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AR Tunkel

Publications and source records attributed to AR Tunkel.

6 recordsLinked to original sources
PubMed2000

Changing Epidemiology of Bacterial Meningitis in the United States.

Bacterial meningitis is an important cause of morbidity and mortality in the United States and throughout the world. Over the past 20 years, there have been significant changes in the epidemiology of bacterial meningitis. The most important change is the decrease in the frequency of Haemophilus influenzae type b as the most common etiologic agent of bacterial meningitis, since the H. influenzae type b conjugate vaccine was introduced. Streptococcccus pneumoniae is now the major cause of bacterial meningitis in the US and bacterial meningitis is now a disease predominantly of adults, rather than of infants and children. Emergence of antimicrobial resistance in S. pneumoniae has also altered the approach to antimicrobial therapy in patients with pneumococcal meningitis, indicating the need to use preventive strategies to reduce the frequency of this serious infection. Recent licensure of the heptavalent pneumococcal conjugate vaccine will likely decrease the overall incidence of pneumococcal meningitis.

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PubMed2000

Impact of Antimicrobial Resistance on the Treatment of Invasive Pneumococcal Infections.

Infectious diseases, such as pneumococcal pneumonia, which were almost invariably lethal in the pre-antibiotic era, caused radically less mortality with the advent of antimicrobial chemotherapy. However, the use, misuse, and abuse of these agents have led to the emergence of antimicrobial resistance. In the past, pneumococci were all exquisitely sensitive to penicillin G. By the late 1960s, penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) was being described. Since then, this problem has achieved epidemic proportions in many areas of the world, including the United States. Many experts no longer consider penicillin an acceptable therapy for patients suspected of having invasive pneumococcal disease, especially if the central nervous system (CNS) is involved. Recommendations for therapy are based on theoretical concerns, in vitro susceptibility testing, animal data, and a few, scattered reports of penicillin failure in patients with invasive disease.

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PubMed1999

Chronic Meningitis.

Chronic meningitis may be caused by a large number of infectious agents, including spirochetes (Treponema pallidum, Borrelia burgdorferi), Mycobacterium tuberculosis, and fungi (primarily Cryptococcus neoformans). The incidence of these specific causes of chronic meningitis has been impacted since the advent of HIV infection, and new information is also available on how this epidemic has affected populations in developing countries of the world. In the area of diagnostics, the development of polymerase chain reaction has been a major advance that has increased our capabilities for identifying etiologic agents (such as M. tuberculosis) that are difficult to culture. Finally, the management of patients with chronic meningitis has evolved, and the availability of new antifungal agents and adjunctive strategies has changed the approach to the patient with cryptococcal meningitis.

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PubMed1999

Adjunctive Therapies for Sepsis and Septic Shock.

The inflammatory cascade that ensues after an infectious insult is protean in its manifestations, resulting in mild self-limited illness in some patients, while progressing to fulminant sepsis and multisystem organ failure in others. Research into the pathophysiology of this cascade has been intense, but advances in the treatment of sepsis have been few and far between. Although mortality rates have been impacted slightly in patients with sepsis--with improved survival in certain patient subgroups--overall survival still reaches only 55% to 60%. In this paper we will review some of the most recent advances in the therapy of the sepsis syndrome, specifically the roles of cytokine modifiers, supranormal delivery of oxygen, granulocyte colony-stimulating factor administration in leukopenic patients, and parenteral nutrition. Hopefully, these modalities represent additional steps in the path towards a meaningful improvement in survival from this catastrophic condition.

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