Biomedical subjects
Publications and source records attributed to R H Latham.
Bipolaris spicifera, one of the darkly pigmented (dematiaceous) fungi commonly found in soil, is an uncommon cause of infection in humans and an unusual cause of meningitis and nosocomial infections. An 18-y-old boy who experienced meningitis with this micro-organism after acoustic neuroma resection was successfully treated with amphotericin B.
Three cases of pubic osteomyelitis in athletes are reported. The clinical presentation in each case was acute groin, hip, or perineal pain; fever; chills; inability to bear weight; and pubic symphysis tenderness. Since radiographic changes in the pubic bone can be delayed, a high index of suspicion is required by the clinician. Although Staphylococcus aureus is the dominant pathogen in pubic osteomyelitis, it is recommended that the diagnosis be established by culture of blood or pubic bone aspirate so that specific therapy can be instituted quickly.
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We conducted a randomized, double-blind, placebo-controlled study to determine the efficacy of postcoital antibiotic prophylaxis in healthy young women prone to recurrent urinary tract infections. Sixteen patients were randomized to receive postcoital administration of a combination product of trimethoprim and sulfamethoxazole, while 11 received postcoital placebo. The treatment groups were similar with respect to age, parity, diaphragm use, history of lifetime urinary tract infections, frequency of intercourse, and number of lifetime sexual partners. In over 6 months of observation, postcoital administration of trimethoprim-sulfamethoxazole was highly effective in preventing recurrent urinary tract infections. Nine of 11 patients who took the placebo developed urinary tract infections (infection rate, 3.6 per patient-year), compared with only two of 16 patients who received postcoital trimethoprim-sulfamethoxazole (infection rate, 0.3 per patient-year). Postcoital administration of trimethoprim-sulfamethoxazole was effective in patients with both low (two or fewer times per week) and high (three or more times per week) intercourse frequencies. Side effects were few and compliance was excellent. We conclude that postcoital trimethoprim-sulfamethoxazole is a safe, effective, and inexpensive approach to management of recurrent urinary tract infections in young women.
We compared the safety and efficacies of ofloxacin and trimethoprim-sulfamethoxazole for the treatment of acute uncomplicated cystitis in women enrolled in a multicenter study. Data from three centers were combined for this report because the study design and study populations were identical, and patients were enrolled within an 18-month period. Cure rates for evaluable patients 4 weeks after treatment were high for all regimens: ofloxacin (200 mg) twice daily for 3 days, 22 of 25 (88%) cured; ofloxacin (200 mg) twice daily for 7 days, 42 of 49 (86%) cured; ofloxacin (300 mg) twice daily for 7 days, 25 of 25 (100%) cured; and trimethoprim-sulfamethoxazole (160/800 mg) twice daily for 7 days, 46 of 52 (88%) cured. Ofloxacin was more effective than trimethoprim-sulfamethoxazole in eradicating Escherichia coli from rectal cultures during and 1 week after treatment. Both ofloxacin and trimethoprim-sulfamethoxazole markedly reduced vaginal colonization with E. coli during and 4 weeks after therapy. Emergence of resistant coliforms in rectal flora was found in 5 (19%) of 27 patients treated with trimethoprim-sulfamethoxazole but none of 50 ofloxacin-treated patients who were studied (P = 0.004). Adverse effects were equally common among the four treatment groups. We conclude that 3 to 7 days of ofloxacin is as safe and effective as trimethoprim-sulfamethoxazole for treatment of uncomplicated cystitis in women and that ofloxacin effectively reduces the fecal and vaginal reservoirs of coliforms in such patients.
Molecular laboratory techniques were used to study the epidemiology of an outbreak of nosocomial Legionnaires' disease. All patient isolates were Legionella pneumophila serogroup 1 and showed identical plasmid profiles and reactions with serogroup-specific monoclonal antibodies. L pneumophila was also cultured from four of five cooling tower water samples; however, the isolate from only one tower was serogroup 1 of the same subtype as patient isolates. Since the cases were temporally clustered and epidemiologically associated with exposure to cooling tower aerosols, the single cooling tower implicated by molecular analysis was the most likely source of the outbreak. Chlorination of cooling tower ponds has eradicated the epidemic strain. Since potable water also harbored the infecting organism and was the probable source for cooling tower contamination, decontamination of the hospital water system was also undertaken. Superchlorination of hot water holding tanks to 17 ppm on a weekly basis has effectively eradicated L pneumophila from the potable water system and appears to be a reasonable, simple, and relatively inexpensive alternative to previously described methods of control.
We evaluated the accuracy and work load of six different approaches to identifying urinary tract infections in a general microbiology laboratory. Midstream urine (MSU) specimens from 387 ambulatory women were examined for pyuria and were cultured using a dual-plating technique that detects both low (10(2) to 10(4) organisms per milliliter) and high (greater than or equal to 10(5) organisms per milliliter) colony counts. Seventy-four urinary tract infections (defined as greater than or equal to 10(5) organisms per milliliter of MSU or greater than or equal to 10(2) aerobic gram-negative bacilli per milliliter of MSU in symptomatic patients) were identified. Twenty-four (32%) of the infections were characterized by low colony counts and would not have been identified using a 10(5) or greater colony-forming units/mL criterion for infection. Using the presence of pyuria to direct microbiological processing of urine specimens was the most accurate and efficient method of identifying urinary tract infections among voided specimens from ambulatory women, particularly if rapid screening methods for pyuria can be used.
We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean follow-up of 9.4 months. Both studies demonstrated a significantly increased risk of UTI in diaphragm users: relative odds were 2.0 in the case-control study and the relative risk was 2.5 in the retrospective cohort study. Vaginal colonization with Escherichia coli was significantly greater in diaphragm users. The incidence of UTI in the cohort study was 26.6 per 1,000 patient-months for diaphragm users and 8.9 per 1,000 patient-months for women taking oral contraceptives. The increased risk of UTI in diaphragm users could not be attributed to differences in age, parity, sexual activity, or previous UTI.
Urinary infections in adult women are extremely common. Yet, dysuria, often a symptom of these infections, can be caused by a number of genitourinary pathogens. Symptomatic urinary infections caused primarily by Escherichia coli or Staphylococcus saprophyticus are best confirmed by demonstrating the presence of 10(2) or more organisms per ml of midstream urine in quantitative cultures. Other causes of dysuria such as vaginitis and urethritis due to venereal disease should be suspected in patients with additional signs and symptoms characteristic of these infections and in young, sexually active females. Effective treatment of urinary infections is achieved with a number of antibiotics; the length of therapy is determined by the location of infection in the urinary tract. Although equal in efficacy to conventional therapy for uncomplicated lower tract infections, single-dose therapy of dysuric women should be limited to patients for whom adequate follow-up can be insured.
The prevalence of uropathogenic Escherichia coli bearing type 1 and/or p fimbriae was assessed in 179 adult women with urinary tract infections, and the presence of specific fimbriae types was correlated with results of localization studies. E. coli with p fimbriae occurred more frequently in patients with clinically defined pyelonephritis (13 of 23 [57%]) than in women with cystitis (22 of 116 [19%]; P = .0004) or asymptomatic bacteriuria (6 of 40 [15%]; P = .0008), whereas organisms with type 1 fimbriae were equally distributed in these three patient groups. In contrast, the presence of p-fimbriated strains was not correlated with infection localized to the upper urinary tract by either the antibody-coated bacteria technique (among symptomatic women) or ureteral catheterization (among asymptomatic women). Thus although p fimbriation seems to be an important virulence factor associated with development of acute pyelonephritis in adult women, its detection appears not to be a useful localization test per se, and efforts to prevent these infections should not be directed against this factor alone.
beta-Lactamase production and MIC determinations for penicillin, methicillin, and cephalothin were assessed for 67 strains of Staphylococcus saprophyticus and correlated with results of disk diffusion susceptibility testing. Fifty-five (82%) of the 67 strains produced beta-lactamase, and 40 (77%) of these beta-lactamase-producing strains were susceptible (zone size, greater than 29 mm) by disk diffusion techniques. Although the range of zone sizes for beta-lactamase producers was broad (26 to 36 mm), all 38 strains with a zone size of less than 31 mm by disk diffusion testing were beta-lactamase producers compared with 17 (59%) of 29 with larger zone sizes (P = 0.0000008). The median penicillin MIC for 12 S. saprophyticus strains was 0.25 micrograms/ml and was not related to beta-lactamase production. Although the methicillin MICs for 15 strains were in the susceptible range (4.0 micrograms/ml), interpretation of disk diffusion testing for oxacillin varied greatly among laboratories using identically prepared media and standardized techniques. Criteria presently used to define susceptibility of Staphylococcus aureus to penicillin and oxacillin by disk diffusion are inappropriate for S. saprophyticus. The clinical significance of the beta-lactamase produced by these strains needs further evaluation.
Dysuria remains one of the most common symptoms experienced by adult women. In the past, women with dysuria were generally classified as having cystitis or the acute urethral syndrome based on results of quantitative urine cultures. Recent studies indicate that this terminology is misleading and that the majority of dysuric women have infections with E. coli and S. saprophyticus detected by cultures of midstream urine. Urethritis caused by C. trachomatis or N. gonorrhoeae and vaginitis can also produce symptoms of urinary infection. Proper management of dysuric women requires evaluation for these illnesses and treatment directed at the specific cause of infection.
We evaluated and compared 81 urinary tract infections (UTIs) with Staphylococcus saprophyticus occurring in 72 college women with Escherichia coli UTIs. During the 14-month study period, S saprophyticus was the second most common cause of UTIs, accounting for 11% of the total. Staphylococcus saprophyticus infections occurred more frequently during the late summer and early fall. Age, history of previous UTI, signs and symptoms of infection, and findings on urinalysis were similar in patients with S saprophyticus and E coli infections. Nine (41%) of 22 S saprophyticus infections were localized to the upper urinary tract by the antibody-coated bacteria technique compared with 18 (16%) of 115 infections with E coli (P = .01). Rectal, vaginal, and urethral colonization with S saprophyticus was associated with UTI caused by these organisms, suggesting that their pathogenesis resembles that of E coli UTIs. In vitro susceptibility testing showed almost uniform sensitivity of S saprophyticus to most antimicrobials used to treat UTIs, but recurrent infections occurred in six of the 72 women despite adequate therapy. Physicians and microbiologists must be aware that S saprophyticus is an important cause of UTIs in young women.
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The use of a novobiocin-containing medium provided little benefit over observable quantitative growth on blood agar in detecting Staphylococcus saprophyticus in urine cultures.
A cluster of cases of hepatitis A that occurred among 46 participants in a family reunion in Utah in August 1980 was investigated with epidemiologic and serologic techniques. No index patient with clinical illness had been present at the reunion. Twenty-three cases of hepatitis A were ultimately identified; 14 developed clinical hepatitis. Immunoglobulin M-specific hepatitis A virus antibody testing identified nine recently infected asymptomatic subjects. Eight additional individuals had serologic evidence of prior infection. Detection of these asymptomatically infected and nonsusceptible subjects among presumably well individuals led to the alteration of the food questionnaire analysis, ultimately implicating the green salad. The green-salad maker was identified as an asymptomatically infected individual and was thought to be the probable index case. Determination of hepatitis A virus antibody status of study subjects revealed age-related differences in clinical manifestations and disease susceptibility between individuals exposed to foodborne hepatitis A.