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Biomedical subjects

I Boldur

Publications and source records attributed to I Boldur.

At least 37 records · Page 2Linked to original sources
PubMed1997

Bacteriology of cholelithiasis in infants and children.

Today, laparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the standard treatment of symptomatic cholelithiasis in children. We reviewed the bile cultures and postoperative course of 30 children who underwent laparoscopic cholecystectomy with the aim of establishing a routine policy for perioperative antibiotic treatment and for the management of biliary leak during that procedure. A positive bile culture was found in only one child (Salmonella Group D). All patients, including six children with intraoperative bile spillage, had a completely normal and uneventful postoperative course. We concluded that the use of preoperative antibiotic treatment should be limited in laparoscopic cholecystectomy in children and is probably not required at all, awaiting proof from a further study. The present study further showed that intraoperative bile spillage is of no clinical significance and can be treated simply with local saline irrigation during the laparoscopic procedure.

Abdomen↗
PubMed1996

How does infected bile affect the postoperative course of patients undergoing laparoscopic cholecystectomy?

OBJECTIVES: To assess the rate of infected bile in patients undergoing laparoscopic cholecystectomy (LC) and to study the influence on the postoperative infective complications in this group of patients. METHODS: Bile samples of 247 patients undergoing LC were collected and cultured for aerobic and anaerobic bacteria. All patients were given prophylactic antibiotics. RESULTS: The overall rate of infected bile was 12.8% (56 positive cultures); of these, 54 were aerobic and 2 anaerobic bacteria. Only 2 patients developed infection at the umbilical site, and in both, the bile was sterile. None of the patients with positive bile cultures developed any signs of infection during a mean follow-up period of 26 months. CONCLUSION: The overall rate of septic complications following LC is extremely low, and at least in our study no correlation was found between infected bile and septic complications.

Adolescent↗
PubMed1996

Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients.

BACKGROUND: The purpose of this study was to assess the causes of community-acquired pneumonia in adult patients admitted to hospital. METHODS: A prospective study was performed on 346 consecutive adult patients (54% men) of mean (SD) 49.3 (19.5) years (range 17-94) admitted to a university affiliated regional hospital in southern Israel with community-acquired pneumonia over a period of one year. Convalescent serum samples were obtained from 308 patients (89%). The aetiological diagnosis for community-acquired pneumonia was based on positive blood cultures and/or significant changes in antibody titres to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, respiratory viruses, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella sp. RESULTS: The aetiology of community-acquired pneumonia was identified in 279 patients (80.6%). The distribution of causal agents was as follows: S pneumoniae, 148 patients (42.8%); M pneumoniae, 101 (29.2%); C pneumoniae, 62 (17.9%); Legionella sp, 56 (16.2%); respiratory viruses, 35 (10.1%); C burnetii, 20 (5.8%); H influenzae 19 (5.5%); and other causes, 21 patients (6.0%). In patients above the age of 55 years C pneumoniae was the second most frequent aetiological agent (25.5%). In 133 patients (38.4%) more than one causal agent was found. CONCLUSIONS: The causal agents for community-acquired pneumonia in Israel are different from those described in other parts of the world. In many of the patients more than one causal agent was found. In all these patients treatment should include a macrolide antibiotic, at least in the first stage of their illness.

Adolescent↗
PubMed1996

Legionella species community-acquired pneumonia. A review of 56 hospitalized adult patients.

BACKGROUND: In a prospective study, Legionella species (Lsp) was identified as the causative agent in 56 (16.2%) of 346 adult patients hospitalized over the course of 1 year with community-acquired pneumonia (CAP), in the Soroka Medical Center, Beer-Sheva, Israel. OBJECTIVE: To characterize patients with Lsp CAP in our study. METHODS: The diagnosis of infection with Lsp was based on serologic testing of antibodies using the indirect immunofluorescent method. RESULTS: In 35 (62.5%) of the patients, at least one other etiologic agent for CAP was identified in addition to Lsp. The patient population was relatively young, with relatively low rates of chronic comorbidity, and a broad spectrum of disease severity compared with previously published studies. No single epidemiologic, clinical, laboratory, or radiographic characteristic differentiated between Lsp CAP and other CAP patients in our study. Three patients (5.4%) who were not treated with erythromycin died. However, in contrast, nine patients who were treated with beta-lactam antibiotics recovered completely. CONCLUSIONS: Lsp is a common cause of CAP in our region, usually as a coinfection with another causative agent. Lsp CAP, which cannot be characterized on the basis of clinical, routine laboratory, or radiographic data, requires specific microbiologic or serologic diagnosis. Treatment with erythromycin appears to be important to reduce mortality from this disease, but in a significant number of patients, the disease may be self-limited.

Adolescent↗
PubMed1996

The dynamics of inflammation of the anterior eye in a novel experimental model for hypersensitivity.

A novel immunologically provoked inflammatory process was studied in guinea pigs. The animals were immunized by i.p. injections of ovalbumin (OA) suspended in Freund's complete adjuvant and challenged by the application of OA into the conjunctival sac of one eye. An inflammatory reaction was seen a few minutes after provocation and lasted normally for 4-7 days. The process was characterized by early damage to the epithelial layer which was partly detached in small flakes; an intense tearing with the tear fluid soon turning mucous and then purulent; vasodilation in the bulbar conjunctiva, in particular towards the limbal region; margination and emigration of polymorphonuclear, and to a lesser extent, eosinophil, leucocytes which migrated towards and infiltrated the surface epithelial layer. Subsequently, the dominant cell type infiltrating the submucosa was lymphocytes. Later, opacity of the cornea occurred, probably due to oedema and neovascularization of the stroma progressing centrally from the periphery. When the antigenic challenge was repeated, thickening of the conjunctival mucosa, and neoformation of collagen bundles in the submucosa led to the swelling of the upper lids. The facets of this inflammatory trauma may not fit easily into any of the classical types of hypersensitivity. Rather, it may combine features of several of them, at least type 1 and type 4. This syndrome shows several features similar to those of human vernal keratoconjunctivitis.

Animals↗
PubMed1995

Q-fever pneumonia in the Negev region of Israel: a review of 20 patients hospitalised over a period of one year.

BACKGROUND: Three-hundred and forty-six patients with community acquired pneumonia were included in a prospective study of patients hospitalised over a 12-month period in the Soroka Medical Center in Beer-Sheva, Israel. Q-fever pneumonia (QFP) was diagnosed in 20 patients (5.8%). A detailed epidemiological and clinical description of this disease, is presented. METHODS: QFP was diagnosed by conventional criteria using a commercial immunofluorescent assay. RESULTS: The age of patients was 41 +/- 14 years (mean +/- S.D., range 20-69). Twelve of the patients were males. No concomitant or chronic disease was present in 16 patients. Chest radiograms revealed alveolar or air space pneumonia in 10 patients, bronchopneumonia in nine and interstitial pneumonia in one patient. The mean febrile period was 10.5 +/- 5.3 days. There was serological evidence of co-infection with Mycoplasma pneumonia in six patients, and with Legionella pneumophila in one patient. Patients treated with beta-lactam antibiotics recovered as quickly as those treated with tetracyclines or erythromycin. CONCLUSIONS: The Negev region of Israel is an endemic area for Q-fever. The diagnosis of QFP can be made only on the basis of a specific serological test. Clinical, radiologic or laboratory findings are not diagnostically definitive. The importance of specific therapy is unclear.

Adult↗
PubMed1995

[Serodiagnosis of atypical bacterial respiratory infections].

Since prevalence of antibodies to bacteria causing atypical respiratory infections in Israel is as yet unknown, a 5-year antibody prevalence study was performed. Seroreactivity to Chlamydia pneumoniae (TWAR), with titers > or = 1:16 by microimmunofluorescence assay (MIF) was detected in 725/1305 (55.5%) of patients. 47/1012 ((4.6%) of adult patients had MIF results indicating recent infection with TWAR, (IgG titers of > or = 1:512, and/or IgM titers of > or = 1:16, and/or seroconversion). Antibody prevalence and titers were low in children aged 1-10 years, increased in teenagers, and peaked in adults and the elderly, in whom prevalence was up to 79% and mean geometric titer up to 1:163. Unlike the consistency in TWAR antibody prevalence and serological evidence of recent infection during the study period, a significant decrease in those variables was observed for Chlamydia trachomatis during the first 3 study years. Antibodies to M. pneumoniae were detected in 53 and to Legionella sp. in 47 out of 763 patients. There was serological evidence of recent infection with M. pneumoniae in 10 (including 7 children) and with Legionellae in 8. Improved diagnosis of atypical respiratory infection might be achieved by the combined use of these proposed serological procedures.

Adolescent↗
PubMed1994

Prevalence of Chlamydia pneumoniae antibodies in patients with acute respiratory infections in Israel.

AIMS: To evaluate the prevalence of antibodies to Chlamydia pneumoniae (TWAR) in relation to other aetiological agents of acute respiratory infections in Israeli patients. METHOD: Serum samples from 604 patients (183 children and 421 adults) were collected over three years. Antibodies to C pneumoniae, C trachomatis, and Legionella sp were evaluated using the microimmunofluorescence (MIF) assay. Antibodies to Mycoplasma pneumoniae were detected using the Serodia Myco II test. RESULTS: Antibodies to TWAR were detected in 319 (51.3%) sera. Twenty one patients had MIF results indicative of recent infection. TWAR prevalence and antibody titres in children (aged 1-10 years) were low, gradually increased in teenagers (11-18 years), and were highest in adults and elderly patients. In contrast to the consistently noted TWAR antibody prevalence and serological evidence of recent infection during the study period, a significant decrease in those variables was recorded for C trachomatis. Six patients had serological evidence of recent infection with both C pneumoniae and C trachomatis. The presence of antibodies to Mycoplasma pneumoniae and Legionella sp was tested in 473 of the patients; 29 had antibodies to M pneumoniae and 23 to Legionella sp. Six patients (including five children) had serological evidence of recent infection with M pneumoniae and four with Legionella sp. CONCLUSION: C pneumoniae should be considered in patients with acute respiratory diseases. MIF is the preferred method for monitoring the presence of antibodies to this organism.

Acute Disease↗
PubMed1992

A 15-year study of the role of Aeromonas spp. in gastroenteritis in hospitalised children.

During a 15-year period, 146 strains of Aeromonas spp. were isolated from 32810 faecal specimens from 13,820 hospitalised patients up to 13 years of age. These isolates constituted 4% of all the pathogenic bacterial strains cultured. For the years 1978-1988, the files of children with gastro-enteritis revealed 81 whose faeces yielded Aeromonas spp. Most of them (94%) were < 3 years of age, 78% < 1 year old. The peak incidence was at 2-6 months, involving severe morbidity including dehydration and vomiting with acidaemia and azotaemia; the mean duration of illness and length of hospitalisation at this age were longer than at other ages. Bloody diarrhoea was found in 7% of the children. Almost all the strains of Aeromonas were resistant to ampicillin. We conclude that Aeromonas spp. are of aetiological significance in gastro-enteritis in small children; culture for this pathogen should be routine in the bacteriological examination of faeces.

Aeromonas↗
PubMed1992

Helicobacter pylori Before and After Gastric Reduction for Morbid Obesity.

Nine patients with morbid obesity were evaluated for the presence of Helicobacter pylon (Hp) before gastric reduction, and all were negative. Fifteen patients, Including those nine, were evaluated for the presence of Hp in antral and 'channel' region biopsies by culture and urease test after gastric reduction. Hp-negative patients totaled 73.3% by both tests, although chronic superficial gastritis type 'B' was found In eight out of 13 (61.5%), and six out of seven (85.7%) gastritis patients were positive for Holicobacter-like organisms in the hematoxylin- and eosin-stained biopsies. Our data suggest that in stomachs of morbid obesity patients before as well as after gastric reduction procedures, the incidence of Hp is very low, and the reasons for this observation are yet unknown.

Journal Article↗
PubMed1991

Western blot analysis of immune response to Legionella bozemanii antigens.

The immune response to individual major antigens of Legionella bozemanii was studied in 67 sera from 26 inpatients with febrile disease using immunoblotting techniques. All the patients had fever of unknown origin and showed strong serological reactions to L bozemanii that cross-reacted with Rickettsia typhi, as determined by a standard indirect microimmunofluorescence assay. Sera analysed by western blotting reacted with 12-14 molecular components of L bozemanii with apparent molecular weights ranging from 14,000 to 94,000 daltons. These reactions compared well with a reference system using antisera of rabbits immunised with the same strain of Legionella. The three major cross-reactive components of R typhi were polypeptide antigens of 94,000, 67,000 and 43,000 daltons. It is concluded that western blotting can help in the differential diagnosis of patients with fever of unknown origin whose sera cross-react to L bozemanii and R typhi.

Adult↗
PubMed1989

Microbiologic flora contaminating open fractures: its significance in the choice of primary antibiotic agents and the likelihood of deep wound infection.

A clear understanding of the significance of wound contamination as well as knowledge of the microbial flora that could be expected are needed in order to administer a rational and effective antibiotic treatment for open fractures. We have conducted a prospective study of the contaminating microbial flora in 89 open fractures. In addition, two more cultures were taken of all wounds not primarily closed. Wound and fracture healing were followed in all patients. Most fractures were Gustilo grade II (58.4%) caused by work-related accidents. Wound cultures were positive in 83% of all fractures, and a total of 84 strains of bacteria were isolated. In 39.3% of cultures, various species of aerobic Gram-negative rods (most commonly Pseudomaonas aeruginosa) were retrieved, followed by Staphylococcus epidermidis (34.5%) and Staphylococcus aureus (26.1%). Repeat cultures were mostly either negative (59.5%) or grew saprophytic organisms that were usually nonpathogenic (such as various species of saprophytic Bacillus bacteria). The only cases that developed deep wound infection were those where a repeat culture 1 day after debridement grew the same organisms as the initial organisms. We conclude that (a) most open fractures are already contaminated upon the patient's arrival at the emergency department, in many cases by potentially pathogenic staphylococci and Gram-negative organisms; (b) contaminating organisms are community acquired and, as such, are sensitive to most routine antibiotics; and (c) persistence of the same organisms in a repeat culture taken 1 day after debridement signifies technical failure of debridement and a subsequent very high risk of infection. Therefore, achieving adequate wound asepsis immediately following debridement is of the utmost importance.

Adult↗
PubMed1987

Isolation of Legionella pneumophila from calves and the prevalence of antibodies in cattle, sheep, horses, antelopes, buffaloes and rabbits.

The lungs of 139 calves presented for autopsy and 29 healthy slaughtered calves were examined for Legionella by culture and by direct immunofluorescence (DIF) with fluorescein-conjugated antisera. About 17% of the cadaver lungs and 4% of lungs from slaughtered animals were positive by DIF. Legionella organisms were only isolated from the lungs of two cadavers (L. pneumophila, serogroup 1). In a prevalence study of antibodies to Legionella in domestic and wild animals of various species, titers of greater than or equal to 64 were demonstrated by indirect immunofluorescence in sera of 10% of dairy cattle, 5% of beef cattle, 4% of sheep, 22% of antelopes, 35% of horses, 36% of buffaloes and 0% of laboratory rabbits. The isolation of Legionella from lung tissue is evidence for a possible etiologic role of Legionella spp. in natural pathology of animals.

Animals↗
PubMed1986

Serological cross-reactions between Rickettsia typhi, Proteus vulgaris OX19, and Legionella bozemanii in a series of febrile patients.

The sera of 19 patients with a febrile disease of undetermined etiology were positive in the indirect immunofluorescence assay (IFA) to Legionella bozemanii serogroup 1 (Lb) and Rickettsia typhi (Rt). To both antigens, high titers of IgG-class and IgM-class antibodies were demonstrated. Several of the patients also had positive IFA and Weil-Felix reactions to Proteus vulgaris OX19 (PX 19). A sharp reduction of the serotiters to all three antigens was achieved by absorption of the sera with any one of the organisms. We demonstrated, by crossed immunoelectrophoresis with an Lb extract and a rabbit reference anti-Lb serum, that a heat-stable and trypsin-resistant antigen (antigen no. 1) reacted consistently with patients' sera that had been incorporated into an intermediate gel. Sera from five patients with high-titer IFA reactions to Rt, but no reaction to Lb, showed no interaction with antigen no. 1.

Antigens, Bacterial↗
PubMed1986

Exposure to Legionella in geriatric institutions.

A study of seroreactivity to six Legionella species (L. pneumophila, L. longbeachae, L. micdadei, L. gormanii, L. dumoffii and L. bozemanii) performed in two geriatric hospitals, a day club for the aged and a group of aged with independent life styles revealed a high prevalence of seropositivity in the hospitals. A titer of 1:256 to at least one antigen was obtained in 30.5% of the patients and 35.7% of the staff members from one hospital, 12.1% of the patients and 17.2% of the staff members from a second hospital, 9.1% of the day club attendants, and in none of the 26 old people living in their own households. A second study of the possible source of Legionella spp. in three geriatric hospitals was performed. Three strains of L. pneumophila [serogroup (SG) 1, 3 and 6] were isolated from water, one water sample was positive for L. pneumophila SG 1-4 (pool), by direct immunofluorescence staining only. In a survey of seroconversion to Legionella antigens, 105 new patients were investigated on their arrival day and over a 2-year period; 24% of the patients who could be followed up significantly seroconverted to at least one of the Legionella antigens. Although the findings proved that Legionella existed on the premises of two hospitals, and the high prevalence of seropositivity to Legionella spp. indicated intramural exposure to the agents of legionellosis at one hospital, we found no evidence linking these agents to patient illness.

Aged↗
PubMed1986

Legionellosis in animals in Israel.

The lungs of 139 deceased and 29 slaughtered calves were examined for Legionella by culture and by direct immunofluorescence (DIF) with fluorescein-conjugated antisera. About 17% of the cadaver lungs and 4% of lungs from slaughtered animals were positive by DIF, but only two L. pneumophila serogroup 1 strains were isolated from the lungs of two cadavers. In a prevalence study of antibodies to Legionella in domestic and wild animals of various species, titers of 1:64 were demonstrated by the indirect immunofluorescence technique in the sera of 10% of the dairy cattle, 5% of the beef cattle, 4% of the sheep, 22% of the antelopes, 35% of the horses, 36% of the water buffaloes and none of the laboratory rabbits. The isolation of Legionella from lung tissue is the strongest indication so far reported of the possible role of Legionella spp. in animal disease.

Animals↗
PubMed1986

Predisposition of the asthmatic child to legionellosis?

The prevalence of seropositivity to Legionella spp. was studied in 184 children with bronchial asthma and in 80 control children, age- and sex-matched, without respiratory tract infections. The sera were examined by indirect immunofluorescence with antigens of six Legionella spp. The asthmatic children showed a significantly higher percentage of seroreactions to L. pneumophila than did the control children. In the asthmatic children, no association was found between age, sex, onset of asthmatic symptoms, living conditions, corticosteroid treatment, or exposure to aerosols and seropositivity to Legionella. No correlation could be found between the asthma severity score and the titer of serum antibodies to L. pneumophila. None of the 32 sera with titers of 256 or higher were reactive for Legionella-specific IgE antibodies. L. pneumophila antigen was detected in the urine of three children by an enzyme-linked immunosorbent assay (ELISA). The high prevalence of antibodies to L. pneumophila found in children with bronchial asthma, together with the detection of antigen in the urine of some of them, suggest that this group of children are highly susceptible to Legionnaires' Disease.

Adolescent↗