Community-acquired pneumonia in adolescents.

Community acquired pneumonia (CAP) is defined as pneumonia acquired outside of the hospital setting. Extensive studies of CAP in adolescents that characterize the true incidence of various etiologic pathogens are not available. However, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae appear to be the most frequently encountered pathogens. These organisms often cause CAP in adults as well; other infections are noted as well, including Legionella. "Atypical pneumonia" refers to pneumonia not presenting with the usual clinical picture of pneumococcal infection (which includes high fever, productive cough, chills, and other "classic" features). The term is frequently used in adolescents with CAP. However, this classification may not help in individual patients, who often show a high degree of variability in the clinical presentation of pneumonia; also it does not always predict microbial cause. There is currently a trend away from the concept of atypical pneumonia syndrome and more discussion of atypical pathogens as commonly causes of CAP. This article reviews recent literature on CAP with special emphasis on its diagnosis and management in adolescent patients.

Linda Richards at the Kalamazoo State Hospital.

Linda Richards was the first nursing graduate in America and a major pioneer in nursing education. Moral therapy was the major treatment at the Kalamazoo Asylum and its use persisted into the early 20th century under the supervision of Richards, one of its adherents. Richards added district nursing experience in the City of Kalamazoo to the curriculum and the school was described by the Trustees as being in vigorous condition during her leadership.

Macrolide antibiotics.

This article is an extensive review of current information available on the macrolide antibiotics. This includes antimicrobial spectrum, pharmacology, complications and side effects, and pediatric use of these drugs. These are important antibiotics, but careful selection of patients must be made and the physician must be alert for evidence of drug-drug interactions, which are not uncommon with several members of this class.

Streptococcal pharyngitis: is penicillin still the drug of choice?

With the advent of cephalosporins, penicillin appears to have lost some ground for treatment of Acute Group A Beta Hemolytic Streptococcal Pharyngitis. It has been argued for some time now whether penicillin should remain the drug of choice for the management of this infection. Evidence has been presented both in favour and against using penicillin for Group A beta hemolytic streptococcal (GABHS) pharyngotonsillitis. In this commentary, we review the available data in the current literature and conclude that penicillin should still remain the drug of first consideration for GABHS pharyngitis. If penicillin treatments were less effective now, the clinical and bacteriologic failure rates should be on the rise compared to the previous years.

Listeria Monocytogenes infections.

This article reviews current information regarding human infection with Listeria monocytogenes. Significant advances have occurred in regard to our knowledge of the epidemiology, pathogenesis, immunology, and treatment of this disease which was formerly believed to be of importance mainly to veterinarians. It remains a cause of high mortality in the many different groups of compromised hosts it infects unless diagnosis and treatment are rapidly established.

Perinatal transmission of bacterial sexually transmitted diseases. Part II: Group B streptococcus and Chlamydia trachomatis.

Sexually transmitted diseases (STDs) have reached epidemic proportion in the United States and have captured the attention of both laypersons and health care professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the second of two parts, reviews issues of prevalence, morbidity, mortality, diagnosis, prevention, and treatment of group B streptococcal and chlamydial infections as they affect the maternal-fetal dyad.

Perinatal transmission of bacterial sexually transmitted diseases. Part I: Syphilis and gonorrhea.

Sexually transmitted diseases (STDs) have reached epidemic proportions in the United States and have captured the attention of both laypersons and health professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the first of two parts, reviews issues of prevalence, morbidity, mortality, prevention and treatment of syphilis and gonorrhea as they affect the maternal-fetal dyad.

Efficiency of skin sterilization for a venipuncture with the use of commercially available alcohol or iodine pads.

Skin sterilization for a venipuncture is routinely done with commercially available alcohol or iodine pads. Selection of the antiseptics, alcohol or iodine, however, in most situations has been made on the basis of very little scientific data. With many patients with granulocytopenia who are undergoing venipunctures, the choice of antiseptic may be an important factor in preventing infections. We investigated two widely and commercially available disinfectant pads, alcohol and iodine, in the efficacy of skin sterilization. Seventy subjects (35 adults and 35 children) were randomly selected for this study. A designated area of the right and left forearm was sterilized either with alcohol or with an iodine pad in a predetermined uniform fashion. Specimens were obtained for cultures before and after sterilization. The bacterial cultures were performed with the use of blood agar plates and trypticase soy broth. For data analysis growth of any organisms on agar plates or trypticase soy broth after sterilization was interpreted as a sterilization failure. The iodine swab was significantly more efficient than the alcohol swab; the former yielded an 80% sterilization rate whereas the latter resulted in a rate of 61% (p less than 0.02). If, however, the growth only in agar plates was compared, the alcohol wipe yielded no growth in 83% and iodine in 84%, virtually identical success rates. Bacillus spp. predominated the residual organisms after either the alcohol or the iodine wipe. A variety of other organisms, however, including Staphylococcus and Corynebacterium spp., grew after alcohol but not after iodine sterilization.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro synergism of rifampin-cephalosporin combinations against Haemophilus influenzae type b.

The in vitro susceptibility of Haemophilus influenzae type b to rifampin, cefotaxime, ceftazidime, ceftriaxone and cefuroxime was examined at inocula of 10(5) and 10(7) CFU/ml. Time-kill curves were then obtained using antibiotic concentrations at one-half the MIC for each drug at the two inocula with combinations of rifampin plus each of the cephalosporins. There was a pronounced inoculum effect with all of the cephalosporins except for cefuroxime, but the MIC values were also higher for the latter drug. The rare failure of some cephalosporins to promptly sterilize the cerebrospinal fluid in meningitis should encourage investigation of the relationship between the inoculum effect, minimum bactericidal concentration and cerebrospinal fluid antibiotic levels in these clinical situations. A marked synergistic effect was noted for most of the isolates, and therefore, cephalosporin-rifampin combinations might show clinical utility.

Ciprofloxacin, imipenem and rifampicin: in-vitro synergy of two and three drug combinations against Pseudomonas cepacia.

The in-vitro activity of ciprofloxacin, imipenem and rifampicin, singly, and in two and three drug combinations was evaluated against 16 isolates of Pseudomonas cepacia. All 16 isolates were resistant to rifampicin; nine isolates were susceptible to ciprofloxacin; six were susceptible and seven had intermediate susceptibility to imipenem. The imipenem and rifampicin combination was synergistic for one of 16, imipenem and ciprofloxacin synergistic for seven of 16 and the three antibiotic combination was synergistic for 12 of 16 isolates. The three antibiotic combination demonstrated synergism with two isolates which were resistant to all three drugs. Combinations of two and three antibiotics resulted in enhanced killing of P. cepacia in this in-vitro study.

In vitro activity of multiple antimicrobial combinations against Pseudomonas cepacia isolates.

For 16 isolates of Pseudomonas cepacia from patients with cystic fibrosis, synergism was determined by the killing curve method, utilizing various combinations of antibiotics [ticarcillin (Ti), rifampin (Ri), tobramycin (To), imipenem (Im), ofloxacin (Of), polymyxin B (PB), and trimethoprim/sulfamethoxazole (S x T)]. All 16 isolates were resistant to Ti, To, Ri, and PB; 11 were sensitive to S x T, 13 were sensitive to Im, and 2 were sensitive to Of. The combination of Im/Ri was synergistic for 8 isolates. Several combinations (Ti/Ri/Im), (Ti/Im/To), (Ri/Im/To) also demonstrated synergism for these 8 isolates. The Im/Ri combination did not demonstrate synergism against the other 8 isolates. The Ti/Im/To combination was synergistic for 6 of these. The Ri/Im/To combination was synergistic for 5 and the Ti/Im/Ri combination was synergistic for 3. Synergism could also be demonstrated with several 4-drug combinations. This study suggests that multi-drug combinations may have a role in the treatment of P. cepacia infections if proven in clinical studies.

Antibiotic susceptibility of community hospital blood culture isolates of gram-negative bacilli.

The comparative in vitro activity of amikacin, cefamandole, cefoperazone, cefotaxime, cefoxitin, cephalothin, chloramphenicol, moxalactam, piperacillin, ticarcillin and tobramycin against 170 community blood culture isolates of gram-negative bacilli was investigated using the quantitative plate dilution method. Results showed that amikacin, cefoperazone, cefotaxime, moxalactam, piperacillin and tobramycin were most active on a weight basis. Tobramycin and amikacin were quite active against Pseudomonas aeruginosa but one isolate showed an MIC of 50 micrograms/ml to both. The order of activity of the remaining drugs for P. aeruginosa was cefoperazone greater than moxalactam greater than cefotaxime and piperacillin greater than ticarcillin.

Infectious mononucleosis in the community hospital.

The clinical records from three community hospitals of 161 patients with a diagnosis of infectious mononucleosis were reviewed. Epidemiological, clinical, and laboratory findings were compared with previous studies of selected populations and age groups as well as with those from referral centers. The purpose of this study was to obtain information on infectious mononucleosis as it presents to primary care physicians in the community setting. Infectious mononucleosis can pose diagnostic difficulties, demonstrated by the variety of admission diagnoses made by physicians prior to the laboratory confirmation of the illness. Although often a benign and self-limited illness, hospitalization was often required for minor and rare major complications. Ampicillin-related rash did not occur so frequently as previously reported. The use of steroids in treatment of complications was felt to be appropriate. With few exceptions, epidemiological, clinical, and laboratory findings generally agreed with previous studies.

Erythromycin resistance in group A beta-hemolytic streptococci.

Recent reports have indicated a high incidence of erythromycin resistance in Group A streptococci isolated from children in Japan. The present study investigated antibiotic susceptibility patterns of 280 pharyngeal isolates from ambulatory patients using the plate dilution technique. The incidences of resistance to erythromycin and tetracycline were 4.3 and 7.8%, respectively. No resistance to penicillin, ampicillin, methicillin, oxacillin, cefaclor or moxalactam was found, and there was no evidence of penicillin tolerance using the standard tube dilution technique. The erythromycin-resistant isolates were of T-pattern 12, M-type 12, and two erythromycin-resistant isolates were also resistant to tetracycline. Data on the source of the isolates suggest that a localized outbreak of erythromycin-resistant streptococcal infection occurred.

Zinc deficiency and behavior: a development perspective.

Zinc deficiency was induced in 35 and 300 day-old male Holtzman rats. Group ZDA was fed ad lib a diet deficient in zinc (1 ppm), ZSP controls were pair-fed a diet supplemented with zinc (50 ppm) and ZSA controls were fed ad lib a diet supplemented with zinc (50 ppm). Physical status and six open-field behaviors were evaluated. Food intake, body weight and plasma zinc concentrations were significantly reduced in both age groups. Expanded use of the open-field revealed significantly lower latencies to explore the novel environment and significantly lower ambulation scores in the young and older zinc deficient rats. Older rats spent significantly less time grooming than their controls. Rearing was significantly less in young zinc deficient rats and "kangaroo-like" posture was evident. Young rats made deficient during critical periods of growth and development, were at greater risk for most parameters tested, compared to the older deficient rats. These rats do demonstrate, however, that feeding low-zinc diets to older, fully developed animals results in significant physical and behavioral impairment.