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Biomedical subjects

R P Reed

Publications and source records attributed to R P Reed.

13 recordsLinked to original sources
PubMed1999

A comparison of polymerase chain reaction and phenotyping for rapid speciation of enterococci and detection of vancomycin resistance.

This study aimed to ascertain the ability of the microbiology laboratory to detect and identify catalase-negative Gram-positive cocci with particular reference to vancomycin-resistant enterococci (VRE). Twenty-seven reference strains and 42 prospectively collected catalase-negative Gram-positive cocci were screened by agar dilution breakpoint susceptibility and linked biochemical methods in routine use. Ability to speciate organisms was then compared using: (i) a multiplex polymerase chain reaction, designed to detect gene sequences specific to Enterococcus faecalis and E. faecium, and vancomycin resistance (van) genes; (ii) a commercial "API 20 strep" (iii) an algorithm using individual tests from a commercial API 20 strep strip; and (iv) the same algorithm utilising traditional phenotyping methods. All vancomycin resistant catalase-negative Gram-positive cocci were detected by an agar dilution screening plate containing 4 micrograms/ml of vancomycin. Polymerase chain reaction (PCR) detected all enterococci with van genes, speciated all vancomycin-sensitive E. faecalis and E. faecium isolates and excluded non-enterococcal vancomycin-resistant catalase-negative Gram-positive cocci. Algorithm-based methods speciated 41 of the 42 study isolates (98%). The API 20 strep correctly identified only 25 (60%) of these organisms, 38 of which were vancomycin-sensitive E. faecalis. VRE are detected by current screening methods for vancomycin-resistant catalase-negative Gram-positive cocci in this laboratory. API 20 strep, currently used to speciate catalase-negative Gram-positive cocci, is less reliable and should be replaced. Algorithm-based phenotyping by either method tested is more reliable for speciation than API 20 strep in its recommended form. Compared to the other methods tested, PCR is a rapid, accurate and inexpensive method of detecting and speciating vancomycin-resistant enterococci and it provides important extra information impacting on clinical therapy and infection control.

Algorithms↗
PubMed1997

Fatal granulomatous amoebic encephalitis caused by Balamuthia mandrillaris.

Granulomatous amoebic encephalitis caused by Balamuthia mandrillaris is rare (63 human) cases reported worldwide) and fatal. We report a case in a five-year-old boy who had previously been well. For 18 months, he had had a slowly progressive, granulomatous mid facial lesion, but despite extensive investigation definitive diagnosis was made only with the acute onset of neurological signs in the last two weeks of life, when a brain biopsy specimen revealed amoebic trophozoites and cysts. Infection with B. mandrillaris should be considered in the differential diagnosis of chronic skin lesions with non-specific granulomatous histopathology and negative microbiological test results.

Adolescent↗
PubMed1997

The epidemiology and clinical features of paraffin (kerosene) poisoning in rural African children.

One hundred and eleven children under 5 years of age admitted with a diagnosis of paraffin ingestion, constituting 9.1% of total ward admissions in this age group, were studied prospectively. The majority were between 13 and 36 months old. One-fifth of the children were in the care of another child at the same time of ingestion. Fourteen families had a past history of paraffin ingestion. Only 22% of households normally stored in paraffin above ground level and in only 15% of cases was paraffin stored in a container specified for that purpose. Emesis was attempted using home remedies in 72% of cases and was associated with a significant increase in vomiting. Vomiting had an impact on the exacerbation of the clinical features of paraffin poisoning, particularly fever. Clinical criteria laid down for suspected superadded bacterial lung infection resulted in half of the study group having blood cultures performed on day 1 and another 17 on day 4. Only two yielded isolates which possibly could have been indicative of bacteremia secondary to infective pneumonia. No child in the suspected group was treated with antibiotics and all recovered uneventfully. Admission chest X-rays contributed little to the management of the illness. Paraffin ingestion remains a serious contributor to child morbidity in rural South Africa and there appears to be room for further preventive education at community level. Specific measures could include storage of paraffin in designated containers above ground level and emphasis on adult supervision of children. Superadded bacterial pneumonia is uncommon and antibiotics in the management of suspected cases are not routinely indicated.

Caregivers↗
PubMed1996

Bacteraemia in malnourished rural African children.

During a 5-month study period, 323 of 863 (37.5%) children below 5 years of age admitted to Shongwe Mission Hospital in rural South Africa were malnourished, two-thirds severely so. The incidence of bacteraemia in malnourished children was 9.6%, 11.8% in those severely malnourished and 5.8% in nutritional dwarfs. The predominant organisms retrieved were Gram-negative enteric bacilli (48.5%). Amongst the severely malnourished, who empirically receive intravenous ampicillin and gentamicin, 95.8% of all isolates were sensitive to this antibiotic combination. The case fatality rate of severely malnourished bacteraemic children was 20.8%. In malnutrition categories overall, the case fatality rate for bacteraemic children (22.6%) was significantly greater than in those without bacteraemia (9.3%). In hospitals with limited resources, full identification of bacteria may not be necessary, provided that regular surveillance for emerging resistance is conducted.

Anti-Bacterial Agents↗
PubMed1996

Campylobacter bacteremia in children.

OBJECTIVE: To describe clinical and laboratory data for, and to propose pathogenesis and management of, children from impoverished communities with Campylobacter bacteremia. METHODS: A retrospective review of patient data generated from laboratory records in an urban tertiary care hospital in Soweto and a rural mission hospital in Eastern Transvaal, South Africa. Participants were 19 children presenting to either hospital with Campylobacter bacteremia. Clinical and laboratory data were collated. RESULTS: Nineteen children with Campylobacter bacteremia were identified; all isolates were Campylobacter jejuni. Sixteen (84%) had malnutrition; 13 of these were severely malnourished. Thirteen (68%) were febrile at the time of bacteremia. Four children (21%) did not have diarrhea. The case fatality rate was 16% and may not have been influenced by aminoglycoside administration. CONCLUSION: Malnourished children may be more likely to have gastrointestinal C. jejuni infection. Immunodeficiency and intestinal mucosal compromise secondary to malnutrition may render such children at increased risk of C. jejuni bacteremia and its consequences. C. jejuni bacteremia is potentially life-threatening and should be managed accordingly.

Aminoglycosides↗
PubMed1995

Urinary tract infection in malnourished rural African children.

During an 8-month period from 1 September 1992 to 30 April 1993, 134 children less than 5 years of age admitted with all grades of malnutrition to a rural hospital were investigated for urinary tract infection. Thirty-five (26.1%) had proven infection. Incidence rates amongst malnutrition categories did not vary significantly. Antibiotic sensitivities with reference to ongoing surveillance and antimicrobial usage is discussed. The value of dipstick screening tests was analysed for predictability and found to be an unreliable alternative to traditional culture techniques. This study emphasizes that urinary tract infection in malnutrition is common and should be routinely investigated.

Child Nutrition Disorders↗
PubMed1994

Neonatal typhoid fever.

Typhoid fever occurs in children less than 2 years of age but is thought to be a mild, often unrecognized illness. Neonatal typhoid fever is a rare but often life-threatening illness, uniformly fatal in the preantibiotic era. Vertical intrauterine transmission from a typhoid-infected mother is implicated in neonatal typhoid fever. Ten cases at a rural African hospital are presented. Three patients died with two deaths associated with empiric management inappropriate for Salmonella typhi. A second clinical presentation in the neonate is asymptomatic persistent excretion. Infants < or = 3 weeks old may also be infected from an exogenous source and have severe disease. Where typhoid is endemic S. typhi should be considered as a cause of sepsis neonatorum and appropriate antibiotics included in empiric therapy.

Anti-Bacterial Agents↗
PubMed1990

Radon-222, 222Rn progeny, and 220Rn progeny levels in 70 houses.

A year-long, multipollutant, indoor air quality study involving 70 occupied houses in four states was completed in 1987. All of the houses included in the study had a partial or complete basement with a concrete slab floor and block walls. On an approximately quarterly schedule, integrating monitors for short-lived Rn progeny, nitrogen dioxide, formaldehyde, and water vapor were exposed for 1 wk in each house on both the basement and main floors. At the beginning of the study, a pair of alpha-track detectors were placed on top of the refrigerator in the kitchen (or some other sampling location on the main floor) and at a location in the basement. One detector at each location was left in place for a year while the other detector was retrieved and replaced once every 3-mo period. In addition, short-term measurements of Rn and 222Rn progeny were made at all sampling locations once per quarter. In this study, comparisons were made between: (1) seasonal and annual averages, (2) summer and winter averages, (3) living-area and basement results, (4) 222Rn and 220Rn progeny, and (5) short- and long-term measurements. The Rn and Rn progeny concentrations in houses near Huntsville, AL were found to be well above recommended action levels (150 Bq m-3). For houses near Birmingham, AL, summer Rn concentrations were found to exceed winter concentrations, whereas for the other houses in the study, winter concentrations exceeded summer concentrations. Potential alpha energy concentrations (PAEC) from 220Rn progeny were found to be generally less than PAEC from 222Rn.

Air Pollutants↗