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Biomedical subjects

R E Levitz

Publications and source records attributed to R E Levitz.

At least 19 recordsLinked to original sources
PubMed1995

Immunization with high-dose intradermal recombinant hepatitis B vaccine in healthcare workers who failed to respond to intramuscular vaccination.

OBJECTIVE: To achieve immunity to hepatitis B in healthcare workers who failed to respond to intramuscular vaccination and boosters. DESIGN: An open prospective study of intradermal vaccination with recombinant hepatitis B vaccine. SETTING: A large community hospital in Connecticut. PARTICIPANTS: Healthcare workers including physicians, nurses, and laboratory workers. RESULTS: Immunization with high-dose intradermal recombinant hepatitis B vaccine, given in up to four doses, achieved immunity in 88% of healthcare workers who had previously been nonimmune. CONCLUSIONS: We conclude that intradermal vaccination is efficacious in the majority of healthcare workers who failed to respond to intramuscular vaccine. Further studies, including randomized comparisons with intramuscular vaccine as well as studies of cell-mediated immunity, appear warranted.

Adult↗
PubMed1992

Seroprevalence of antibodies to hepatitis C virus in high-risk hospital personnel.

OBJECTIVE: To estimate seroprevalence of antibodies to hepatitis C virus in healthcare workers at high risk for blood exposure. DESIGN: A prospective anonymous seroprevalence survey of 243 healthcare workers. SETTING: A large referral hospital and 2 community hospitals in Connecticut. PARTICIPANTS: Healthcare workers, including surgical personnel, dentists, hemodialysis workers, laboratory workers, and emergency room staff. RESULTS: Antibody to hepatitis C virus was found in 1.6% (95% confidence interval [CI95] = 0-3.2%) of healthcare workers. None of the prevalent seropositives had a past history of clinical hepatitis or blood transfusion. CONCLUSIONS: We conclude that the seroprevalence of hepatitis C virus in healthcare workers with a high degree of blood exposure is low and is similar to seroprevalence rates reported for volunteer blood donors. However, first-generation hepatitis C serologic tests may underestimate the true prevalence of infection. Further studies, including prospective cohort studies, will be required to determine if the low seroprevalence is from low risk of acquisition of disease or from loss of measurable humoral antibody response to the virus.

Adult↗
PubMed1992

Intraocular penetration of rifampin in humans.

The penetration of rifampin into human aqueous humor was determined in 15 patients undergoing elective cataract surgery. Between 0.9 and 5.5 h after administration of a single 600-mg oral dose, concentrations ranged from 6.0 to 21.5 mg/liter in serum and from less than 0.2 to 1.3 mg/liter in aqueous humor.

Administration, Oral↗
PubMed1992

Clinical manifestations and antibiotic treatment of Lyme disease.

As the incidence of Lyme disease increases in Connecticut and world-wide, considerable attention has been given to its prompt diagnosis and treatment. Creating further interest in this infection is the awareness that inappropriate therapy may result in significant disabling sequelae many years later. In this review, we focus mainly on current treatment options, but stress that the recommendations may change appreciably, as more information appears on the efficacy of new antibiotics.

Anti-Bacterial Agents↗
PubMed1987

Gastroenteritis, sepsis, and osteomyelitis caused by Plesiomonas shigelloides in an immunocompetent host: case report and review of the literature.

We report the 11th human case of bloodstream infection with Plesiomonas shigelloides. This was the first case without any apparent underlying immunocompromising disease, and the patient was the first adult to survive the infection. We review all the extraintestinal cases associated with this organism, giving special attention to the clinical characteristics of the bloodstream infections reported previously.

Arthritis, Infectious↗
PubMed1987

Invasive Haemophilus influenzae disease in adults.

In a five-year period, 29 cases of bacteremia and/or meningitis in adults caused by Haemophilus influenzae were seen in our large community hospital. There were 17 cases of bacteremic pneumonia and 12 cases of serious extrapulmonary infections. The extrapulmonary infections included cases of endocarditis, meningitis, cholecystitis, epiglottitis, tubo-ovarian abscess, and cellulitis. In contrast with the pediatric experience, H influenzae type B was the causative pathogen in only 45% of patients and only one isolate was ampicillin resistant.

Adult↗
PubMed1986

Therapy of Mycobacterium marinum infections. Use of tetracyclines vs rifampin.

We describe four patients with Mycobacterium marinum infections who did not respond to two- to six-week courses of therapy with tetracycline, minocycline, and doxycycline. All four patients had prompt responses to therapy with either rifampin alone (two patients) or rifampin in combination with ethambutol. Results of antimicrobial sensitivity tests may be helpful in guiding therapy. Rifampin may be the drug of choice for treatment of these infections.

Adult↗
PubMed1984

Pharmacokinetics of trimethoprim and sulfamethoxazole in serum and cerebrospinal fluid of adult patients with normal meninges.

The pharmacokinetics of trimethoprim (TMP) and sulfamethoxazole (SMX) in cerebrospinal fluid (CSF) and serum after a single intravenous infusion of 5 mg of TMP and 25 mg of SMX per kg of body weight over approximately 120 min were studied i nine patients who had uninflamed meninges and were undergoing elective myelography. Peak concentrations of TMP and SMX in CSF were 1 microgram/ml and 13.8 micrograms/ml, respectively. The peak TMP concentration in CSF occurred significantly earlier than the peak SMX concentration (60 versus 480 min postinfusion). At 15 h, there was no detectable TMP in the CSF, and there was 4.7 micrograms of SMX per ml of CSF. In the postdistribution phase (in CSF), simultaneous CSF-to-serum concentration ratios ranged from 0.23 to 0.53 for TMP and from 0.20 to 0.36 for SMX. CSF penetration (measured by comparison of the area under the curve of the composite CSF and serum concentration-time curves) was 18% for TMP and 12% for SMX. A loading dose of TMP-SMX (bases on TMP) of 10 to 12 mg/kg and a maintenance dose of 6 mg/kg every 8 h or 8 mg/kg every 12 h (with a 2-h infusion) should yield steady-state peak concentrations of at least 5 micrograms of TMP per ml of serum and 160 micrograms of SMX per ml of serum. Further studies of TMP-SMX administered in these doses in the treatment of serious bacterial infection, including meningitis, are warranted.

Adult↗
PubMed1984

Trimethoprim-sulfamethoxazole for bacterial meningitis.

Trimethoprim-sulfamethoxazole has excellent microbiologic activity against most pathogens that produce meningitis; both components of this drug have high penetration into tissues, including the cerebrospinal fluid. Clinical experience shows that trimethoprim-sulfamethoxazole may be beneficial in the treatment of gram-negative bacillary meningitis caused by organisms only moderately susceptible to third-generation cephalosporins (Enterobacter cloacae, Serratia marcescens) or resistant to these antibiotic agents (Pseudomonas cepacia, Acinetobacter). The success of trimethoprim-sulfamethoxazole in the treatment of four patients with Staphylococcus aureus and two patients with Listeria monocytogenes meningitis shows that this drug may also be useful in treating infrequent types of gram-positive meningitis.

Adolescent↗
PubMedDate not supplied

Herpes simplex encephalitis: a review.

Patients with herpes simplex encephalitis generally have altered mental function and are rarely able to provide a good medical history. Failure to diagnose this serious disease may result in permanent neurologic damage or death of the patient. Rapid institution of newer diagnostic tests such as polymerase chain reaction for herpes simplex virus is essential for proper diagnosis. Parenteral acyclovir therapy is efficacious but, clearly, improvements in prevention and therapy are still important research goals. This review is meant to inform physicians and nurses concerning the current diagnosis and management of this treatable but potentially fatal illness.

Acyclovir↗