PubMed Health⌕ Search

Biomedical subjects

S T Shulman

Publications and source records attributed to S T Shulman.

At least 145 records · Page 8Linked to original sources
PubMed1986

Group C and group G streptococci. In-office isolation from children and adolescents with pharyngitis.

The importance of non-group A streptococci as etiologic agents of acute pharyngitis in endemic circumstances is unclear. The authors attempted to clarify this issue in patients undergoing throat culture for acute pharyngitis in a suburban pediatric practice. Of 6,694 throat cultures, 2,243 (34%) yielded B-hemolytic streptococci, 83 percent (1,783) of which were bacitracin-sensitive and presumptive group A organisms. A random selection of 279 of the 460 bacitracin-resistant streptococci yielded 56 group C, 42 group G, 35 group F, 2 group A, and 3 mixed groups of streptococci. Paired serologic specimens were obtained from 12 children with group C or G streptococci. Four of six group C subjects from whom paired serum specimens were obtained had a significant increase in anti-streptolysin O titer. However, no change in anti-C/G hyaluronidase or anti-C carbohydrate titer was observed. Similarly, two of six subjects with group G streptococci on throat culture in whom paired serum specimens were obtained showed an increase in ASO titer. No seroconversion to anti-C/G hyaluronidase, anti-C, or anti-G carbohydrates was demonstrated. Despite substantial clinical and circumstantial evidence, it could not be confirmed serologically that group C and G streptococci produced acute pharyngitis in this endemic setting.

Adolescent↗
PubMed1985

Treatment of pediatric infections with amikacin as first-line aminoglycoside.

Because of increased aminoglycoside resistance of hospital bacterial isolates, aminoglycoside sensitivity patterns of isolates in a large children's hospital were assessed before and during a 33-month period of almost exclusive amikacin use. There was no significant change in overall resistance rates of gram-negative enteric bacteria to gentamicin (4.8 percent and 4.6 percent), tobramycin (2.5 percent and 3.6 percent), and amikacin (1.2 percent and 1.8 percent) from the pre-amikacin period to the amikacin usage period, respectively. No significant differences were observed for isolates of Escherichia coli, Klebsiella, Serratia, Acinetobacter, and Pseudomonas species. In contrast, significant decreases in gentamicin and tobramycin resistance rates for Enterobacter, Citrobacter, and Pseudomonas aeruginosa and in gentamicin resistance of Proteus were found. Very little change in resistance of staphylococcal isolates was seen during a shorter evaluation period. Pediatric aminoglycoside usage includes therapy of neonatal infections, cystic fibrosis, febrile neutropenic episodes in patients with cancer, abdominal surgery, bacterial endocarditis, and gram-negative central nervous system infections. Amikacin has also been used successfully as single-dose therapy of urinary tract infections, and acceptable cerebrospinal fluid levels of amikacin have been documented in hydrocephalic patients with ventriculitis. In vitro studies of 22 bacterial isolates demonstrated synergy between amikacin and penicillin or newer cephalosporins in 13, an additive effect in seven and indifference in two. No antagonism was found. In addition, in vivo synergy between imipenem and amikacin was found in neutropenic infant rats with P. aeruginosa sepsis using a strain with which no synergy was demonstrable in vitro. Amikacin is effective in pediatric infections and is well tolerated by children. Because excessive or inadequate levels are frequent with usually recommended doses, particularly in neonates and patients with compromised renal function or cystic fibrosis, serum levels should be monitored to minimize risk and to ensure therapeutic levels.

Amikacin↗
PubMed1985

Acyclovir treatment of disseminated varicella in childhood malignant neoplasms.

Primary varicella-zoster virus infection (chickenpox) in immunocompromised children is frequently associated with visceral dissemination and attendant high mortality. Eight children with malignant neoplasms and chickenpox with visceral involvement (seven with hepatitis, three with pneumonitis, two with encephalitis, and two with coagulopathy) were initially treated with intravenously (IV) administered vidarabine but demonstrated progressive visceral involvement. After three days of vidarabine treatment (two days for two patients), seven had rising serum SGPT levels, all eight had pneumonitis, seven had deteriorating mental status and/or seizure activity, and six had worsening coagulopathy. Vidarabine was replaced by IV administered acyclovir, with subsequent improvement in all but the most severely ill patient who died. Seven of eight patients recovered completely; no side effects of acyclovir were observed. This clinical experience suggests that acyclovir may be more effective than vidarabine in disseminated varicella infection; however, controlled clinical trials will be necessary to establish this.

Acyclovir↗
PubMed1985

Hematogenous pelvic osteomyelitis in children. Clinical correlates of newer scanning methods.

The records of 18 children with hematogenous pelvic osteomyelitis seen over a four-year period were reviewed. The mean age of the patients was 7.8 years and their most common presenting symptoms were gait disturbance (present in 94%) and pain about the hip (61%) with only mild limitation of motion; 11 (61%) of 18 patients were afebrile at presentation. Although leukocytosis was uncommon, the erythrocyte sedimentation rate was almost always elevated (greater than 40 mm/hr in 94% of the patients). While initial plain roentgenograms were usually normal, gallium citrate Ga 67 and technetium Tc 99m oxidronate scintigrams were abnormal in all patients who underwent these studies. Computed tomography proved to be a useful complementary study to radionuclide scintigraphy, yielding positive findings in nine of 11 cases. Patients presented for medical care a median of 2.5 days after the onset of symptoms, whereas a longer period of time (median, 7.5 days) was required to establish the correct diagnosis after presentation for care. The only observed complications occurred in two patients in whom there was significant delay in institution of therapy. Prevention of complications from pelvic osteomyelitis lies in early recognition and appropriate treatment of the disease. In our experience, newer imaging techniques facilitate prompt diagnosis.

Adolescent↗
PubMed1985

Penicillin plus rifampin eradicates pharyngeal carriage of group A streptococci.

We evaluated the efficacy of rifampin in eradicating chronic pharyngeal carriage of group A streptococci. Carriers were defined as healthy children whose throat cultures showed persistence of group A streptococci 3 weeks after receiving benzathine penicillin G intramuscularly. Subsequent M and T typing of group A streptococcal isolates and limited serologic studies confirmed that enrolled patients were carriers. Thirty-eight carriers (37 completed the study) were randomly assigned to three groups: group 1 (13 patients) received no treatment; group 2 (10) received benzathine penicillin intramuscularly; group 3 (14) received benzathine penicillin intramuscularly plus rifampin orally (10 mg/kg twice a day for eight doses). Throat cultures were obtained every 3 weeks for at least 9 weeks. Group 2 and 3 patients who still had positive cultures 3 weeks after treatment were crossed to the opposite group. Cultures became negative in 93% (13 of 14) of patients in group 3, compared with 23% in group 1 and 30% in group 2 (P less than 0.001 and P less than 0.01, respectively). Including patients crossed over, the penicillin plus rifampin regimen was effective in 17 (89%) of 19 treatment courses and was significantly superior to no therapy or to penicillin alone (P less than 0.0005 and P less than 0.005, respectively). We conclude that rifampin plus benzathine penicillin intramuscularly is an effective regimen for those selected patients in whom eradication of group A streptococcal carriage is judged to be desirable.

Administration, Oral↗
PubMed1985

Rifampin and penicillin for the elimination of group B streptococci in nasally colonized infant rats.

Although multiple antibiotic strategies to eradicate group B streptococci (GBS) from colonized infants and women have been utilized, no regimen has been successful in eliminating GBS carriage reliably. Because rifampin has been successful in terminating nasopharyngeal colonization with other bacteria, we tested both the in vitro sensitivity of GBS to rifampin and the in vivo efficacy of rifampin in eliminating GBS from a new animal model of nasally colonized infant rats. The minimal inhibitory concentration of rifampin for 18 clinically derived strains of type III GBS ranged from 0.1 to 0.4 micrograms/ml. Atraumatic nasal inoculation of infant rats with 10(6)-10(7) colony forming units of GBS twice daily for 4 days resulted in heavy asymptomatic carriage for at least 10 days. Colonized animals were divided into four treatment groups: saline, oral rifampin, intraperitoneal penicillin, or oral rifampin plus intraperitoneal penicillin. Treatment was administered every 12 h for 4 days. All 78 saline-treated controls and 47 of 52 (90.4%) penicillin-treated animals had continued GBS carriage 36 h after completion of therapy. In contrast, only 18 of 52 (34.6%) rifampin-treated animals and seven of 54 (13.0%) rifampin plus penicillin-treated animals remained GBS-positive. No rifampin-resistant GBS were detected. Combination rifampin plus penicillin therapy was significantly more effective in terminating GBS carriage compared to saline or penicillin alone (p less than 0.0001) or to rifampin (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Advances in antiviral therapy: acyclovir.

Acyclovir [9-(2-hydroxyethoxymethyl)guanine] is a newly licensed acyclic nucleoside analog that is active in vitro and in vivo against herpes simplex virus (HSV) and varicella zoster virus (VZV). This agent is available in the United States in topical and intravenous forms, and the oral preparation is currently being evaluated in clinical trials. The precise therapeutic role for acyclovir in patients with herpesvirus infections is still evolving. This article reviews the current status of this exciting new antiviral agent.

Acyclovir↗
PubMed1983

Uveitis complicating autoimmune chronic active hepatitis.

A patient with autoimmune hepatitis B surface antigen-negative chronic active hepatitis (CAH) developed uveitis during the course of her disease. The occurrence of this eye disorder provides additional support for an autoimmune pathogenesis for CAH. Clinicians should be alert to the association of uveitis with CAH, so that patients at risk may be examined for this potentially serious ocular disease.

Autoimmune Diseases↗
PubMed1983

Serologic cross-reactions among streptococcal group A, A-variant, and C polysaccharides.

Serologic cross-reactions among streptococcal groups A, A-variant (A-V), and C cell wall polysaccharides were found previously in studies employing capillary or quantitative precipitin techniques. Similar cross-reactions occur with radioimmune precipitation using extrinsically labeled 125I-streptococcal antigens. This study was performed to determine the degree of cross-reactivity when intrinsically labeled 14C-polysaccharide antigens were used in the radioimmune precipitin assay. Unadsorbed antisera from rabbits immunized with group A streptococci bound 3-5% as much 14C-A-V antigen as homologous A carbohydrate but undetectable amounts of C polysaccharide. Similarly, A-V antisera bound 3-5% as much 14C-A or 14C-C carbohydrate as A-V antigen. Group C antiserum bound 1-2% as much A and A-V antigens as C carbohydrate. Thus, less than 3% of intrinsically labelled 14C-A or 14C-C carbohydrate represents exposed A-V antigenic sites, i.e., exposed polyrhamnose backbone. Otherwise, group A, C, or A-V carbohydrates failed to exhibit heterologous determinants. Anti-peptidoglycan antibodies in antisera did not result in serologic cross-reactivity. These data suggest that formamide-extracted streptococcal group-specific polysaccharides, intrinsically labeled with 14C, may possess greater group specificity than 125I-carbohydrates and yield only negligible cross-reactivity with heterologous antisera. This degree of cross-reactivity does not appear to be sufficient to account for the persistently elevated serum levels of antibody to group A carbohydrate in patients with rheumatic heart disease.

Acetylgalactosamine↗
PubMed1983

Single-dose ceftriaxone pharmacokinetics in pediatric patients with central nervous system infections.

Ceftriaxone has greater in vitro and in vivo efficacy against many common bacteria than other third-generation cephalosporins. Single-dose ceftriaxone pharmacokinetics were studied in 17 patients, aged 0.6 to 52 months, with infections of the central nervous system. Patients received a randomized dose of 50 or 75 mg/kg ceftriaxone intravenously over 5 minutes on the second to fifth day of illness. Serial blood samples were collected over 24 hours in all patients, and cerebrospinal fluid (CSF) was obtained 1 to 4.5 hours after injection. Ceftriaxone mean peak plasma concentrations, determined by high-power liquid chromatography, were 267 and 184 microgram/ml for the 75 and 50 mg/kg dosage groups, respectively. The harmonic mean elimination half-life was 4.2 hours, and the mean percent drug penetrance into CSF was 4.8 +/- 3.5%. Of CSF studies evaluated, the glucose concentration was correlated most closely (inversely) with CSF penetration of ceftriaxone. Individual CSF concentrations of ceftriaxone exceeded the minimal inhibitory concentrations of the respective bacteria causing infection by 480 to 5,600 times. Ceftriaxone may be useful in the treatment of serious pediatric infections, including meningitis.

Cefotaxime↗