Outbreaks of drug-resistant tuberculosis at AIDS centre.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
T Cleary
Publications and source records attributed to T Cleary.
The antimicrobial susceptibility patterns of the Bacteroides fragilis group in the United States, 1987.
A nationwide survey to monitor the susceptibility of the Bacteroides fragilis group, which began in 1981, was continued during 1987. In addition to the eleven drugs evaluated in 1986, sulbactam, a potent beta-lactamase inhibitor, was tested alone and in combination with ampicillin and cefoperazone. Imipenem, ampicillin/sulbactam, cefoperazone/sulbactam, and ticarcillin/clavulanic acid were the most active newer drugs tested, with less than 1% resistance rates. Chloramphenicol, metronidazole and clindamycin also had excellent activity with resistance rates of 0%, 0%, and 3% respectively. Resistance rates to cefoxitin remained stable at 8%. Ceftizoxime and cefotetan had resistance rates of 26% and 29%, respectively. Rates of resistance varied among different institutions and between the various species.
Anti-Bacterial Agents↗
Comparative activities of newer beta-lactam agents against members of the Bacteroides fragilis group.
A nationwide susceptibility survey of 557 isolates of the Bacteroides fragilis group was continued in 1986. The most active beta-lactam drugs were imipenem and ticarcillin-clavulanic acid, which had 0.2 and 1.7% resistance, respectively. The rank order of activity of beta-lactam drugs was imipenem, ticarcillin-clavulanic acid, cefoxitin, piperacillin, moxalactam, ceftizoxime, cefotetan, cefotaxime, cefoperazone, and ceftazadime.
Anti-Bacterial Agents↗
Detection of Epstein-Barr virus genomes in normal human lacrimal glands.
Epstein-Barr virus (EBV) has been implicated in several ocular diseases; however, detection of the EBV genome in ocular tissues has not been documented. We report the detection of amplified EBV genomic sequences in 11 of 26 normal lacrimal gland DNA samples by using the polymerase chain reaction. Serum was available for 19 of the lacrimal gland donors. All 19 were EBV seropositive, although of the 19 lacrimal gland-seropositive patients, EBV sequences were detected in only 10 of the samples. Further, amplified EBV sequences were not detected in circulating lymphocyte DNA from normal seropositive volunteers, most likely because of the low frequency of circulating EBV-infected B cells. Amplification of EBV from cadaver lacrimal gland DNA was possible with minute quantities of DNA, whereas peripheral blood mononuclear cell DNA from normal volunteers did not amplify EBV sequences. Interestingly, the peripheral blood mononuclear cell polymerase chain reactions contained approximately 100 times more DNA than the lacrimal gland polymerase chain reactions. We conclude that the lacrimal gland may be a site for EBV persistence and that positive EBV serology is not an indicator of which individuals may have EBV harbored within their lacrimal glands.
Base Sequence↗
Detection of herpes viral genomes in normal and diseased corneal epithelium.
Herpetic ocular disease is one of the major causes of corneal blindness. Clinical diagnosis of corneal disease is based principally on corneal appearance. However, abnormal morphology of the corneal epithelium (CE) is not an indicator for the presence of a herpes virus. Further, it has not been established if herpes viruses are present in normal corneal epithelial tissue. In these studies, the polymerase chain reaction was used to evaluate normal and diseased corneal epithelium for the presence of herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) genomic sequences. Thirty-two normal corneal epithelium specimens obtained from cadavers shortly after death were analyzed for HSV-1, EBV and CMV genomic sequences. Three of the 32 normal CE specimens were positive for amplified EBV DNA, 1 was positive for HSV-1 DNA, and none was positive for CMV DNA. We also tested eight herpetic dendritic lesions of which 3 were HSV-1 culture and PCR positive. The remaining five dendritic lesions were HSV-1 culture and PCR negative. Since these lesions were not evaluated for other herpesviruses, the etiology of these dendritic lesions is unknown. Six corneal epithelium samples from HIV-infected donors were negative for EBV, CMV and HSV-1 amplified sequences. Positive EBV, CMV and HSV-1 serology on all normal donors and on donors with clinically apparent disease did not correlate with positive PCR results. The results of these studies suggest that EBV and HSV-1 DNA can be amplified from a small percentage of apparently normal corneal epithelium.
Adult↗
Susceptibility of the Bacteroides fragilis group in the United States: analysis by site of isolation.
An ongoing survey of the susceptibility of the Bacteroides fragilis group of bacteria was continued at New England Medical Center in 1984 and 1985. A total of 1,229 strains were obtained from eight centers in the United States. These results were compared with those for 1,847 isolates tested in 1981 through 1983. The most active beta-lactam drugs were imipenem and ticarcillin-clavulanic acid (Timentin), which had a less than 1% resistance rate. No metronidazole- or chloramphenicol-resistant isolates were found during the 5 years of the study. Isolates obtained from blood, perinatal, and bone sites of infection were more resistant to a variety of antimicrobial agents. Susceptibility patterns of the members of the B. fragilis group varied at the eight hospitals and among species. These data indicate the need for determining the susceptibility patterns for the B. fragilis group of organisms at each hospital.
Anti-Bacterial Agents↗
Tuberculosis and nontuberculous mycobacteriosis in patients with AIDS.
Thirty-six patients with AIDS and culture-proven nontuberculous mycobacteriosis were compared to 20 patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis with regard to clinical signs, symptoms, and diagnostic methods. Patients with nontuberculous mycobacteriosis were more often younger and homosexuals, while patients with tuberculosis were usually Haitian-American or users of intravenous drugs. A majority of patients with tuberculosis presented with fever and weight loss. These symptoms were seen in approximately 50 percent of the patients with nontuberculous mycobacteriosis. A distinct syndrome of dyspnea, chills, hemoptysis, and chest pain was seen in a significant minority of patients with nontuberculous mycobacteriosis. Lymphadenopathy was seen almost exclusively in patients with tuberculosis. Pulmonary sources (expectorated sputum or bronchoscopy specimens) were the most common source of diagnosis in both groups. Patients in both groups in whom the diagnosis was obtained from pulmonary sources frequently had negative chest x-ray films on presentation. Cavitary disease was absent from both groups.
Acquired Immunodeficiency Syndrome↗
Nationwide study of the susceptibility of the Bacteroides fragilis group in the United States.
A nationwide susceptibility survey of the Bacteroides fragilis group was continued at New England Medical Center in 1983. A total of 555 strains were obtained from eight centers in the United States. In addition to the nine antimicrobial agents studied in the two previous years, three other agents were added to the evaluation: cefamandole, cefuroxime, and cefonicid. The results for the strains tested with the original nine drugs in 1983 were compared with those for 1,292 isolates tested in 1981 and 1982. The most active beta-lactam drug was piperacillin, which had an 8% resistance rate. Cefoxitin resistance increased from 10% in 1982 to 16% in 1983. High rates of resistance to cefotaxime, cefoperazone, cefamandole, cefonicid, and cefuroxime were encountered. No metronidazole- or chloramphenicol-resistant isolates were found during the 3 years of the study. Susceptibility patterns varied at the eight hospitals: the outbreak of cefoxitin resistance reported in 1982 at New England Medical Center remitted, while a high clindamycin resistance rate was documented at one hospital in 1983. These data indicate the need for determining the susceptibility patterns for the B. fragilis group of organisms at each hospital.
Anti-Bacterial Agents↗
Serratia marcescens contaminated disinfectants.
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Disinfectants↗
Multiple-dose amikacin kinetics in pediatric oncology patients.
Amikacin kinetics was studied in 8 pediatric oncology patients who received the drug by intravenous infusion over 30 or 60 min at a dose of 5 mg/kg every 6 or 8 hr. This regimen is recommended but, due to patient variability, patients should be monitored. Dosing intervals during 1 or 2 and 3 or 4 days of therapy were studied with serum samples collected before and at the end of the infusion and serially to the end of the dosing interval. The data appeared consistent with and were analyzed according to 1-compartment model. An equation describing serum concentration with time for the multiple-dose case was fit to each patient's multiple-interval data with nonlinear regression. Half-life averaged 1.2 hr. volume of distribution 0.24 l/kg, and total body clearance 109 ml/min/1.73 m2 or 2.51 ml/min/kg. The volume of distribution and the clearance are greater than reported for adults and probably account for the larger dose needed to achieve and maintain therapeutic levels. Although the total daily dose was greater than previously reported, there were no signs of toxicity, although therapuetic concentrations were maintained.
Adolescent↗
Enzyme immunoassay of hepatitis associated antigen (HAA).
Due to its high sensitivity, radioimmunoassay has become of great importance in the detection and measurement of levels of proteins and steroids in body fluids. However, this method involves the use of expensive equipment and radioactive material. Herein is described an alternate method to radioimmunoassay, which uses an enzyme-labeled rather than a radioactively-labeled antibody. An enzyme immunoassay procedure, the Cordia HAA-enzyme Immunoassay, for the detection of hepatitis-associated antigen has been evaluated. With this technique a sandwich type immunoassay with an alkaline phosphatase tagged second antibody is used. The presence of antigen is detected by the p-nitrophenyl phosphotase activity of the bound enzyme. In 1083 clinical samples from patients of Jackson Memorial Hospital, only 19 discrepant results were found when tested by both the Cordia and the Ausria II methods. Eight had sufficient sera for retesting, yielding two positive Cordia, negative Austia; one negative Cordia, positive Ausria; one borderline positive; and four unconfirmed false positives by Cordia.
Animals↗
Mycoplasma hominis septic thrombophlebitis in a patient with multiple trauma: a case report and literature review.
Mycoplasma hominis was recovered from the site of a septic thrombophlebitis on the left cephalic veins of a patient with pelvic and other multiple trauma. The organisms were initially isolated from routine cultures in conventional blood agar media incubated anaerobically. The absence of other demonstrable pathogens and the patient's serologic response to the isolate support the role of the organism as the cause of this previously unreported mycoplasmal infection. M. hominis should be considered a possible cause of sepsis in selected cases of infections following pelvic trauma or manipulations of the genitourinary tract.
Adult↗
Evaluation of a mannitol-salt-oxacillin-tellurite medium for the isolation of methicillin-resistant Staphylococcus aureus from contaminated sources.
A mannitol-salt medium supplemented with 0.002% tellurite (MSOT) supported the growth of 104 of 109 strains of methicillin-resistant Staphylococcus aureus (MRSA) while suppressing 74 of 102 strains of mannitol-positive, methicillin-resistant coagulase-negative staphylococci. MSOT was equally or more sensitive and more differential than a similar formulation without tellurite for the isolation of MRSA from the skin and nares of hospitalized patients. Only S. haemolyticus produced dark gray-to-black colonies on MSOT similar to those of MRSA. MSOT is a useful adjunct to other nonselective culture formulations for the isolation of MRSA from contaminated sources.
Axilla↗