Biomedical subjects
J W Bass
Publications and source records attributed to J W Bass.
Penicillin tolerance and erythromycin resistance of group A beta-hemolytic streptococci in Hawaii and the Philippines.
Penicillin remains the drug of choice for the treatment of streptococcal pharyngitis, with erythromycin as an alternative drug for individuals who cannot take penicillin. Two areas of concern in the management of streptococcal pharyngitis are (1) the prevalence of penicillin-tolerant group A beta-hemolytic streptococci reported in recent studies and (2) the high prevalence of erythromycin resistance in some geographic areas. We tested 305 isolates of group A beta-hemolytic streptococci from Hawaii and the Philippines for penicillin minimum inhibitory concentrations and minimum bactericidal concentrations and erythromycin minimum inhibitory concentrations. There was no evidence of penicillin resistance or tolerance. The prevalence of erythromycin-resistant and moderately susceptible isolates was 3.6% and 2.3%, respectively. There was a trend toward greater erythromycin resistance levels among Hawaiian isolates, but this was not statistically significant.
Impetigo. Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies.
We attempted to determine the causative bacterial pathogens of impetigo in children in our area, to compare the effectiveness of three frequently used oral antimicrobial treatment regimens, and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment. Seventy-three children with impetigo were randomly assigned to receive penicillin V potassium or cephalexin monohydrate, both administered in dosages of 40 to 50 mg/kg per day, or erythromycin estolate administered in a dosage of 30 to 40 mg/kg per day. All drugs were given in three divided doses for 10 days. Treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies. Forty-five (62%) cultures showed Staphylococcus aureus only, 14 (19%) showed S aureus and group A beta-hemolytic streptococci, six (8%) showed group A beta-hemolytic streptococci only, and eight (11%) showed no growth or other organisms. Treatment failure occurred in six (24%) of 25 patients treated with penicillin V, one (4%) of 25 patients treated with erythromycin estolate, and no patients treated with cephalexin. We conclude that S aureus is the most common cause of impetigo in children in our study population, that cephalexin is the most effective treatment, that erythromycin estolate is nearly equally effective and may be preferred on a cost-effectiveness basis, and that penicillin V is inadequate for treatment of this infection.
Cefuroxime versus ceftriaxone for bacterial meningitis.
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The use of hyaluronidase in the treatment of intravenous extravasation injuries.
Intravenous extravasation injuries are a major cause of morbidity in the pediatric population. A variety of commonly used drugs and intravenous fluids have been shown to cause injury, particularly when infants are infused subcutaneously. Optimal management of intravenous extravasations remains controversial. The enzyme hyaluronidase degrades hyaluronic acid, a constituent of the normal interstitial barrier; by degrading interstitial bonds, it can increase the distribution and absorption of locally injected substances. To test the hypothesis that hyaluronidase might prevent skin injury associated with extravasations, a reliable skin injury model in immature pigs was created using subcutaneous CaCl2 injections. Hyaluronidase, in a concentration of 150 U/mL injected subcutaneously in a circumferential fashion immediately following the injection of CaCl2, significantly reduced the area of necrosis (P less than .01). As a control for the diluent volume administered with the hyaluronidase injection, the effect of a circumferential injection of 1.0 mL normal saline was compared with a similar injection of 1.0 mL normal saline with 150 units of hyaluronidase. Again, the area of skin necrosis following injection with hyaluronidase was statistically smaller (P less than .01). We have created a reliable skin injury model using immature porcine skin, which resembles human skin. Our data using this model suggest that the use of hyaluronidase may decrease the morbidity associated with intravenous extravasation injuries.
Do newborn infants have passive immunity to pertussis?
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Nontyphoidal Salmonella enteric infections and bacteremia.
Antimicrobial treatment of nontyphoidal Salmonella gastroenteritis is usually advocated for infants younger than 3 months of age based on published data showing that infants in this age group are more prone to have bacteremia and develop extraintestinal focal infections. A review of nontyphoidal Salmonella isolates from our institution from January, 1981, through March, 1988, was undertaken to assess the role of age and specific serovar on the incidence of bacteremia. Two hundred twenty isolates were identified: one cerebrospinal fluid, 14 blood and 205 stool. The mean age of patients with bacteremia was 182 months, not significantly different from the mean age of 142 months for patients with stool isolates. Salmonella weltevreden was the most frequent isolate accounting for 23% of all isolates and all isolates of this organism were from stool cultures. Patients with S. weltevreden infections had mean and median ages of 50 and 2.5 months and were younger than patients with stool isolates from other serovars who had mean and median ages of 174 and 38 months. Infants younger than 3 or 6 months of age with positive stool cultures in whom blood cultures were obtained did not demonstrate a higher incidence of bacteremia than did older patients. We conclude that the incidence of bacteremia in patients with nontyphoidal Salmonella gastroenteritis is highly related to the invasiveness of the infecting specific Salmonella serovar.
Tropical splenomegaly syndrome associated with cytomegalovirus infection.
The tropical splenomegaly syndrome (TSS) is characterized by massive splenomegaly with hypersplenism, moderate hepatomegaly, and lymphocytic infiltration of the hepatic sinusoids. In previous reports this syndrome has been shown to be a consequence of a disordered immunologic response of the host to malarial infection. Treatment with antimalarial drugs has resulted in a decrease in malarial antibody titers and a reduction in splenic size. We report a child who had TSS associated with cytomegalovirus infection rather than malaria. Our results suggest that TSS may be precipitated by a variety of infections producing chronic antigenic stimulation and perhaps by autoantigenic stimulation as well.
Survival after isolated cerebral mucormycosis.
Cerebral mucormycosis is a rare disorder caused by several genera of the family Mucoraceae. The genera Rhizopus, Absidia, and Mucor are the predominant pathogenic groups. Disease caused by these organisms usually complicates an underlying chronic illness, such as diabetes mellitus or malignancy. Cerebral involvement usually occurs from an ascending infection from the paranasal sinuses via the orbit and is usually associated with poorly controlled diabetes. The pulmonary system is the most common site of infection in patients with leukemia. Isolated cerebral mucormycosis not associated with head trauma or intravenous drug abuse is a rare disorder. We report what we believe to be the first successfully treated case of isolated cerebral mucormycosis in a patient with acute lymphocytic leukemia in remission.
Tinea nigra palmaris and plantaris: a black fungus producing black spots on the palms and soles.
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Prenatal screening for hepatitis B infection in the military population in Hawaii.
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Streptococcal pharyngitis. Comparison of latex agglutination and throat culture.
Despite its imperfections, the throat culture remains the "gold standard" against which all rapid streptococcal antigen detection tests are compared. Using triple throat swabs, the accuracy of a rapid latex agglutination (LA) test and back up throat culture was determined and compared with a simultaneously obtained additional throat culture in children with suspected streptococcal pharyngitis. Although there was a 95 percent concordancy between throat cultures, the sensitivity of the throat culture was only 87 percent. Despite the LA test's lower sensitivity (78 percent), in this clinical population with a relatively low prevalence of positive throat cultures (19 percent), the predictive value of a negative LA test was only slightly lower than that of the throat culture (94-95 percent vs. 97 percent). Backup throat cultures are commonly recommended for patients with initially negative LA test results, but 10 percent of the patients with group A beta-hemolytic streptococci-positive throat cultures would have been undetected using this approach.
Is there a carrier state in pertussis?
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Treatment of streptococcal pharyngitis revisited.
Penicillin has remained the drug of choice for treatment of patients with streptococcal pharyngitis for the past four decades. From the early 1950s into the 1970s, a single injection of intramuscular penicillin G benzathine, alone or in combination with penicillin G procaine, was the preferred treatment. Because this regimen consistently produced the highest cure rate and because compliance was assured, it evolved as the gold standard with which other treatment regimens were compared. In the late 1960s and the 1970s, studies showed that in private practice settings with counseling as to the need to take oral penicillin for a full ten days to prevent rheumatic fever, good compliance with results equal to intramuscular penicillin G benzathine could be achieved. By the early 1980s, oral treatment was preferred by most primary physicians in the United States. Oral penicillin V in a dosage of 250 mg, twice daily for ten days, affords optimal treatment for children. In areas where rheumatic fever is still prevalent, particularly in poor and crowded inner-city populations where medical care is episodic, follow-up may be lacking, and compliance in taking oral penicillin cannot be relied on, treatment with intramuscular penicillin G benzathine remains preferred. Studies now confirm that early treatment of streptococcal pharyngitis can reduce the duration of symptoms to less than 24 hours in most cases, decrease the incidence of suppurative complications, limit spread of the disease in the family and community, and permit earlier return of the child to school. Recently developed tests that permit rapid, laboratory-confirmed diagnosis of streptococcal pharyngitis directly on the throat swab at the initial clinic visit may soon guide early treatment with these inherent benefits.
Rapid enzyme fluorescence test for diagnosis of streptococcal pharyngitis.
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Low CSF glucose and high protein levels in neonatal herpes simplex meningoencephalitis.
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