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Biomedical subjects

B A Oppenheim

Publications and source records attributed to B A Oppenheim.

At least 37 records · Page 2Linked to original sources
PubMed1998

PCR-ELISA for the early diagnosis of invasive pulmonary aspergillus infection in neutropenic patients.

AIM: To evaluate a newly developed aspergillus mitochondrial gene PCR-ELISA assay for the early diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients. METHODS: The aspergillus mitochondrial gene was chosen for the amplification target for use with a solution hybridisation assay with colorimetric end stage detection in microtitre plate format (PCR-ELISA). The study group comprised neutropenic patients undergoing febrile episodes not responding to standard antibacterial antibiotics. Patients underwent computed tomography and bronchoscopy. Bronchoalveolar lavage (BAL) fluids were examined by culture and PCR. RESULTS: The aspergillus mitochondrial gene PCR-ELISA was both sensitive (100%) and specific (100%) for IPA in neutropenic patients. All 12 patients with definite or probable IPA had PCR positive BAL fluids. None of the patients with undiagnosed or confirmed infections of other aetiologies were mitochondrial PCR positive. Speciation based upon amplicon size difference was possible. CONCLUSIONS: Aspergillus mitochondrial DNA PCR-ELISA on BAL fluid is useful in the early diagnosis of IPA in neutropenic patients alone or, potentially, as an indication for thoracic computed tomography.

Adolescent↗
PubMed1998

Molecular characterisation of methicillin resistant Staphylococcus aureus.

Finer discrimination between strains of methicillin resistant Staphylococcus aureus (MRSA) than phage typing can provide is needed to identify and characterise spread of infection in outbreaks. This study compares three molecular methods with each other and with phage typing. Pulsed field gel electrophoresis provides the greatest discrimination, but finer discrimination is obtainable by combining methods.

Bacterial Typing Techniques↗
PubMed1997

Endotoxin antibodies in African sleeping sickness.

Antibodies to the core region of endotoxin (endotoxin core antibodies, EndoCAb), which cross-react with endotoxin from a range of Gram-negative bacteria, are maintained in relative homeostasis in health, but undergo marked changes in a number of different diseases associated directly or indirectly with endotoxaemic or septicaemic states. The levels of EndoCAb IgG in the blood and cerebrospinal fluid (CSF) of 35 late-stage sleeping sickness patients and 9 control individuals were measured by ELISA. EndoCAb levels were significantly elevated in the patient blood (mean EndoCAb value 290 MU/ml cf. control 182 MU/ml, P < 0.001), and CSF (mean EndoCAb value 254 MU/ml cf. control 150 MU/ml, P < 0.001). EndoCAb IgG levels correlated with endotoxin levels in patient blood (r = 0.78, P < 0.001), but not in the CSF and were not reduced 6 weeks following chemotherapy, unlike the endotoxin levels. It is concluded that late-stage sleeping sickness is associated with chronic exposure to endotoxins from Gram-negative bacteria.

Antibodies, Bacterial↗
PubMed1997

Antibiotic resistance in Neisseria meningitidis.

Penicillin has long been recognized as the antibiotic of choice for treatment of meningococcal infections, but clinicians have recently become concerned about the susceptibility of meningococci to penicillin and other antibiotics used in the management of meningococcal disease. Strains relatively resistant to penicillin (minimum inhibitory concentrations ranging from 0.1 mg/L to 1.28 mg/L) have been reported from a large number of countries, although the frequency with which such isolates are found varies widely. The mechanism of relative resistance to penicillin involves, at least in part, the production of altered forms of one of the penicillin-binding proteins. Although treatment with penicillin is still effective against these relatively resistant strains, there is evidence that low-dose treatment regimens can fail. beta-Lactamase production in meningococci is extremely rare but has been reported, and this finding is of great concern. Resistance to sulfonamides and rifampin is of particular concern in regard to the management of contacts of patients with meningococcal disease.

Drug Resistance, Microbial↗
PubMed1997

Screening for bacterial vaginosis: a novel application of artificial nose technology.

The AromaScan system was used to analyse vaginal swabs from 68 women attending a genitourinary clinic. Using clinical criteria, subjects were assessed for bacterial vaginosis. After training the AromaScan system to recognise patterns generated from four patients with and four patients without bacterial vaginosis, 16 of the 17 (94%) remaining subjects were correctly identified as having the condition. The positive predictive value of the test was 61.5%. These results indicate that the AromaScan technology may be of value as a screening test for bacterial vaginosis.

Clinical Laboratory Techniques↗
PubMed1997

Monitoring wound healing by odour.

A pilot study using electronic aroma detection was performed over a six-month period to assess the aroma of chronic non-healing venous leg ulcers and the effect of appropriate antibiotic therapy on modification of the aroma. Deep infection with pathogenic organisms was found on biopsy culture in 13 out of 15 patients. Odour analysis was performed at weekly intervals on the ulcer dressings using an AromaScan instrument. Data points on the aroma maps moved from their pre-treatment presentation. Alterations in aroma data correlated well with the progress of the ulcers. Aroma analysis is shown to be a potential tool in monitoring the progress towards healing of chronic venous ulcers.

Aged↗
PubMed1996

Fatal Candida tropicalis fungaemia in a leukaemic patient receiving fluconazole prophylaxis.

A 50-year-old man with newly diagnosed acute myeloid leukaemia developed breakthrough candidaemia while receiving fluconazole as antifungal prophylaxis during remission-inducing chemotherapy. Candida tropicalis was isolated; the strain was resistant to fluconazole on in vitro sensitivity testing, a phenomenon which has not been previously reported in this setting.

Antifungal Agents↗
PubMed1996

Prospective survey of the incidence, risk factors and outcome of hospital-acquired infections in the elderly.

Four hundred and thirty-six patient admissions to either an acute assessment or a rehabilitation ward for the care of the elderly were studied. A total of 113 episodes fitting the definition of a hospital-acquired infection (HAI) occurred in 81 (18.5%) of admissions. The global infection rate was 10.8 per 1000 patient bed days and did not differ between the wards. The chest and urinary tract were the commonest sites of infection, and 26 patients appeared to be infected at more than one site. The majority of first infections occurred within 14 days of admission. Median length of stay for patients with one or more infective episodes was significantly longer than for those who did not develop an HAI. The presence of an HAI, multiple-site infections and chest infections were significantly associated with fatal outcome. HAI occurs commonly in elderly patients and is associated with prolonged hospital stay and increased mortality.

Adult↗
PubMed1996

Epidemiology of an outbreak due to glycopeptide-resistant Enterococcus faecium on a leukaemia unit.

The clinical and molecular epidemiology of two clusters of colonization and infection of patients by glycopeptide-resistant enterococci (GRE) on a leukaemia and bone marrow transplantation unit was studied over a two-and-a half-year period. Thirty-five patients became colonized, of whom six developed clinical infections. Of the 53 isolates of GRE, 49 were Enterococcus faecium, multiply-resistant to vancomycin and ampicillin. DNA fingerprinting of 48 E. faecium isolates by pulsed-field gel electrophoresis identified six DNA types. One strain of VanB phenotype E. faecium predominated during the initial outbreak, and an unrelated strain of the VanA phenotype was present in a second cluster. Environmental and patient isolates of E. faecium were indistinguishable by DNA typing. The VanA phenotype enterococci probably arose by transfer from the renal ward at a nearby hospital, and a patient with persistent diarrhoea may have contributed to contamination and cross-infection. GRE may cause significant infections in immunocompromised patients, and are readily transmitted between them. GRE were controlled, but not eradicated on the unit; infection control measures included improved environmental cleaning and modification of antibiotic use. In order to control GRE, it is necessary to educate healthcare workers and implement the traditional, effective values of good personal hygiene and environmental cleanliness.

Adult↗
PubMed1996

Kitchens as a source of Aspergillus niger infection.

In this study we investigated the epidemiology of a cluster of cutaneous infections owing to Aspergillus niger, which occurred in neutropenic patients in a bone marrow transplant unit. Heavy environmental contamination with the mould was found in the ward kitchen adjacent to the unit. The clinical and environmental isolates were typed by random amplification of polymorphic DNA (RAPD), which showed one of the patients was infected with the same strain as that isolated repeatedly from the kitchen area. In another case, contaminated stockinette material was implicated as the source of infection. Thorough cleaning of the ward kitchen resulted in no further cases on the unit. This highlights the fact that aspergilli may spread to patients by air, food or other vehicles, and underlines the importance of searching for a source and ensuring high levels of hospital hygiene are maintained.

Adult↗
PubMed1996

Endotoxins in the blood and cerebrospinal fluid of patients with African sleeping sickness.

Endotoxin levels were measured in the blood and cerebrospinal fluid (CSF) of control individuals and 2 groups of patients with African sleeping sickness. Endotoxin levels were markedly elevated in the blood (infected groups mean endotoxin values 40.2 pg/ml and 53.8 pg/ml, compared to control 11.6 pg/ml, P < 0.0001 for both increases) and CSF (infected groups mean endotoxin values 45.8 pg/ml and 50.1 pg/ml compared to control 6.3 pg/ml, P < 0.0001 for both increases) of the patients. The levels were reduced 6 weeks following different drug treatments in the 2 groups (blood levels to mean 33.8 pg/ml and 28.5 pg/ml; CSF levels to 37.4 pg/ml and 27.0 pg/ml). The blood endotoxin values correlated with the CSF values before treatment (r = 0.74 and 0.57 for the 2 groups; P < 0.0001 for both) and after treatment (r = 0.57 and 0.56 for the 2 groups; P < 0.0001 for both). It is concluded that raised endotoxin equilibrates in the blood and CSF compartments, and may contribute significantly to the pathology of sleeping sickness.

Adolescent↗
PubMed1996

Sleeping position and upper airways bacterial flora: relevance to cot death.

The hypothesis that the prone sleeping position is associated with accumulation of upper airways secretions and increased bacterial growth was investigated in adults. Ten subjects with upper respiratory tract infection lay prone for one hour and then supine for one hour. Nasal swabs after the prone period yielded higher bacterial counts than swabs obtained after the supine period. This result could be relevant to sudden infant death syndrome (SIDS), as infants who sleep in the prone position are at increased risk of SIDS and one theory is that death is caused by toxins produced by bacterial overgrowth in the upper respiratory tract following a viral infection.

Adult↗
PubMed1995

The safety and efficacy of amphotericin B colloidal dispersion in the treatment of invasive mycoses.

Amphotericin B colloidal dispersion (ABCD), a novel formulation of amphotericin B and cholesteryl sulfate in a 1:1 ratio, was developed to reduce the toxicity of amphotericin B yet retain its antifungal efficacy. In an open-label trial, ABCD at dosages as high as 6 mg/(kg.d) was administered to 168 patients with documented or presumed systemic mycoses. All patients had responded incompletely to at least 7 days' treatment with conventional amphotericin B (CAB), had experienced CAB-induced nephrotoxic effects, had preexisting renal impairment, or had experienced other CAB-related, treatment-limiting toxic effects. The clinical response to ABCD could be evaluated in 97 patients. Complete clinical response or improvement was noted in 48 (49%) of them after a mean treatment duration of 18.5 days. All 168 enrolled patients were evaluated with regard to safety of the treatment. Even at daily doses as high as 6 mg/kg, and mean and median cumulative doses of 4.0 g and 2.4 g, respectively, ABCD had little renal toxicity: the mean change in serum level of creatinine from baseline to final value was -0.02 mg/dL. Hypokalemia developed in eight patients (5%). This study provides preliminary evidence that ABCD is effective in treating invasive mycoses and lacks the dose-limiting nephrotoxicity of CAB.

Adult↗