Eur J Pediatr, 1991 Jul, 150(9), 612 - 8 Osteoarticular infections due to Kingella kingae in children; Lacour M et al.; By the description of two cases of osteoarticular infections due to Kingella kingae in two young children we wish to draw the attention of clinicians to invasive infections due to this micro-organism . Since its biological characterization in 1976, K . kingae has been increasingly reported as a human pathogen . Most common presentations are endocarditis, bacteraemia, septic arthritis, osteomyelitis and spondylodiscitis . Interestingly, osteorticular involvement is largely predominant in previously healthy children . From the literature, we reviewed 51 cases of K . kingae bone and joint infections, representing 23 cases of septic arthritis, 17 of osteomyelitis and 11 spondylodiscitis . Of the cases 88% occurred in children below 5 years of age and in all cases only one bone or joint was involved . An underlying disorder could be found in only 4 patients . Since these infections have a favourable outcome with intravenous antibiotic treatment, proper isolation and identification of K . kingae is essential. Pathology, 1991 Jul, 23(3), 248 - 9 Fulminant tuberculous bronchopneumonia in a young Hong Kong Chinese woman; Dickens P; A 24-yr-old, previously healthy Chinese woman presented with symptoms of acute bronchopneumonia which led to acute respiratory failure and death 6 days after admission to hospital despite intensive antibiotic treatment . Autopsy showed acute tuberculous bronchopneumonia of the acinar type . This is a rare presentation and outcome of tuberculous infection in Hong Kong, where 124 cases per 100,000 population were notified in 1988, and indicates that tuberculosis can mimic acute bronchopneumonia and should be considered in cases so presenting, particularly when there is no growth on routine culture and no response to conventional antibiotics . Acute respiratory failure developing in such cases can cause a delay in the diagnosis of tuberculosis. Fortschr Med, 1991 Jun 30, 109(19), 397 - 400 {Sinusitis in the child from the ENT specialty point of view}; Hildmann H; In the child, acute sinusitis generally accompanies infections of the upper airways, so that, as a rule, treatment of the infection also deals with the sinusitis at the same time . Against this background, clinical diagnosis is adequate, and further diagnostic measures--in particular x-ray examinations, are superfluous . Only if the child feels really ill, or if inflammation spreads to the orbits is a diagnostic x-ray required . Bacterial superinfection, in particular with orbital involvement, necessitates massive antibiotic treatment and, where appropriate, the exclusion of an abscess and/or intracranial complications . In clinically healthy children, radiopacities can often be seen on the x-ray of the paranasal sinuses, in which case, we are dealing with an occult sinusitis . In general, this clears up spontaneously, and only rarely needs treating . Polypous sinusitis in childhood is rare and requires surgical therapy. Antimicrob Agents Chemother, 1991 Jun, 35(6), 1142 - 6 Hippocampal activity in the presence of quinolones and fenbufen in vitro; Dimpfel W et al.; Rare side effects on the central nervous system including dizziness, restlessness, and even very rare convulsions as reported during the course of antibiotic treatment with quinolones were the topic of a well-controlled in vitro approach . The excitability of brain matter was tested by electrically evoking field potentials in the CA1 region of the rat hippocampus in vitro . Direct effects of nalidixic acid, enoxacin, pefloxacin, norfloxacin, ofloxacin, and ciprofloxacin were found to occur as a dose-dependent increase in amplitude of this field potential, which is in line with the view that the quinolones increase excitability . The highest increase was found with enoxacin and nalidixic acid, and the lowest increase was found with ciprofloxacin . In order to keep the potential risk of the antibiotic therapy as low as possible, ciprofloxacin might be the drug of choice of the quinolones . In contrast to the quinolones, which only increased the amplitudes of electrically evoked potentials, fenbufen induced spontaneous firing in the pyramidal cell layer without stimulation in addition to its dose-dependent effects on the amplitudes of the evoked potentials . Threshold doses of the quinolones tested (0.25 microM) increased the amplitudes of evoked potentials in the presence of an otherwise ineffective concentration of fenbufen (1 microM) to different degrees, ranging from 39.2% for ciprofloxacin to 72.6% for enoxacin. Arch Emerg Med, 1991 Jun, 8(2), 125 - 9 A study to compare the use of fusidic acid viscous eye drops and chloramphenicol eye ointment in an accident and emergency department; James MR et al.; A total of 300 patients attending an Accident and Emergency department with ophthalmic complaints needing topical antibiotic treatment were treated with fucithalmic or chloramphenicol (chloromycetin) . Their compliance and the incidence of side effects were assessed . There was a 70.3% response rate to the questionnaire . Of the patients 51.3% using fucithalmic completed the 5 day course compared with 37.2% of those taking chloramphenicol . However, no patients were found to have suffered as a result of failing to complete the course . The incidence of side effects was similar in both groups. J Hosp Infect, 1991 Jun, 18 Suppl A, 65 - 72 Measurement of the costs of hospital infection by prevalence surveys; French GL et al.; Data from seven single-day prevalence surveys were used to assess the costs of hospital-acquired infection (HAI) by matching infected cases with controls and reviewing patient case notes for details of mortality, length of hospitalization and antibiotic treatment costs . Many cases with a high risk of HAI could not be matched and probably had inevitable infection . Cases that could be matched had the same risks of HAI as the controls, and these infections were potentially avoidable . Compared with controls, infected patients had an excess mortality rate of 7.4%, an average excess hospital stay of 23 days and an average excess antibiotic expenditure of US$190 . By extrapolation we calculate that the annual costs of avoidable HAI at Prince of Wales Hospital is now approximately 130 lives, 42 000 bed-days and US$0.3m of antibiotics; costs of a similar magnitude have already been saved by a programme of hospital infection control . We conclude that hospital-acquired infection is very expensive, infection control is highly cost-effective, and prevalence surveys are practical tools for the measurement of rates and costs of hospital infection. Med J Aust, 1991 May 6, 154(9), 592 - 6 Branhamella (Moraxella) catarrhalis: pathogenic significance in respiratory infections; Boyle FM et al.; OBJECTIVES: To assess the pathogenic significance of Branhamella catarrhalis isolates in patients with respiratory infections and to define the clinical characteristics of such patients . DESIGN and SETTING: Respiratory specimens were assessed in a three-year prospective study performed in a Brisbane metropolitan hospital . Assessment of the pathogenic significance of isolates of B . catarrhalis was based on four predetermined criteria: (i) clinical evidence of respiratory infection based on history, examination and chest x-ray; (ii) isolation of B . catarrhalis as the sole potential pathogen; (iii) absence of antibiotic treatment in the previous two weeks; and (iv) subsequent clinical response to an antibiotic to which the isolate was sensitive . RESULTS: B . catarrhalis was identified in 118 respiratory samples, 92 (78%) being from patients less than 10 years old . Infection with B . catarrhalis was more commonly seen in winter months and was community-acquired in two-thirds of cases . Isolation of this organism was associated with a broad variety of upper and lower respiratory tract syndromes . Isolates were considered to be of pathogenic significance (all four above criteria satisfied) in 35% of cases and of possible significance (the first and fourth criteria satisfied) in a further 15% of cases . Isolates were more likely to be of pathogenic significance in older patients and in those with pre-existing cardiorespiratory disease; however, a number of serious infections were observed in previously-well children . Expectorated sputum and tracheal aspirates were more likely to yield a clinically significant isolate than nasopharyngeal aspirates . Production of beta-lactamase was demonstrated in 88% of isolates . CONCLUSION: B . catarrhalis causes respiratory infection more frequently than is generally appreciated . Isolation of this organism from the respiratory tract had pathogenic significance or possible pathogenic significance in 50% of our patients . If therapy is indicated in patients with respiratory infection caused by this organism, traditional beta-lactam regimens cannot be relied upon, as shown by the high rate of beta-lactamase production in this study; a tetracycline, erythromycin, a second or third generation cephalosporin, or the combination of a penicillin derivative and beta-lactamase inhibitor should be considered. Rev Infect Dis, 1991 May-Jun, 13 Suppl 7, S621 - 5 Multicenter trial of prophylaxis with clindamycin plus aztreonam or cefotaxime in gynecologic surgery; Mangioni C et al.; A prospective, randomized, multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy . Patients received three intravenous doses of clindamycin (900 mg) plus either aztreonam (1 g) or cefotaxime (1 g); the doses were given at the induction of anesthesia and 8 and 16 hours later . A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated . Following abdominal hysterectomy infections occurred at the operative site in 1.2% of patients given a regimen including aztreonam and in 4.7% of those given a regimen including cefotaxime; the difference between the two groups was not significant . Neither were significant differences observed in the incidence of fever, the incidence of bacteriuria, the need for postoperative antibiotics, or the duration of postoperative hospitalization, although results were slightly better for patients receiving clindamycin plus aztreonam . Following vaginal hysterectomy, slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime . Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime . It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy. Lakartidningen . 1991 May 1;88(18):1673. {Do not forget the old intrauterine device in the uterus}; Odlind V; PIP: A 23-year old patient became pregnant in spite of using an IUD and underwent legal abortion with vacuum aspiration . The IUD was not found even after repeated follow-up scrapings with a curet . A new IUD inserted at the request of the patient worked satisfactorily for 5 years . The IUD was removed because of the patient's desire to have a child; however, the patient did not became pregnant . 6 years after the extraction of the IUD, an investigation was started concerning the inability to conceive . It was found that the husband had a poor sperm test with a suspicion of infection . After antibiotic treatment, his sperm test improved . Still no pregnancy ensued, and at age 38 the patient underwent a hysterosalpingographic X-ray test during which the old copper IUD was found in the uterus . It was removed during hysteroscopy which also revealed exceptionally uneven and mucous synechiae in the uterus . The patient felt very bitter towards the doctor who had left the IUD in her uterus 15 years earlier . If a patient gets pregnant while wearing an IUD, ultrasound or pelvic overview X-ray can be used to locate it . It has to be removed as soon as possible, because the risk of miscarriage or prematurity is considerable . Also, the safest IUDs are recommended for use to avoid such a problem . Neurology, 1991 May, 41(5), 706 - 11 Frequency and clinical significance of Lyme seropositivity in patients with isolated optic neuritis; Jacobson DM et al.; We evaluated antibody reactivity against Borrelia burgdorferi in 20 consecutive patients with newly diagnosed isolated optic neuritis who resided in a region endemic for Lyme disease . Four (20%) patients had positive serology . All three patients who had follow-up serologies showed rising convalescent levels of Borrelia-specific IgM . One patient refused lumbar puncture, one had normal CSF constituents except for an elevated Lyme antibody index, and two had CSF lymphocytic pleocytosis that remained unexplained after extensive evaluations for causes other than Lyme disease . We treated both patients who had CSF pleocytosis with intravenous ceftriaxone; the pleocytosis and optic nerve function improved . The other two patients received oral antibiotics and showed excellent recovery of visual acuity . We believe that serologic testing for Lyme disease is warranted for individuals with optic neuritis who reside in an endemic region, and patients with rising convalescent antibody levels or unexplained CSF pleocytosis should receive antibiotic treatment for Lyme disease. Eur J Epidemiol, 1991 May, 7(3), 276 - 81 Antibiotic treatment of rickettsiosis, recent advances and current concepts; Raoult D; The author reviews the recent advances in the treatment of Mediterranean Spotted Fever and Q fever . In mediterranean spotted fever (M.S.F.), in vitro and preliminary in vivo data support the place of quinolones and josamycin in the treatment of M.S.F . In children josamycin could become the first choice drug as well as in pregnant woman . In Q fever chronic disease should be treated using a combination of antibiotic (doxycycline + quinolones) for a minimum of 3 years. Antimicrob Agents Chemother, 1991 May, 35(5), 944 - 7 Amikacin pharmacokinetics in patients receiving high-dose cancer chemotherapy; Davis RL et al.; We retrospectively analyzed amikacin pharmacokinetics in 28 patients (mean age, 47.4 +/- 13.6 years) who received high-dose chemotherapy during a neutropenic febrile episode . Patients received an experimental protocol of high-dose anticancer chemotherapy . Amikacin pharmacokinetic parameters were calculated from two or more concentrations in serum around a single dose by the method of Sawchuck and Zaske (J . Pharmacokinet . Biopharm . 4:183-195, 1976) . Predicted parameters were calculated by using standard methods . The observed amikacin volume of distribution and clearance were significantly greater and the elimination half-life was longer than predicted (0.38 +/- 0.13 versus 0.25 liter/kg {P = 0.0001}, 1.51 +/- 0.92 versus 1.17 +/- 0.38 liters/h/kg {P = 0.012}, and 3.8 +/- 2.4 versus 2.9 +/- 1.1 h {P = 0.011}, respectively) . Multivariate analysis revealed that albumin correlated negatively and creatinine correlated positively with the volume of distribution and the elimination half-life . Creatinine and the percentage below the ideal body weight correlated negatively and hematocrit correlated positively with clearance . Administration of dosage regimens based on predicted pharmacokinetic parameters yielded subtherapeutic amikacin concentrations in serum in our patients . Because of the increased dosage requirements and the need for adequate antibiotic treatment in this population, we suggest guidelines for empiric dosing for patients with advanced cancer receiving intensive chemotherapy. Age Ageing, 1991 May, 20(3), 206 - 11 A comparison of single-dose versus conventional-dose antibiotic treatment of bacteriuria in elderly women; Flanagan PG et al.; The efficacy of single-dose antibiotic therapy for the treatment of bacteriuria in a group of non-catheterized elderly women was compared with that of conventional 7-10 day courses of antibiotic therapy . Thirty-one women received single-dose treatment and 22 conventional-dose treatment . The cure rates at 1 and 6 weeks for the single-dose treatments were 52% and 38%, respectively, and the cure rates for the conventional-dose treatments at 1 and 6 weeks were 59% and 52%, respectively . It is concluded that there may be a place for the use of single-dose antibiotic therapy for the treatment of selected elderly women with bacteriuria, but larger studies are needed. Age Ageing, 1991 May, 20(3), 193 - 8 The febrile response to mild infections in elderly hospital inpatients; Darowski A et al.; We studied 74 patients whose temperature was normal according to nurses' temperature charts and who were not on antibiotic treatment . The subjects were inpatients whose condition had deteriorated on the ward, or patients admitted the previous day in whom no diagnosis had been established . One simultaneous set of measurements was made of sublingual, rectal, axillary and proximal auditory canal temperatures . A fever was recorded in 63 of 74 patients (85%); 54 febrile patients had a raised rectal temperature, and 54 had a raised proximal auditory canal temperature; 60 patients were febrile at one or both of these sites . A further three patients had raised sublingual temperatures alone . All patients who were regarded as being definitely or probably infected were febrile at one or more sites . Eighty-one per cent of those considered to be possibly infected, and 71% of those with no clinical evidence of infection were also febrile . Rectal and proximal auditory canal temperatures can each detect fever in approximately 86% of febrile patients, sublingual temperature in 66%, and axillary temperature in 32% . Rectal temperature is clinically the most useful temperature measurement in elderly patients . We conclude that significant infections in patients in a warm environment result in a fever which often remains undetected when only sublingual temperature is measured. J Laryngol Otol, 1991 May, 105(5), 337 - 40 Serum antibodies against respiratory tract viruses in episodes of acute otitis media; Harsten G et al.; Although the findings of epidemiological studies have suggested viral respiratory tract infection (RTI) to be crucially involved in the development of acute otitis media (AOM), the relationship between AOM and viral RTI remains unclear . Serum samples, obtained in the acute and convalescent phases of 57 AOM episodes (in 35 children during the first three years of life) were analysed for IgG antibodies against influenza A viruses, influenza B viruses, parainfluenza virus type 1, respiratory syncytial virus and adenoviruses . One third of the AOM episodes (18/57) could be related to viral RTI, as evidenced by significant increases in viral serum antibody activity . Treatment failure occurred in four AOM episodes where increases in serum viral antibody activity were noted . In three of these failures, antibiotic treatment was unsuccessful despite the bacterial strains not being resistant to the drug used . This suggests that concomitant viral infection may be a determinant of treatment outcome in some AOM episodes. J Reprod Med, 1991 Apr, 36(4), 270 - 3 Results of a preventive program for congenital toxoplasmosis; Ghidini A et al.; All pregnant women followed during the period 1982-87 were screened for toxoplasmosis, and 35 patients had documented seroconversion or doubtful toxoplasmosis titers . One patient opted for pregnancy termination . The remaining were followed with a protocol that included serial ultrasound examinations and prophylactic antibiotic treatment of the mother and neonate . No fetal abnormalities related to congenital toxoplasmosis were found . All the infants had negative toxoplasmosis test titers at birth; at follow-up only one was found to have developed a subclinical infection, at 2 months of age . Our data suggest that antiparasitic treatment during pregnancy for those at risk for Toxoplasma infection may reduce the transmission rate. Rev Fr Gynecol Obstet, 1991 Apr, 86(4), 327 - 30 {Influence of Chlamydiae serology and the presence of a pelvic inflammatory state on the results of in-vitro fertilization}; Agnani G et al.; The authors investigated the influence of Chlamydiae serology and the presence of a pelvic inflammatory state on the outcome of in-vitro fertilization on the basis of an analysis of 116 stimulation cycles . The study included 71 female patients suffering from infectious sterility of tubular origin with distal lesions . Chlamydiae trachomatis serology was considered to be positive at IgG titers in excess of 1/64 . When the serum test was positive, there was a significant reduction in the number of clinical pregnancies and the cleavage rate . The percentage of ectopic pregnancies (6 ectopic pregnancies out of 29 clinical pregnancies) was very high, particularly if the serum test was positive and a pelvic inflammatory state persisting after antibiotic treatment contraindicated microsurgery . Surgery was performed only in favorable cases and did not appear to have any negative impact on the outcome . The presence of a non-stabilized pelvic infectious state was correlated with a significant increase in the drop-out rate and the number of post-menopausal gonadotropin required to achieve stimulation . The fact that unexpected spontaneous pregnancies may occur after an unsuccessful attempt must be taken into account when sterilization or salpingectomy are envisaged in an attempt to improve the outcome. Pharmacol Res, 1991 Apr, 23(3), 259 - 69 Recovery of impaired gluconeogenesis in kidney-cortex tubules of gentamicin-treated rabbits; Michalik M et al.; Rabbits were given gentamicin over a period of 10 days . At 1, 3, 5 and 10 days renal proximal tubules were isolated and glucose synthesis from several substrates was measured . A relationship between the inhibition of renal gluconeogenesis, accompanied by a decline of both pyruvate carboxylase and phosphoenopyruvate carboxykinase (PEPCK) activities, and an increased gentamicin level in kidney-cortex was noticed after 5 days of therapy . Both the rates of glucose formation from various substrates as well as pyruvate carboxylase and the cytosolic PEPCK activity recovered fully within 3 weeks after cessation of antibiotic treatment while an increase of activity of the mitochondrial PEPCK occurred during chronic administration of the drug for 10 days . It is concluded, that gentamicin-induced inhibition of gluconeogenesis is one of the events occurring during complex action of this drug on renal cortex. Arthritis Rheum, 1991 Apr, 34(4), 393 - 402 T cell proliferation induced by Borrelia burgdorferi in patients with Lyme borreliosis . Autologous serum required for optimum stimulation; Krause A et al.; The cellular immune response to Borrelia burgdorferi was studied in 24 patients with seropositive and seronegative Lyme borreliosis, 30 patients with arthritides of different origin (non-Lyme arthritides), and 20 normal blood donors . By far, the strongest T cell stimulation was induced by incubation with autologous serum; there was a significantly lower response or no response after incubation with allogeneic or heterologous sera . In patients with Lyme borreliosis, including seronegative patients, there was a strikingly elevated proliferation in response to whole B burgdorferi bacteria (mean 64,750 dpm) compared with that of normal donors (mean 19,700 dpm; P less than 0.0001) and especially that of non-Lyme arthritis patients (mean 11,600 dpm; P less than 0.0001) . Levels of proliferation declined significantly in patients with Lyme borreliosis after successful antibiotic treatment . Parallel cultures using B burgdorferi and Treponema phagedenis as antigens showed that cells from patients with Lyme borreliosis responded significantly more to B burgdorferi than to T phagedenis, but this did not occur with cells from individuals with non-Lyme arthritides . There was no correlation between disease stages and proliferation values . These data indicate that lymphocyte proliferation assays may provide an important tool for the diagnosis of Lyme borreliosis, most notably in patients with arthritides and in those who are seronegative . Conversely, the lack of reactivity appears to be a strong indicator of the absence of active Lyme disease . It seems to be crucial, however, to use autologous sera in these assays. J Pediatr, 1991 Apr, 118(4 ( Pt 2)), S99 - 108 Refeeding of infants with acute diarrheal disease; Lifshitz F et al.; The purpose of this study was to determine which infant formula among five would be the most efficacious for the refeeding of infants during an acute episode of diarrhea . Fifty male infants less than 12 months of age with severe diarrhea and at least 5% dehydration were admitted to a metabolic unit and studied in a prospective, single-blind protocol . Ten infants randomly received one of five types of formula: two-thirds diluted cow milk, cow milk formula (Nanon, Nestle, Inc., Sao Paulo, Brazil), Portagen, Pregestimil, or Prosobee (Mead Johnson & Co . Division, Evansville, Ind.) . They continued to receive the same formula for 72 hours unless dehydration occurred . There were no associated infections, and they received no prior antibiotic treatment . Oral hydration together with intravenous fluid therapy was given to all patients during the initial treatment . During the first 72 hours of refeeding, patients fed Portagen excreted the least amount of stool and required reduced quantities of intravenous fluids or oral hydration . In contrast, patients fed diluted cow milk or any other formula had more severe diarrhea . Nine of the 10 patients fed Portagen completed the 72-hour treatment, whereas only 2 of 10 fed diluted cow milk tolerated it . Similarly, the cumulative proportions for high purging rate, dehydration, carbohydrate intolerance, and vomiting were more favorable for Portagen and least acceptable for diluted cow milk . No differences were found among the remaining three formulas tested . These data show that diluted cow milk is poorly tolerated by infants with severe diarrhea, whereas Portagen is more effective. Radiology, 1991 Apr, 179(1), 55 - 9 Scrotal inflammatory disease: color Doppler US findings; Horstman WG et al.; A study of 45 patients with 51 cases of hemiscrotal inflammatory disease was done to determine the color Doppler ultrasonographic appearance of scrotal inflammatory disorders . The diagnosis was ultimately established by means of appropriate response to antibiotic treatment (47 cases) or surgery (four cases) . In all cases, there was evidence of hyperemia: an increased number and concentration of detectable vessels in the affected portion of the scrotum . In 17 cases, the gray scale images were normal, and the only evidence of inflammation was the presence of hypervascularity . Abnormally decreased epididymal vascular resistance was detected in 14 cases of epididymitis; abnormally decreased testicular vascular resistance was detected in six cases of orchitis . Spontaneous venous flow was present in 18 patients . The authors conclude that color Doppler can demonstrate the hyperemic response to scrotal inflammatory disease and that, in the proper clinical setting, it can supplement the gray scale findings and increase diagnostic confidence. Minerva Urol Nefrol, 1991 Apr-Jun, 43(2), 101 - 11 {Physiopathological and nutritional changes in hemodialysis patients and in those who have undergone renal transplantation}; Pace V et al.; The paper examines the complex metabolic behaviour of patients undergoing hemodialysis and renal transplantation . It underlines the importance of the metabolic and nutritional status of these patients since inadequate nutritional therapy may result in the failure of hemodialysis and/or surgery . Given the complexity of the metabolic syndrome and its bronchopulmonary, cardiovascular and septic complications, it is necessary to monitor the various chemical and clinical parameters in these patients in order to guarantee an optimal recovery and satisfactory survival rate . Fortunately today, by replacing the use of Azathioprine, Cyclosporin--irrespective of its collateral and/or secondary effects--has replaced the use of corticosteroids whose immunodepressive action made it obligatory to start simultaneous prophylactic antibiotic treatment and/or chemotherapy in order to avoid the development of other chance disease . The paper also reports the findings of a retrospective study (1976-1986) which evaluated various physiopathological and metabolic parameters and compared them to data reported in the literature. West J Med, 1991 Apr, 154(4), 405 - 9 Diagnosis and antibiotic treatment of community-acquired pneumonia; Rodnick JE et al.; Only a few pathogens cause most community-acquired pneumonias . In outpatients, treatment is empiric, based on the results of chest films, leukocyte counts, and Gram's stains (if available) . Antibiotics must always cover pneumococci and should cover Mycoplasma pneumoniae in young adults and during epidemic periods . A follow-up chest film in smokers and those older than 40 years is strongly recommended . In inpatients, the evaluation and treatment are tailored to individual cases . A search for a wider range of causes, using invasive tests if necessary, is undertaken, and all likely pathogens should be covered with the initial antibiotic therapy. Rev Clin Esp, 1991 Apr, 188(6), 288 - 94 {Syphilis and human immunodeficiency virus infection: diagnostic and therapeutic problems . Presentation of 2 cases and review of the literature}; Gonzalez-Clemente JM et al.; We here present the clinical cases of two homosexual patients, carriers of human immunodeficiency virus (HIV), who later presented a syphilis infection and who after receiving the usually recommended treatment, suffered a relapse of the infection six months afterwards, with neurologic involvement in one case . The clinical characteristics are discussed as well as the diagnostic and therapeutic problems which syphilis infection presents in HIV infected patients . Serological results are comparable to those of the general population, although face positives have been occasionally reported as well as some abnormally elevated titers . It is possible that neurosyphilis might be more frequent and of earlier appearance in HIV infected patients . Therefore, it might be necessary to carry out a spinal fluid exam, in these type of patients, in order to rule out the existence of an early and/or asymptomatic neurologic affectation and give the appropriate antibiotic treatment. Pathology, 1991 Apr, 23(2), 118 - 24 C-reactive protein: a critical review; Young B et al.; We have reviewed the literature to determine the value of C-reactive protein (CRP) measurements in the diagnosis and management of a wide range of conditions . CRP levels are of value in 6 clinical situations: (a) monitoring the response to antibiotic treatment in patients with known bacterial infections, (b) in obstetric patients with premature rupture of membranes, a rise in CRP can give early warning of intrauterine infections, (c) differentiation between active disease and infections in patients with systemic lupus and ulcerative colitis where the level of response to active disease has been previously established, (d) as a measure of disease activity and response to disease-modifying drugs in rheumatoid arthritis, (e) early detection of complications in postoperative patients, (f) in differentiating between infection and graft-versus-host-disease in bone marrow transplant patients . CRP levels have been used in an attempt to differentiate between bacterial and viral infections in various clinical situations, however the published literature does not support this role. Age Ageing, 1991 Mar, 20(2), 135 - 9 Aztreonam-flucloxacillin double beta-lactam treatment as empirical therapy of serious infections in very elderly patients; Knockaert DC et al.; Aztreonam, the first monocyclic beta-lactam antibiotic with pure anti-Gram-negative activity, combined with flucloxacillin, a penicillinase resistant penicillin, was given as empirical treatment of 53 serious infections in very elderly people . Eighteen of the cases had positive blood cultures and 11 had a clinical picture of sepsis without positive blood cultures: Of 49 evaluable infections, 45 (92%) were cured . In 40% of the infections, antibiotic treatment could be narrowed after 72 hours to one antibiotic . Diarrhoea, mostly transitory, was the only side-effect . Aztreonam-flucloxacillin combination is a safe and effective empirical treatment regimen for serious infections in very elderly patients. Ir Med J . 1991 Mar;84(1):29. Fournier's gangrene; Thiruvengadam NS et al.; Fournier's gangrene or synergistic gengrene of scrotum and penis is a relatively rare but serious condition which can occur in any general or hospital practice . Early diagnosis with prompt aggressive treatment including antibiotics and surgical debridement are necessary to achieve patient survival . We report our clinical experience with three cases which occurred in three different hospitals in the Irish Republic . In two of these cases diabetes mellitus was an important predisposing factor . All three patients underwent surgery as well as antibiotic treatment in spite of which one patient failed to survive. Antimicrob Agents Chemother, 1991 Mar, 35(3), 533 - 7 Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis; Levy PY et al.; We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment . Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized . Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case) . Two patients died before the beginning of the treatment . Nineteen patients had hemodynamic failure and subsequently underwent valve replacement . Nine valve tissue cultures were positive despite previous antibiotic treatment . In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant . We conclude that the addition of quinolones to doxycycline is beneficial . On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics . We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline. J Reprod Med, 1991 Mar, 36(3), 161 - 4 Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women . Prevalence, risks and management at a South African infertility clinic; Marais NF et al.; Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies . Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms . We studied the wives in 40 consecutive infertile couples . Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs . M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs . Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal . DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis . One patient was lost to follow-up and excluded from the study . For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative . M hominis was isolated from 3 (7.5%) endocervical swabs . None of the endocervical swabs yielded a culture positive for U urealyticum . Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms . The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening . The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved . Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline. Am J Dis Child, 1991 Mar, 145(3), 287 - 90 Ventriculitis in newborns with myelomeningocele; Charney EB et al.; It has frequently been cited that a delay in back closure of beyond age 48 hours in newborns with myelomeningocele is associated with an increased risk of ventriculitis . It has been suggested that antibiotic therapy prior to surgery might minimize this risk . We reviewed our experience with ventriculitis in newborns with myelomeningocele and its relationship to antibiotic usage and time of back closure . Of 186 newborns, ventriculitis developed in 13 (7%), and there was no observed difference by time of back closure, clinical severity of infant at birth, status of myelomeningocele sac at birth, or type of delivery . There was a significant association between antibiotic usage and ventriculitis among the infants with delayed surgery, of which only one (1%) of 73 receiving broad-spectrum antibiotic prophylactic therapy developed ventriculitis compared with five (19%) of the 27 who did not receive antibiotics . Our data support the suggestion that antibiotic treatment is effective in minimizing the risk of ventriculitis among infants with myelomeningocele undergoing surgery after 48 hours of age. J Dermatol, 1991 Mar, 18(3), 125 - 42 Lyme borreliosis--a review and present situation in Japan; Carlberg H et al.; The skin diseases Erythema (chronicum) migrans (ECM, EM), Lymphadenosis benigna cutis (LABC), and Acrodermatitis chronica atrophicans (ACA) have long been described in northern Europe, and dermatologists are very familiar with these manifestations, which have been successfully treated with penicillin for about 40 years without the causative agent being known . Certain neurologic symptoms could be linked to tickbites during the 1920's and later also to EM . In 1977, Steere et al . reported a new form of inflammatory arthritis, mainly in school children in the community of Lyme, Connecticut, U.S.A., which they could also associate with preceding erythema and tickbites . Five years later, Burgdorfer was able to isolate Borrelia spirochetes from Ixodes ticks, which are known to be vectors of Lyme disease as well as of EM and ACA . The following year, Borrelia spirochetes were also isolated from Ixodes ticks and from skin lesions of patients in Sweden and Germany . These findings resulted in a large number of reports of new discoveries related to this infection, which is now known under the names of tick-borne or Lyme borreliosis and, in the U.S., also as Lyme disease or Lyme arthritis . It has proven to be a great imitator disease, mainly through its involvement of the neurological system, and to be far more widespread than previously thought . The full course of the disease is not yet known, however it is clinically, like another spirochetosis, syphilis, divided into early and late stages . Manifestations involve mainly the skin, the joints, the nervous system (Neuroborreliosis), and the heart . Antibiotic treatment is effective, especially in the early stages . Like syphilis, the disease can be self-healing without treatment . People who are exposed to ticks should be aware of the risk of contracting this disease, also in Japan where Ixodes ticks have been shown to be carriers of Borrelia spirochetes . Cases, particularly of EM, but also with neurological symptoms, have already been diagnosed in Hokkaido, Honshu, Shikoku, and Kyushu . As Lyme borreliosis is now proven to exist in Japan, it is beneficial for dermatologists to know about the various presentations of this disease . This paper will briefly summarize the historical background, the clinical stages, the diagnosis, and the treatment of Lyme borreliosis, with a summary of the present situation in Japan. Ned Tijdschr Geneeskd, 1991 Feb 23, 135(8), 323 - 7 {Chlamydia trachomatis infection in women and the use of oral contraceptives}; van Voorst Vader PC et al.; We determined the prevalence of genital Chlamydia trachomatis infection in women who visited a clinic for sexually transmitted diseases (STD) and the influence of the number of partners and the use of oral contraceptives (OC), with special attention to the recognition of pelvic inflammatory disease (PID) and to the results of therapy . Of 217 women, with a mean age of 26 years (range 14-56), who visited the STD clinic of the University Hospital of Groningen from July 1985 until November 1987, anamnestic data were collected as well as the results of swabs from cervix and urethra taken for culture and direct immunofluorescence test of C . trachomatis and for gonococcal culture . The influence of the number of partners (1 versus greater than 1) and OC on the prevalence of C . trachomatis infection was evaluated by logistic regression analysis . PID was excluded in cooperation with the department of gynaecology . C . trachomatis-infected women were treated by doxycycline orally (day 1 2 x 100 mg, day 2-7 1 x 100 mg) according to the dosage scheme advised by the Dutch Health Council in 1986 . A control culture was taken 2-3 weeks after treatment . C . trachomatis was detected in 72/217 (33%) women by culture and (or) direct IF test and in 22/41 (54%) women with gonorrhoea . In connection with the number of partners in the year preceding the examination, the following prevalences were found: 18/74 (24%) (1 partner), 43/108 (40%) (2-5 partners) and 10/27 (greater than 5 partners).(ABSTRACT TRUNCATED AT 250 WORDS) PIP: The authors determined the prevalence of genital Chlamydia trachomatis infection in women who visited a clinic for sexually transmitted diseases (STDS) and the influences of the number of partners and of the use of oral contraceptives (OCs), with special attention paid to the recognition of pelvic inflammatory disease (PID) and to the results of therapy . Of 217 women with a mean age of 26 years (range 14-56), who visited the STD clinic of the University Hospital of Groningen from July 1985-November 1987, anamnestic data were collected as well as the results from swabs of the cervix and urethra taken for culture and direct immunofluorescence (IF) test of C . trachomatis and for gonococcal culture . The influence of the number of partners (1 vs 1) and OCs on the prevalence of C . trachomatis infection was evaluated by logistic regression analysis . PID was excluded in cooperation with the department of gynecology . C . trachomatis-infected women were treated by doxycycline orally (day 1, 2x 100 mg, days 2-7, 1x 100 mg) according to the dosage scheme advised by the Dutch Health Council in 1986 . A control culture was taken 2-3 weeks after treatment . C . trachomatis was detected in 72/217 (33%) of the women by culture and/or direct IF test and in 22/41 (54%) women with gonorrhea . In connection with the number of partners in the year preceding the examination, the following prevalences were found: 18/74 (24%, 1 partner), 43/108 (40%, 2-5 partners), and 10/27 (5 partners) . The prevalence among OC-using women was significantly higher (p0.05) than in non-OC using women: 44.101 (44%) vs 21/93 (23%) . This was also true when OC users were compared to sterilized women (9/47, 19%), regardless of number of partners and age . Active PID was found in 2 women, both infected . After treatment with positive C . trachomatis cultures, control cultures were negative in 39/40 (98%) . A relatively high prevalence of genital C . trachomatis infection is found in women visiting STD clinics, as well as in women with only 1 partner during the year preceding the examination . This study supports the hypothesis of OC use being a risk factor . How OC use influences PID risk is not fully understood . Within the framework of reliable contraception and prevention of STD complications, the combination of OC + a barrier method should be advised to women without a steady partner . Further study is necessary to determine whether preventive antibiotic treatment of asymptomatic adolescents with anamnestic risk factors for C . trachomatis infection is indicated at the start of a new relationship . (author's modified) Ugeskr Laeger, 1991 Feb 4, 153(6), 440 - 1 {Elephantiasis nostras . A rare complication to erysipelas}; Jensen LP et al.; A case of elephantiasis nostras in a lower limb is presented . A thorough programme of investigation could only reveal a single episode of erysipelas as the possible etiological origin . The therapeutic possibilities are briefly reviewed . The most important are early institution of adequate antibiotic treatment and antibiotic treatment of every recurrence of disease. Chest, 1991 Feb, 99(2), 493 - 5 Endobronchial actinomycosis simulating bronchogenic carcinoma . Diagnosis by bronchial biopsy; Ariel I et al.; Five cases of actinomycosis of the main bronchi or trachea which were suggestive clinically of bronchogenic carcinoma are described . In four patients the correct diagnosis was made by a bronchial biopsy or wash, or both . Three of them recovered following antibiotic treatment, and one died a few days after bronchoscopy . In one case the Actinomyces were found in the bronchial wash retrospectively following diagnosis of pulmonary actinomycosis in the lobectomy specimen . A concomitant endobronchial lipoma was found in one of the patients . The diagnosis of pulmonary actinomycosis by bronchial biopsy may save the patient major surgical intervention. Rev Esp Enferm Dig, 1991 Feb, 79(2), 143 - 6 {Whipple's disease with gastric and duodenal involvement . A new case}; Anton Botella F et al.; Whipple's disease (WD) is a chronic multisistemic process in which the gastrointestinal tract is almost invariably affected . It is believed to be bacterial in origin, although a causative agent has not yet been isolated . Antibiotic treatment is usually quickly effective . We report a case of Whipple's disease in a 69-year-old man with typical clinical history and laboratory data . However, an associated allergic vasculitis not yet described in WD, the characteristical endoscopic appearance, and a partial response to treatment with persistence of histological lesions, made us consider of interest the report of the case. Z Erkr Atmungsorgane, 1991, 176(1), 65 - 9 Pulmonary Lymphogranulomatosis; Hajduk I et al.; The authors describe a case originally assumed to be pneumonia . As a consequence of unsuccessful antibiotic treatment surgical intervention took place . Then histological examination revealed pulmonary lymphogranulomatosis . The authors draw the attention to the responsibility of the GP-s and hospital doctors to include pulmonary lymphogranulomatosis in the range of suspected diseases if the symptoms are similar to those of the analysed case. J Clin Epidemiol, 1991, 44 Suppl 2, 67S - 72S Drug use and the role of patients and prescribers; Sterky G et al.; In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded . Both the public and private sector have to be addressed . In the latter the pharmacists might be studied using a tracer, fictitious client . One important factor influencing prescribing, drug information, has rarely been assessed scientifically . Experimental studies using group randomization are, however feasible even in developing countries . The individual human being must be in the focus of drug studies and health care and health in the foreground . The combination of qualitative and quantitative methods will assist us to achieve rational drug use that is culturally acceptable, economically feasible and pharmacologically soundPIP: In the effort to improve rational drug use in local or national settings, especially in developing countries, the behavior of prescribers and users is the subject of the least research . The effectiveness of drugs depends on a complex set of factors involved in the situation of prescription and acquisition . One aspect that needs examination is the information given to prescribers by drug advertisers and detailers, a deficiency being addressed by an international network of prescribers . In many countries, the largest outlet for drugs is the private sector pharmacies, where drugs are often dispensed without prescription . A simple inexpensive way of researching prescription behavior is to use fictitious tracers to follow case management of given conditions, such as infant diarrhea . There are many factors involved in prescribing; the process must be studied with an epidemiologic approach, i.e., by description, analysis, intervention and evaluation . Standard treatment schedules, essential drugs lists, targeted intervention with treatment guidelines should be audited by local therapeutic committees . Drug information should also be scientifically evaluated by the same analytical principles . The experimental method of group randomization is suggested as a feasible choice for developing countries . In this technique groups of physicians are observed or interviewed, and quantitative outcome data are collected . Behavior of individual users is best studied by combining anthropological and biomedical approaches, from the case-study perspective . An example of a problem amenable to this approach is the possible use of shorter courses of antibiotic treatment to lessen the risk of development of resistant organisms . Pharmacotherapy, 1991, 11(2 ( Pt 2)), 99S - 104S Management of intraabdominal infections; Sirinek KR; Intraabdominal bacterial infections (secondary peritonitis and intraabdominal abscesses) involve a large number of aerobic and anaerobic organisms and require a multifactorial therapeutic approach that consists of general supportive measures, surgical intervention, and antibiotic treatment . In spite of advances in antibiotic therapy, morbidity and mortality remain high . Well-conducted studies using standardized classification of infections are necessary to determine the best antibiotic regimen, and to lower morbidity and mortality. Age Ageing, 1991 Jan, 20(1), 29 - 32 Duodenal mucosal morphometry of elderly patients with small intestinal bacterial overgrowth: response to antibiotic treatment; Haboubi NY et al.; Microscopic changes in duodenal biopsy specimens from 16 elderly patients with small-bowel bacterial overgrowth were studied before and after cyclical courses of antibiotic treatment, using computer-aided morphometry measurements as well as visual assessment . Twenty-three subjects in the same age group with no evidence of intestinal disorder were studied as controls . Mean villus height was significantly reduced in the pre-treatment study compared to the post-treatment measurements and those in controls . Similar significant differences were found in mean crypt depth and total mucosal thickness . The mean intra-epithelial lymphocyte count was raised before treatment and fell after treatment to a level similar to that of the controls . The mean lymphocyte count in the peripheral blood rose significantly after treatment . This study provides objective evidence of microscopic structural changes in the bacterial overgrowth syndrome in old age . The return to normality after antibiotic treatment suggests that these changes are directly attributable to the presence of bacteria in the gut lumen. Neuroradiology, 1991, 33(1), 85 - 6 Post-myelographic meningeal irritation with iohexol; Alexiou J et al.; A 45-year-old woman developed signs of meningeal irritation after myelography with iohexol . Her condition improved very quickly (after antibiotic treatment) . Rapid improvement, absence of pathogenic organisms in the pre-treatment CSF culture, the level of CSF pleocytosis and protein were in favor of chemical meningitis. Neuroradiology, 1991, 33(1), 43 - 7 Percutaneous aspiration biopsy in cervical spine lytic lesions . Indications and technique; Tampieri D et al.; We describe the technique and the results of the percutaneous aspiration biopsy (PAB) in a series of 9 patients presenting with neck pain and different degrees of myelopathy, in whom the cervical spine X-ray demonstrated lytic lesions of unknown origin . PAB is a useful, relatively safe technique, and leads to histological diagnosis between metastatic and inflammatory processes . Furthermore, in inflammatory lesions with negative hemoculture . PAB may help in detecting the micro-organism responsible and therefore allow a better antibiotic treatment. Eur Neurol, 1991, 31(1), 18 - 20 Brown-Séquard syndrome caused by Borrelia burgdorferi; Berlit P et al.; We report the case of a patient with Brown-Sequard syndrome resulting from Borrelia burgdorferi infection . Antibiotic treatment led to complete recovery. ORL J Otorhinolaryngol Relat Spec, 1991, 53(1), 19 - 22 Ototoxicity monitoring with ultra-high frequency audiometry in peritoneal dialysis patients treated with vancomycin or gentamicin; van der Hulst RJ et al.; Ototoxicity affects the higher frequencies first and extends to the lower frequencies during continuation of the ototoxic treatment . Peritonitis due to continuous ambulatory peritoneal dialysis (CAPD) regularly demands ototoxic antibiotic treatment, e.g . with gentamicin and vancomycin . In this study ultra-high frequency audiometry (10-20 kHz), 'normal' audiometry (0.125-8 kHz) and registration of blood concentrations of the antibiotics were used to assess ototoxic hearing loss during treatment of CAPD patients with peritonitis. APMIS, 1991 Jan, 99(1), 69 - 74 Immune response in chlamydial conjunctivitis among neonates and adults with special reference to tear IgA; Herrmann B et al.; Tear and serum samples from 128 neonates and 122 adults with conjunctivitis were examined for antibodies to Chlamydia trachomatis with a micro-immunofluorescence (MIF) technique and the results compared to antigen detection by culture, enzyme immunoassay (EIA) (Chlamydiazyme, Abbott) and direct immunofluorescence (IF) (MicroTrak, Syva and Chlamyset, Orion) tests . From the 52 culture-positive adults, chlamydial IgA (titre greater than or equal to 1:8) antibodies were detected in 81% of the tear and in 62% of the serum samples, while 88% had such serum IgG antibodies (titre greater than or equal to 1:32) . The persistence of chlamydial IgA in tears and sera was related to the duration of symptoms of conjunctivitis and the antibody titres declined after institution of antibiotic treatment . In the adults, the sensitivity of the MIF tear IgA antibody test (81%) was higher than that of the EIA (71%) and the IF (MicroTrak 71% and Chlamyset 62%) tests . The specificity for the MIF test was 79%, while it was 100% for the EIA and the two IF tests . Of the 67 chlamydia-infected neonates, 36% had chlamydial tear IgA antibodies, while such antibodies were only found in 15% of the sera . No neonates with chlamydia-negative conjunctivitis had chlamydial IgA antibodies . The MIF test may be used as a diagnostic method complementary to culture, EIA and IF tests in the diagnosis of chlamydial conjunctivitis in adults, but is not applicable in neonates. J Nucl Med, 1991 Jan, 32(1), 13 - 5 Indium-111-labeled leukocyte scan in detection of synthetic vascular graft infection: the effect of antibiotic treatment; Chung CJ et al.; To determine the sensitivity and specificity of the indium-111-(111In) labeled leukocyte scan for prosthetic vascular graft infection in patients treated with antibiotic therapy, a retrospective study was performed . Of 41 consecutive 111In-labeled leukocyte scans performed to evaluate possible vascular graft infection, 23 scans were performed in patients treated with antibiotics . The average duration of antibiotic therapy was 21 days . Twelve positive and 11 negative scans for graft infection were found . By surgical and autopsy correlation of all positive cases, and clinical correlation (of all negative cases), there were 10 true-positive, 11 true-negative, 2 false-positive, and no false-negative scans for graft infections, for an overall sensitivity of 100% and specificity of 85%. Am J Kidney Dis, 1991 Jan, 17(1), 43 - 6 Successful prophylaxis for fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: six years' experience; Zaruba K et al.; Fungal peritonitis as a serious complication of continuous ambulatory peritoneal dialysis (CAPD) is often associated with severe morbidity, CAPD "drop-out" and, occasionally, death . Most episodes of fungal peritonitis occur during or after a period of antibiotic treatment of various bacterial infections, usually bacterial peritonitis . From April 1979 to December 1982 (period I), 10 episodes of fungal peritonitis occurred during 415 patient-months, ie, 10.5% of all peritonitis episodes recorded in our CAPD program . After the introduction of oral prophylaxis with 3 x 500,000 IU {corrected} nystatin during every course of antibiotic treatment, only four episodes of fungal peritonitis occurred during 2,102 patient-months, ie, 3.1% of all peritonitis episodes from January 1983 to March 1989 (period II) . This difference between the first and second periods is significant (P less than 0.05) . Moreover, none of the four patients who contracted fungal peritonitis in the second period received nystatin prophylaxis . Thus, the simple measure of oral prophylaxis using this nonabsorbable antifungal agent in every case of an antibiotic treatment largely eliminates the risk of fungal peritonitis in patients on CAPD. Scand J Infect Dis Suppl, 1991, 77, 15 - 6 Lyme borreliosis from a patient's view-point; Gamstorp I; The paper describes my own case of Lyme borreliosis, thus from the patient's point of view, stressing the clues which might have led to an earlier diagnosis . Intense antibiotic treatment is of value, also when given first some 15 years after the probable time of the infection, as, at least in my case, it stopped the progress of all symptoms and removed some of them, particularly muscle pains and skin abnormalities . Long-standing, well-established neurological symptoms, however, remain unchanged, but their previous slow, steady progress has stopped . The diagnosis is in itself valuable, as it is a relief to know what is behind the complaints. Scand J Infect Dis Suppl, 1991, 77, 145 - 50 Antibiotic treatment in Lyme borreliosis; Philipson A; Before the etiology of Lyme borreliosis became known, its human manifestations were most often treated with penicillin . Treatment was mostly successful, in spite of the fact that lower doses were generally used, but the doses were given with shorter intervals . Lately, other antibiotics have been tried, more or less successfully, but there is still no consensus as to which--if any--antibiotic is superior to others, or if one manifestation of the infection is better treated than another with a particular antibiotic. Acta Orthop Belg, 1991, 57 Suppl 1, 242 - 6 Management of wound sepsis after spinal fusion surgery; Harle A et al.; In wound sepsis after spinal surgery a first attempt to control infection without removal of the implants is justified, as implant removal after correction of scoliosis and kyphosis and in reduction of slipped vertebrae would often cause instability of the segments operated on . If the first revision is not successful, a second should not be delayed too long . Sometimes partial removal of the implants may be sufficient for infection control, thus maintaining a certain stability . We use local antibiotic treatment with Septopal chains, as suction irrigation sometimes is complicated by secondary bacterial contamination . By applying this treatment rationale we were able to control infection in 50 out of 53 patients with wound infection. Scand J Infect Dis, 1991, 23(1), 117 - 8 Branhamella catarrhalis as a cause of multiple subpleural abscesses; Ejlertsen T et al.; A pure growth of Branhamella catarrhalis was obtained from subpleural abscesses in a 65-year-old fisherman with a persistent pneumothorax; underlying disorders included lung fibrosis, rheumatoid arthritis, and diabetes mellitus . A thoracotomy revealed extensive thickening of the visceral pleura covering multiple subpleural abscesses . There was a protracted postoperative course despite surgical debridement and antibiotic treatment with a cephalosporin and erythromycin. Int Urol Nephrol, 1991, 23(3), 257 - 9 Malakoplakia of the prostate; Alpern HD; Malakoplakia of the prostate is a rarely reported granulomatous inflammatory disorder which may clinically mimic carcinoma of the prostate gland . A case of a 70-year-old man, with long follow-up, is reported . Histologic diagnosis allows for effective antibiotic treatment. Bull Acad Natl Med, 1991 Jan, 175(1), 93 - 8; discussion 98-102 {Helicobacter pylori gastritis: a new infectious disease . Reflections from a personal experience}; Schmitt J et al.; To determine the relationship of microscopic chronic antral gastritis to Helicobacter pylori, 69 consecutive patients were studied . In a prospective longitudinal study, at least 2 successive gastroscopies with antral biopsies were performed (177 investigations on the whole) . Sixty six of the 69 patients were treated with various therapeutic regimens i.e . antiulcer drugs and/or antibiotics . The type and intensity of inflammation (as based on whole inflammatory infiltrate density, polymorphonuclear cells presence or absence and IgA and IgM plasma cells counts) were correlated with H . pylori status (Giemsa staining and/or biopsy culture) . The presence of the organism (Hp) and the gastritis were significantly correlated (high grade of whole inflammatory infiltrate Hp + ve: 98/109 90%, Hp-ve: 9/61 15%, p less than 0.001--presence of neutrophil PMNC Hp + ve: 80/109 73%, Hp-ve: 1/61 2%; p less than 0.001--IgA and IgM plasma cells respectively Hp + ve: 7.6 +/- 6.6, 10.6 +/- 7.1, Hp-ve 1.9 +/- 2.9, 4.2 +/- 4.5; p less than 0.005) . Clearance and/or eradication of H . pylori after antibiotic treatment were associated with the disappearance of chronic gastritis activity and a statistically significant decrease of whole inflammatory infiltrate density (p less than 0.001) and IgA (p less than 0.005) and IgM (p less than 0.01) plasma cells counts . Mucosal inflammation was unchanged in case of H . pylori persistence and inflammation worsening occurred in case of infection relapse . H . pylori gastric mucosa colonization seemed to be responsible for the antral chronic inflammation associated with its presence.(ABSTRACT TRUNCATED AT 250 WORDS) Eur J Clin Pharmacol, 1991, 40(6), 631 - 3 Effect of ampicillin on mefloquine pharmacokinetics in Thai males; Karbwang J et al.; The kinetics of a single oral dose of mefloquine given either alone or with ampicillin has been studied in 8 healthy Thai male volunteers . There was a significantly higher maximum whole blood mefloquine concentration after coadministration with ampicillin (1648 vs 1228 ng.ml-1), as well as a significantly reduced terminal half life (15.3 vs 17.7 days), mean residence time (20.1 vs 23.4 days) and volume of distribution at steady state (14.1 vs 19.4 l.kg-1) . Although there was no significant change in the AUC from zero time to infinity, the AUC from zero time to 5 days was significantly increased by ampicillin (4.86 vs 3.27 micrograms.ml-1 day) . These changes in mefloquine disposition after antibiotic treatment may be due both to an increase in fractional bioavailability and a reduction in the enterohepatic recycling of mefloquine. Scand J Infect Dis, 1991, 23(3), 283 - 5 Varicella-zoster infection in adults with cystic fibrosis: role of acyclovir; Ong EL et al.; Of 159 adult patients with cystic fibrosis, 5 were documented to have varicella-zoster infection that resulted in an infective pulmonary exacerbation that required intravenous acyclovir and additional antibiotic treatment . Stable serial pulmonary function values were observed over a 1-year period in 4 patients and no complications resulted from treatment . Early treatment with acyclovir in combination with appropriate antibiotics may prevent pulmonary deterioration in adult patients with cystic fibrosis who develop varicella-zoster infection. Dermatologica, 1991, 182(3), 145 - 54 Borrelia burgdorferi and different types of morphea; Aberer E et al.; Thirty patients with different clinical manifestations of morphea (circumscribed scleroderma) were investigated for serum antibodies against Borrelia burgdorferi determined by ELISA and Western blot analysis . Forty-six percent of the patients were seropositive . Western blots confirmed the ELISA results in 10 of 25 patients (40%), showing a reactivity pattern which can be seen in the course of Lyme borreliosis . In some cases the outcome after antibiotic treatment suggests a direct correlation between the further development of skin lesions and Borrelia infection . Because of these findings we suggest some morphea types to be possibly due to a B . burgdorferi infection. J Gynecol Obstet Biol Reprod (Paris), 1991, 20(3), 443 - 6 {Newborn bacterial infection caused by materno-fetal contamination . Retrospective epidemiologic study at a maternity unit}; Blond MH et al.; A retrospective epidemiological study of neonatal bacterial infection due to contamination from the mother was carried out in maternity unit . We analysed the results of taking bacterial swabs from the skin and GI tract in newborn children when there was a possibility, or even probability, from the criteria given that there would be infection . These results compare with different criteria . In 19 months there were 2,622 live born children; 40.6% of those had swabs taken; the infection rate was 0.61% of newborns, but 16% of the newborns, had asymptomatic colonisation by bacteria . The high risks of finding positive swabs as shown by increased infection rates by colonisation occurred where the mothers had high temperatures . Our results led us to change the criteria for antibiotic treatment immediately after birth, in newborn babies. Child Nephrol Urol, 1991, 11(1), 29 - 32 Treatment of vesicoureteric reflux: results after 3 years in a prospective study; Scholtmeijer RJ; Between 1982 and 1986, 96 children with nonobstructive vesicoureteric reflux were treated in a prospective study . There were 134 refluxing ureters . Results are reported after a follow-up period of 3 years in 94 children with 130 refluxing ureters . Initially all children with reflux grade III or less had antibiotic treatment only . Those with reflux grade IV were randomized for antibiotic treatment alone versus surgery plus antibiotic treatment, while the primary treatment of reflux grade V was reimplantation . In 84 ureters treated by antibiotics alone, reflux disappeared in 52 cases and in 18 ureters the reflux was reduced . In 49 ureters treated by reimplantation, reflux was cured in 39 cases and no severe ureteric obstruction was seen . Conservative management of reflux grade IV was less successful than surgery . The results of conservative, nonsurgical treatment of reflux grade I to III are satisfactory, but for grades IV and V reflux surgery should be the treatment of choice, provided that detrusor instability can be excluded. Drugs Exp Clin Res, 1991, 17(12), 555 - 61 Effect of cefodizime (HR 221) on immunological defects induced by surgical stress; Auteri A et al.; Cefodizime, a new aminothiazolylcephalosporin, has been shown to possess immunomodulating activity in many experimental models in vivo and in vitro . The in-vivo effect of the drug was evaluated in a model represented by the surgical patient, being surgical practices usually associated with an immunological impairment involving many aspects of the immune response . Two groups of ten subjects were treated respectively with cefodizime (2 g i.v . daily) and another cephalosporin (ceftriaxone) at the same dosage . Aspecific immunity (complement activity, neutrophil phagocytosis, chemiluminescence and superoxide anion production) and cell-mediated reactivity (lymphocyte subpopulations and E-rosette-forming cells) were evaluated before, and at predetermined intervals after, surgery and antibiotic treatment . In the control group an important immunological derangement is observed, involving both lymphocytes and neutrophil functions and complement system . The treatment with cefodizime displays a positive effect with a significant improvement of impaired functions . The effect of the drug particularly influences neutrophil phagocytosis, explored with both the NBT test and determinations of chemiluminescence, and the complement system, through both the classic and the alternative pathways . A slight effect is observed on lymphocyte functions. J Gynecol Obstet Biol Reprod (Paris), 1991, 20(5), 680 - 4 {Acute salpingitis . Celioscopy before and after treatment: 110 cases}; Le Bouedec G et al.; The authors report their experience concerning 110 cases of acute salpingitis that were diagnosed and controlled laparoscopically one month after antibiotic treatment had been achieved . During the second look laparoscopy three parameters were appreciated: pelvic adhesions, tubal patency, and residual inflammation . Laparoscopic findings at the time of early second look have shown relationship between the occurrence of tubal sequelae and the seriousness of initial PID: the relation was statistically significant regarding pelvic adhesions and tubal patency . Chlamydia trachomatis infections were associated with a poorer reproductive potential outcome . Second look laparoscopy seems particularly indicated after severe form of PID (pyosalpinx, tubo-ovarian abscess), in the presence of Chlamydia trachomatis, among young nulliparous woman wishing to conceive. Gastroenterol Clin Biol, 1991, 15(10), 762 - 5 {Liver abscess and appendicular foreign body}; Paul G et al.; We report a case of liver abscess secondary to appendicitis which was due to a wire within the appendix . Appendicitis was asymptomatic, probably because of its retrocaecal position and/or previous antibiotic treatment . The abscess was treated with broad-spectrum antibiotics and percutaneous drainage, followed by a second stage appendicectomy . This case illustrates the value of gastrointestinal radiological investigations before considering the abscess as cryptogenetic. Ann Chir Gynaecol, 1991, 80(4), 323 - 8 Diagnostic factors for postoperative candidosis in abdominal surgery; Rantala A et al.; Abdominal surgery patients with postoperative septicaemia and a deep septic focus were analyzed in an attempt to identify characteristics typical of postoperative candidosis . There were 36 patients, 10 with candidosis and 26 with bacterial septicaemia . Typical for candidosis when the septic signs appeared was a history of prolonged antibiotic treatment before the operation (10/10), long courses of antibiotics (7/10), and therapy with combinations containing aminoglycoside (7/10) . Operations on the small intestine were characteristic of candidosis patients (4/10) . A poor clinical condition (9/10) on admission to the hospital, late onset of septicaemic symptoms postoperatively (7/10), long hospitalization (9/10), parenteral nutrition (10/10) and reoperations (9/10) were also features associated with the development of candidosis . Patients with postoperative candidosis have several characteristics on the basis of which the developing serious infection can be suspected and empirical therapy started . It may be appropriate to initiate antifungal prophylaxis in connection with operations when necrotic intestine is resected . Avoiding long courses of postoperative antibiotics could also be a measure to diminish the incidence of postoperative candidosis. Klin Wochenschr, 1991, 69 Suppl 26, 57 - 60 {Antibiotic-associated pseudomembranous colitis--a case report with review of the literature}; Hegelmaier C et al.; We report on one rare case of recurrent pseudomembranous colitis associated with antibiotic treatment with Aztreonam . The acute recurrence of colitis following oral treatment with vancomycin together with acute abdominal symptoms was successfully treated by an emergency operative procedure (anus praeter coecalis et sigmoidalis) . Subsequent local antibiotics (transcoecal vancomycin) were given . Based on a review of the literature, we discuss the etiology, pathogenesis, diagnostics and treatment of pseudomembranous antibiotic-associated colitis. Klin Wochenschr, 1991, 69 Suppl 26, 53 - 6 {The role of antibiotic therapy for postoperative infectious complications}; Bartels H et al.; Prospective analysis of the postoperative course of 1461 patients following major visceral surgery showed that postoperative complications scurred in 17.3% (253) of cases; 81% of the complications were related to the surgical procedure (surgical complications), whereas in 18.2% (46) of the patients, they complications were not related to surgery (non-surgical complications) . Among septic cases, the relationship between surgical vs non-surgical complications was 141 to 29 patients, or 5:1 . Early surgical reintervention was performed in all 141 patients exhibiting abdominal sepsis . Only 103 subjects (73%) in this group received additional antibiotic treatment . In contrast, all 29 patients who developed non-surgical sepsis were initially treated with antibiotics . When postoperative septic complications occur, abdominal sepsis should be considered first . Early surgical reintervention is always the treatment of choice for these complications . Antibiotics are regarded only as an adjuvant measure . For the rather rare septic complications that are not related to surgery, antibiotic therapy is used. Acta Chir Hung, 1991, 32(1), 45 - 55 A case of multiple cholangiogenic liver abscess due to residual biliary stone cured by percutaneous drainage controlled by CT and endoscopic papillotomy; Fazekas T et al.; The case of a patient treated for multiple cholangiogenic liver abscess due to residual biliary stone after acute cholecystitis is reported . The multiple liver cyst was cured by percutaneous transhepatic double drainage controlled by CT as well as puncture and aimed local systemic antibiotic treatment . The residual gallbladder stone was removed by endoscopic papillotomy . A similar case has not been reported so far. Pediatr Radiol, 1991, 21(6), 404 - 5 Pulmonary changes in congenital syphilis; Austin R et al.; Three of seven infants afflicted with congenital syphilis at our institution in the past five years showed diffuse pulmonary infiltrates . These persisted long after adequate antibiotic treatment of the primary infection . Review of pathologic literature suggests these infiltrates represent pulmonary immaturity, extramedullary hematopoiesis, and interstitial scarring. Scand J Urol Nephrol, 1991, 25(1), 9 - 13 Long term survival after transurethral resection of the prostate . Influence of preoperative bacteriuria and indwelling catheter treatment on late mortality; Adell L et al.; In this report we have analysed the long term survival after transurethral resection of the prostate in patients with cancer and benign hyperplasia, with special reference to the effect of bacteriuria . One hundred and eighty-nine men were followed for seven years after operation . Life tables according to the Kaplan-Meier method indicated a decreased survival rate for patients with preoperative catheter treatment and/or bacteriuria (p = 0.004 and p = 0.013, respectively) . In order to evaluate the influence on the long-term survival of each of these factors alone as well as of other factors like diagnosis, age at operation and perioperative antibiotic treatment, a multivariate analysis, according to Cox proportional hazards method was made . This displayed a two-fold increase of mortality in the patients attributed to the catheter treatment per se, whereas bacteriuria alone was not associated with an increased risk of earlier death. Adv Perit Dial, 1991, 7, 169 - 72 Use of streptokinase or urokinase in recurrent CAPD peritonitis; Dasgupta MK; In patients undergoing CAPD treatment, removal of peritoneal catheters has become a standard practice after two or more episodes of recurrent peritonitis which are refractory to antibiotic treatment . Immediate replacement of peritoneal catheters is not always safe in the presence of active peritonitis . Temporary institution of hemodialysis treatment in some of these patients may also be impossible because of unstable hemodynamic states or loss of vascular access sites . Successful continuation of CAPD treatment in some of these patients has been reported by using intraperitoneal (IP) administration of fibrinolytic agents such as streptokinase or urokinase as an adjunctive therapy to antibiotic treatment and as an outpatient procedure . Although numbers of cases reported are few in the literature and controlled studies in large numbers of patients are lacking, these reports emphasize the safety of IP use of these agents without any major systemic adverse effects . The reports are reviewed here to provide some practical guidelines for safe use of these agents in selected patients with recurrent CAPD-associated peritonitis. Dtsch Med Wochenschr, 1990 Dec 21, 115(51-52), 1956 - 9 {Encephalitis in Legionella bozemanii pneumonia}; Platzeck C et al.; A 44-year-old man, a known alcoholic and heavy smoker, was hospitalized with high fever and respiratory failure which a few hours later required intubation and artificial ventilation, although the chest x-ray had been unremarkable . Later serial chest x-ray films showed intrapulmonary infiltrations, while Legionella Bozemanii was demonstrated by direct immunofluorescence . Cranial computed tomography was unremarkable, despite the onset of tetraparesis and a severe midbrain syndrome . Cerebrospinal fluid contained merely mild lymphocytic pleocytosis . However, magnetic resonance imaging revealed symmetrical demyelinization foci in the brainstem as a sign of encephalitis . The neurological deficits regressed almost completely after several weeks of antibiotic treatment and rehabilitation measures over several months. Ugeskr Laeger, 1990 Dec 17, 152(51), 3862 - 5 {Pneumococcal meningitis . A 40-year case load}; Horstmann P; Eighty-four cases of pneumococcal meningitis were admitted to the medical-epidemic department C, Odense Hospital, during the period from 1940 to 1980 . 39% of the patients were under 10 years, 17% under one year, whereas 23% were over 50 years . The proportion males to females in all groups was approximately 3:2 . Pneumococcal meningitis, like other types of meningitis, responds dramatically to antibiotic treatment, but must still be considered a serious disease . Following treatment with a combination of penicillin, streptomycin, sulphonamides and chloramphenicol the mortality during the period 1952 to 1980 decreased to 12.7% . The fatal cases after 1952 all occurred during the years 1975-77 . Patients with meningitis are very sensitive to overhydration . It was therefore decided to restrict intravenous administration in these patients . Following the introduction of this regimen the mortality decreased again . The prevailing cause of death from meningitis during the antibiotic era was brain edema, which may occur even if the inflammation of the meninges has vanished . Therefore it is considered important to avoid overhydration in these patients. Schweiz Med Wochenschr, 1990 Dec 8, 120(49), 1880 - 3 {Gonococcal endocarditis: an infection as rare as it dangerous . Apropos of a case: the importance of suspicion in diagnosis and of immediate treatment}; de'Clari F et al.; Gonococcal endocarditis, although extremely rare, is increasing in frequency, particularly among young exposed patients . It has a distinct predilection for aortic and mitral valve involvement and tends to cause rapid valvular destruction and acute heart failure . Blood cultures are often negative during the first (3 to 31) days . Echocardiography with Doppler is helpful in detecting valvular vegetations, regurgitation and signs of hemodynamic deterioration . Early antibiotic treatment may stabilize the hemodynamic situation only in mitral but not in aortic valve involvement, which necessitates prompt valvular replacement in the event of perforation and/or annulus abscess . Gonococcal endocarditis should be the first item to be excluded in cases of fever with systemic symptoms in young people with a history of sex-transmitted disease . We present a typical case. Lancet, 1990 Dec 8, 336(8728), 1404 - 6 Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis; Dattwyler RJ et al.; 72 adults with erythema migrans (early Lyme borreliosis) were enrolled in a randomised prospective trial comparing amoxycillin 500 mg plus probenecid 500 mg three times a day with doxycycline 100 mg twice a day for 21 days . These antibiotic regimens were chosen because of the known in-vitro sensitivity of Borrelia burgdorferi, the antibiotic tissue penetration, the pharmacokinetics of the drugs, and because the organism can disseminate early in the course of infection . 72 patients were evaluable (35 in the doxycycline group and 37 in the amoxycillin/probenecid group) . The two regimens were equally effective for treatment of erythema migrans . Mild fatigue or arthralgia were the only post-treatment complaints, which resolved within 6 months . None of the patients needed further antibiotic treatment for Lyme borreliosis. J Laryngol Otol, 1990 Dec, 104(12), 949 - 51 Lateral sinus thrombosis: a problem still with us; O'Connell JE; Lateral sinus thrombosis is now a rare complication of ear disease in the developed world, since the advent of the widespread use of antibiotics . The classic picture is often modified by previous antibiotic treatment making diagnosis and management difficult . Lack of familiarity with this condition amongst present day otologists may lead to late diagnosis and treatment . We review three cases that we have managed recently and compare their clinical courses with the classic description of the disease. Ann Surg, 1990 Dec, 212(6), 655 - 62 Hepatic abscess . Changes in etiology, diagnosis, and management; Branum GD et al.; Most recent reviews of pyogenic hepatic abscess emphasize percutaneous versus open surgical management and devote little time to studying the etiology or the clinical condition of the patient . In this study a detailed review was performed with a computerized analysis of multiple clinical parameters in 73 patients treated for pyogenic hepatic abscess during a 17-year period . The mean age of the patients was 55 years and 38 of them (52%) were male . The mortality rate was comparable for solitary (17%) and multiple (23%) abscesses . The likelihood of death was higher with antibiotic treatment alone (45%) or percutaneous treatment (25%) than with surgical treatment (9.5%) . The primary determinant of outcome, however, was the underlying disease, i.e., malignancy or an immunocompromised patient, rather than solitary versus multiple abscesses . In addition the incidence of hepatic abscess seen at this center has doubled from the first half to the second half of the review, reflecting a population of more severely ill patients . It is apparent that in current clinical practice several methods of management are effective, and the choice of therapy should be determined by individualized selection . The principle of timely diagnosis and prompt institution of treatment appropriate to the specific patient remains the standard of care in this potentially grave disease. Am J Med, 1990 Dec, 89(6), 722 - 4 Ofloxacin treatment of Chlamydia pneumoniae (strain TWAR) lower respiratory tract infections; Lipsky BA et al.; PURPOSE: Limited data suggest that tetracycline or erythromycin is the antibiotic of choice for treating Chlamydia pneumoniae infection, but they are not always effective or well tolerated . Because the fluoroquinolone ofloxacin is effective for Chlamydia trachomatis infections, we investigated its role in treating C . pneumoniae infections . PATIENTS AND METHODS: Eighty-seven patients were enrolled in a randomized trial of antibiotic therapy for acute lower respiratory tract infections . The patients were randomly assigned to oral treatment with either ofloxacin (400 mg twice a day) or erythromycin (400 mg four times a day) for 10 days . Frozen acute and convalescent serologic specimens were tested for TWAR antibody by microimmunofluorescence . Susceptibility testing of C . pneumoniae to ofloxacin was also performed . RESULTS: Four patients who received ofloxacin were retrospectively identified as having C . pneumoniae pneumonia (two) or bronchitis (two) . Within 2 weeks of starting ofloxacin therapy, all were cured or markedly improved . The minimum inhibitory concentrations of ofloxacin for three previously isolated clinical strains of C . pneumoniae were determined to be 1.0 to 2.0 micrograms/mL, well within the achievable serum levels (3 to 5 micrograms/mL) with ofloxacin therapy . CONCLUSION: Ofloxacin may be an effective alternative antibiotic treatment for C . pneumoniae respiratory infections. J Formos Med Assoc, 1990 Dec, 89(12), 1096 - 8 Pulmonary mucormycosis: the first case with preoperative diagnosis and successful surgical treatment in Taiwan; Lee CH et al.; Pulmonarycosis is a rare disease, which refers to an infection by fungi belonging to the order Mucorales . This organism usually invades the skin, nose mouth, paranasal sinus, gastrointestinal tract, lung, brain, eyes and so forth . It usually occurs in patients with diabetes mellitus, hematological malignancy or other immunocompromised states . Until recently, this disease was rarely diagnosed before death . We report a case of pulmonary mucormycosis in a woman with poorly controlled diabetes mellitus . This is the first case in Taiwan of pulmonary mucormycosis diagnosed preoperatively and treated successfully by lobectomy only . Persistent pulmonary lesions resistant to antibiotic treatment in high risk patients should arouse the suspicion of mucormycosis . Prompt bronchoscopic examination, open lung biopsy and transthoracic pulmonary aspiration cytology and biopsy should be done . Surgical resection of localized lesions remains the treatment of choice. Ugeskr Laeger . 1990 Nov 26;152(48):3621. {Postoperative synergistic infection}; Fuglsig S et al.; Two cases of synergist postoperative infection are described . The importance of radical wound toilet and broad-spectrum antibiotic treatment is emphasized . Synergist infection should be borne in mind in cases where postoperative wound infection continues to spread despite thorough wound toilet. N Engl J Med, 1990 Nov 22, 323(21), 1444 - 50 Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome . A double-blind, placebo-controlled trial; Gagnon S et al.; BACKGROUND . Preliminary reports suggest that patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia may benefit from the addition of corticosteroid treatment to antibiotic therapy . METHODS . We conducted a double-blind, placebo-controlled trial to assess the efficacy of adjunctive corticosteroids in patients with AIDS and severe P . carinii pneumonia . Patients with marked abnormalities in gas exchange who had been treated with antibiotics for less than 72 hours were randomly assigned to receive either methylprednisolone (40 mg) or placebo every 6 hours for 7 days, in addition to treatment for 21 days with trimethoprim-sulfamethoxazole . The primary outcome measures were survival until hospital discharge and the development of respiratory failure . RESULTS . Twenty-three patients were enrolled in the study; there were no significant differences in base-line clinical or laboratory measures between the two treatment groups . Of 12 patients treated with corticosteroids, 9 (75 percent) survived until hospital discharge, as compared with only 2 of 11 placebo recipients (18 percent) (P less than 0.008) . Respiratory failure developed in nine placebo recipients, as compared with only three patients treated with corticosteroids (P less than 0.008) . No patient required the interruption or discontinuation of corticosteroid or antibiotic treatment because of toxicity or a complicating event . Because of the marked difference in survival, it was deemed unethical to continue the trial, and the study was terminated . CONCLUSIONS . Early adjunctive corticosteroid therapy can improve survival and decrease the occurrence of respiratory failure in patients with AIDS and severe P . carinii pneumonia. Orv Hetil, 1990 Nov 18, 131(46), 2543 - 8 {Management of gas gangrene in Hungary during 1979-1988 based on data from Public Health Centers}; Sere G et al.; Authors present data on the therapy of 223 gas gangrene cases between 1979-1988, a ten years period, based on the reports of Public Health Stations in Hungary . Of the 223 patients 150 died, thus lethality was 67.3% . In lack of surgical intervention there was no chance of survive . Merely wound exposure resulted in a much higher fatality rate than necrectomy of the wound . Local hydrogen-hyperoxide treatment improved survival essentially . Specific antitoxin therapy did not influence the survival rate . The effect of a single antibiotic was poor; combined antibiotic treatment gave a significantly better result . As for combination, the most effective were erythromycin, the lincosamids and chloramphenicol . According to the data presented, it would be possible to reduce to the half the fatality rate of gas gangrene in Hungary. Klin Wochenschr, 1990 Nov 9, 68(21), 1054 - 8 Proteinase-antiproteinase imbalance in meningitis: determination of alpha 1 proteinase inhibitor (alpha 1PI), elastase-alpha 1PI complex, and elastase inhibition capacity in cerebrospinal fluid; van Wees J et al.; Mortality and long-term neurologic sequelae are still frequent complications of meningitis despite effective antibiotic treatment . This suggests that pathogen-independent inflammatory mechanisms may play an important role in the course of this illness . Neutrophil granulocytes form the primary immune defense in meningitis . Once activated, these cells release elastase into the cerebrospinal fluid (CSF) . Elastase may induce tissue damage if local antiproteinase capacity is low as under normal conditions . To define the relevance of this mechanism we studied 22 patients with meningitis . Concentrations of elastase in complex with the main antiproteinase alpha 1-proteinase inhibitor (elastase-alpha 1 PI), alpha 1-proteinase inhibitor (alpha 1PI), and elastase inhibition capacity (EIC) were measured in CSF of 9 patients with bacterial meningitis (BM), aged 1 month-14 years; 13 patients with non-bacterial meningitis (NBM), aged 1 month-15 years; and 20 patients in whom meningitis was excluded after spinal tap (control group), aged 6 months-15 years . The concentration of elastase-alpha 1PI in the BM group (median 552 micrograms/l) was significantly higher than in either the NBM group (median 30 micrograms/l, p less than 0.01) or the control group (median 30 micrograms/l, p less than 0.01) . Similarly, the alpha 1PI-concentration in the BM group was significantly higher (median 113 mg/l) than either the NBM group (median 13.7 mg/l, p less than 0.025) or the control group (median 6.3 mg/l, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) Lancet, 1990 Nov 3, 336(8723), 1090 - 3 Effect of short-term intermittent antibiotic treatment on growth of Burmese (Myanmar) village children; Khin-Maung-U et al.; To test the hypothesis that subclinical enteric infection (such as bacterial overgrowth), rice malabsorption, and growth faltering are causally linked, a field trial of low-dose, short-term, intermittent antibiotic treatment was carried out in 142 hydrogen-producing (by lactulose breath hydrogen test) Burmese village children aged 6-59 months . The children were randomly allocated treatment with metronidazole (20 mg/kg or 5 mg/kg daily), amoxycillin (25 mg/kg daily), or placebo given 1 week per month for 6 months . A cooked rice meal breath hydrogen test was done to classify the children as rice absorbers (RA) or rice malabsorbers (RM) before treatment and monthly on the day before each cycle of treatment . There were no differences between the treatment groups, so they were considered together . Factorial analysis showed that antibiotic treatment did not significantly affect the proportion of RM children . The only significant difference between antibiotic-treated and placebo-treated children's growth was in the subgroup of RM children aged 36-47 months; the antibiotic-treated children had significantly greater linear growth . In other age groups antibiotic treatment had no effect on growth. J Trauma, 1990 Nov, 30(11), 1324 - 9 Gunshot injuries to the hip and abdomen: the association of joint and intra-abdominal visceral injuries; Becker VV Jr et al.; A retrospective review of all gunshot injuries to the hip at our medical center over a 24-year period was performed . Adequate information and radiographs were available for 49 patients . Of these, five patients (10.2%) had associated abdominal visceral injuries . These five patients were examined at an average of 5.9 years after their injury, and compared by utilizing the Harris Hip Score rating . Radiographs were also obtained . Four of these five patients (80%) had initially developed infections in their hip joints, with all four having poor functional outcomes, with an average Harris Hip Score of 48.5 from their hip injury . Careful initial evaluation and aggressive surgical and antibiotic treatment are recommended to prevent these poor results. Chest, 1990 Nov, 98(5), 1081 - 4 Quality of well-being before and after antibiotic treatment of pulmonary exacerbation in patients with cystic fibrosis; Orenstein DM et al.; General quality of life has only recently been measured with an objective tool in patients with cystic fibrosis (CF), and there have been no reported attempts to document changes in patients' overall well-being over time, as patients deteriorate or respond to intervention . We applied the Quality of Well-Being scale (QWB) in 28 patients with CF before and after a two-week course of oral ciprofloxacin used to treat pulmonary exacerbations . There were significant correlations between changes in QWB and various pulmonary function test results; QWB vs FEV1: r = 0.4, p less than 0.03; QWB vs FVC: r = 0.5, p less than 0.01; and QWB vs SaO2: r = 0.4, p less than 0.05 . Thus, the QWB can track changes in general well-being in CF patients over a brief time and detect changes associated with pulmonary exacerbation and its treatment. Obstet Gynecol, 1990 Nov, 76(5 Pt 1), 769 - 72 Prenatal diagnosis of congenital toxoplasmosis; Foulon W et al.; Prenatal diagnosis of congenital toxoplasmosis was attempted in 50 pregnant women at risk for giving birth to an affected child . Fifteen of these patients seroconverted during pregnancy and 35 had a high initial antibody level in their first serum sample . Prenatal diagnosis consisted of a combination of ultrasound screening, amniocentesis, and funipuncture at about 20 weeks' gestation . Diagnosis of congenital toxoplasmosis was based on a positive toxoplasma culture of amniotic fluid or fetal blood and on the presence of specific immunoglobulin M antibodies in fetal blood . In addition, alterations in fetal hematology, cellular immunology, and fetal liver tests were indicative of infection . Fetal infection was detected in six fetuses; two died in utero as a consequence of the infection and four were born after 37 weeks' gestation . Despite antibiotic treatment with pyrimethamine and sulfadiazine, one child has internal hydrocephalus and chorioretinitis and another has unilateral chorioretinitis . In the two other children, the disease is still subclinical . Of the 44 children born after a negative prenatal diagnosis, 35 have reached the age of 1 year; toxoplasma antibodies have disappeared in all of them . Investigation of the remaining nine children showed a decrease in toxoplasma antibodies, suggesting that none of them are affected . Prenatal diagnosis was never associated with fetal loss, and premature delivery occurred in only two cases . We conclude that prenatal diagnosis of congenital toxoplasmosis is safe and reliable. Acta Chir Scand, 1990 Nov-Dec, 156(11-12), 751 - 7 Effectiveness of perioperative short-term antibiotic prophylaxis in reducing surgical risk induced by malnutrition and anergy; Braga M et al.; The ability of perioperative short-term antibiotic prophylaxis to reduce the predictive significance of nutritional indicators for postoperative infections was evaluated in 162 patients undergoing major surgery for gastric or colorectal cancer . All patients were randomly assigned to a group receiving such prophylaxis or a group with postoperative antibiotic treatment . Preoperative serum albumin, total iron-binding capacity and weight loss were the nutritional indicators, and the evaluation included delayed hypersensitivity response . Postoperative infections occurred in 29% of the total series, with highest incidence in the group with postoperative antibiotics (p less than 0.001) and in anergic patients (p less than 0.05) . Increased risk of postoperative infection was related also to the number of altered nutritional indicators (p less than 0.005) . Multiple logistic analyses showed that the short-term prophylaxis independently contributed to fall in the infection rate and reduced the prognostic importance of nutritional and immunologic factors . Indeed, heightened incidence of postoperative infection was found only when all three nutritional factors were altered. Dtsch Med Wochenschr, 1990 Oct 19, 115(42), 1596 - 9 {Acute emphysematous cholecystitis as a cause of pneumoperitoneum}; Urban PP et al.; A 48-year-old man developed progressively more severe epigastric pain, pain on pressure in the right upper abdomen and fever up to 38.6 degrees C so that acute cholecystitis was suspected . Ultrasound did not demonstrate a gall-bladder but a sickle shaped, dense echo with a distal adjoining echo-free zone . Computed tomography revealed air in the gall-bladder lumen as well as intramural and pericholecystic air pockets, findings pathognomonic for emphysematous cholecystitis . In addition pneumoperitoneum was diagnosed . Subsequent cholecystectomy intraoperatively revealed a gangrenous, nonperforating gall-bladder in which E . coli was demonstrated . During the first postoperative week, there were no complications under transitory antibiotic treatment with tobramycin and ticarcillin with clavulanic acid . Then, an abscess developed in the residual gall bladder bed; this abscess was cured after drainage, local irrigation and re-initiation of antibiotic treatment . The patient was finally discharged well. Klin Wochenschr, 1990 Oct 17, 68(20), 1032 - 5 {Reversible space-occupying lesions of the kidney in HIV infection}; Bogner JR et al.; In January 1990 a 32 year old nurse was admitted with fever, weight loss of 9 kilogramms and pain of her right flank . HIV infection due to intravenous drug abuse had been diagnosed in 1986 . Ultrasonic imaging revealed a solid tumor of low echogenicity in the cranial part of the right kidney . This finding could be confirmed with computed tomography and magnetic resonance imaging . Angiographic study showed a missing of blood vessels in the same area . A transcutaneous puncture with a thin needle resulted histologically in unspecific findings like detritus, lymphoid cells and neutrophils . Antibiotic treatment with amoxicilline and cefuroxim was without success . Symptoms as well as ultrasonic findings completely disappeared following oral administration of ofloxazine . The clinical course and the successful treatment support the diagnosis of an atypical renal abscess . As a second diagnosis a histologically proven cirrhosis of the liver could be established . Hepatitis C serology proved to be positive. Tierarztl Prax, 1990 Oct, 18(5), 473 - 6 {The problems of the success of afterbirth removal in cattle . Expert veterinary opinion}; Grunert E et al.; If a severe uterine inflammation is diagnosed 15 days post partum in a cow with retained placenta by clinical examination, it has to be assumed that this inflammation was already manifest two days before (in the discussed case at the time of purchase) . By an external examination of the animal this genital inflammation cannot be seen, if there is no vaginal discharge or dried uterine fluids at the tail and around the vulva . The inflammation is the consequence of the placental retention, even if there has been veterinary assistance (manual removal of the retained placenta, antibiotic treatment of the uterus) in time . After manual removal of the placenta, part of it is normally left in the tips of the uterine horns; they cannot be reached by the veterinarian's hand . Even by additional means - like application of oxytocin, lifting the abdomen of the cow with the aid of a plank or trying to invert the tip of the uterine horn - the fetal membranes cannot always be totally removed . The statement that the placenta has been totally removed, is correct only if the end of the chorionic membranes could be clearly identified . Each placental retention in cattle carries the risk of reduced fertility . If a cow is sold a few days post partum, this defect, which can reduce the animal's breeding value, may be unnoticed. Ther Umsch, 1990 Oct, 47(10), 809 - 18 {Diarrhea in returning travellers (etiology, diagnosis and therapy)}; Meier R et al.; International tourism is constantly expanding and traveller's diarrhea has become a common disease . Although traveller's diarrhea may already have ceased after return, more and more general practitioners are confronted with patients complaining of GUT-symptoms associated with the journey . To manage these patients the precise knowledge of the etiology of traveller's diarrhea and the forms leading to chronic diarrhea is mandatory . This review deals with the etiology of diarrhea after returning home from tropical/subtropical areas and gives special emphasis on adequate diagnosis and treatment . It also points to the importance of parasites as cause of chronic traveller's diarrhea . Parasitic disease needs more often antibiotic treatment than infectious diarrhea due to bacterial agents . We summarize the etiology, the diagnostic and therapeutic approach. Compr Ther, 1990 Oct, 16(10), 40 - 5 Thoracic empyema: causes, diagnosis, and treatment; Cowen ME et al.; Thoracic empyema is a disease that has been recognized for centuries . The principles of management as stated by Hippocrates remain more or less unchanged . Diagnosis can be masked by the underlying cause, preemptive antibiotic treatment, or the now frequently associated debilitating diseases . With no other specific investigation, the main diagnostic test remains diagnostic thoracentesis . When an empyema is encountered, the objectives are to save life; eliminate the empyema, its complications, and chronicity; return pulmonary mechanics to normal; and reduce the duration of the hospital stay . The introduction of antibiotics has dramatically influenced the spectrum of the disease now encountered . If the original infection is adequately treated, empyema rarely occurs . Penicillin has removed the major cause of empyema, and further developments in antibiotics now mean that the majority of empyemas occur when patients are disabled by other disease processes or malnutrition, or where there remains a delay in medical attention . These patients are often less able to withstand the prolongation of the infective processes that is sometimes encountered with the staged approach to treatment . Developments in operative and postoperative care have meant that these patients can best be treated by more aggressive and definitive surgical management. Drug Des Deliv, 1990 Oct, 6(4), 311 - 8 Effect of antibiotic pretreatment on glycoside/glycosidase-based colonic drug delivery; Friend DR et al.; The effect of antibiotic pretreatment on the intestinal distribution and hydrolysis of the prodrug prednisolone-beta-D-glucoside was studied in rats . A combination of neomycin, lincomycin, and metronidazole was administered twice daily by gastric intubation for three days to young adult male rats . On the fourth day, prednisolone-beta-D-glucoside was administered intragastrically . The distribution of prodrug and drug in the intestinal contents was significantly altered by the antibiotic treatment . In comparison with untreated rats, stomach to cecum transit time appeared to be reduced, and more prodrug was hydrolyzed in the small intestine . In addition, an appreciable amount of the dose was retained longer in the small intestine of treated animals . The total recovery of prodrug and drug was unaltered by the pretreatment . Possible explanations for the observed results are presented. Physiol Behav, 1990 Oct, 48(4), 561 - 5 Are antibiotic effects on sleep behavior in the rat due to modulation of gut bacteria? Brown R, Price RJ, King MG, Husband AJ. The sleep-inducing substance Factor S (FS) is unique among candidate sleep molecules because of its bacterial origin . FS is derived from the bacterial cell wall and accumulates in the brain and body fluids of sleep-deprived animals including man . Exogenous administration of FS and related muramyl peptides results in an increase in slow-wave sleep (SWS) . To test the possibility that gastrointestinal bacteria are a source of FS, rats were placed on an antibiotic regimen (neomycin and metronidazole in drinking water) and sleep measures taken after one week . There was a significant reduction in SWS in the first three hours of the lights-on period as well as an increase in sleep latency . No other sleep parameters, including Rapid Eye Movement (REM) sleep measures, were affected, suggesting that there was a specific SWS effect due to bacterial reduction . Possible toxic effects of the antibiotic treatment were unlikely factors in SWS reduction due to the stability of other sleep measures such as number of episodes of SWS and REM, total sleep time and REM latency . Oral administration of live E . coli to rats did not affect any sleep measures . It appears that FS may be specifically involved in the early sleep period where it promotes sleep onset and SWS generation. Ugeskr Laeger, 1990 Sep 3, 152(36), 2550 - 2 {Preventive antibiotic treatment in cases of complicated injuries of the extremities . A questionnaire study}; Neumann L et al.; A questionnaire about prophylactic antibiotic treatment of open bone, tendon or joint lesions in the extremities was sent to the 83 casualty departments in Denmark . The questionnaire was answered by 56 casualty departments which treated 72% of the orthopaedic surgical injuries in Denmark . In cases of lesions of the hands and feet, 23% of the patients were treated in casualty departments where prophylactic antibiotic therapy was rarely employed while 24% were treated in casualty departments where prophylactic antibiotic therapy was always employed . In cases of lesions proximal to the wrist or ankle joints, the figures were 26% and 38%, respectively . Penicillin was nearly always employed and treatment was commenced before or during operation . The majority of departments continued treatment for four days or longer . Considerable scatter was reported in the dosage of penicillin employed . The literature about prophylactic antibiotic treatment in cases of complicated lesions of the extremities is insufficient and controlled investigations are necessary to elucidate a series of conditions. Cesk Otolaryngol, 1990 Sep, 39(5), 271 - 5 {Rhinogenous phlegmons of the orbit}; Droppa J et al.; During the past 15 years we treated at the ENT department and ophthalmological department of the hospital with policlinic type III in Nitra 10 patients with orbital phlegmons or an abscess of the eyelid after an eye injury treated and cured by antibiotic treatment and external drainage . Twelve patients had a rhinogenic phlegmon or abscess in the orbit (one patient had a dentogenic aetiology of the inflammation) . This group of 12 patients were treated in addition to antibiotics in different combinations also surgically (in one case also by drainage of the abscess from a lateral quadrant of the orbit) . In five instances the authors found in addition to the phlegmon of the periorbital tissue also an abscess in the depth of the orbit and six times an abscess of the eyelid . Despite the radical approach to the inflammation of the paranasal sinuses and inflammation of the orbit, two patients developed blindness of the damaged eye and one patient died from rhinogenic suppurative meningitis. J Trauma, 1990 Sep, 30(9), 1148 - 53; disscussion 1153-4 The role of antibiotic therapy in the prevention of empyema in patients with an isolated chest injury (ISS 9-10): a prospective study; Brunner RG et al.; The purpose of this study was to determine the impact of an antibiotic regimen on the incidence of empyema in patients admitted with isolated chest trauma (ISS 9/10) and hemopneumothorax requiring tube thoracostomy . All patients with isolated chest trauma and hemopneumothorax (estimated ISS 9 or 10) seen in our trauma center were considered eligible for this study . Patients were excluded for the following reasons: age less than 18 years, presence of shock at the time of initial resuscitation, ongoing antibiotic therapy for unrelated disease, documented pre-existing infection or documented abnormal immune status . Ninety patients were randomized to two treatment limbs: antibiotics and tube thoracostomy or tube thoracostomy alone . All patients had the procedure performed in the trauma center in a standard fashion . Wound care and tube care were identical . Antibiotic therapy consisted of a first-generation cephalosporin (cefazolin), one dose given just before the procedure and then q 6 h into the tube removal . Injury Severity Scores were established as described by Schwab after the manner of Baker . Statistical analysis was performed using Fisher's exact test of binary outcome . In this study, antibiotics were able to reduce the incidence of empyema in patients with isolated chest trauma and for such patients antibiotic treatment appears justified . Further work is required to determine the effect on patients with more severe injury and multisystem involvement. Clin Nucl Med, 1990 Sep, 15(9), 597 - 602 Tc-99m labeled leukocytes in imaging of patients with suspected acute abdominal inflammation; Laitinen R et al.; One hundred patients with suspected acute abdominal inflammation were imaged at 0.5, 2-3, 4-6, and 24 hours after the administration of Tc-99m HMPAO labeled autologous leukocytes . Scan findings were retrospectively compared with final diagnosis, serum C-reactive protein (CRP), and antibiotic treatment . Clinical findings were confirmed with surgery, barium enema, or sigmoidoscopy in 61 patients, and diagnosis was based only on clinical findings in 13 patients . In 26 patients, symptoms subsided before a final diagnosis was made . Tc-99m leukocyte images were positive in 45 of the 61 patients with a confirmed diagnosis, including all patients with acute cholecystitis (N = 4) and inflammatory bowel disease (N = 8) . They were also positive in nineteen out of 25 patients who had acute colonic diverticulitis and in 6 out of 7 who had intra-abdominal abscesses . Abnormal activity was found i