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Biomedical subjects

T Chonmaitree

Publications and source records attributed to T Chonmaitree.

53 records · Page 3Linked to original sources

Comparison of three rapid diagnostic techniques for detection of respiratory syncytial virus from nasal wash specimens.

We report results of three rapid tests for respiratory syncytial virus antigen detection. An immunofluorescence assay using commercial antibody and two commercial enzyme immunoassays (Ortho Diagnostics, Inc., Raritan, N.J., and Abbott Laboratories, North Chicago, Ill.) were applied to 199 nasal wash specimens. The Abbott enzyme immunoassay was the most sensitive technique, with a sensitivity of 93.8%. The specificities of the three techniques were comparable and greater than 95%. The availability of reliable rapid diagnostic techniques will allow for better care of infants with severe respiratory syncytial virus infection.

Antigens, Viral↗

Presence of respiratory viruses in middle ear fluids and nasal wash specimens from children with acute otitis media.

During a 28-month period, 84 children with acute otitis media were studied by viral and bacterial cultures of middle ear fluid and viral cultures of nasal lavage fluid. Viruses were isolated from the middle ear fluid of 17 (20%) patients. Evidence of viral infection was demonstrated by positive viral cultures of middle ear fluid and/or nasal lavage fluid in 33 (39%) patients. Rhinovirus in one patient and influenza b virus in another were the only pathogens isolated. Influenza virus, enterovirus, and rhinovirus were the most common viruses found in middle ear fluids. Parainfluenza virus, adenovirus, and respiratory syncytial virus were found less often. In 82% of cases, the virus isolated from middle ear fluid was also isolated from nasal lavage fluid, but only 44% of viruses found in nasal lavage fluid were also found in middle ear fluid. Mixed bacterial and combined viral-bacterial infections were common. Only 15% of patients had no pathogen isolated from middle ear fluids. Using tissue culture techniques, we demonstrated that enterovirus and rhinovirus are also common middle ear pathogens. Our data reemphasize the significance of viruses as etiologic agents of acute otitis media and propose several questions regarding the viral-bacterial interactions and the types of viruses involved in the pathogenesis of the disease.

Acute Disease↗

Once-daily ceftriaxone therapy for serious bacterial infections in children.

Ceftriaxone administered as a single daily dose of 50 mg/kg was evaluated in the treatment of 35 children with a variety of nonmeningitic bacterial infections. In two of the patients, the drug was discontinued before the response to the drug could be evaluated. All of the remaining patients had a satisfactory response. In 22 of the patients, plasma was available for the determination of ceftriaxone levels 1 h after a dose and immediately before the next dose. All but one of these patients had trough ceftriaxone levels which exceeded the MIC of the infecting organism, although marginally so for Staphylococcus aureus. Ceftriaxone appears to be safe and effective in the treatment of a variety of bacterial pathogens in children when administered at a single daily dose of 50 mg/kg. This drug may be especially useful in those patients in whom outpatient antibiotic therapy is contemplated or in whom maintenance of intravenous access is difficult.

Adolescent↗

Twice daily ceftriaxone therapy for serious bacterial infections in children.

The clinical efficacy and safety of ceftriaxone, a long half-life cephalosporin were evaluated in 48 children with a variety of serious bacterial infections. Clinical cure was achieved in 92% (44 of 48) of patients. Peak serum bactericidal titres for Haemophilus influenzae type b, Streptococcus pneumoniae, Str. pyogenes and Escherichia coli were greater than or equal to 1:1024. Mean peak and trough ceftriaxone levels were 173 and 42 mg/l, respectively. Mild and transient diarrhoea was observed in 10% of patients. Laboratory side effects encountered were eosinophilia, thrombocytosis and neutropenia in another 8%. Ceftriaxone is a useful antibiotic for common childhood infections. Its prolonged half-life allows twice daily administration which reduces problems related to intravenous therapy as well as the cost and personnel time.

Adolescent↗

Five-year surveillance of aminoglycoside usage in a university hospital.

Because an increased incidence of nosocomial bacteremia due to gentamicin-resistant organisms occurred in our hospital, amikacin was substituted for gentamicin as the primary empiric aminoglycoside. Prospective surveillance of aminoglycoside use and of bacterial resistance to aminoglycosides was done before and after the substitution. We compared the baseline period when gentamicin was the primary aminoglycoside with the subsequent period when amikacin accounted for 81% of aminoglycoside used. During the two periods the patient population did not differ with regard to indications for aminoglycoside therapy. Among the gram-negative organisms isolated, rates of amikacin resistance during the baseline (1.1%) and usage (1.05%) periods were not significantly different (p greater than 0.6). Resistance to gentamicin and tobramycin during the period of amikacin use showed a statistically significant decrease (p greater than 0.001) due to decreased resistance to gentamicin of Providencia, Serratia, indole-positive Proteus, and decreased resistance to tobramycin of Pseudomonas aeruginosa. Unrestricted use of amikacin does not necessarily lead to increase in amikacin resistance but may lead to a decrease in resistance to gentamicin and tobramycin among gram-negative organisms.

Amikacin↗

Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962-1980.

Between 1962 and 1980, 50 children admitted to Strong Memorial Hospital had a pleural effusion or an empyema associated with pneumonia. Such parapneumonic effusion and empyema accounted for 52 per cent of cases of pleural effusion and empyema of all etiologies admitted during those years. Review of cases of parapneumonic effusion and empyema suggested that clinical manifestations, laboratory, and roentgenographic findings did not separate these two groups of patients before thoracentesis was performed. Specific organisms were identified in 29 per cent of cases with parapneumonic effusion and 62 per cent with parapneumonic empyema. Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes were responsible for 35, 30, and 20 per cent of cases, respectively. Parapneumonic effusions were treated without closed-chest tube drainage in 76 per cent of the cases, while closed-chest drainage was necessary in virtually all cases of children with empyema.

Adolescent↗

The clinical relevance of 'CSF viral culture'. A two-year experience with aseptic meningitis in Rochester, NY.

The clinical relevance of CSF viral cultures was evaluated by reviewing the records of 390 patients whose CSF was cultured for virus during a two-year period. The diagnoses at hospital discharge were aseptic meningitis, meningoencephalitis, or both in 111 patients, and enterovirus was isolated from the CSF or other test specimens in 46 patients (41%). The diagnosis or management of nearly one half of the patients from whom enterovirus was isolated was directly influenced by this information. Hospitalization and the unnecessary use of antibiotics were shortened by at least 70 days. Enterovirus was the only virus isolated from the CSF during the study period. The CSF was more likely positive for an enterovirus if it was drawn from a young patient with aseptic meningitis during the summer of fall months. The clinical data obtained from this study are discussed and compared with national statistics.

Adolescent↗

Incidence of rotavirus infection in different age groups of pediatric patients with gastroenteritis.

An enzyme immunoassay was used to detect rotavirus in the stools of 176 pediatric patients presenting with gastroenteritis. The highest incidence of rotavirus infection was found among patients less than 1 year of age. In contrast to previously reported studies, 23% of neonates with gastroenteritis had rotavirus in their stools. This relatively easy and rapid method was helpful in the management of pediatric patients with gastroenteritis.

Adolescent↗

Ring 4 chromosome with terminal p and q deletions.

A ring 4 chromosome was found in a boy with low birth weight, microcephaly, micrognathia, rounded broad nose, malformed ears, cleft soft palate, and retardation in growth and development. The ring 4 is formed by union of the ends after breakage and loss of the terminal parts of the short (p) arm and the long (q) arm. G-banded chromosome studies showed our patient to have a union at p16q35. Clinical findings in our patient were compared with those in others with the union at p16q35, p15q35, and p16q33. The patients with p15q35 had a deletion of more p-arm genetic material than those with the p16q35 union, and the patient with p16q33 had a greater loss of q-arm material. The loss of only a small part of the p16 band is associated with low birth weight, microcephaly, and retardation in growth and development.

Abnormalities, Multiple↗

Interferon production by human mononuclear leukocytes: differences between respiratory syncytial virus and influenza viruses.

The ability of respiratory syncytial virus (RSV) to induce interferon production by human mononuclear leukocytes was compared with that of influenza viruses. Cell culture fluids were assayed for interferon activity 1, 3 and 7 days after exposure to RSV or to one of two subtypes of influenza A virus (H0N1 and H3N2). RSV induced interferon production inconsistently and in low titers. Varying the multiplicity of infection did not improve the ability of RSV to induce interferon production. In contrast, influenza viruses were effective inducers of interferon production. Seropositivity to the influenza virus strains was not associated with increased interferon titers. Interferon produced after exposure to RSV or to the influenza viruses was resistant to low pH treatment. The data suggest that interferon production may not be a major component of human immunological defense against RSV infection.

Adult↗

Enterovirus 71 infection: report of an outbreak with two cases of paralysis and a review of the literature.

Enterovirus 71 (E-71) infection was first reported in 19745 in the United States; subsequent outbreaks were reported in worldwide distribution. In the summer of 1977, we identified 12 patients, mostly children, with E-71 infection. The striking feature of this outbreak is the occurrence of two cases with polio-like paralytic disease. Other diseases associated with E-71 included aseptic meningitis, meningoencephalitis, respiratory disease, gastroenteritis, and hand-foot-mouth disease. The spectrum of illness observed in our community was compared to that seen in other outbreaks. It is suggested that the significance of E-71 lies in its neuropathogenic potential.

Adolescent↗

Bacteria and viruses induce production of interferon in the cerebrospinal fluid of children with acute meningitis: a study of 57 cases and review.

The CSF of 57 infants and children with bacterial or enterovirus meningitis was analyzed for the presence of interferon (IFN). CSF was collected when the diagnosis of meningitis was made; a bacterium or enterovirus was isolated in all cases. IFN was detectable in CSF in 24% of cases of bacterial meningitis and in 75% of cases of viral meningitis. Titers of IFN were generally lower in cases of bacterial meningitis. Neither the presence of IFN nor the level of IFN titers correlated with the patient's age or number of white blood cells or mononuclear cells in the CSF. Coxsackievirus induced production of IFN more consistently and in higher titers than did echovirus. None of 35 control patients had detectable IFN in CSF. A literature review and our data indicate that the presence of IFN in CSF suggests infection of the CNS but does not differentiate bacterial from viral infection. The finding of IFN in the CSF of children with bacterial meningitis supports evidence that bacteria and other nonviral microorganisms induce IFN production. The protective role of IFN in nonviral infections deserves further investigation.

Acute Disease↗

Staphylococcal protein A in the serologic diagnosis of congenital rubella and toxoplasmosis.

Staphylococcal protein A (SPA) has been used to remove maternal IgG from cord or neonatal sera to make serologic testing for congenital infection more IgM specific. To evaluate the clinical usefulness of this procedure, sera sent for TORCH titers that had rubella hemagglutination inhibition (RHI) reciprocal titers greater than or equal to 8 or toxoplasmosis indirect fluorescent antibody (TFA) titers greater than or equal to 16 were adsorbed with SPA and retested. Nine of 109 sera were TFA positive by routine testing, and all but one from an infant with congenital toxoplasmosis became negative after SPA adsorption. A repeat TFA at 4 to 26 months of age was negative in all six children without evidence of toxoplasmosis who returned for follow-up. Fifty of 55 sera were RHI positive by routine testing, and all but one from an infant with congenital rubella became negative after SPA adsorption. The repeat routine RHI was negative in 32 of 35 children whose sera were initially negative after SPA adsorption. SPA adsorption greatly increased the specificity of routine RHI and TFA tests in the diagnosis of congenital rubella and toxoplasmosis.

Female↗