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Biomedical subjects

M Gurwith

Publications and source records attributed to M Gurwith.

At least 37 records · Page 2Linked to original sources
PubMed1981

A prospective study of rotavirus infection in infants and young children.

Diarrhea in neonates, followed as a cohort, and their families was studied prospectively. The families were followed for an average of 16.3 months. Stool and serum specimens were obtained at least every three months. Stool specimens were examined for viruses by electron microscopy and cultured for enteropathogens, and serum specimens were tested for antibodies to rotavirus and Norwalk virus. During the study, 237 episodes of gastroenteritis were observed in 104 infants and their 62 siblings. Rotavirus, detected 82 times in 72 children, was by far the most common enteropathogen. It was associated with gastrointestinal symptoms in 72% (with diarrhea in 65%). Rotavirus diarrhea occurred mostly in winter months and was significantly more frequently associated with respiratory symptoms than were diarrheas with other etiologies. Rotavirus infection was uncommon in the first six months of life, but by two years of age, 62% of the infants had had at least one infection. Neither breast feeding nor the presence of antibody to rotavirus in cord blood appeared to be protective.

Antibodies, Viral↗
PubMed1980

Enterotoxigenic Escherichia coli in central Canada.

During epidemiological studies carried out in urban and rural areas of the midwestern Canadian province of Manitoba, we cultured enterotoxigenic Escherichia coli (ETEC) from 16 (1.7%) of 945 diarrheal stools and 4 (0.3%) of 1,282 normal stools. ETEC was found in not more than 2.3% of diarrheal stools obtained from any population during any season. Diarrhea associated with ETEC persisted for a mean of 9 days. Two children were dehydrated and required intravenous fluid therapy, and one adult suffered a cholera-like syndrome. Half of the children required hospitalization for management of their diarrhea. Two adults and two children who harbored ETEC were completely asymptomatic. The pattern of toxin production correlated with serotype and the serotypes encountered were (with a few exceptions) similar to those found in other areas. We conclude that ETEC is an uncommon cause of diarrhea, both in rural and urban areas of central Canada. However, the possibility that ETEC might cause severe sporadic cases or epidemics of gastroenteritis remains.

Adult↗
PubMed1979

Rotavirus infection in adults. Results of a prospective family study.

To study the epidemiologic and clinical features of rotavirus infections, we enrolled 98 families in a prospective study of diarrhea in households with newborn children. Families were seen at three-month intervals and whenever ill. The mean follow-up period was 16.4 months. Rotavirus infections were documented by electron microscopy of feces, indirect fluorescent-antibody assays in serum or both. The 43 infections identified in adults represented an attack rate of 0.17 per adult per year. Ninety-three per cent of these infections occurred from November through May. Seventeen adults had gastrointestinal symptoms, most often diarrhea (in 14) or abdominal cramps (in 11). Rotavirus infections occurred in 36 of 102 adults whose children had rotavirus infection, as compared with four of 86 without infected children (P less than 0.001). Serum rotavirus antibody did not correlate with a reduced risk of infection or symptomatic disease. Rotavirus is a mild but common infection in parents of young children.

Adult↗
PubMed1978

Prolonged outbreak of nosocomial urinary tract infection with a single strain of Pseudomonas aeruginosa.

Sixty-six hospitalized patients became infected with a single strain of multiply resistant Pseudomonas aeruginosa over a 22-month period. The catheterized urinary tract was the site of the infection in 59 patients (89%). The outbreak was confined to a urology ward until an infected patient from this ward spent 2 weeks in the surgical intensive care unit (SICU). Subsequently patients who acquired the infection in the SICU were discharged to surgical wards throughout the hospital. Urine measuring containers and urometers used in the SICU were the reservoir of the P. aeruginosa; daily sterilization of this equipment terminated the outbreak. Urometers appeared to be the reservoir of the epidemic strain in subsequent outbreaks. Five patients were still infected when they were readmitted 3 to 12 months after the first admission, and therefore represented an additional reservoir of infection.

Cross Infection↗
PubMed1978

Oral vancomycin for antibiotic-associated pseudomembranous colitis.

Nine patients with antibiotic-associated pseudomembranous colitis were treated with oral vancomycin. All had severe diarrhoea, tissue-culture evidence of a clostridial toxin in stool, and typical lesions on sigmoidoscopic examination, despite discontinuation of all antimicrobials for periods of 10 days to 8 weeks. Oral vancomycin was given in doses of 2 g daily. All patients showed a good clinical response with gradual resolution of diarrhoea over 7 days and a rapid decrease in concentrations of the toxin in stools. Follow-up sigmoidoscopies in seven patients showed major improvement or complete clearing of lesions after 7-10 days of vancomycin treatment. The mean concentration of vancomycin in twenty-five stools obtained during treatment was 3100 microgram/g, levels in serum being very low. These results suggest a role for oral vancomycin treatment of antibiotic-associated pseudomembranous colitis which persists for extended periods despite discontinuation of the incriminated antimicrobial.

Administration, Oral↗
PubMed1978

Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia.

A substance producing cytotoxicity in tissue culture was detected in stool specimens from all of four patients with pseudomembranous colitis due to antibiotics and in one of 54 with antibiotic-associated diarrhea. These stools also caused enterocolitis when injected intracecally into hamsters. On each occasion, cytotoxicity in tissue culture and enterocolitis in hamsters were neutralized by pretreatment with gas-gangrene antitoxin. The toxicity in both tissue cultures and hamsters could be reproduced with broth cultures of clostridia strains isolated from four of the five stools. These results suggest that toxin-producing clostridia are responsible for antibiotic-associated pseudomembranous colitis.

Ampicillin↗
PubMed1978

Granulocytopenia in hospitalized patients. II. A prospective comparison of two antibiotic regimens in the empiric therapy of febrile patients.

The results of empiric antibiotic therapy in 126 hospitalized patients with fever during 192 episodes of granulocytopenia were studied. Febrile granulocytopenic patients were randomly allocated to receive either carbenicillin, methicillin and gentamicin, or carbenicillin and cephalothin. The response rate for the two antibiotic regimens was similar, 49 (60 per cent) of 81 responded to the former and 42 (54 per cent) of 78 to the latter. The response rate in patients receiving other antibiotics because of specific indications or counterindications was 19 (58 per cent) of 33. Thirty-nine (35 per cent) of 110 patients who responded to initial antibiotic therapy had an increase in circulating granulocytes of one log10 or more compared to only 10 (12 per cent) of 79 nonresponders with such an increase. The mortality rate in adult patients receiving carbenicillin, methicillin and gentamicin was eight (16 per cent) of 51, compared to 18 (37 per cent) of 49 in those receiving cephalothin and carbenicillin (P less than 0.05). The significance of this difference in the initial response rate or mortality rate between patients treated with the two antibiotic regimens when only patients with documented bacterial infection were considered. Patients who responded to their initial antibiotic regimen, and patients for whose fever no explanation was found, had the best prognosis.

Adolescent↗
PubMed1978

A prospective study of enteropathogenic Escherichia coli in endemic diarrheal disease.

The rate of isolation of Escherichia coli belonging to the traditional serotypes enteropathogenic for infants was studied prospectively in two groups. Group 1 consisted of children with diarrhea and of controls without gastrointestinal disease who were matched for age and inpatient or outpatient status. Group 2 consisted of families entered in a prospective study of rotavirus infections. In group 1 enteropathogenic Escherichia coli were found in 13 (6%) of 220 children younger than 12 months of age and in nine (6%) of 143 children 12--35 months of age, all of whom had diarrhea. Enteropathogenic E. coli were found in only one of an equal number of matched controls (P = 0.002 and 0.004, respectively). In group 2 enteropathogenic E. coli were present in seven (18%) of 38 specimens obtained during diarrheal episodes, as compared with five (1%) of 492 specimens obtained when there was no diarrhea (P less than 0.001). The enteropathogenic E. coli isolated were not enterotoxigenic. The most common serogroup was O111, but many different O:H serotypes were detected. Thus, the association of enteropathogenic E. coli with endemic diarrhea was significant, even though no enteropathogenic mechanism was apparent.

Adolescent↗
PubMed1978

Prospective comparison of cefoxitin and cefazolin in infections caused by aerobic bacteria.

Intravenous cefazolin and cefoxitin were compared in a prospective randomized trial in infections where the suspected pathogen was expected to be susceptible to both antibiotics. In the cefazolin group (12 patients) the diagnosis was pneumonia in 4, including 2 with pneumococcal bacteremia, soft tissue infection in 5, Staphylococcus aureus bacteremia in 1, acute pyelonephritis in 1, and disseminated gonococcal infection in 1. In the cefoxitin group (10 patients) the diagnosis was pneumonia in 4, including 2 with pneumococcal bacteremia, soft tissue infection in 4, acute pyelonephritis in 1, and disseminated gonococcal infection in 1. In the cefazolin group receiving an evaluable course of therapy, a good clinical response was seen in 10 of 11 patients, and a bacteriological response was seen in 5 of 7. Cefazolin failed to eradicate S. aureus bacteremia in 1 patient and S. aureus in a skin ulcer of another patient. All 10 cefoxitin patients had good clinical and bacteriological responses, but in 1 patient S. aureus colonization of a postoperative wound recurred after discontinuation of the drug. Side effects in both groups included skin rash, phlebitis, and elevation of the serum alkaline phosphatase. Both cefoxitin and cefazolin appeared effective in infections caused by susceptible aerobic pathogens with the possible exception of S. aureus, although all 11 strains of S. aureus isolated in this study were susceptible in vitro to both antibiotics. Cefoxitin appeared to be equivalent to cefazolin in efficacy and occurrence of side effects.

Adult↗
PubMed1977

Cholera-like diarrhea in Canada. Report of a case associated with enterotoxigenic Escherichia coli and a toxin-producing Aeromonas hydrophila.

A 67-year-old Indian patient was admitted with an acute cholera-like illness. Toxigenic Escherichia coli producing both heat-stable and heat-labile enterotoxins grew from cultures of feces. In addition, an Aeromonas hydrophila producing a cytotoxic toxin was also isolated from this patient's feces. The unusual severity of this patient's illness may have resulted from coinfection with these two toxigenic organisms, although any role of the toxin produced by a hydrophila is speculative.

Aeromonas↗