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Biomedical subjects

W E Peetermans

Publications and source records attributed to W E Peetermans.

At least 55 records · Page 3Linked to original sources
PubMed1999

Prevention of pneumococcal disease: an update on the Belgian Consensus Report.

An ad hoc working party on pneumococcal vaccine with representatives of the Belgian Society for Infectiology and Clinical Microbiology, the Belgian Society of Pulmonology and Scientific Societies of General Practitioners reviewed new data on the epidemiology of S. pneumoniae infections in Belgium, on the efficacy and the cost-effectiveness of the 23-valent capsular polysaccharide vaccine. We discuss recent data on vaccination with a new conjugate pneumococcal vaccine, shown to be highly effective in children. The Working Group of the Belgian Scientific Societies endorses the recommendations issued by the Hoge Gezondheidsraad in 1993 and described in a consensus report in 1996.

Aged↗
PubMed1999

Foreign body infection: a new rat model for prophylaxis and treatment.

A subcutaneous catheter model in the rat was developed that allowed the study of prevention and treatment strategies for foreign body infection. In contrast to earlier models, the foreign body was inoculated with a low inoculum of Staphylococcus epidermidis just before implantation, thus mimicking intraoperative contamination with skin flora. Reproducible infection of all catheters followed if no prophylaxis was given. However, foreign body infection could be prevented or treated with antibiotics such as teicoplanin, which was marginally effective, and rifampicin, which proved very effective.

Animals↗
PubMed1999

Amplified-fragment length polymorphism analysis versus macro-restriction fragment analysis for molecular typing of Streptococcus pneumoniae isolates.

Forty-eight pneumococci were genotyped by on-line laser fluorescence amplified-fragment length polymorphism (AFLP) and pulsed-field gel electrophoresis (PFGE) analysis of chromosomal restriction fragments. Overall, the data generated by the two methods corresponded well. However, with AFLP, clusters were delineated at a higher similarity level, and isolate differentiation was more pronounced. AFLP and PFGE were equally efficient for assessing intraserotype diversity. We conclude that AFLP is a useful alternative to PFGE.

Algorithms↗
PubMed1999

A probable primary HIV infection associated with acute non-specific myocarditis causing severe dilated cardiomyopathy.

A patient with a probable primary HIV infection and a biopsy proven non-specific myocarditis is reported. The patient developed a severe dilated cardiomyopathy and initially presented with global heartfailure and fever. The left ventricular function partially recovered. One week after discharge the patient was readmitted in a septic shock and died. Current hypotheses concerning the etiology of left ventricular dysfunction in HIV infection are discussed.

Acute Disease↗
PubMed1998

Recurrence of blackwater fever: triggering of relapses by different antimalarials.

Five cases of blackwater fever (BWF) are described, all of whom had a history of recent quinine therapy. In two cases a second haemolytic crisis was induced by halofantrine, in one case also a third. Increasing frequency of this syndrome with its dramatic clinical presentation is to be expected as imported P. falciparum infection, parasite resistance to chloroquine and the use of quinine and other related antimalarials become more frequent.

Adult↗
PubMed1998

A cluster of airport malaria in Belgium in 1995.

In Europe 64 cases of airport malaria have been registered between 1969 and 1996, most of them in France, Switzerland and Belgium. In the summer of 1995 six cases of airport malaria occurred at the International airport of Brussels, Belgium. Of the six patients three were airport employees, three were occasional visitors. One patient died, the diagnosis was made by PCR amplification and DNA sequencing after exhumation. Two different species of Plasmodium were detected, and infections occurred on at least two different floors of the airport. An inquiry revealed that the cabin of airplanes is correctly sprayed, according to WHO recommendations, but that the inside of the hand luggage, the cargo hold, the animal compartment, the wheel bays and container flights remain possible shelters for infected mosquitoes. In a case of fever of unknown origin, airport malaria should be considered in the differential diagnosis, especially during hot summers, and when thrombocytopenia is present. Additional antimosquito measures should be generalised, encompassing highly exposed personnel, container content and handling buildings, animal cages, wheel bays, and the boundary between the sorting and the reception of luggage.

Adult↗
PubMed1997

Pneumocystis carinii pneumonia. Review of 32 cases in immunocompromised hosts.

The records of patients in whom Pneumocystis carinii pneumonia (PCP) was diagnosed between January 1989 and December 1991 were reviewed. Thirty-two patients--all immunocompromised--were included in the study: 41% were HIV-positive and 59% HIV-negative. In 23 patients (72%) concomitant pathogens were isolated, most frequently Cytomegalovirus. Presenting symptoms included fever (97%), cough (75%) and dyspnea (63%). All HIV-infected patients had a T4-lymphocyte count below 200/mm3 (or 20%). The majority of patients (80%) treated with trimethoprim-sulfamethoxazole experienced adverse events which were usually well tolerated so that a therapy change was necessary in only 12% of patients. PCP was fatal in 34% of the patients. Respiratory failure requiring mechanical ventilation carries a poor prognosis. The ratio of non-AIDS/AIDS patients infected with PC is increasing. This increase is due to the growing contribution of patients treated with immunosuppressive agents and patients with disease-associated immunodeficiencies other than AIDS. Our study suggests that treatment of PCP is more successful with early diagnosis. In addition, as mortality rate is high in non-AIDS patients, our data suggest that the more frequent use of PCP prophylaxis in patients given immunosuppressive drugs, might reduce the incidence of PCP and PCP related mortality.

AIDS-Related Opportunistic Infections↗
PubMed1997

Polyclonal staphylococcus endocarditis.

Coagulase-negative staphylococcus (CNS) is the most frequent cause of nosocomial bacteremia and prosthetic valve endocarditis. CNS bacteremia can be polyclonal. No data exist on the clonality of CNS causing endocarditis. We present a case of CNS aortic homograft endocarditis in which at least five different genotypes of CNS were identified in initial blood-culture isolates by genomic macrorestriction enzyme analysis and pulsed field gel electrophoresis. Since the polyclonality was accompanied by differences in antibiotic susceptibility, this observation may have important consequences for the treatment of CNS endocarditis. Because of the parallels in the pathogenesis of CNS prosthetic valve endocarditis and CNS infections of a variety of other prosthetic devices, it might also have consequences for CNS prosthetic device infections in general. We suggest that antibiotic susceptibility testing of just one blood-culture isolate may be insufficient.

Coagulase↗
PubMed1997

Clonal analysis and identification of epidemic strains of methicillin-resistant Staphylococcus aureus by antibiotyping and determination of protein A gene and coagulase gene polymorphisms.

Forty-three methicillin-resistant Staphylococcus aureus (MRSA) isolates with known genetic and epidemiological relatedness and different degrees of transmission were analyzed by antibiotyping, protein A gene polymorphism analysis, and coagulase gene polymorphism analysis. The three typing systems were evaluated for their performance and convenience to define clones and to discriminate between epidemic MRSA (EMRSA) and sporadic MRSA (SMRSA). Antibiotyping and AluI restriction fragment length polymorphism analysis of the coagulase gene were able to define clones in the same way as DNA macrorestriction analysis (SmaI). However, both techniques presented disadvantages, making neither of them useful as a single typing method. Protein A gene polymorphism analysis appeared to be of no value for clonal analysis. None of the three typing methods was able to differentiate between EMRSA and SMRSA.

Bacterial Typing Techniques↗
PubMed1997

Prophylactic, empiric and therapeutic use of antibiotics. Do we need a guide: a universal edition or a local one?

The goal of the antibiotic policy in hospitals is a correct and restrictive use of antimicrobial agents. Guidelines on antibiotic use aim to improve the quality of care, to reduce costs and to prevent the emergence of (multi-)resistant microorganisms. Strategic options and methods to reach these objectives are published by consensus committees of scientific societies and health care organizations. The local guidelines must be based upon the universal principles of prophylactic, empiric and therapeutic use of antimicrobial agents but they also take into account the local epidemiology of infectious diseases, microbiology and resistance patterns as well as the local clinical experience. Our experience on how an antibiotic policy was developed and implemented in our large university hospital is described.

Anti-Bacterial Agents↗
PubMed1996

Tetanus--still a topic of present interest: a report of 27 cases from a Belgian referral hospital.

OBJECTIVE: To study the clinical presentation, treatment and outcome of tetanus in a European population. DESIGN: A retrospective study. SETTING: A large university hospital with a regional as well as a referral service. SUBJECTS: All patients with tetanus from 1983 till 1993. RESULTS: Twenty-seven patients (13 men, 14 women; mean age 68.5 years) were studied. Seventeen out of 24 wounds (three patients had no history of a recent wound) were described as tetanus-prone. Ten patients had medical wound care, but none received tetanus immunoglobulins despite the absence of tetanus immunity. All patients had the generalized type of the disease. The classical symptoms of trismus, dysphagia and muscular rigidity were present in all patients. Treatment consisted of wound management, neutralization of tetanus toxin by immunoglobulins, antibiotics, treatment of muscle spasm and instability of the autonomic nervous system, and supportive care. Twenty-five patients were admitted to the intensive care unit for a mean duration of 25.7 days. Sixteen patients were artificially ventilated for a mean duration of 27.5 days. Three patients died, 11 patients had a complicated course caused by haemodynamic instability and 15 patients had pulmonary complications. CONCLUSIONS: Tetanus has not vanished. It remains a difficult-to-treat disease with a substantial morbidity and mortality rate. Prevention during wound management of tetanus-prone wounds was inappropriate in many patients. The elderly population may have the highest risk for tetanus since they may not have had tetanus toxoid immunization or regular booster injections.

Aged↗
PubMed1996

Cutaneous cryptococcosis in corticosteroid-treated patients without AIDS.

Two corticosteroid-treated patients with cutaneous cryptococcal infection are described. One patient had pustulous lesions on the back of his left hand and cellulitis of his left forearm, the other patient had ulcerous lesions of the right forearm and cellulitis of the right lower leg. In both cases diagnosis was suggested by histopathological examination of a biopsy and confirmed by culture. One patient may have had disseminated cryptococcal disease as suggested by a positive cryptococcal capsular antigen test, the other had no evidence of dissemination. Treatment consisted of oral fluconazole for six weeks. One patient died of an unrelated cause after four weeks treatment. Secondary antifungal prophylaxis was not given. Cutaneous cryptococcal infections are described in AIDS patients, but only seldom observed in other immunocompromised patients. Early recognition of the cutaneous lesions is important, as they can be the first sign of disseminated cryptococcosis. Untreated, the mortality of this disease is high. Therapy consists of amphotericin B with or without flucytosine. Fluconazole may be valuable alternative. The optimal treatment regimen and duration are not defined yet. Contrary to AIDS patients with cryptococcal infection, who need life-long secondary antifungal prophylaxis in order to prevent relapses, suppressive treatment is not indicated for immunocompromised non-AIDS patients.

Aged↗
PubMed1996

Amikacin as first-choice aminoglycoside in a medical intensive care unit: a one-year bacteriological surveillance study.

The aim of this study was to determine the baseline pattern of resistance to aminoglycosides in a medical intensive care unit and to evaluate the influence on resistance rates of the use of amikacin as first-line aminoglycoside. A prospective bacteriological surveillance study was done during a 3-month baseline period with all aminoglycosides freely available, followed by a 9-month study period with predominant amikacin use. All patients admitted for more than 24 hours who were colonized or infected were included. Susceptibility rates for all isolates during the baseline period were 69% for amikacin, 32% for gentamicin, 35% for tobramycin and 46% for netilmicin. During the amikacin study period susceptibility rates rose to 75%, 43%, 44% and 51%, respectively. The increase in susceptibility to gentamicin and tobramycin, considering all isolates, was statistically significant. There was also a significant increase in susceptibility to netilmicin for gram-negative bacteria. There was no significant change in susceptibility to amikacin. We conclude that the use of amikacin as a first-choice aminoglycoside in a medical intensive care unit is warranted because of the better susceptibility rates and does not lead to a rapid rise in amikacin resistance. The predominant use of amikacin may have a favorable influence on susceptibility to the other aminoglycosides. To answer the question of whether these conclusions will remain valid over a longer period of predominant amikacin use, follow-up surveillance studies are mandatory.

Adolescent↗