Cat-scratch disease diagnosed serologically using an enzyme immunoassay in a patient with neuroretinitis.
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Antibodies, Bacterial↗
Biomedical subjects
B Wasilauskas
Publications and source records attributed to B Wasilauskas.
Expert systems.
The concept of computerized expert systems is explained, the potential utility of these systems in pharmacy is explored, and strategies and imperatives for implementing them are described. Computerized expert systems attempt a higher level of analysis than traditional computer programs. They can be defined as systems that attempt to make or assist in a decision that is not yet completely and reliably definable in objective terms. Because of the information-intensive nature of pharmacy practice, this field is particularly suited to use of expert systems. Current applications include screening for drug interactions and therapeutic drug monitoring. Expert systems must offer a substantial advantage over human expertise (for example, by quickly analyzing enormous quantities of data); those that perform functions that humans could perform have failed to gain widespread use. An ideal hospital expert system would have access to any data available about a patient's care and would detect critical situations as they occur. Such a system would require pharmacists to shift from a prescription-based orientation to a case-management orientation. Factors to consider in implementing an expert system include linkage among multiple departments, usage options, development strategies, and maintenance requirements. Computerized expert systems hold great potential for application to pharmacy and may influence the pharmacist's role in patient care.
Drug Interactions↗
Inhibitory effect of the Isolator blood culture system on growth of Mycobacterium avium-M. intracellulare in BACTEC 12B bottles.
The examination of 6,938 clinical specimens collected during the period January 1991 through December 1992 suggested that the Isolator blood culture system (Wampole) inhibited growth of Mycobacterium avium-M. intracellulare complex (MAC) in BACTEC 12B medium. Of 162 MAC blood culture isolates, 94% were recovered from Lowenstein-Jensen (LJ) medium, while only 50% were recovered from 12B medium. The time to detection with LJ medium was 18 days, while that with 12B medium was 24 days. In contrast, 62% of the 305 MAC nonblood culture isolates were recovered from the LJ medium, while 87% were found in the 12B medium. The time to detection for these cultures was also reversed, i.e., 28 days for LJ medium versus 15 days for 12B medium. Dilution studies using the lysis-anticoagulant reagent from Isolator tubes demonstrated inhibition of both clinical and American Type Culture Collection strains of MAC, even at low concentrations of lysis-anticoagulant reagent. Washing the Isolator blood sediment prior to inoculating the 12B bottles eliminated any growth inhibition. Clinical and experimental data suggest that the use of the Isolator blood culture tube with the BACTEC 12B medium is contraindicated for mycobacterial blood cultures.
Bacteremia↗
Personal computer-based expert system for quality assurance of antimicrobial therapy.
A personal computer (PC)-based expert system developed to monitor the appropriateness of antimicrobial therapy is described. Susceptibility test data and antimicrobial therapy data are downloaded daily from the microbiology department and pharmacy department computer systems. Relational database software allows for the indexing, sorting, and manipulation necessary for analysis. The expert system accomplishes its analyses using (1) databases of organisms, antimicrobial drugs, and susceptibility cutoff values, (2) programs for evaluating pathogenicity and therapy, and (3) algorithms that determine the timing and sequence of the analysis. System output consists of discrepant therapy reports that indicate that no therapy is being given despite the presence of pathogens, that the pathogens isolated are resistant to the therapy being given, that the therapy cannot be matched with susceptibility data on the isolates, or that the therapy was discontinued too quickly. The expert system has been in continuous operation at an 800-bed referral hospital since July 1991. During an 11-month period, the system generated 1538 discrepant therapy reports. The percentage of isolates resulting in reports varied substantially with the source of the isolate. Therapy was more likely to be improved when the physician was contacted about the potential problem indicated by the report than when the physician was not contacted. A PC-based expert system using data from unlinked pharmacy and microbiology computer systems automatically evaluated the appropriateness of antimicrobial drug therapy in light of susceptibility test data.
Anti-Bacterial Agents↗
Apparent increase in the incidence of invasive group A beta-hemolytic streptococcal disease in children.
Recently, among adults, an increase in the incidence of invasive disease caused by group A beta-hemolytic streptococci (GABS) has been noted, as has the appearance of a severe illness called "toxic shock-like syndrome," also caused by GABS. We now report an apparent increase beginning in 1987 in the incidence of invasive disease caused by GABS in children. Among these patients the manifestations were varied. One child had signs and symptoms compatible with the streptococcal toxic shock-like syndrome. Among the GABS isolates from our patients, 8 (80%) of 10 evaluated for M-protein antigens were nontypeable. Further studies will be necessary to determine the relationship between serotypes and virulence of GABS. Physicians should be aware of the possibility of an increasing incidence of invasive GABS disease in children, as well as its manifestations, which may include toxic shock-like syndrome.
Adolescent↗
Multicenter comparison of MicroScan and BACTEC blood culture systems.
Recently, MicroScan (Baxter MicroScan Div., W. Sacramento, Calif.) introduced a radiolabeled-blood-culture system that is compatible with the BACTEC 460 (Johnston Laboratories, Inc., Towson, Md.). A multicenter blood culture study was initiated to evaluate this new system. Approximately 20 ml of blood was obtained from each patient and divided equally between BACTEC and MicroScan bottles which were incubated and processed identically. Aerobic bottles were examined twice on days 1 and 2 and once on days 3, 4, 5, 6, and 7. Anaerobic bottles were examined once a day for 7 days. There were 3,451 cultures evaluated, and 414 of these subsequently grew microorganisms. Of these positive cultures, 64 were judged to be contaminated. Of the remaining 350 positive cultures, 253 grew in both systems, 54 grew in BACTEC bottles only, and 43 grew in MicroScan bottles only. The average times to detect positive cultures were 1.8 and 2.1 days by the BACTEC and the MicroScan systems, respectively. No significant difference in the number or kind of organisms recovered or in the detection times for positive cultures was observed between the two blood-culturing systems.
Aerobiosis↗
Capnocytophaga in the amniotic fluid of a woman in preterm labor with intact membranes.
Chorioamnionitis is thought to be uncommon with intact fetal membranes. A case is reported of a woman in preterm labor with intact membranes from whose amniotic fluid, placenta, and infant's gastric aspirate an unusual organism, Capnocytophaga, was identified. The findings are discussed.
Adult↗
Counterimmunoelectrophoretic detection of a high incidence of precipitin reactions in normal human sera against staphylococcal teichoic acids and protein A.
The use of counterimmunoelectrophoresis (CIE) for detection of serum antibodies to staphylococcal teichoic acids was evaluated against teichoic acids prepared by sonic treatment or lysostaphin extraction of Staphylococcus aureus (Lafferty strain). Of 54 patient sera from suspected cases of staphylococcal endocarditis, osteomyelitis, or septicemia, 33 (61.1%) were positive by CIE analysis; however, 128 of 291 sera (44.0%) from normal adult donors were also positive. Selected CIE-positive sera from patient and control groups were titered by Ouchterlony gel diffusion. In the control group of normal sera, 65% were also positive by gel diffusion, but only 15% had titers of >/=1:2. Of the patient sera, 44.4% had gel diffusion titers of >/=1:2. In addition to the specific teichoic acid band, a second precipitation band could be demonstrated with both patient or normal sera by CIE or gel diffusion. This second precipitin band was shown to involve interactions of test sera with staphylococcal protein A present in the teichoic acid extracts. The protein A precipitins were detected at high concentrations of the antigen extracts, whereas the anti-teichoic acid precipitins were optimally detected at lower antigen concentrations. The formation of protein A precipitin bands did not correlate with the presence of anti-teichoic acid antibodies, as most sera tested were positive for protein A regardless of anti-teichoic acid activity. This study suggests that a high incidence of normal people have levels of antibodies to teichoic acids which are detectable by the highly sensitive, but nonspecific, technique of CIE.
Adult↗
Meningitis due to Haemophilus influenzae type b resistant to ampicillin and chloramphenicol.
Invasive disease due to Haemophilus influenzae type b (Hib) resistant to chloramphenicol and ampicillin is rare in the United States. Review of the literature reveals that all previously reported cases occurred in children with meningitis. These children were treated initially with ampicillin and chloramphenicol and had complicated courses characterized by delayed sterilization of the cerebrospinal fluid. The present report describes an infant who developed meningitis due to ampicillin- and chloramphenicol-resistant Hib. The patient received cefotaxime from the onset of therapy and had an uncomplicated course. The presence of Hib strains resistant to chloramphenicol and ampicillin should be considered in patients with meningitis due to Hib who respond poorly to treatment with these two drugs. Furthermore, the in vitro susceptibility of all Hib isolates to chloramphenicol (as well as to other antimicrobial agents) should be evaluated routinely. If the incidence of such resistant organisms increases, a change will be warranted in the commonly recommended combination of ampicillin and chloramphenicol as empiric therapy for bacterial meningitis in pediatric patients.
Ampicillin Resistance↗