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Biomedical subjects

M Gurwith

Publications and source records attributed to M Gurwith.

41 records · Page 3Linked to original sources

Rapid screening method for enterotoxigenic Escherichia coli.

A rapid screening method for detection of Escherichia coli producing heat-labile enterotoxin is described. Single colonies are transferred directly from primary culture plates into 96-well microculture plates containing 0.3 ml of brain heart infusion broth in each well. After 24 h at 37 degrees C, each brain heart infusion broth culture is assayed by the miniculture method in the corresponding well of a microculture plate in which Y-1 mouse adrenal tumor cells have been grown. All enterotoxigenic isolates detected by this method were confirmed in the assay but with culture supernatants.

Adrenal Gland Neoplasms↗

Encephalitis after administration of live measles vaccine.

In a previously well child with no evidence of pre-existing immunologic defect a fatal encephalitis developed 10 days after administration of measles vaccine. There was pathologic evidence of an early viral encephalitis characterized by perivascular mononulcear infiltrates. Although the virus was not recovered, the diagnosis of a measles virus infection and encephalitis is supported by the postmortem findings of Warthin-Finkeldey cells in lymphoid tissues, an intranuclear inclusion in the brain and histologic changes of encephalitis.

Autopsy↗

Trimethoprim-sulfamethoxazole and trimethoprim alone for prophylaxis of infection in granulocytopenic patients.

Prophylactic trimethoprim-sulfamethoxazole (TMP-SMZ) has been shown to reduce the incidence of fever, parenteral antibiotic usage, and infections with gram-negative bacteria in hospitalized patients with neutropenia. Furthermore, TMP-SMZ was found to be equivalent to or better than oral, nonabsorbable antibiotics in direct comparisons and to have an additive effect when given together with other oral, nonabsorbable antibiotics. Adults given TMP-SMZ continuously had fewer readmissions for infection than did controls given TMP-SMZ only while hospitalized. TMP-SMZ used continuously in children with acute leukemia was effective in preventing bacterial and Pneumocystis carinii infections. For prophylaxis in granulocytopenic patients, TMP appeared equivalent to TMP-SMZ both in efficacy and incidence of side effects. However, TMP was less effective in suppressing gastrointestinal flora, including TMP-resistant gram-negative rods. Thus, TMP-SMZ has some role in preventing infections in high-risk patients, but further studies, especially comparisons with untreated patients may still be required. TMP used alone offers little advantage and has the theoretical disadvantage of not preventing infections caused by P. carinii or TMP-resistant gram-negative bacteria.

Adult↗

Use of amphotericin B colloidal dispersion in children.

PURPOSE: To describe the experience with a new lipid-based amphotericin product (amphotericin B colloidal dispersion or ABCD) in children with fever and neutropenia who are at high risk for fungal infection. PATIENTS AND METHODS: Forty-nine children with febrile neutropenia were treated in a prospective, randomized trial comparing ABCD with amphotericin B. An additional 70 children with presumed or proven fungal infection were treated with 5 different open-label studies of ABCD. Patients were registered into these studies for reasons of: 1) failure to respond to amphotericin B; 2) development of nephrotoxicity or preexisting renal impairment; or 3) willingness to participate in a dose-escalation study. Extensive data detailing response and toxicity were collected from each patient. RESULTS: In the randomized trial, there was significantly less renal toxicity in the children receiving ABCD than in those receiving amphotericin B (12.0% vs. 52.4% [P = 0.003]). Other adverse symptoms were not significantly different. In the additional open-label studies, although 80% of patients receiving ABCD reported some adverse symptom, the majority of these were infusion related, and nephrotoxicity was reported in only 12% of these patients. CONCLUSIONS: ABCD was well-tolerated at doses up to 5 times greater then those usually tolerated with amphotericin B. Renal toxicity was markedly less than expected, and there were no other unexpected severe toxicities. Further randomized studies are needed to further define the role of this and other liposomal products in children.

Adolescent↗