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Biomedical subjects

R G Penn

Publications and source records attributed to R G Penn.

At least 19 recordsLinked to original sources
PubMed1999

Molecular characterization of a multiply resistant Klebsiella pneumoniae encoding ESBLs and a plasmid-mediated AmpC.

Organisms encoding multiple antibiotic resistance genes are becoming increasingly prevalent. In this report we describe a multiply resistant Klebsiella pneumoniae which possesses at least five different beta-lactamase genes. Isoelectric focusing, polymerase chain reaction and restriction fragment length polymorphism analysis identified TEM-1, multiple SHVs, OXA-9 and a plasmid-mediated ampC, beta-lactamase. Furthermore, Southern analysis and conjugation experiments established that most of the resistance genes were encoded on one large transferable plasmid. This report demonstrates the complexity of multiply resistant organisms.

Adult↗
PubMed1989

Cerebrospinal fluid shunt infections by unencapsulated Haemophilus influenzae.

Three cases of cerebrospinal fluid (CSF) shunt infection by unencapsulated Haemophilus influenzae are presented. In all, 22 cases of H. influenzae CSF shunt infections have previously been reported. In contrast to these cases, the current three patients showed acute involvement of the peritoneal end of the shunt with unencapsulated H. influenzae. Medical therapy without shunt removal is successful in eliminating H. influenzae type b shunt infection associated with meningitis. However, significant involvement of the peritoneal portion of the catheter by unencapsulated H. influenzae is an indication for removal of the distal portion of the catheter along with appropriate antibiotic therapy.

Anti-Bacterial Agents↗
PubMed1986

Articular sporotrichosis.

Sporotrichosis is a fungal disease caused by Sporothrix schenckii, which is seen worldwide. Infection usually involves cutaneous and subcutaneous tissues. Articular involvement is rare. A 29-year-old man with ankle sporotrichosis is reported to demonstrate the differential diagnosis and treatment.

Adult↗
PubMed1984

Endocarditis caused by Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans is a gram-negative coccobacillus which is a very rare cause of bacterial endocarditis. Preexisting cardiac lesions are a main contributing factor, and antibiotic prophylaxis has long been felt necessary before dental or other manipulation to prevent endocarditis. Penicillin in combination with an aminoglycoside has been the most often used treatment regimen. We present a case of endocarditis caused by this organism which developed after antibiotic prophylaxis for dental cleaning. Streptomycin and rifampin therapy resulted in the cure of the infection. The treatment and epidemiology of Actinobacillus endocarditis are reviewed.

Actinobacillus Infections↗
PubMed1983

Comparison of moxalactam and gentamicin in the treatment of complicated urinary tract infections.

Moxalactam and gentamicin were compared in a prospective, randomized study of 49 hospitalized patients with complicated urinary tract infections. Patients received parenteral moxalactam, 250 mg every 12 h, or gentamicin, 1 mg/kg every 8 h. The average duration of therapy (moxalactam, 7.5 days; gentamicin, 8.6 days) was similar for both groups. Sixty-two percent of patients treated with moxalactam and 57% of those receiving gentamicin were cured of their infection, as defined by a negative culture after therapy. No side effects required discontinuation of either drug. An enterococcus caused two superinfections and three reinfections in patients treated with moxalactam. Moxalactam resistance developed in Pseudomonas aeruginosa isolates from three patients treated with moxalactam. Moreover, two of these isolates showed decreased susceptibility to gentamicin, tobramycin, and amikacin. An additional 10 patients with gentamicin-resistant but moxalactam-susceptible isolates were treated with moxalactam. Forty percent of these patients were cured of their infections. Moxalactam appears to be a safe, effective drug for complicated urinary tract infections caused by susceptible bacteria, including those resistant to gentamicin. However, patients receiving moxalactam should be carefully monitored to detect enterococcal superinfections or development of resistance to moxalactam in isolates of P. aeruginosa.

Adult↗
PubMed1982

Adverse reactions to nitrofurantoin in the United Kingdom, Sweden, and Holland.

A study was carried out comparing the reporting of adverse reactions to nitrofurantoin in Sweden, Holland, and the United Kingdom. The Swedish drug regulatory authorities receive more reports of adverse reactions to nitrofurantoin than to any other drug, and the annual reporting rate is increasing despite a steady fall in the prescription of nitrofurantoin. In the United Kingdom the total number of adverse reaction to nitrofurantoin reported to the Committee on Safety of Medicines has been steadily falling for many years, as has the number of prescription. Lung reactions and liver damage are more commonly reported in Sweden than in the UK, where gastrointestinal symptoms and peripheral neuropathy are more common. Such figures as were available in Holland showed an intermediate picture. The incidences of blood dyscrasias and allergic reactions are similar in the three countries. The causes for such differences are unresolved, but it is disturbing that the incidence and range of adverse reactions to such a common drug as nitrofurantoin reported to the national authorities can differ so much in countries that have close ethnic, dietary, and economic similarities. Thus great caution must be observed when data on adverse drug reactions from the country are extrapolated to another.

Chemical and Drug Induced Liver Injury↗
PubMed1982

Emergence of resistance to beta-lactam and aminoglycoside antibiotics during moxalactam therapy of Pseudomonas aeruginosa infections.

In four patients with Pseudomonas aeruginosa infections, the infecting strain developed resistance to moxalactam during therapy with this drug. In addition, P. aeruginosa isolates from two of these four patients showed increased resistance to aminoglycosides. Isolates from a third patient acquired cross-resistance to other antipseudomonal beta-lactams. In three of the cases, disk susceptibility tests failed to detect the resistance that was demonstrated in broth dilution assays. Isolate identities were confirmed by serotyping. No new plasmids were found by agarose gel electrophoresis. The mechanisms for this resistance did not involve enzymatic antibiotic degradation. These findings suggest that currently available expanded-spectrum cephalosporin derivatives should probably not be used alone for most serious infections due to P. aeruginosa. They also suggest that strains with multiple antibiotic resistance may become more prevalent in hospitals if these drugs are used extensively.

Aminoglycosides↗
PubMed1982

Plesiomonas shigelloides overgrowth in the small intestine.

An 83-year-old male presented with chronic diarrhea and protein malnutrition associated with Plesiomonas shigelloides overgrowth in the small intestine. This overgrowth was related to achlorhydria and small-bowel diverticula. Tests for heat-labile and heat-stable enterotoxin were negative on the P. shigelloides isolated from both the small bowel aspirate (3 x 10(8) bacteria per ml) and the patient's stool. The patient responded satisfactorily to tetracycline, to which this unusual isolate was susceptible in vitro. The ability to correctly identify and determine the antimicrobial susceptibility of P. shigelloides in the setting of small-bowel overgrowth will help determine appropriate therapy.

Achlorhydria↗
PubMed1976

A theoretical approach to the management of paracetamol overdosage.

Possible ways of treating paracetamol hepatotoxicity are briefly reviewed. This toxicity appears to be due to an oxidation metabolite which is normally detoxified by conjugation with glutathione, but when in excess, as in paracetamol overdosage, binds covalently to hepatic proteins to cause liver necrosis. Depletion of hepatic glutathione may also lead to other contributory disorders of cellular metabolism. Physical methods of preventing this would appear to be of little value, and treatments are being developed which aim to lessen the production of the toxic metabolite, antagonize its attachment to hepatic tissue or to combat this toxicity via basic cellular mechanisms. At this moment the most effective substances appear to be glutathione precursors and other compounds which interfere with oxidation of paracetamol.

Acetaminophen↗
PubMed1975

The passage of benorylate into the synovial fluid and tissue of rheumatoid patients.

After a preliminary wash-out period of 3-7 days during which no anti-inflammatory drugs were given, 11 female patients with classical or definite rheumatoid arthritis were given 8 g of benorylate as the 40% suspension 3-7 days prior to synovectomy of the knee. Samples of synovial tissue and fluid from the affected knee were assayed for their content of benorylate, salicylate and paracetamol in an attempt to relat these concentrations to the length of medication and the severity of the disease process as measured clinically, by X-ray, by open inspection at operation and by histology of the synovial tissue. The esterase activity of the blood and synovial fluid was also measured by the capacity to hydrolyse benorylate used as substrate.

Arthritis, Rheumatoid↗