained for syphilis and HIV antibody testing. RESULTS: Antibody to HIV was detected in 9 of the 30 (30%) patients studied. Recognised sexually transmitted pathogens were detected in both aspirates and endocervical specimens: Chlamydia trachomatis was detected in 3 aspirate and 2 endocervical specimens whilst Neisseria gonorrhoeae was cultured in 5 aspirate and 7 endocervical specimens. When comparing microorganisms isolated from HIV antibody positive and negative women, only Bacteroides species yielded a significantly higher growth (p = 0.01) in the antibody positive women. CONCLUSION: Our findings show that women with Bartholin's gland abscesses have a high prevalence of HIV antibody. Furthermore, this is the only study that demonstrates a role for C trachomatis in the aetiology of Bartholin's gland abscesses. Health workers should be aware of the need for appropriate counselling, and comprehensive treatment of sexually transmitted infections including C trachomatis in women with Bartholin's gland abscesses.

Abscess↗
PubMed1992

Eradication of a multiple drug resistant Salmonella paratyphi A causing meningitis with ciprofloxacin.

A previously healthy breast-fed baby was admitted at 10 days of age to a hospital in the north of Pakistan with diarrhoea and fever. He was treated for suspected sepsis with intravenous cefotaxime and tobramycin. Cultures of blood and faeces at that time proved negative. At 12 days of age, seizures began and examination of CSF revealed evidence of pyogenic meningitis but bacteria were neither seen microscopically nor isolated in culture. Ceftazidime was substituted for cefotaxime and carbenicillin was given also. Since the baby's condition continued to deteriorate with persistent fever, vomiting and recurrent seizures, he was transferred to the Aga Khan University Hospital, Karachi. Examination of CSF there confirmed the diagnosis of pyogenic meningitis and revealed Gram-negative bacteria. Cultures of CSF and faeces yielded Salmonella paratyphi A but the blood culture was negative. The isolate was found to be multiple antimicrobially resistant but sensitive to ciprofloxacin. Treatment with this drug was therefore started 3 days after the baby's admission to the Aga Khan Hospital. Within 36 h, improvement was observed. From then onwards, the baby made a progressive recovery and was healthy when seen at 7 months of age.

Ciprofloxacin↗
PubMed1992

Systemic manifestations of invasive amebiasis.

Eighty-four patients with serious infection due to Entamoeba histolytica were evaluated for systemic complications by objective criteria for dysfunction of the organ systems normally assessed in surgical sepsis. Of 71 patients with amebic liver abscess (ALA), 41% had systemic complications and 13% had more than one organ system involved. Patients > or = 40 years of age and those being treated with steroids were at significantly increased risk of developing complications (P < or = .05). The erythrocyte sedimentation rate and the levels of the acute-phase markers C-reactive protein (CRP) and serum amyloid A (SAA) were significantly elevated in patients with ALA over values in those without ALA (P < or = .05). ALA patients with complications had lower CRP and SAA concentrations than those without complications (P < or = .05). Blood and liver aspirates in ALA patients were usually bacteriologically sterile. The pathogenesis of systemic complications and the associated acute-phase response requires further study, and ways of predicting disease severity and intervening therapeutically must be devised.

Adolescent↗
PubMed1990

Outbreak of multiresistant non-encapsulated Haemophilus influenzae infections in a pulmonary rehabilitation centre.

15 out of 21 patients admitted to a pulmonary rehabilitation centre were infected with a non-encapsulated strain of Haemophilus influenzae. All isolates showed identical outer membrane protein patterns, harboured a 40 MD plasmid, produced beta-lactamase, and were resistant to amoxycillin, co-trimoxazole, chloramphenicol, and tetracycline. The strain was first isolated from sputum of another 3 patients in the same hospital ward. 2 of them later introduced it into the rehabilitation centre. The strain spread among the other patients over the next 2 months. The absence of a common iatrogenic source of the organism and its slow spread indicate that the most likely means of transmission was person to person.

Adult↗
PubMed1990

Effects of a restrictive antibiotic policy on clinical efficacy of antibiotics and susceptibility patterns of organisms.

To assess the impact of a restrictive antimicrobial policy, the efficacy of therapeutic and prophylactic antibiotic regimens and the susceptibility patterns of infecting bacterial microorganisms were studied during a two-month period in 1986 in inpatients in a general hospital. Twenty-eight percent of patients received antimicrobial agents, 21% as treatment and 7% as prophylaxis. In the 359 evaluable episodes of infection cure was obtained in 88% of cases with the initial therapy and in 7% after a change of drugs, but treatment failed in 5%. Of the 18 cases of failure, improvement was seen in eight although the infection persisted. Ten patients died but in seven of them the infection only partially contributed to this outcome. Ten (8%) of 127 patients receiving antimicrobial prophylaxis developed an infection but in three there was no relation to the condition for which the prophylactic regimen was originally prescribed. No changes were found in the susceptibility patterns of microorganisms.

Anti-Bacterial Agents↗
PubMed1989

[Detection of Mycobacteria in tissue sections].

A study of 31 patients with Mycobacterium infection was performed. The results of Ziehl-Neelsen(ZN) and auramine-rhodamine(AR) staining techniques were compared with the results of cultures. This study demonstrates that the AR method is more sensitive than the ZN method, but they complement each other and when used in combination allow fast and reliable screening for organisms. The culture is important for classification of Mycobacterium species and drug susceptibility testing.

Adult↗
PubMed1989

Mobiluncus species and other anaerobic bacteria in non-puerperal breast abscesses.

Samples of 109 breast masses were cultured aerobically and anaerobically for Mobiluncus spp. using selective and non-selective media. Two of the 103 evaluable samples were sterile and 57 (55%) yielded facultative bacteria only. The remaining 44 (43%) contained anaerobic growth alone or mixed infections. Seven (16%) of the 44 samples with anaerobes, six from women and one from a man, yielded Mobiluncus spp. Six were identified as Mobiluncus curtisii and one as Mobiluncus mulieris. There were two types of breast abscesses: one with Staphylococcus aureus predominating and one with anaerobes predominating. Most of the anaerobes belonged to the normal vaginal flora, but some were members of the normal oral flora. These results support the hypothesis that breast infections with these anaerobes result from sexual activities.

Abscess↗
PubMed1989

Gardnerella vaginalis in infections of the urinary tract.

During a period of 6 months, urine from 3576 patients was cultured for Gardnerella vaginalis. Specimens from 32 patients yielded this species. Eleven (0.3%) of the isolates were judged to be of clinical importance. Seven were from women and four from men. Two of these patients, both women, suffered from spontaneous cystitis. Hence G. vaginalis is very unusual as a primary pathogen in the urinary tract. More often it may cause infections related to urological abnormalities or as a complication of urological procedures. Two of the men in our series had chronic prostatitis, one an infected urinoma. All six remaining patients had either undergone a urological procedure or had had an indwelling urethral catheter for more than 6 hours. A selective medium for G. vaginalis is recommended for screening cultures before urological procedures and when this species is suspected on microscopy. The role of metronidazole in extravaginal infections is discussed and the use of an antibiotic more active against G. vaginalis is recommended.

Adult↗
PubMed1989

Netilmicin in the treatment of gram-negative bacteremia: single daily versus multiple daily dosage.

Seventy patients with culture-proven bacteremia with gram-negative rods were randomly treated with either a single (S) dose daily or multiple (M) doses daily of netilmicin. All bacterial strains were susceptible to the antibiotic. No differences were found with respect to efficacy. Therapy for bacteremia failed in two M patients, but bacteria persisted in 17 (10 S, 7 M) at the primary infection site. In 12 there was an anatomic or physiologic factor contributing to this persistence. One S patient showed mild nephrotoxicity, but ototoxicity was not found in any of the 35 patients who underwent serial audiography. Mild reversible rises of transaminases were found in 5 of 35 S patients and in 3 of 34 M patients. Once-daily administration of netilmicin seems to be as effective and as safe as conventional multiple daily doses.

Adult↗
PubMed1989

Chemotaxis inhibition by Gardnerella vaginalis and succinate producing vaginal anaerobes: composition of vaginal discharge associated with G vaginalis.

The influence of six succinate producing vaginal anaerobes and Gardnerella vaginalis on the chemotactic activity of granulocytes was studied by the under agarose method. G vaginalis, Mobiluncus species, and three Gram negative anaerobes elicited hardly any response, but Peptostreptococcus productus showed clear positive chemotaxis, as did the Escherichia coli strain used as a control. Inhibition of the chemotactic response of white blood cells was found with all strains, but the high succinate producers from the genus Bacteroides showed the most pronounced effect. The inhibition of chemotaxis by succinate producing anaerobes in the pathogenesis of non-specific vaginitis (NSV) is postulated, and B ureolyticus or Mobiluncus spp, rather than G vaginalis, are suggested as possible causes of NSV.

Bacteria, Anaerobic↗
PubMed1988

Rational use of antimicrobial agents and diagnostic microbiology facilities.

During a two month period doctors' motives for prescribing antimicrobial chemotherapy were studied. Of the 1775 patients admitted, 374 (21%) received antimicrobial agents for 384 infective episodes. In 44 (11.5%) no infection could be subsequently proven. Of the remaining 340, drug selection was based on a susceptibility report in 120 (35%), on the advice of a medical microbiologist with the aid of a Gram stain in 66 (19%), and without this assistance in 51 (15%). In 103 (30%) episodes the clinician selected the agent without advice and laboratory tests. Infection was proven in 237 of 238 episodes in which therapy was started following a known susceptibility result or the advice of the microbiologist. Four (1.7%) of these later required a change of therapy, compared with 22 (21%) of the 103 courses started without such help (P less than 0.0005). This study has shown that the use of the laboratory and consultation with a medical microbiologist improves the rational prescribing of antimicrobial chemotherapy.

Anti-Bacterial Agents↗