Chemoprophylaxis of bacterial meningitis.
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Anti-Bacterial Agents↗
Biomedical subjects
U B Schaad
Publications and source records attributed to U B Schaad.
Chronic granulomatous disease: uptake and intracellular activity of fosfomycin in granulocytes.
In chronic granulomatous disease (CGD) polymorphonuclear leukocytes (PMN) are unable to kill phagocytized catalase-positive bacteria. Therefore, patients with CGD are prone to infections and dependent on antimicrobial agents able to penetrate PMN membranes and to act intracellularly. Owing to their good lipid solubility, trimethoprim/sulfamethoxazole and rifampicin passively diffuse the membrane. In contrast, fosfomycin is transported actively into the cell. In normal PMN, it reaches cellular-to-extracellular ratios of 1.83 after 15 min, in CGD-PMN 2.18 after 30 min. At concentrations between 16 and 200 mg/liter, fosfomycin was able to kill staphylococci surviving within CGD-PMN, thus compensating for the bactericidal deficiency in CGD. A combination of low concentrations of fosfomycin (8 mg/liter) plus rifampicin (0.06 mg/liter) was more effective at the intracellular level than either agent alone. Apart from a stimulation of PMN-chemiluminescence of yet unknown significance, the agent did not interfere with other neutrophil functions. Clinical investigations are indicated to study whether fosfomycin can be added to the small number of antibiotics useful in CGD.
Adolescent↗
Acquired immunodeficiency syndrome (AIDS) in pediatric patients. Case report and review.
The first pediatric case of acquired immunodeficiency syndrome (AIDS) observed in Switzerland is described. The 3-year-old African/Swiss patient was most probably vertically infected from her asymptomatic, HTLV-III antibody positive Zairian mother. Clinical symptomatology started at 14 months of age, and diagnosis was made at 22 months when medical care and comprehensive investigation were initiated at this clinic. Review of the literature revealed 125 pediatric patients with AIDS. Based on these data, relevant and practically orientated information is given concerning definition, epidemiology, clinical presentation, laboratory findings, management, and prognosis of this newly recognized entity.
Acquired Immunodeficiency Syndrome↗
[Possibilities and limits in the detection of nosocomial rotavirus infections].
During an epidemiological survey on rotavirus gastroenteritis in the area of Berne (Switzerland) different virus types were analyzed according to their genome segment pattern. Nosocomial rotavirus infections among pediatric patients were carefully investigated. Possible limitations of such studies are discussed in details.
Child↗
[Brainstem encephalitis and vesicular exanthema caused by Mycoplasma pneumoniae].
Serologically proven Mycoplasma pneumonitis followed by vesicular mucocutaneous eruptions and aseptic brainstem encephalitis was observed in a 4-year-old boy. Both neurological and dermatological symptoms occurred approximately 2 weeks after the onset of pneumonia. The patient was treated with tetracyclines, corticosteroids and general supportive care and recovered completely over several months. An etiological relationship between mycoplasmal infection and neurological and dermatological symptoms, as already described in the literature, is postulated. A viral etiology was excluded by appropriate serological and cultural investigations.
Brain Stem↗
[Tick-borne meningoradiculitis--a form of spirochetosis].
Three pediatric cases of tick-borne meningoradiculitis are presented. This disease is characterized by a distinct sequence of symptoms: erythema chronicum migrans, localized pain, and eventually radicular asymmetric neurologic involvement (in particular facial palsy) associated with findings of aseptic meningitis. On the basis of specific serologic data in these three patients, it is suggested that the etiology of tick-borne meningoradiculitis is also spirochetal , as recently shown for the tick-associated Lyme disease. Analogue positive spirochetal antibody titers were found in additional patients with erythema chronicum migrans and in a child with B afverstedt cutaneous lymphadenosis (see addendum). 20% of tick specimens collected in the area of Lucerne (Ixodes ricinus) were infected by these spirochetes.
Adolescent↗
The cephalosporin compounds in severe neonatal infection.
The new cephalosporin compounds have increased in vitro activity against gram-negative enteric bacilli and penetrate well into cerebrospinal fluid. Moreover, their pharmacokinetic properties are favorable and their safety seems adequate, although insufficiently evaluated to date. Interest has been focused on them as therapeutic agents for neonatal sepsis and meningitis caused by Enterobacteriaceae. In this review the third generation cephalosporins are evaluated for their possible use in the neonates; opinions are based on currently available data. It is concluded that moxalactam and cefotaxime and probably also ceftriaxone and ceftazidime represent valuable alternatives to aminoglycosides for therapy of severe neonatal infection.
Cefotaxime↗
Chemoprophylaxis for the prevention of bacterial meningitis.
Close contacts of index patients with Neisseria meningitidis or Haemophilus influenzae type b meningitis show higher nasopharyngeal carriage rates and are at an increased risk of contracting the disease. The key issue in the management of such contacts remains close and careful surveillance, because prophylaxis will never result in the absolute prevention of secondary cases. Adequate chemoprophylaxis with rifampin eradicates nasopharyngeal colonization in more than 90% and may prevent both co-primary and secondary diseases. Routine chemoprophylaxis for close contacts of systemic meningococcal diseases is recommended. However, there are several factors inherent in rifampin prophylaxis for the prevention of H. influenzae type b meningitis which exclude its use as a routine measure.
Adolescent↗
Granulocyte neutral proteases and Pseudomonas elastase as possible causes of airway damage in patients with cystic fibrosis.
We studied the possible role of granulocyte neutral proteases as mediators of airway destruction in patients with cystic fibrosis (CF) who were infected with Pseudomonas aeruginosa. We measured the enzymatic activities of bronchial secretions on purified radioactively labeled complement component three (C3), elastin, and a granulocyte elastase-specific substrate. Bronchial secretions from 18 patients with CF who were infected with P aeruginosa had a significantly higher mean value for C3 cleaving, elastolytic, and granulocyte elastase-like activity than did two control groups. High enzymatic activities were observed in patients with CF who have advanced bronchial disease (that had been determined by a clinical scoring system). Kinetics of proteolysis of radioactively labeled C3 and inhibition profiles of the activities of the three enzymatic activities studied suggest that they are mainly derived from granulocytes. In addition, 20 of 31 strains of P aeruginosa isolated from patients with CF inactivated purified alpha 1-antiprotease in vitro. We postulate that granulocyte neutral proteases and P aeruginosa may act synergistically in the airways of patients with CF and may contribute to the destruction of elastin and inactivation of C3.
Adolescent↗
[Antibiotic therapy of bacterial meningitis].
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Adult↗
[Prospective comparison of miconazole gel and nystatin suspension in the treatment of oral candidiasis].
Miconazole gel and nystatin suspension were compared in a prospective randomised therapeutic trial including 51 cases of oral candidiasis in hospitalised pediatric patients. Clinical evaluations, microscopic examinations and adequate cultures were the basis for diagnosis and follow-up over 3-4 weeks. Miconazole oral gel therapy resulted in an optimal cure rate of 100% and in a relapse rate of only 4%, whereas for nystatin suspension these values were 75% and 22% respectively. However, apart from producing a better effect compared to nystatin suspension, miconazole gel also involved a higher rate of minor gastrointestinal side effects and worse acceptance. Older children often tolerated poorly the sweet taste of miconazole gel. It is recommended that the gel form of the potent antimycotic agent miconazole be mainly used in infants and young children.
Adolescent↗
[Meningitis and sepsis in the newborn age: therapy concepts and antibiotic therapy].
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Animals↗
[Phenylhydrargyrum boricum in glycerin (Glycero-Merfen) in young children: undesirable mercury resorption in mouth mucosa even when free of lesions].
The formulation of phenylhydrargyrum boricum in glycerine (Glycero-Merfen) being frequently used in infants and young children, attention is drawn to the potentially symptomatic mercury absorption associated with its topical administration in that age group. This finding applies to both inflamed and normal oral mucosa. The use of this drug formulation in pediatric patients should be avoided.
Absorption↗
Which number of infecting bacteria is of clinical relevance?
The infective dose is the number of microorganisms required to produce infection in man. This value varies according to the mode of transmission, the virulence of the infecting agent and the host defense. The individual infective dose bears important implications with regard to epidemiology, prevention and therapy of the given infection. Theoretical remarks and relevant data from the literature are presented to help in the assessment of this basic problem in bacterial infectious diseases.
Adult↗
Reversibility of lung function abnormalities in children with perennial asthma.
Extrinsic perennial bronchial asthma was studied by whole-body plethysmography in 118 patients to evaluate the degree and character of functional abnormalities during the asymptomatic "interval phase" of the disease. Study patients were divided into three functional subgroups, and the efficacy of albuterol (salbutamol), a beta-2-sympathomimetic drug, on bronchial obstruction of hyperinflation was analyzed. Response to medication was best in the group with predominant bronchial obstruction without hyperinflation. In contrast, patients with hyperinflation in the presence or absence of bronchial obstruction had only partial reversibility of their pathophysiologic alterations. Hyperinflation usually causes only minor clinical symptoms but tends to develop into irreversible lung damage in the form of "loss of elastic recoil." We suggest that early diagnosis and strict medical management in patients with hyperinflation are mandatory.
Adolescent↗
Single-dose pharmacokinetics of intravenous clavulanic acid with amoxicillin in pediatric patients.
Pharmacokinetics of a parenteral formulation comprised of 5 parts of amoxicillin and 1 part of clavulanic acid were determined in 12 pediatric patients, 2 to 14 years of age. A single dose amounting to 25 mg of amoxicillin and 5 mg of clavulanic acid per kg of body weight was infused intravenously over 2 min. Mean plasma concentrations 5 min after dosing were 89.4 micrograms of amoxicillin per ml and 19.5 micrograms of clavulanic acid per ml. Terminal phase plasma half-lives were 1.2 and 0.8 h, respectively. The data acquired in this study indicate that amoxicillin and clavulanic acid are pharmacokinetically compatible. Moreover, taken with assessment of microbiological activities by others, the present data suggest that intravenous administration of 25 mg of amoxicillin plus 5 mg of clavulanic acid per kg every 6 h is a reasonable starting regimen for assessing the activity of the combined drug formulation in noninvasive childhood diseases caused by Haemophilus influenzae, Staphylococcus aureus, Streptococci spp., Neisseria spp., Branhamella catarrhalis, and other susceptible organisms.
Adolescent↗
[Infectious diarrhea in childhood].
The present review summarizes the actual knowledge of infectious diarrhea in the pediatric age group. Main emphasis is placed on discussion of pathogenesis, etiology and therapy. Own data on etiology and clinical presentation of diarrhea in hospitalized children, so far not available from Switzerland, are presented and compared with results from other centres.
Age Factors↗
[Vaccination reactions and complications].
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Adolescent↗