[Remarks on the opinions of the DSTDG on the current situation of syphilis therapy in Germany. JDDG 2003; 1:668].
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Germany↗
Biomedical subjects
F B Spencker
Publications and source records attributed to F B Spencker.
Development of resistance in Pseudomonas aeruginosa obtained from patients with cystic fibrosis at different times.
OBJECTIVE: Determination of the extent of changes in quantitative resistance in Pseudomonas aeruginosa isolates from patients with cystic fibrosis over a period of approximately 2 years. METHODS: Three hundred and ninety nine isolates of P. aeruginosa collected from 34 pediatric patients in the period between April 1994 and April 1996 were investigated. During the 2 years the children were treated with a combination of a betalactam and an aminoglycoside, approximately every 3 months. In between they received ciprofloxacin orally, when required. The minimal inhibitory concentrations (MICs) of 38 clones of P. aeruginosa defined by different patterns in macrorestriction analysis (pulse field gel electrophoresis, PFGE) were established for 12 antibiotics: gentamicin, amikacin, tobramycin, ciprofloxacin, levofloxacin, moxifloxacin, trovafloxacin, imipenem, meropenem, ceftazidime, cefepime, and piperacillin by means of broth microdilution tests according to DIN 58940. RESULTS: Twenty-four of the 38 clones developed increased MIC values during the time of observation especially for aminoglycosides and quinolones. Comparatively less affected were ceftazidime, imipenem and meropenem. An association between the number of the intravenous treatment courses and the increase of the MIC values could not be verified. CONCLUSIONS: A trend towards an increase of the MICs against antipseudomonal agents was observed over a limited period of time. It is necessary to prevent this development possibly by employing suitable combinations of antibiotics and the introduction of new substances.
Aminoglycosides↗
Nosocomial neonatal outbreak of Serratia marcescens--analysis of pathogens by pulsed field gel electrophoresis and polymerase chain reaction.
BACKGROUND: We investigated an outbreak of Serratia marcescens in the neonatal intensive care unit (NICU) and the pediatric intensive care unit (ICU) of the University Children's Hospital Leipzig, Germany. PATIENTS AND METHODS: From September to November 1998 15 patients were infected or colonized by S. marcescens. During the outbreak swabs from eye, blood, throat and nose were taken from every patient hospitalized in the ICUs. RESULTS: In 15 cases (14 from the NICU and one from the pediatric ICU) the cultures yielded S. marcescens. All strains were investigated by pulsed field gel electrophoresis (PFGE) as well as by polymerase chain reaction (PCR) fingerprinting. Both molecular typing methods revealed corresponding fingerprint patterns in all of the 15 isolates. Typing results of the outbreak-related isolates demonstrated that two epidemic strains of distinct genotypes were associated with cross-infections of a group of five and a group of ten patients, respectively. The three invasive and seven of the colonizing isolates were related genotypically. CONCLUSION: This survey shows that PCR and PFGE are comparable in respect to the discrimination and reproducibility for epidemiological studies of S. marcescens strains in nosocomial outbreaks. Genotypic fingerprinting of bacterial isolates is useful and important to limit nosocomial infections. Fingerprinting sources of nosocomial infections can be traced both by PFGE and PCR. All patients infected recovered completely and the nosocomial outbreak could be stopped rapidly.
Cross Infection↗
Epidemiologic characterization of Pseudomonas aeruginosa in patients with cystic fibrosis.
OBJECTIVE: To determine persistence and variability of colonization with Pseudomonas aeruginosa in cystic fibrosis patients over long time periods, and to look for possible cross-colonization. METHODS: In total, 469 Pseudomonas aeruginosa isolates were obtained from 30 patients during the period from April 1994 to April 1996. The sources were mainly sputum and a few deep throat swabs. All grown strains dissimilar in macromorphology were processed separately. Typing with PFGE was carried out by contour-clamped homogeneous electric field electrophoresis. Genomic DNA was subjected to the rare-cutting restriction enzyme SpeI. For pyocin typing, the procedure described by Fyfe was applied. RESULTS: After typing with PFGE, we observed 40 restriction profiles. Eighteen different pyocin types were found. The most frequent pyocin type was type 3, followed by types 1 and 5. Twenty-two patients were persistently colonized by one clone specific and different for each patient, and four were co-colonized by a second clone also different for each of these patients. Cross-colonization had apparently been rare in the cystic fibrosis center of Leipzig. CONCLUSIONS: Typing with PFGE is well suited for detailed investigations of colonization with Pseudomonas aeruginosa in cystic fibrosis patients. Pyocin typing can provide additional information for epidemiologic purposes.
Adolescent↗
Facial palsy caused by Borrelia infection in a twin pregnancy in an area of nonendemicity.
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Adult↗
[Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis].
BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.
Borrelia burgdorferi Group↗
[Haemophilus influenzae meningitis in childhood].
From January 1971 until the end of 1989, 94 infants suffering from meningitis caused by Haemophilus influenzae were treated in the Department of Pediatrics of the University of Leipzig. The anamnestic data, signs and symptoms, laboratory findings, the courses and final results of treatment are described. 88 children survived; in eight of them neurological or mental sequelae were found on discharge. Generally, a certain stagnation regarding treatment results is observed over the observation period. Therefore vaccination against Haemophilus influenzae type B should be encouraged.
Anti-Bacterial Agents↗
[Oral ciprofloxacin therapy in juvenile patients with cystic fibrosis--results of a prospective pilot study].
Efficacy and safety of oral ciprofloxacin were studied in a prospective study at three cystic fibrosis centres, covering 24 in-patients suffering from cystic fibrosis and acute bronchopulmonary exacerbation. The patients were between 10 and 17 years of age. Pseudomonas infection was present in 75% of these patients. Despite frequent persistence of the pathogens, clinical improvement was noted in 75% of the treated children. A definite increase of the average MIC was not seen in 20 cases of persisting strains. No serious side effects occurred during the 14-day oral treatment course. Ciprofloxacin is a useful alternative to conventional parenteral treatment with antibiotics in patients suffering from cystic fibrosis and infections of the airways.
Adolescent↗
[Pneumococcal cellulitis].
Streptococcus pneumoniae as a cause of cellulitis is rarely reported in children and adults. We report on an infant with facial cellulitis due to pneumococci and review already described cases since 1975. The main features of this infection, underlying diseases and problems of diagnostics and therapy are discussed.
Ampicillin↗
[Current status and change in infectiology].
Clinical infectiology had passed through a marked transformation in the past, it is changing in the present time and will do so in the future. The most important factors for these changes are: the change of the living standard of the people, the increased number of persons with dispositions for infections, a better knowledge about the microbial etiology of infections and new possibilities of diagnostics and therapy of infectious diseases. The importance of these changes are in Germany inadequately reflected not only in the clinical practice but also in medical teaching and research. The reintegration of the infectiology as an important medical specialty in the Germany's medicine is urgently indicated.
AIDS-Related Opportunistic Infections↗
[Clinical microbiology as a basis of antimicrobial chemotherapy].
Clinical microbiology is a facet of medical microbiology which is dedicated to all aspects of human infectious disease diagnosis, especially in patients treated in hospitals. The specific tasks of such a laboratory can be solved at best, if it is integrated in the hospital and if there is close co-operation with clinical specialists. Different methods for susceptibility testing of isolated bacteria are possible: agar diffusion test, agar dilution test, bouillon dilution test etc., the results of which need to be interpreted considering further aspects. During antimicrobial chemotherapy certain tests are also necessary or useful. The objective of future developments is to avoid the need of cultures and to establish antibiotic profiles within hours to provide the clinician with relevant results.
Anti-Bacterial Agents↗
Effects of two antibiotics on hepatic function in low birth weight infants: ampicillin vs. cefotaxime.
In 21 low birth weight infants with two regimens of antibiotic therapy during the first 3 days of life possible hepatotoxic side effects were studied 8 days after the last administration of the tested drugs. Fourteen of the infants were treated with ampicillin/gentamicin and 7 received cefotaxime/gentamicin. The serum concentrations of total bile acids, the activities of transaminases in serum and the cumulative 15N excretion in urine after administration of 3 mg of 15N-labeled methacetin/kg of body weight were used as markers of hepatotoxic side effects. Neither the concentrations of total bile acids (22.6 +/- 12.1 and 19.4 +/- 10.8 mM, respectively) nor the activities of transaminases (alanine aminotransferase, 0.27 +/- 0.06 vs. 0.30 +/- 0.09 mumol/second/liter; aspartate aminotransferase, 0.46 +/- 0.11 vs. 0.49 +/- 0.10 mumol/second/liter) were different between the two groups. In contrast the cumulative 15N excretion in urine was significantly lower in the group treated with cefotaxime/gentamicin than in the group treated with ampicillin/gentamicin (17.2 +/- 6.4 vs. 33.0 +/- 5.1% of intake; P less than 0.01) and also lower than the reported age-related reference values. On the 28th day of life no differences could be found between the cumulative 15N excretion in the urine of the infants treated with cefotaxime/gentamicin and the reported age-related reference values of this test. The results indicate a limited capacity of the monooxygenase system of the liver of low birth weight infants during the first weeks of life and a specific reversible influence of cefotaxime on this hepatocellular system. Further investigations are required to evaluate the clinical relevance of this drug-specific inhibition of the hepatic monooxygenase pathway.
Acetamides↗
[Diagnosis, therapy and prevention of necrotizing enterocolitis in newborn infants].
The necrotizing enterocolitis is a severe and frequently fulminant disease with a considerable mortality. The main event is the enteral septicemia. Only prompt diagnostics and adequate therapy permit the survival of the newborns. The most important aspects of signs and symptoms, diagnostics and therapy as well as course of disease and prophylaxis are delineated, whereas the problems of pathogenesis are excluded.
Combined Modality Therapy↗
[Bacterial bone and joint infections in childhood--a review. 1. Acute hematogenous osteomyelitis].
This is an overview of modern aspects concerning diagnostics and therapy in children with acute hematogenous osteomyelitis. A close cooperation of pediatricians, pediatric surgeons, microbiologists and radiologists in this field is essential.
Child↗
[Bacterial bone and joint infections in childhood--a review. 3. Bacterial arthritis].
This overview presents the most important topics of etiology, pathogenesis, diagnostics, differential diagnostics and treatment of septic arthritis in children. A child with bacterial arthritis is always a case of emergency. Only immediate and adequate treatment can avoid permanent sequelae. Medical care for these patients should be done always in close cooperation of pediatricians, pediatric surgeons, radiologists, and sometimes orthopedists.
Arthritis, Infectious↗
[Some clinical aspects of therapeutic administration of iron preparations in childhood: iron and infections].
Iron is one of the most important metals for living organisms. There are many different reasons for an iron deficiency, which can lead to an iron deficiency anemia and can be treated by iron-containing drugs. But there are also some reasons leading to an iron overload, which can impair the defense against bacterial infections. An anemia in the course of an infection is usually not a result of iron deficiency but a physiological reaction against the invading microorganisms. A treatment with iron-containing drugs is only indicated in the case of an undoubtedly proven iron deficiency.
Anemia, Hypochromic↗
[Liver abscess caused by Aeromonas hydrophila].
Because of the rare incidence of liver abscess in childhood and of extremely rare observed Aeromonas hydrophila as pathogen of such a disease we report on a 14 7/12 year old girl with a liver abscess. For the last 4 years she had to be enrolled in chronic hemodialysis. The treatment comprised opening of the abscess cavity and drainage, and antibiotic therapy with cefotiam. We were unable to isolate Aeromonas hydrophila in the environment of the hemodialysis center. Some aspects of clinical importance of liver abscess in childhood and of Aeromonas spp. as pathogens in human infections are discussed.
Adolescent↗
[Bacteriologic diagnosis in suspicion of bacterial infection in newborn infants--a review].
The present paper gives a survey about bacteriological examinations, which had proved worthwhile in relation to own experiences and to the literature. Besides methods of preliminary diagnostics cultural examinations of samples from normally sterile body sites are in the center of discussion. The value of body surface cultures, however, especially swabs used for possible prediction of threatening infection is also discussed.
Bacteria↗