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Biomedical subjects

R S Daum

Publications and source records attributed to R S Daum.

106 records · Page 6Linked to original sources
PubMed1980

Cutaneous necrosis associated with intravenous nafcillin therapy.

Four children had cutaneous necrosis associated with the administration of intravenous (IV) nafcillin sodium therapy. One patient required skin grafting. Hospitalization was prolonged with this patient and with one other in an effort to ensure healing. Adult rats, inoculated subcutaneously with nafcillin that was appropriately diluted according to manufacturer's recommendations, exhibited similar lesions. Oxacillin sodium, methicillin sodium, and cephalothin sodium, similarly diluted, did not necrose skin. Nafcillin should be added to the list of agents that produce similar toxic conditions. Frequent observation of the IV infusion site to detect extravasation may obviate this hazard.

Animals↗
PubMed1979

Effect of ampicillin and chloramphenicol alone and in combination on ampicillin-susceptible and -resistant Haemophilus influenzae type B.

To evaluate ampicillin (Amp) and chloramphenicol (Cm) alone and in combination against Haemophilus influenzae type b, we examined the viability of 5 log(10) colony-forming units (CFU) of early-log-phase organisms per ml after 4 and 8 h of incubation with the drug(s). Nine Amp-susceptible (Amp(s)) and five Amp-resistant (Amp(r)) systemic isolates were examined. Antibiotic concentrations included: the minimum inhibitory concentration (MIC) of Amp, 50% of the MIC of Amp, 25% of the MIC of Amp, the MIC of Cm, 50% of the MIC of Cm, 25% of the MIC of Cm, and nine combinations of these concentrations. Both Amp and Cm at their MIC significantly reduced bacterial titers of Amp(s)H. influenzae type b after 8 h of incubation (1.36 and 1.47 log(10) CFU/ml, respectively; both p < 0.01); only Cm at its MIC significantly reduced the number of viable organisms after 4 h (0.91 log(10) CFU/ml; P < 0.001). With Amp(r) organisms, significant reductions in mean bacterial titers occurred after 4 and 8 h of incubation in the presence of Amp at its MIC (1.66 and 2.06 log(10) CFU/ml, respectively; both P < 0.02); smaller but significant reductions were noted after 4 and 8 with Cm at its MIC (0.56 and 0.87 log(20) CFU/ml, respectively; both P < 0.025). Antagonism with Amp(s) or Amp(r) strains was not seen. We conclude that combinations of Amp and Cm have indifferent effects on Amp(s) and Amp(r)H. influenzae type b.

Ampicillin↗
PubMed1979

Comparison of two antigen detection techniques in a primate model of Haemophilus influenzae type b infection.

Rapid diagnosis of Haemophilus influenzae type b meningitis is possible using immunological tests for capsular antigen (polyribophosphate, PRP), such as countercurrent immunoelectrophoresis (CIE) and latex particle agglutination (LPA). We compared two tests in monkeys with evolving, serially quantitated H. influenzae type b bacteremia (n = 23) and meningitis (n = 21). In vitro, the LPA test was sensitive to 0.5 ng of PRP/ml of saline, and the CIE test was sensitive to 1.0 ng/ml; in serum, however, CIE detected 5.0 ng of PRP/ml, whereas the sensitivity of LPA was unchanged. LPA detected PRP earlier in the course of bacteremia (mean, 12 h after onset; range, 4 to 36 h) than did CIE (mean, 45 h; range, 4 to 168 h) (P less than 0.01). A positive LPA test required greater than or equal to 100 bacteria per ml of blood, whereas CIE required greater than or equal to 1,000/ml. PRP accumulated with continuing blood stream infection, aiding detection of low-grade bacteremia. LPA detected antigen in cerebrospinal fluid (CSF) earlier in the course of meningitis and at a lower bacteria density than did CIE. Both methods detected antigen reliably with greater than or equal to 1,000 bacteria per ml of CSF. A close correlation existed between CSF concentrations of capsular antigen and bacteria (r = 0.90, P less than 0.001). We conclude that the LPA method permits earlier diagnosis of H. influenzae type b infection in part because of its greater sensitivity.

Animals↗
PubMed1978

Ventricular involvement in experimental Hemophilus influenzae meningitis.

We determined the frequency of ventricular involvement during Hemophilus influenzae type b meningitis in ten bacteremic infant rhesus monkeys. Meningitis was defined as cerebrospinal fluid obtained from the lumbar subarachnoid space or cisterna magna containing bacteria and ten or more leukocytes per mm3. HIB were cultured from 22 of 22 ventricular CSF samples. In 17 of 18 comparisons of bacterial density in ventricular and cisternal CSF, the values were within one log10: similarly, 5 of 8 quantitative ventricular-lumbar comparisons were within one log10. This concordance was present at bacterial densities of 2 x 10(1) to 1 x 10(9) CFU/ml. When discordance was present, the ventricular CSF contained more bacteria. In 15 of 20 comparisons of leukocyte density in ventricular and cisternal CSF, the ventricular pleocytosis was lower (mean ventricular/cisternal ratio 0.08). We conclude that infection of the lateral cerebral ventricle is a uniform feature of HIB meningitis in infant monkeys, but the cellular inflammatory component is less.

Animals↗
PubMed1971

A "new" disorder of isoleucine catabolism.

A disorder of isoleucine catabolism was found in a child with intermittent metabolic acidosis. The block occurs at the stage of propionate synthesis, and two intermediates--alpha-methylacetoacetate and alpha-methyl-beta-hydroxybutyrate--accumulate. The condition is apparently inherited.

Acetoacetates↗
PubMedDate not supplied

Rifampin alone and in combination with trimethoprim in chemoprophylaxis for infections due to Haemophilus influenzae type b.

The efficacy of rifampin in eradicating Haemophilus influenzae type b from the pharynx of colonized individuals was assessed for 1,467 close contacts of 291 children hospitalized with invasive infections due to H. influenzae type b. Twenty-six percent of all contacts were carrying H. influenzae type b in the pharynx, and 52% of contacts younger than age five had throat cultures positive for this organism. Four different regimens of rifampin were studied and compared with placebo for efficacy in eradication of carriage of H. influenzae type b. The most effective dosage was 20 mg of rifampin/kg given once daily for four days. This schedule was associated with eradication of carriage in 96.2% of 52 colonized, compliant contacts. Carriage of H. influenzae type b was eradicated in 90.9% of the 22 colonized contacts who were younger than age five. Significantly lower rates of carriage eradication were seen with other regimens of rifampin. Potential problems associated with widespread rifampin usage are reviewed.

Carrier State↗
PubMedDate not supplied

Haemophilus influenzae type b infections in day care attendees: implications for management.

Haemophilus influenzae type b is a major cause of several infectious syndromes in young children, the most important of which is meningitis. The mortality rate for H. influenzae meningitis in the United States is less than 10%; 10%-15% of survivors are left with neurologic sequelae. Children in day care may be at increased risk for acquiring primary invasive H. influenzae infection, although the mechanism of increased risk and the age of increased susceptibility are not known. Three prospective studies estimated the risk of subsequent or secondary infections as significantly lower than that observed in age-susceptible household contacts; a retrospective analysis suggested a different conclusion. Asymptomatic carriage rates of H. influenzae type b in day care centers vary widely. A retrospective analysis suggested that the administration of rifampin might have prevented subsequent infections in day care contacts; prospective studies are necessary to convincingly demonstrate the efficacy of rifampin prophylaxis among day care contacts. Acquisition of H. influenzae type b carriage has occurred even among those previously treated with rifampin. Until further data are available, rifampin prophylaxis is usually reserved for use in those facilities in which two or more cases of invasive disease have occurred within 60 days. The impact of the H. influenzae type b capsular polysaccharide vaccine on the epidemiology of disease in day care facilities is not known. However, because the immunogenicity and protective efficacy of the H. influenzae capsular polysaccharide vaccine are strikingly age-related, we recommend immunizing children in day care at 24 months.

Age Factors↗
PubMedDate not supplied

Counterpoint: the red book opts for red urine.

Several important issues regarding chemoprophylaxis for H. influenzae type b infections should be resolved before general adoption of the recommendations of the Committee on Infectious Diseases. Unfortunately the recommendations place the practicing pediatrician in a medical-legal dilemma if he does not comply. The prematurity of the recommendations may preclude further placebo-controlled, prospective evaluation of the efficacy of rifampin or other agents in the prevention of secondary disease. In any event the administration of chemoprophylaxis must not replace close surveillance of all members of the contact group. Band et al. estimated that 150 to 200 of the approximately 20,000 cases of invasive H. influenzae type b disease that occur each year in the United States may be preventable by prophylaxis. Primary prevention with a safe effective vaccine would have a much greater impact.

Adult↗
PubMedDate not supplied

Capsular polysaccharide serotypes of coagulase-positive staphylococci associated with tenosynovitis, osteomyelitis, and other invasive infections in chickens and turkeys: evidence for new capsular types.

To study the role of capsular polysaccharides in staphylococcal infections in chickens and turkeys, we surveyed 101 coagulase-positive isolates obtained from investigators in geographically diverse locales in the United States and Canada. Fifty-six isolates were obtained from chickens; 51 (91%) were type 5, and 5 (9%) were type 8. Forty isolates were obtained from turkeys; 13 (33%) were type 5, 15 (38%) were type 8, and 12 (29%) were untypable. Five type 5 isolates were obtained from poultry of uncertain species. Two untypable turkey isolates were studied further. Rabbit serum obtained after immunization with formalin-killed staphylococci was type-specific as assessed by a tube agglutination test and promoted opsonophagocytosis of the isolate that had been used for immunization. Chromatography of carboxy-reduced capsular polysaccharide from one of the isolates suggested that mannoseaminouronic acid was present in the unreduced polysaccharide. The spectrum obtained by 13C-nuclear magnetic resonance suggested the presence of N-acetyl sugars such as mannoseaminouronic acid and 6-deoxy sugars such as N-acetyl fucosamine. The structure of the polysaccharide differed from that of the type 5 and type 8 capsular polysaccharides. Thus, poultry isolates can be classified into at least four serotypes on the basis of their capsular polysaccharides. This observation provides a new focus for investigation into the epidemiology and virulence determinants of this important pathogen in chickens and turkeys.

Animals↗