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Biomedical subjects

P J Geiseler

Publications and source records attributed to P J Geiseler.

10 recordsLinked to original sources
PubMed1987

Tuberculosis in physicians. Compliance with preventive measures.

Compliance with public health recommendations for tuberculosis control was evaluated by a survey of 4,417 physicians who had not contracted tuberculosis during medical school nor during the 4 decades after graduation through 1981. Thirty-one percent of the cohort had been vaccinated with bacille Calmette-Guérin (BCG) and 47% considered themselves tuberculin-positive. Thirty-two percent of 1,088 physicians who graduated after 1974 had been exposed to 3 or more patients with infectious tuberculosis in the previous year. Fifty-eight percent of 738 unimmunized, tuberculin-negative physicians who had been exposed to one or more patients with infectious tuberculosis in the previous year had tuberculin tests every 1 to 2 yr. Forty-nine percent of 597 unimmunized tuberculin reactors with similar occupational exposure had chest roentgenograms every 1 to 2 yr. The BCG-vaccinated physicians were less likely to have frequent tuberculin tests but no different frequency of chest roentgenograms. Eight percent of 1,460 unimmunized tuberculin reactors received isoniazid chemoprophylaxis, including 39% of 128 tuberculin reactors who graduated after 1974 (the majority of the latter were younger than 35 yr of age). Of 66 physicians who had active tuberculosis during medical school or after graduation, 20 (30%) had not received any antituberculosis chemotherapy, whereas 2 of 46 who did, received chemotherapy only after a second episode of tuberculosis. In summary, our study documents poor compliance by physicians with recommended policies for the prevention of tuberculosis in health care workers.

Antitubercular Agents↗
PubMed1986

Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study.

We conducted a randomized, double-blind, placebo-controlled trial to test the efficacy of the 14-valent pneumococcal capsular polysaccharide vaccine in 2295 high-risk patients (patients with one or more of the following: age above 55 years and the presence of chronic cardiac, pulmonary, renal, or hepatic disease, alcoholism, or diabetes mellitus). Seventy-one episodes of proved or probable pneumococcal pneumonia or bronchitis occurred among 63 of the patients (27 placebo recipients and 36 vaccine recipients). Vaccine-serotype Streptococcus pneumoniae strains were recovered in association with 11 infections in the placebo group and 14 infections in the vaccine group. Pneumococcal infections occurred most frequently among patients with chronic pulmonary, cardiac, or renal diseases. Among vaccine recipients who subsequently had vaccine-type pneumonia or bronchitis, the majority did not make or sustain serum antibodies against their infecting organism in concentrations that were twice as high as the base-line values, or more than 400 ng of antibody nitrogen per milliliter, although their base-line levels were higher than those in subjects in whom infection did not develop. We were unable to demonstrate any efficacy of the pneumococcal vaccine in preventing pneumonia or bronchitis in this population. Our data suggest that chronically ill patients, who are most susceptible to infection, may have an impaired immune response to the pneumococcal vaccine.

Antibodies, Bacterial↗
PubMed1986

Antibiotic-resistant isolates of Streptococcus pneumoniae from clinical specimens: a cluster of serotype 19A organisms in Brooklyn, New York.

Ten of 294 isolates of Streptococcus pneumoniae from patients enrolled in a Veterans Administration Cooperative Studies Program trial of pneumococcal vaccine efficacy were moderately resistant or resistant to penicillin. Nine of these organisms were serotype 19A isolated from patients at the Brooklyn (New York) V.A. Medical Center over an 18-month period (March 1983-November 1984). The minimal inhibitory concentration of penicillin for these pneumococci ranged from 1.0 to 2.0 micrograms/ml by the agar dilution technique and from 4.0 to 8.0 micrograms/ml by tube dilution. These organisms were resistant also to other beta-lactam antibiotics and to tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole. They were sensitive to erythromycin, clindamycin, vancomycin, and rifampin. The epidemiological source of these isolates was not discovered. However, it is possible that a focus of multiple antibiotic-resistant serotype 19A S. pneumoniae is present in Brooklyn.

Drug Resistance, Microbial↗
PubMed1986

Tuberculosis in physicians: a continuing problem.

We evaluated the occurrence of active tuberculosis in 4,575 physicians who graduated between 1938 and 1981 from the same medical school. There were 66 cases. Fifteen (23%) cases were detected after 1970 including 4 diagnosed in 1981. For most years, the incidence of tuberculosis was higher in physicians than in the general population. Forty-eight (73%) patients were between 25 and 34 yr of age at the time of diagnosis. Two thirds of all cases occurred within 6 yr of graduation, even in graduates since 1970. The risk of tuberculosis was 140 per 100,000 persons-years within 6 yr of graduation. Sixty-three percent of initially tuberculin-negative medical students who subsequently had active tuberculosis converted their tuberculin reaction during medical school or clinical training. Recipients of BCG vaccine had 40% less tuberculosis than unimmunized, initially tuberculin-negative, physicians. Health authorities should be cognizant of the continuing risk of tuberculosis in medical students and physicians.

Adult↗
PubMed1985

Dosage of antituberculous drugs in obese patients.

There are no published data defining efficacious drug therapy for obese patients with active tuberculosis. Current dosage recommendations are based on total body weight (TBW); drug toxicity might result in obese patients receiving TBW doses. Peak and trough serum levels were measured for rifampin, streptomycin, ethambutol, and pyrazinamide in an obese patient (166 kg TBW, 87 kg ideal body weight (IBW] with miliary and meningeal tuberculosis. The observed drug levels and the calculated serum half-lives of these drugs were compared with the expected serum levels and serum half-lives in lean patients treated with literature-recommended doses. The observed serum levels in our obese patients were within the expected range for lean patients when dosage was based on IBW rather than on TBW. The observed cerebrospinal fluid penetrations of the drugs studied in our obese patient were similar to those reported in lean patients.

Adult↗
PubMed1979

Failure of trimethoprim/sulfamethoxazole in invasive Nocardia asteroides infection.

A case of pulmonary nocardiosis occurred with progressive involvement of the pleura, pericardium, mediastinum, and sternum. Surgical resection and drainage procedures followed by administration of the drug combination, trimethoprim/sulfamethoxazole, over a six-month period led to clinical recovery. Discontinuation of drug therapy, however, was followed by relapse and further invasion by the same organism. A literature survey of Nocardia asteroides infections treated with trimethoprim/sulfamethoxazole disclosed that posttreatment follow-up is often too brief or unknown, making the ultimate success of therapy uncertain.

Administration, Oral↗
PubMedDate not supplied

Results of therapy in systemic nocardiosis.

The effect of therapy on the clinical course of pleuropulmonary and systemic Nocardia asteroides disease in 78 reported cases was analyzed. All patients were treated with drugs. In 72 cases sulfonamides alone or in combination with other antibiotics was given; 45 patients underwent surgical procedures. The extent of disease had a bearing on survival as only 3 of 39 patients (7.6%) with isolated pleuropulmonary involvement died. These fatalities occurred among the 16 patients of this group who received immunosuppressive drugs. One of 12 patients (8.3%) with suppurative foci other than brain abscess and pleuropulmonary nocardiosis died, whereas the fatality rate of cases with nocardial brain abscess was 47.8%. Thirty-one patients relapsed or had progression of disease while receiving drugs for nocardiosis, 30 of them within the first three months. Prolonged post-treatment observation is essential in the management of nocardiosis as four patients relapsed after drug therapy was discountinued, three of them between six and eight months. Although there was no significant difference in the survival of patients treated with only drugs when compared to those who also had surgery, no fatalities occurred among those medically treated for six months or longer (p = .0091).

Anti-Bacterial Agents↗