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Biomedical subjects

R Ellis-Pegler

Publications and source records attributed to R Ellis-Pegler.

15 recordsLinked to original sources
PubMed2007

High-risk febrile neutropenia in Auckland 2003-2004: the influence of the microbiology laboratory on patient treatment and the use of pathogen-specific therapy.

BACKGROUND: International guidelines recommend routine microbiological assessment of patients with febrile neutropenia, but do not recommend a change from broad-spectrum antibiotic therapy to pathogen-specific therapy when a clinically relevant organism has been isolated. The aim of the study was to determine the aetiology of febrile neutropenia in adult haematology patients at Auckland City Hospital, to document the changes in treatment made following isolation of a clinically relevant organism and to assess adverse outcomes in any patient who received pathogen-specific therapy after a positive culture result. METHODS: The results of all microbiological tests together with antibiotic therapy were recorded from consecutive patients with fever and a neutrophil count <0.5 x 10(9)/L over 1 year beginning in May 2003. RESULTS: One thousand one hundred and ninety-six specimens were collected from 81 patients during 116 episodes of febrile neutropenia. A pathogen was isolated from blood cultures in 40 episodes: Gram-positive cocci accounted for 46% of isolates and Gram-negative bacilli for 35%. Isolation of a pathogen from blood cultures resulted in a change of treatment in 25 of 40 (62.5%, 95%CI 46-77%) episodes. In 12 of these episodes, antibiotic therapy was optimized to a single pathogen-specific agent. No adverse events or subsequent changes in antibiotic therapy occurred in any of these 12 patients. Isolation of a pathogen from specimens other than blood seldom led to a change in therapy. CONCLUSION: Isolation of a pathogen from blood cultures often allows antibiotic therapy to be simplified to a pathogen-specific regimen. Further study of this approach is warranted.

Anti-Bacterial Agents↗
PubMed2004

Short course intravenous benzylpenicillin treatment of adults with meningococcal disease.

BACKGROUND: Short-course treatment of meningococcal disease (including meningitis) with 4-5 days of an i.v. beta-lactam is of proven efficacy. Since April 1998, all adult patients with meningococcal disease admitted to Auckland Hospital were prospectively treated with 3 days of i.v. benzylpenicillin. AIMS: To assess the clinical features, laboratory findings, disease complications and outcome of patients with meningococcal disease prospectively treated with 3 days of i.v. benzylpenicillin. METHODS: A retrospective chart review of all adult patients with meningococcal disease admitted to Auckland Hospital from April 1998 to December 2002 was conducted. RESULTS: Ninety patients with definite (n = 72) or -probable (n = 16) meningococcal disease were admitted during the study period. Two were excluded on the basis of treatment duration. The remaining 88 patients received a mean +/- standard deviation duration of treatment of 3.1 +/- 0.5 days (excluding those who died while receiving treatment). Six patients (7%) died, four of whom while on treatment. There were no relapses. CONCLUSION: Three days of i.v. benzylpenicillin for the treatment of adults with meningococcal disease is effective.

Adult↗
PubMed2001

The evidence for rickettsial disease arising in New Zealand.

AIM: To describe the first cases of serologically proven riskettsial disease reported in non-travelling New Zealanders. METHODS: We used clinical and laboratory based surveillance, review of clinical records and patient interviews. Information collected included demographics, presenting signs and symptoms, laboratory results, treatment and outcome. A limited seroprevalence study of rural-living friends and relatives was performed. We tested for rickettsial antibodies in the sera of possums trapped on properties close to the area of residence of the first two cases. RESULT: Serological results support the diagnosis of a rickettsial disease in nine patients. Clinical findings at presentation were nonspecific but included fever, rigors and headache. A rash was noted in four (44%). All had abnormal liver enzymes. Eight were hospitalised. No patient died but two were admitted to intensive care. CONCLUSIONS: There is strong clinical and serological evidence that Rickettsia typhi (the causative organism of murine typhus) or a Rickettsia typhi-like organism is present in the greater Auckland region. To prove it, the organism will need to be cultured or rickettsial DNA detected by molecular methods. Rickettsial infection needs to be included in the differential diagnosis of patients presenting with fever, headache and myalgia, particularly in those with rural lifestyles at least in the greater Auckland area.

Adult↗
PubMed1995

Human immunodeficiency virus infection in women in Auckland: an evolving epidemic.

AIMS: To study the epidemiology, presenting features and outcome of HIV infection among women in Auckland. METHODS: Retrospective review of the medical records of all HIV infected women cared for by the adult infectious disease unit or the sexual health clinic at Auckland Hospital up to the end of December, 1993. RESULTS: Thirty women with HIV infection were cared for between September 1986 and December 1993. Heterosexual intercourse, often with a man from a country with endemic heterosexual HIV transmission, was the most common means of acquiring HIV infection. Late diagnosis of infection probably contributed to the brief median survival seen in the nine women who developed AIDS. CONCLUSIONS: Increased education is necessary to inform women about the risks of acquiring HIV infection. This education should encourage safer sexual behaviour and the use of needle exchange programmes to minimise the growth of this epidemic.

Adolescent↗
PubMed1990

Plasma and dialysate levels of pefloxacin and its metabolites in CAPD patients with peritonitis.

Six patients with acute peritonitis undergoing continuous ambulatory peritoneal dialysis for end-stage renal failure received an 800 mg loading dose of pefloxacin mesylate orally followed by 400 mg twice daily orally for 10 or 21 days. Plasma and dialysate levels of both pefloxacin and its metabolites were measured. Plasma levels in excess of the MIC for all infective bacteria were achieved within 90 min and in dialysate within 4 h. No significant accumulation of pefloxacin or its metabolite norfloxacin was noted. However, both serum and dialysate levels of the metabolite pefloxacin N-oxide rose continuously during treatment. Plasma and dialysate levels of all three agents fell rapidly during the five days after treatment had stopped. No major side effects were observed, although two patients developed Achilles tendonitis.

Adult↗
PubMed1990

Oral pefloxacin mesylate in the treatment of continuous ambulatory peritoneal dialysis associated peritonitis: an open non-comparative study.

Twenty-two (15 female and 7 male) patients with continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis were entered into an open non-comparative evaluation of oral pefloxacin mesylate. An initial loading dose of 800 mg was followed by 400 mg twice daily. Five patients were subsequently excluded or withdrawn. The mean age of the patients was 44 +/- 12.6 years. All three Gram-negative infections (Escherichia coli, Acinetobacter calcoaceticus, Serratia liquefaciens) and all three culture negative infections were cured after 21 days treatment. In contrast one of four (25%) Staphylococcus aureus infections was cured, two persisted during treatment and one relapsed, after treatments of between 10 and 25 days. One of seven (14%) Staph. epidermidis infections was cured, three persisted and three relapsed after treatments of between nine and 25 days. Two of the five persistent isolates became resistant: all four relapsed isolates remained sensitive. Twelve of the 22 (55%) patients had 16 side effects, most commonly skin or musculo-skeletal. Three stopped pefloxacin because of them, though one had taken an excessive dose in error. Pefloxacin mesylate is not optimal treatment for Gram-positive coccal peritonitis in patients on CAPD, but its role in Gram-negative disease needs further evaluation.

Administration, Oral↗
PubMed1980

Bone marrow transplantation in a child with acute lymphoblastic leukaemia.

A caucasian female infant with acute lymphoblastic leukaemia in second remission received a bone marrow transplantation. Engraftment was confirmed at 14 days following infusion of bone marrow from a sex-matched, ABO and HLA compatible sibling. 171 days posttransplantation the patient is clinically well and in haematological remission. A mild transient skin rash and hepatocellular disturbance, the only manifestations of graft versus host disease, responded successfully to high dose prednisone.

Bone Marrow Transplantation↗
PubMed1979

Transfer factor and hepatitis B: a double blind study.

A prospective, double blind placebo-controlled trial was carried out on twenty-nine patients with hepatitis B. Thirteen received transfer factor and sixteen placebo. There were no significant differences between the two groups in any clinical or laboratory measurements made, although a rapid early reduction of serum aspartate transaminase levels by transfer factor is possible. Similarly, no significant changes were delineated by the in vitro measurements of lymphocyte function. Transfer factor did not alter the natural course of hepatitis B.

Adult↗