Microbiology testing and the pediatrician's office.
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Certification↗
Biomedical subjects
K B Waites
Publications and source records attributed to K B Waites.
Development of a reverse transcription-polymerase chain reaction assay for diagnosis of lymphocytic choriomeningitis virus infection and its use in a prospective surveillance study.
Lymphocytic choriomeningitis virus (LCMV), which is one of several arenaviruses that are pathogenic for humans, causes encephalitis and meningitis in man. In this study, single-stage and nested reverse transcription-polymerase chain reaction (RT-PCR) assays were developed that targeted the GPC and N genes of LCMV. Both assays detected < 1 TCID50 unit of LCMV. These assays were used to measure the incidence of LCMV infection by testing cerebrospinal fluid (CSF) samples with > or = 10 leukocytes/microl collected over 1 year from patients undergoing lumbar puncture for diagnostic reasons at two Birmingham hospitals. Samples were tested for the presence of LCMV RNA by using the RT- PCR assay and for LCMV-specific IgM antibody by using an ELISA assay. None of the specimens collected from 813 patients was positive by either assay. Although no cases of acute infection were detected, 4% (11/272) of serum collected from a subset of patients was positive for LCMV-specific IgG. A significantly greater rate of seropositivity was found among subjects over 60 years of age (9.4%; P < 0.025) than was found in younger subjects (2.4% at 30-59 years of age; 0% at < 30 years of age). These data suggest that serious central nervous system disease due to LCMV infection is not common in this population. The high rate of seropositivity in those over 60 years of age suggest that infection was once more common.
Adult↗
When to use fluconazole.
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Amphotericin B↗
Isolation of Ureaplasma urealyticum from low birth weight infants.
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Bacteriological Techniques↗
Compliance with annual urologic evaluations and preservation of renal function in persons with spinal cord injury.
We located 59 persons with spinal cord injury (SCI) who had not been examined for 3-15 years and paid them to undergo evaluation and comparison with 101 controls examined on an annual basis. Renal function during the first year post-injury and at follow-up was measured by radioisotopic scanning to determine effective renal plasma flow (ERPF) and information was obtained regarding occurrence of specific secondary complications. Subjects and controls were alike with respect to demographic characteristics, injury-related variables and occurrence of specific secondary complications. Mean initial and follow-up ERPF values adjusted for increasing age were not significantly different for subjects and controls, nor was there significant change within individuals over time. Although serial examination of the urinary tract following SCI is important, after the first few years it may be acceptable to lengthen the periods between examinations or substitute less expensive, noninvasive diagnostic techniques. SCI care centers should carefully evaluate recommendations regarding follow-up urologic examinations in persons with SCI in order to provide the most cost-effective program while maintaining optimum patient care.
Adolescent↗
Pulmonary infection due to Legionella cincinnatiensis in renal transplant recipients: two cases and implications for laboratory diagnosis.
We report two cases of pneumonia caused by Legionella cincinnatiensis, a species previously identified as a pathogen in only one other instance. Both infections occurred in renal transplant recipients who were receiving only moderate doses of immunosuppressive drugs several years after transplantation; both patients had no recent episodes of rejection. Their clinical courses varied from mild symptoms to multisystem organ failure and death. Species identification by direct fluorescent antibody testing was misleading; initial results revealed infection due to Legionella longbeachae for one patient and infection due to Legionella dumoffii for the other patient. Slide agglutination testing eventually identified both isolates as L. cincinnatiensis. Infection with Legionella species, including L. cincinnatiensis, should be considered not only in the first months after transplantation but also later in the posttransplantation period as either a nosocomial or community-acquired infection.
Adult↗
Serum concentrations of erythromycin after intravenous infusion in preterm neonates treated for Ureaplasma urealyticum infection.
Erythromycin is receiving renewed attention as an alternative for treatment of neonatal infections caused by Ureaplasma urealyticum because of recently proved abilities of this organism to produce systemic disease in this population. Although erythromycin has been used clinically for almost 40 years, very little is known about its activity in the preterm neonate. Fourteen neonates, birth weights < or = 1500 g and < or = 15 days of age, from whom U. urealyticum was isolated from the lower respiratory tract were randomized to receive erythromycin lactobionate either 25 or 40 mg/kg/day in four divided doses at 6-hour intervals scheduled for a total of 10 days. Blood samples collected at multiple time points after initial and steady state doses were assayed for erythromycin by liquid chromatography. Minimal inhibitory concentrations (MICs) of erythromycin for the U. urealyticum isolates were determined. MICs ranged from 0.031 to 2 micrograms/ml; MIC90 = 2 micrograms/ml. Serum erythromycin concentrations met or exceeded most MICs, with peak values of 3.05 to 3.69 and 1.92 to 2.9 micrograms/ml for the 40- and 25-mg/kg/day dosage groups, respectively. Pharmacokinetic parameters were calculated after the initial dose and at steady state for both dosage groups and compared. No adverse effects thought to be related to administration of erythromycin were observed. These preliminary findings showed that erythromycin is well-tolerated, has favorable pharmacokinetic activity in the preterm neonate and should be further investigated for treatment of ureaplasmal infections.
Bacteriological Techniques↗
Erythromycin lactobionate toxicity in preterm neonates.
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Erythromycin↗
Phagocytosis of urinary pathogens in persons with spinal cord injury.
Urinary tract infections (UTI) are a major source of morbidity in persons with spinal cord injury (SCI), often prolonging hospitalization, interfering with rehabilitation, and leading to secondary urologic complications. Greater understanding of host and bacterial factors that may predispose to invasive UTI and identification of persons at greatest risk for renal deterioration could facilitate development of measures to improve the quality of life for these individuals. A prospective investigation of host phagocyte-bacterial interactions was undertaken as a means to assess whether persons with SCI who develop renal deterioration may be deficient in this important means by which invasive bacteria are eliminated from tissues. Neutrophil phagocytic and serum opsonic activities against uropathogenic Escherichia coli and Enterococcus fecalis were studied in 17 persons with SCI who had diminished renal function and 25 persons with SCI who had normal renal function. Phagocytic and opsonic activities of neurologically intact persons were also comparatively studied as an additional control group. No differences in efficiency of opsonization or phagocytosis were detected when persons with SCI and impaired renal function were compared with persons with SCI who had normal renal function or neurologically intact controls. Whether biochemical characteristics of urine or other undefined local aspects of the urinary tract influence host-bacterial relationships and urologic outcome following SCI are topics worthy of future investigation.
Adult↗
Spinal osteomyelitis due to Mycobacterium avium-intracellulare in an elderly man with steroid-induced osteoporosis.
Disseminated mycobacterial infections are becoming widely appreciated among immunosuppressed and debilitated persons. Specific microbiologic diagnosis may take several weeks, requiring empiric therapy in the interim. A case of an elderly man undergoing steroid treatment who developed spinal osteomyelitis initially thought to be caused by Mycobacterium tuberculosis is described. He was eventually shown to have infection due to M. avium-intracellulare, which requires a different therapeutic approach. The importance of considering atypical mycobacteria in systemic infections and the value of aggressive antimicrobial therapy in conjunction with a comprehensive rehabilitation program during hospitalization are emphasized in order to provide optimal management and prevent further disability.
Aged↗
Epidemiology and risk factors for urinary tract infection following spinal cord injury.
A prospective study was performed to quantitate frequency and evaluate risk factors for urinary tract infection (UTI) in 64 catheter-free spinal cord injury (SCI) patients who were visited monthly in their homes for up to 1 year by a public health nurse who performed a physical examination and collected urine for culture and urinalysis. Patients also mailed in urine dip slides weekly. UTI was defined as > or = 100,000 CFU/mL. Of 406 UTIs evaluated, 111 (27%) were asymptomatic, whereas 295 (73%) evidenced some sign or symptom possibly referable to the urinary tract. Fever and chills occurred in 43 (11%) episodes. Incidence of UTI overall was 18.4 episodes per person-year at risk whereas the rate for those associated with fever and chills was 1.82 episodes per person-year at risk. Prevalence of UTI was 57.4%. Pyuria was significantly associated with the occurrence of fever and chills (p < 0.0001), with gram-negative bacterial species being relatively more pyogenic than gram-positive species. Demographic and behavioral factors shown to correlate with risk for UTI by rate ratios and 95% confidence intervals were: black ethnicity, poor personal hygiene, and less-than-daily condom catheter changes. Racial difference was observed independently of the other two variables. Bladder drainage method, age, years since injury, income, education, sex, neurologic level, and administration of prophylactic antibiotics were not correlated with increased risk of UTI. This study provides new data regarding characteristics and frequency of UTI following SCI as well as risk factors that influence its development.
Alabama↗
Eradication of urinary tract infection following spinal cord injury.
A prospective study to evaluate the microbiological efficacy of antimicrobial treatment for urinary tract infection (UTI) was performed in 64 catheter-free spinal cord injured (SCI) patients who were visited monthly by a public health nurse who collected urine for culture and urinalysis. Patients also mailed urine dip slides for weekly bacterial counts. UTI was defined as a culture yielding > or = 100,000 colonies/ml. Treatment was given to asymptomatic patients only if pyuria (> or = 10 urinary leukocytes/high powered microscopic field) was present. Initial treatment was for 7-14 days (group 1). When it became apparent during the study that eradication was difficult and relapse or reinfection frequently occurred within a short time after cessation of antibiotic, a second treatment course of > or = 28 days (group 2) was given. By the end of the study, in which all patients were followed for a minimum of 30 days post treatment, 39/42 (93%) cases in group 1 and 11/13 (85%) in group 2 who had initial eradication, had relapsed or become reinfected. The median number of days and standard error for group 1 to relapse or become reinfected was 16 +/- 2.5, and for group 2 it was 27 +/- 6. Development of drug resistance was documented when bacteria isolated prior to any treatment were compared with strains isolated after > or = 28 days of antibiotics. In this study, urine sterility was achieved in a minority of treated UTIs and was relatively short lived.(ABSTRACT TRUNCATED AT 250 WORDS)
Anti-Bacterial Agents↗
Radiographic changes associated with tracheal isolation of Ureaplasma urealyticum from neonates.
Recent studies show an association between the presence of Ureaplasma urealyticum in tracheal aspirates and bronchopulmonary dysplasia. We hypothesized that among infants with birth weights < or = 1,250 g and respiratory disease, those with U. urealyticum in their tracheal aspirates would have radiographic evidence of more-severe pulmonary disease more often than would those without this organism. A total of 292 low-birth-weight infants who had endotracheal aspirate cultured within 7 days of birth were enrolled. The radiographic outcome variables were pneumonia, early severe bronchopulmonary dysplasia (precocious), and chronic lung disease. Microorganisms were isolated from 128 infants (44%); U. urealyticum was isolated from 44 (15%). Pneumonia was significantly more common in infants with than without U. urealyticum (30% vs. 16%, P = .03). U. urealyticum also was associated with precocious bronchopulmonary dysplasia independent of prematurity, race, and sex (odds ratio, 2.2; P < .05). Tracheal isolation of U. urealyticum within 7 days of birth is associated with pneumonia and precocious bronchopulmonary dysplasia.
Bronchopulmonary Dysplasia↗
Systemic neonatal infection due to Ureaplasma urealyticum.
During the past decade considerable evidence, first based on individual case reports and later on prospective studies, has indicated that Ureaplasma urealyticum may be an important neonatal pathogen. Infections of the bloodstream, respiratory tract, and central nervous system have been documented. Isolation of U. urealyticum from the lower genital tract in a large percentage of healthy women and the likelihood that many may transmit infection to their offspring, either in utero or at delivery, have made it difficult to determine the pathogenic potential of this organism in perinatal infections. Early studies showed that newborn infants colonized superficially by U. urealyticum suffered no adverse effects. However, more recent studies involving primarily preterm neonates have clearly demonstrated the ability of U. urealyticum to produce invasive disease. Future investigation should be directed towards a more in-depth characterization of the basic biology of U. urealyticum, identification of the risk factors predictive of invasive disease among those colonized, and the development of rapid tests to detect its presence and to determine the overall significance and prevalence of this organism in specific neonatal infections.
Bacteremia↗
Therapeutic considerations for Ureaplasma urealyticum infections in neonates.
Appreciation of Ureaplasma urealyticum as a human pathogen and documentation of antibiotic resistance have heightened interest in susceptibility testing and treatment alternatives. Treatment of neonates poses special problems because of potential drug toxicity, clinical unfamiliarity with the various conditions that may be due to or associated with ureaplasmal infection, and frequent isolation of the organism from mucosal surfaces in the absence of overt illness. Case reports have undeniably demonstrated the ability of U. urealyticum to cause neonatal bacteremia, pneumonia, and meningitis, although the frequency with which such clinically significant infections occur among the greater population of colonized neonates is unknown. The association of U. urealyticum with development of chronic lung disease of prematurity further intensifies the need for knowledge concerning effective antimicrobial treatment. Despite controversy stemming from nonstandardized susceptibility testing, erythromycin is the drug of choice for treating neonatal ureaplasmal infections not involving the central nervous system. The use of erythromycin is supported by its activity in vitro, limited data from clinical experience, and preliminary pharmacokinetic and safety studies.
Bronchopulmonary Dysplasia↗
A quantitative study of genital skin flora in male spinal cord-injured outpatients.
Skin flora from the perineum, penis and urethra of 15 adult male outpatients with spinal cord injury (SCI) and neurogenic bladder dysfunction were compared with that of 10 neurologically normal controls. Gram-positive cocci and diphtheroids were the predominant isolates from controls with no enteric organisms recovered except Escherichia coli in four instances. Among SCI patients, in addition to normal Gram-positive flora, one species of Gram-negative rod was isolated from three patients, two species from five patients, three species from three patients, four species from three patients and five species from one individual. Skin isolates included various members of Enterobacteriaceae, Pseudomonas, Acinetobacter and Enterococcus. Average bacterial counts in perineal, penile and urethral cultures from SCI patients were each 1 log greater than in controls. Bacteria were isolated from 12 of 14 urine cultures obtained from SCI patients immediately after collection of skin cultures. Organisms isolated from urine were present in one or more skin sites in every instance. Differences in skin flora between SCI patients and neurologically normal persons may be the result of variables such as antibiotic usage, presence of a condom catheter, skin moisture, urine leakage, pH, skin temperature, personal hygiene and/or neurogenic bowel management.
Adult↗
Ureaplasma urealyticum intrauterine infection: role in prematurity and disease in newborns.
Ureaplasma urealyticum, a common commensal of the urogenital tract of sexually mature humans, is gaining recognition as an important opportunistic pathogen during pregnancy. While its etiologic significance in many aspects of adverse pregnancy remains controversial, recent evidence indicates that U. urealyticum in the absence of other organisms is a cause of chorioamnionitis. Furthermore, ureaplasmal infection of the chorioamnion is significantly associated with premature spontaneous labor and delivery. In at least some cases, it appears to be causal. Present evidence indicates that U. urealyticum is a cause of septicemia, meningitis, and pneumonia in newborn infants, particularly those born prematurely. There is strong but not definitive evidence that ureaplasmal infection of the lower respiratory tract can lead to development of chronic lung disease in very low-birth-weight infants. Although risk factors for colonization of the lower genitourinary tract have been identified, little information is available concerning risk factors for intrauterine infection and host immune responses to invasive infection. Recent establishment of animal models of respiratory and central nervous system diseases should provide an opportunity to evaluate risk factors, pathogenic mechanisms, and operative immune mechanisms. However, the most critical need is additional information concerning indications for diagnosis and treatment as well as efficacy of treatment.
Bacteremia↗