PubMed Health⌕ Search

Biomedical subjects

W A Altemeier

Publications and source records attributed to W A Altemeier.

At least 145 records · Page 8Linked to original sources
PubMed1981

Management of febrile outpatient neonates.

To determine whether all febrile outpatients below the age of two months should be routinely hospitalized and given parenteral antibiotics because of the possibility of occult sepsis or meningitis, 147 such admissions were reviewed over four years. None of the neonates had occult bacterial meningitis, while one may have had occult sepsis. Because serious infections may have been missed in outpatients not hospitalized, the outcome of all such illnesses seen in the clinic during a subsequent six months was monitored; none of 17 hospitalized or 20 followed as outpatients experienced sepsis or meningitis. If our findings are confirmed in other studies, febrile outpatient neonates with a well appearance, normal cerebrospinal fluid and physical examination, and dependable follow-up may not require universal hospitalization and antibiotics.

Ambulatory Care↗
PubMed1981

Studies of the staphylococcal causation of toxic shock syndrome.

The data presented in this study indicate that the Staphylococcus aureus is related casually to the toxic shock syndrome and that the dominant phage type was 29. This type has occurred singly as well as in combination with phage type 52 and some other group I phage types. The 29, 52 complex was present in approximately two-thirds of a series of 159 isolates of Staphylococcus aureus obtained from patients with toxic shock syndrome, while another fourth was nontypable. In further support of this concept was the evidence that 94.1 per cent of the isolates of the 29, 52 phage complex tested were capable of producing pyrogenic exotoxin C. These results gave confirmatory evidence of the etiologic importance of this phage type complex of Staphylococcus aureus. The high percentage of 25.8 per cent nontypable isolated has remained unexplained, and this is suggestive of the possibility that another important phage type may be present but obscure, since 83 per cent were shown to be capable of producing pyrogenic C toxin. The data reported also indicated that the current activity of this phage type is another manifestation of the versatility of Staphylococcus aureus and its ability to produce different pathogenic strains capable of causing different or new infections in clinical practice.

Anti-Bacterial Agents↗
PubMed1980

Complement, opsonins, and the immune response to bacterial infection in burned patients.

Studies were performed to evaluate complement, opsonins, and the immune response to bacterial infection in burned patients. Concentrations and functional acitivities of components of the classical and alternative complement pathways were measured in the sera of four septic, two bacteremic, and four nonseptic burned patients. In addition, heat-labile and heat-stable opsonic activity and agglutinin titers directed against the infecting bacterial strains were measured in the sera of the four septic patients and in an additional group of 11 septic burned patients with abnormal complement profiles. Functional activity of the alternative complement pathway and the concentration of properdin were shown to be persistently decreased during eight weeks postburn in the septic, bacteremic, and nonseptic burned patients; reduced classical pathway activity was demonstrated during the initial postburn period only in the septic patients. Two of the 15 septic patients had decreased heat-labile serum opsonic activity for their infecting bacterial strains, which occurred only during the initial postburn period. Heat-stable opsonins and agglutinin titers in the patients' sera directed against the infecting bacterial strains were equivalent to those in normal human sera, except for the agglutinin titers to Streptococcus faecalis which were increased in the patients' sera in comparison to the normal sera. These results indicate that the multiple complement abnormalities which occur in septic burned patients do not predispose these patients to bacterial infection by decreasing serum opsonic activity. Moreover, heat-stable immune IgG antibodies are not produced during septicemia which facilitate opsonization of the infecting bacterial strains in the absence of an intact complement system.

Adolescent↗
PubMed1980

Reduced incidence of parenting inadequacy following rooming-in.

Low-income mother-infant pairs were randomly assigned to rooming-in (N = 143) or to routine (N = 158) postpartum contact to determine whether rooming-in affects subsequent adequacy in parenting. At mean age 17 months, two rooming-in and ten control children had experienced inadequate parenting. One rooming-in and eight control children were hospitalized for these problems. One rooming-in and five control families were reported to Protective Services for mistreatment of the study child; five control and no rooming-in children were in the care of adults other than their parents at the time of data analysis. In this study, rooming-in correlated with fewer subsequent cases of parenting inadequacy.

Adolescent↗
PubMed1979

Fluorescent antibody test kit for rapid detection and identification of members of the Bacteroides fragilis and Bacteroides melaninogenicus groups in clinical specimens.

The Fluoretec fluorescent antibody test kit (Pfizer Inc., New York, N.Y.), developed for the rapid detection of members of the Bacteroides fragilis and B. melaninogenicus groups, was evaluated by testing 58 stock cultures and 76 clinical specimens. The test reagents detected 100% of 40 B. fragilis and B. thetaiotaomicron stock culture strains, although only 22% of 18 B. vulgatus, B. distasonis, and B. ovatus strains showed positive fluorescence. The 76 clinical specimens were evaluated by examining fluorescent antibody-stained smears of 49 specimens of purulent material and smears of 27 blood cultures which were positive for gram-negative bacilli by Gram stain or subculture. The fluoretec reagent detected members of the B. fragilis group in 28 (97%) of the 29 specimens of purulent material and all (100%) of the 16 blood cultures in which these anaerobes were demonstrated by culture. Overall, the Fluoretec reagent detected members of B. fragilis group in 44 (98%) of the 45 clinical specimens which were shown by culture to contain these anaerobes. Two of the 76 clinical specimens gave positive fluorescence for members of the B. fragilis group but failed to yield these organisms by culture. Members of the B. melaninogenicus group were detected by culture in 15 specimens and in each case their presence was demonstrated by the Fluoretec reagent. No members of the B. melaninogenicus group were isolated from five clinical specimens that gave positive fluorescence with the B. melaninogenicus reagent.

Anaerobiosis↗
PubMed1979

The septic burned patient: a model for studying the role of complement and immunoglobulins in opsonization of opportunist micro-organisms.

Studies were performed to determine the effects of septicemia on complement levels and activities and opsonic function in septic and nonseptic burned patients. None of the nonseptic burned patients had consumption of classical pathway activity during their clinical course. Patients who did not survive septicemia had consumption of all of the classical complement components (C1-C5) prior to and during their septic episodes. Patients who survived septicemia had multiple patterns of classical complement pathway consumption. In these patients, classical pathway activity was restored to normal following the last positive blood culture. Alternative complement pathway consumption was demonstrated in only one of the septic burned patients, as evidenced by decreased factor B and C3b INA levels and decreased C3 and C5 conversion in sera treated with 10 mM ethylene glycol tetraacetic acid and 10 mM MgCl(2) (MgEGTA) and in untreated sera. In all of the other septic patients and in the nonseptic patients, reduction in C3 and C5 conversion in MgEGTA sera and untreated sera was not associated with decrease in factor B or C3b INA. Reduction in complement levels and activities did not reduce the ability of the patients' sera to promote phagocytosis and intracellular killing of their infecting micro-organisms by normal human peripheral polymorphonuclear leukocytes. The results indicate that measurement of classical pathway activity in burned patients can be used as a diagnostic tool for predicting the severity of septic episodes and for monitoring recovery. In addition, the observation that complement consumption did not reduce the opsonic capacity of the patients' sera for their infecting micro-organisms suggests that current concepts regarding the role of immunoglobulins and complement in opsonization of opportunist micro-organisms require re-evaluation.

Adolescent↗
PubMed1978

The radiological features of Histoplasma pericarditis.

The radiographic features of pericarditis due to Histoplasma capsulatum are described in 5 children. This diagnosis is suggested when enlargement of the cardiac silhouette is associated with pneumonia, parenchymal nodules or adenopathy. These findings are particularly significant if the patient lives or has lived in an area which is endemic for histoplasmosis. While pleural effusion is rare in primary histoplasmosis, it is frequently present in patients with histoplasma pericarditis.

Adolescent↗
PubMed1978

Emergence of clinical isolates of Staphylococcus aureus resistant to gentamicin and correlation of resistance with bacteriophage type.

A total of 623 clinical isolates of Staphylococcus aureus were tested for sensitivity to antibiotics by the disk diffusion method and were bacteriophage typed. The emergence of isolates resistant to gentamicin was noted. Eighteen percent of the isolates from patients on surgical services were resistant to gentamicin; 83% of these resistant strains were phage type 95. Five percent of the isolates from patients on services other than surgical were resistant to gentamicin, and 61% of these gentamicin-resistant strains were phage type 94, 96. Physicians are urged to be aware of the possible emergence of such strains with epidemic potential.

Bacteriophage Typing↗
PubMed1978

Host defense against opportunist microorganisms following trauma. I. Studies to determine the association between changes in humoral components of host defense and septicemia in burned patients.

Total hemolytic complement (CH(50)), conversion of C3 by inulin, and immunochemical levels of Clq, C4, C2, C3, C5, factor B, C3b inactivator (KAF), and properdin were measured in the sera of 15 patients with severe thermal injury during nine weeks postburn. Five of the 15 patients had multiple episodes of septicemia as documented by positive blood cultures and clinical findings. Decrease in CH(50), Clq, C4, C2, C3, and C5 occurred prior to and during septic episodes in these patients. Although conversion of C3 by inulin was often reduced during septic episodes, levels of factor B and KAF were generally normal or elevated. In only one patient did consumption of complement occurring during septicemia decrease the opsonic capacity of the patient's sera for the patient's infecting microorganism, an isolate of E. coli; sera from the same patient opsonized her infecting strain of S. aureus normally. The microorganisms isolated from the other septic patients, which were opsonized normally by the patients' sera despite complement consumption, were also with one exception strains of Staphylococci. In the nonseptic burned patients, decrease in properdin and C3 conversion by inulin, and increase in C3, factor B and KAF were demonstrated as we have previously reported. The results indicate that the classical complement pathway was activated during septicemia in burned patients and that activation of this pathway occurred preferentially due to inhibition of the alternative pathway. In addition, the data show that complement consumption may reduce the opsonic capacity of a patient's sera for certain microorganisms and not for others.

Adolescent↗
PubMed1978

Host defense against opportunist microorganisms following trauma. II. Changes in complement and immunoglobulins in patients with abdominal trauma and in septic patients without trauma.

Total hemolytic complement (CH50), conversion of C3 by inulin and cobra venom factor (CoVF), and immunochemical levels of Clq, C4, C2, C3, C5, factor B, properdin, C3b inactivator (KAF), and immunoglobulins (Igs) G, A, and M were measured in the sera of ten patients with abdominal trauma and ten medical patients with septicemia without trauma. Reduction in C3 conversion by CoVF and decrease in the levels of properdin and KAF were demonstrated in the trauma sera. CH50 and the level of C5 were also decreased. Conversion of C3 by inulin and levels of factor B, Clq, C4, C2, and C3 were found to be normal in the patients' sera. Complement levels and activities were found to be normal in the sera of the septic non-trauma patients. A decrease in serum IgM was observed in both patient groups; levels of IgG and IgA were normal. These results indicated that abnormalities of immunoglobulin and of the alternative and classical complement pathways were associated with nonburn trauma. Moreover, the data suggested that consumption of the classical complement pathway associated with septicemia in the thermally injured patient resulted from synergism between the trauma and infection rather than from septicemia per se.

Abdominal Injuries↗
PubMed1978

Cyclic variations in emerging phage types and antibiotic resistance of Staphylococcus aureus.

Data are presented showing phage types and antibiotic-resistant patterns of Staphylococcus aureus over the last 20 years. The spontaneous emergence of different phage types associated with increases and decreases in antibiotic resistance has been shown to be cyclic in nature with prevalence for 5 to 8 years, followed by spontaneous disappearance. Staphylococci resistant to almost all antibiotics and with specific phage types now are being isolated with increasing frequency and pose a serious and sometimes life-threatening situation in surgical patients.

Anti-Bacterial Agents↗
PubMed1977

Lupus-associated chorea in childhood.

Chorea associated with systemic lupus erythematosus (SLE) has been reported in only 28 patients. The clinical and laboratory features of these cases are reviewed here, along with those of a 7-year-old boy who, we believe, represents the youngest child reported to date. In approximately half of these 29 individuals, most of whom were children, chorea preceded other manifestations of SLE. The age range and clinical characteristics of lupus-associated chorea were not appreciably different from those of Sydenham's chorea and most of the patients in whom chorea developed before other manifestations of SLE were initially assumed to have Sydenham's chorea. Systemic lupus erythematosus should especially be considered if chorea begins in the older child or is associated with a persistently elevated erythrocyte sedimentation rate.

Child↗