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Biomedical subjects

J A Jacobson

Publications and source records attributed to J A Jacobson.

At least 73 records · Page 4Linked to original sources
PubMed1988

Evaluation of single-dose cefazolin prophylaxis for toxic shock syndrome.

Otolaryngologists have increased their use of parenteral prophylactic antibiotics to prevent toxic shock syndrome following nasal surgery. This rare but potentially serious postoperative complication presumably requires nasal carriage of a toxigenic strain of Staphylococcus aureus by a susceptible patient. We investigated the effect of a single preoperative dose of intravenous cefazolin on nasal carriage of S aureus. Thirty patients were studied; 15 were S aureus carriers initially and 12 (80%) remained culture positive after prophylaxis and at the time surgery was completed. We conclude that this particular regimen is unlikely to have a major effect on the incidence of toxic shock syndrome following nasal surgery.

Cefazolin↗
PubMed1988

Serious Pseudomonas infections associated with endoscopic retrograde cholangiopancreatography.

After observing a single case of Pseudomonas aeruginosa bacteremia following endoscopic retrograde cholangiopancreatography (ERCP), six other P. aeruginosa infections that were temporally related to ERCP were retrospectively found over one year (August 1985 through July 1986) at LDS Hospital. In all seven patients, infection developed within five days after an ERCP. Five patients had bacteremia and two had cholangitis. All five of the Pseudomonas isolates available for testing were serotype 010. Cultures from the ERCP endoscope and several other endoscopes also yielded P. aeruginosa serotype 10, as did environmental cultures from equipment used to clean endoscopes. Among 167 ERCPs performed during the outbreak period, no other patient acquired P. aeruginosa infection. Each of the patients in the outbreak received the first scheduled ERCP of the day. The mean duration between the cleaning of the ERCP endoscope and its subsequent use was significantly longer in cases than in matched controls, a factor that may have permitted contaminating organisms to achieve high inocula in the inadequately cleaned endoscope. Epidemic control measures included improved disinfection of endoscopes, ongoing surveillance, and appropriate antimicrobial prophylaxis. This experience suggests that exogenous infection with Pseudomonas is associated with ERCP, that protracted and insidious outbreaks may occur, and that the occurrence of even a single case of Pseudomonas infection after ERCP should stimulate an epidemiologic investigation.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1988

Safety and efficacy of topical norfloxacin versus tobramycin in the treatment of external ocular infections.

Bacterial conjunctivitis appears to resolve more rapidly when treated with appropriate topical antimicrobial agents. In this multicenter, randomized, double-blind study of efficacy and safety, patients with presumed bacterial external eye infections were assigned to topical therapy with 0.3% norfloxacin or 0.3% tobramycin. A total of 120 patients were enrolled. Of the total, 65 had documented bacterial infections and were evaluable; 59 of these patients had bacterial conjunctivitis. All of the patients with documented infections were cured or improved regardless of the drug treatment regimen or in vitro susceptibility testing results. The most common bacteria isolated were Haemophilus influenzae, Streptococcus pneumoniae, alpha-hemolytic streptococci, Staphylococcus aureus, and Staphylococcus sp. No patients had serious adverse reactions attributed to their therapy. Norfloxacin ophthalmic solution seems to be a safe, effective, and appropriate agent for the treatment of bacterial external eye infections.

Administration, Topical↗
PubMed1987

Trends in infections and antibiotic usage in a community hospital.

The results of a physician-performed prevalence survey of infections and antibiotic use at the Salt Lake City LDS Hospital in 1984 were compared with results of surveys done in 1971 and 1979. The hospital census and length of stay declined in successive surveys, contributing to the changes observed. Community-acquired infections were more prevalent in 1984 than in the previous surveys, whereas hospital-acquired infections were seen with similar frequencies. Among hospital-acquired infections, lower respiratory tract and soft-tissue infections were more prevalent in 1984. Gram-negative bacilli accounted for 34% of hospital-acquired infections in 1984 versus rates of 60% or more found in the 1970s. Although the overall prevalences of antibiotic use were similar in the three surveys, the proportion attributed to cephalosporins increased from 17.5% (1971) to 49.2% (1979) and 59.1% (1984). Antibiotic prophylaxis was less frequent in 1984 (14.4%) than in 1979 (24.1%) and reversed the trend found after 1971 (11.0%). Despite extensive educational efforts since the prevalence survey of 1979, perioperative antibiotics were used for durations longer than 48 hours after surgery in 43% of the patients receiving such prophylaxis in 1984. The LDS Hospital has adopted a restrictive antibiotic formulary in part as a result of the present survey.

Anti-Bacterial Agents↗
PubMed1987

Low incidence of toxic shock syndrome in children with staphylococcal infection.

Children have frequent staphylococcal infections, and many lack antibody to TSST-1, a toxin associated with the toxic shock syndrome (TSS). To determine why there have been no nonmenstrual cases of TSS reported in children in Utah, the authors tested S. aureus isolated from children for TSST-1 by radial immunodiffusion and sera from other hospitalized children by radioimmunoassay for antibody to TSST-1. TSST-1 was produced by 25% of S. aureus. Fifty-two children had infections with toxin producing strains. None had TSS. The prevalence of presumably protective levels of antibody (greater than or equal to 1:100) was high in newborns (80%), declined until age 2 years and then gradually increased with age. Therefore, there may have been about 20 children with toxigenic infection who lacked protective antibody but did not show the usual features of TSS. We conclude that the rarity of TSS in children is not caused by misdiagnosis, underreporting, or the absence of toxigenic strains or susceptible patients. Additional factors, such as local conditions or duration of carriage, may influence the clinical presentation of infection with TSST-1 producing staphylococci.

Antibodies, Bacterial↗
PubMed1986

N-acetyl-L-glutamate synthase of Neurospora crassa. Characteristics, localization, regulation, and genetic control.

N-Acetylglutamate synthase, an early enzyme of the arginine pathway, provides acetylglutamate for ornithine synthesis in the so-called "acetylglutamate cycle." Because acetylglutamate is regenerated as ornithine is formed, the enzyme has only a catalytic or anaplerotic role in the pathway, maintaining "bound" acetyl groups during growth. We have detected this enzyme in crude extracts of Neurospora crassa and have localized it to the mitochondria along with other ornithine biosynthetic enzymes. The enzyme is bound to the mitochondrial membrane. The enzyme has a pH optimum of 9.0 and Km values for glutamate and CoASAc of 6.3 and 1.6 mM, respectively. It is feedback-inhibited by L-arginine (I0.5 = 0.16 mM), and its specific activity is augmented 2-3-fold by arginine starvation of the mycelium. Mutants of the newly recognized arg-14 locus lack activity for the enzyme. Because these mutants are complete auxotrophs, we conclude that N-acetylglutamate synthase is an indispensible enzyme of arginine biosynthesis in N. crassa. This work completes the assignment of enzymes of the arginine pathway of N. crassa to corresponding genetic loci. The membrane localization of the enzyme suggests a novel mechanism by which feedback inhibition might occur across a semipermeable membrane.

Acetyltransferases↗
PubMed1986

Toxic shock syndrome after nasal surgery. Case reports and analysis of risk factors.

Toxic shock syndrome (TSS) occurs most often in menstruating women who use tampons. It also occurs following surgical procedures. The occurrence of three cases after nasal surgery prompted us to determine the incidence of this complication and to evaluate possible risk factors. Our cases showed that onset of TSS after surgery is rapid. Early symptoms include nausea, vomiting, diarrhea, erythroderma, and hypotension. The wound does not appear grossly infected. Incidence of TSS after nasal surgery during 1980 through 1983 was 16.5 per 100,000, higher than the incidence in women of menstrual age. Splints were used more frequently in patients who developed TSS than in patients who did not. Nasal packing was used in all patients with TSS and in 98% of all patients. Topical or systemic antibiotics did not have a demonstrable protective effect.

Adult↗
PubMed1986

Prevalence of antibody to hepatitis B virus surface antigen in emergency medical personnel in Salt Lake City, Utah.

Because of the potential geographic variation in prevalence and exposure to hepatitis B virus and the high cost of hepatitis B immunization, we performed serologic screening on prehospital care personnel in Salt Lake City, Utah. All individuals screened had been in a line (street) position for at least five years. Their average age was 38.5 years. One of the 50 paramedics and none of 110 emergency medical technicians had serum antibody to hepatitis B surface antigen (0.6%; 95% confidence limits, 0.03 to 3.53%). Because the estimated annual incidence based on the observed prevalence is less than 1%, we conclude that exposure to hepatitis B virus is not a major occupational hazard for these employees in our area.

Adult↗
PubMed1985

Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections.

The growing popularity of heated pools, especially whirlpools and hot tubs, has been accompanied by increasingly frequent outbreaks of an illness produced by Pseudomonas aeruginosa. The illness usually includes folliculitis, pruritic skin rash, and/or otitis externa and occasionally mastitis and systemic symptoms. Although usually self-limited, rare severe cases have been described. Motel and hotel whirlpools are most often implicated as the source of outbreaks. The relative importance of pool conditions and the bacteriology of P. aeruginosa in the pathogenesis of this illness remain to be elucidated. Implementing CDC Guidelines for public spas and hot tubs seem the most reasonable way of reducing the risk of large outbreaks. Prevention of cases arising from home hot tubs or whirlpools will be very difficult and may depend on extensive public education or the development of simple, inexpensive and effective disinfection systems.

Dermatitis↗
PubMed1985

Acute respiratory failure caused by primary pulmonary coccidioidomycosis. Two case reports and a review of the literature.

Acute respiratory failure caused by infection with Coccidioides immitis is a rare, usually fatal, event. We report 2 patients who survived acute respiratory failure caused by primary pulmonary coccidioidomycosis. We attribute the severity of illness to a large inoculum of organisms. Their treatment included antifungal therapy with amphotericin B and diuresis to decrease noncardiogenic pulmonary edema. Coccidioidomycosis causing respiratory failure may be more frequent than currently clinically appreciated and may result from primary pulmonary coccidioidomycosis, miliary pulmonary disease, or as part of the multisystem organ failure seen in fungemic patients.

Adult↗
PubMed1985

Toxic shock syndrome in Utah--1976 to 1983.

The sustained high incidence of staphylococcal toxic shock syndrome (TSS) in Utah provided an opportunity to examine changes in the epidemiology of this disease during a period of greater media attention to the syndrome and increased scientific understanding of its etiology and pathogenesis. An apparent peak in the statewide incidence of TSS in 1980 appears in part attributable to self-reporting of outpatient cases. The incidence of the syndrome in patients having a nasal operation appears equal to or greater than the incidence in menstrual-age women. The case-fatality ratio and recurrence rate of TSS have declined since widespread recognition of the syndrome, possibly related to earlier diagnosis and initiation of antistaphylococcal therapy. Identifying milder cases has also contributed to a lower mortality.

Adolescent↗
PubMed1984

Group A meningococcal disease in skid rows: epidemiology and implications for control.

Interviews conducted during outbreaks of group A meningococcal disease in skid row communities suggested that heavy alcohol use was associated with increased risk of disease. Frequent moving within skid row and from one skid row to another was characteristic of a subpopulation with increased risk of disease and may have facilitated spread within and between skid rows. The observations discussed herein have important implications for control of communicable diseases in and near skid rows.

Adult↗