Biomedical subjects
D Isaacs
Publications and source records attributed to D Isaacs.
Acronymophilia: an update.
The history, epidemiology, clinical features, and treatment of the epidemic infection, acronymophilia, a sinister scourge of modern medicine are described.
Rationing antibiotic use in neonatal units.
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Cerebral infarctions: evaluation with single-axis versus trace diffusion-weighted MR imaging.
OBJECTIVE: Our purpose was to determine the usefulness of single-axis diffusion-weighted imaging versus trace diffusion-weighted imaging in the evaluation of cerebral infarctions. SUBJECTS AND METHODS: Twenty-six patients harboring 34 infarctions were examined using single-axis and trace diffusion-weighted imaging within 48 hr of the onset of symptoms. Two neuroradiologists who were not aware of the clinical findings reviewed all images obtained with both techniques and noted the following: type of infarction (small [<15 mm] versus territorial), location of infarction, presence of infarction (seen only on single-axis images, seen only on trace images, seen on both), lesion conspicuity (better on single-axis images, better on trace images, or equal on both), and lesion size (larger on single-axis images, larger on trace images, or equal on both). Differences in opinion were resolved by consensus. RESULTS: Of the 18 small and 16 territorial infarctions, all were identified on both single-axis and trace imaging. Lesion conspicuity was judged to be slightly better on trace images for both types of infarctions. Lesion size was judged to be larger on single-axis images for territorial infarctions. CONCLUSION: Both single-axis and trace diffusion-weighted imaging showed all small and territorial cerebral infarctions. Both types of infarctions were slightly larger on single-axis images but this did not affect correct interpretation in any case. The single-axis technique provided sufficient information for the diagnosis of cerebral infarction in our clinical settings.
Bacteraemia in febrile children presenting to a paediatric emergency department.
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A population-based study of children with cerebral tuberculosis in New South Wales.
OBJECTIVE: To determine the incidence of childhood cerebral tuberculosis (tuberculous meningitis [TBM] and tuberculoma) in a defined population. DESIGN: Retrospective, population-based study. SETTING AND PARTICIPANTS: All resident children aged up to 14 years in New South Wales diagnosed with cerebral tuberculosis, from 1982 to 1996. MAIN OUTCOME MEASURE: Population-based incidence of childhood TBM. RESULTS: 10 children with TBM and one with tuberculoma were identified in the 15 years. The incidence of TBM was 0.053 (95% CI, 0.025-0.097) per 100,000. Eight of the 10 TBM patients were born in Australia and five were of white European origin. Only one had been vaccinated with BCG vaccine. Three of the children died. CONCLUSIONS: The incidence of childhood TBM in New South Wales is low, and comparable with that in other First World countries.
Transmission of tuberculosis from a seven-year-old child in a Sydney school.
OBJECTIVES: To determine whether a 7-year-old child with extrapulmonary and pulmonary tuberculosis (TB) and direct smear positive sputum for acid-fast bacilli was infectious to home and school contacts, and to ascertain potential adult sources of infection for these contacts. METHODS: Contact tracing by Mantoux testing was conducted on 220 children at a primary school and after-school care facility, and 59 selected adults considered potential sources of infection. RESULTS: The participation rate for the children was 98% and 92% for the adults. Mantoux positivity (induration >/= 10 mm, or >/= 15 mm with previous BCG) among children was 13% at the school (anticipated rate 2-3%), 26% among school staff, and 7% among children at the after-school care centre where the index case attended. One exposed adult hospital staff member converted from Mantoux negative to positive. No other cases of TB disease were detected among children or adults tested. CONCLUSION: Although spread of TB from children to others is rare, the findings of this investigation indicate that transmission of TB from a young child to other children and an adult may have occurred, and that sputum testing and contact tracing for sputum smear positive children should be considered.
Intrapartum antibiotics and early onset neonatal sepsis caused by group B Streptococcus and by other organisms in Australia. Australasian Study Group for Neonatal Infections.
OBJECTIVE: Early onset group B streptococcal (EOGBS) infection, the major neonatal infection in industrialized countries, can be prevented by intrapartum antibiotics, but population studies are lacking. This study aimed to determine the incidence of early onset infections caused by group B Streptococcus (GBS) and other organisms in Australia and to assess intrapartum antibiotic use. DESIGN: Longitudinal, prospective surveillance of neonatal infections in Australian neonatal units from 1991 to 1997. Early onset infection defined as clinical sepsis in first 48 h after birth, with positive cultures of blood or cerebrospinal fluid or positive urine GBS antigen detection. RESULTS: The incidence of EOGBS sepsis fell from 2.0 per 1000 live births (95% confidence interval, 1.4, 2.5) in 1991 to 1993, to 1.3 (1.2, 1.4) in 1993 to 1995, to 0.5 (0.4, 0.7) in 1995 to 1997 (P < 0.0001). The incidence in Aboriginal babies was 5.2 (1.8, 8.6) in 1991 to 1993, 5.1 (3.0, 7.2) in 1993 to 1995 and 1.8 (1.1, 2.5) in 1995 to 1997 (P < 0.05). The incidence of early onset infections caused by organisms other than GBS also fell, from 1.2 per 1000 live births (0.8, 1.7) in 1991 to 1993, to 0.8 (0.7, 0.9) in 1993 to 1995 and 0.5 (0.3, 0.7) in 1995 to 1997 (P < 0.0001). In 1991, 3 of 9 study hospitals had a formal policy on intrapartum antibiotic use, whereas in 1997 all 11 hospitals had a formal policy (P=0.002). CONCLUSIONS: A steady fall in EOGBS infections in Australia from 1991 to 1997 has been associated with increasing use of intrapartum antibiotics. Increased antibiotic use is probably causal in the fall in GBS, because the incidence of early onset infections caused by other organisms has also fallen.
Ulcerative lesion of the nasal bridge in a five-month-old infant.
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Differential avian and human tuberculin skin testing in non-tuberculous mycobacterial infection.
OBJECTIVE: To determine the sensitivity of differential avian and human delayed-type hypersensitivity skin testing in the diagnosis of non-tuberculous mycobacterial lymphadenitis. METHOD: Retrospective review of all patients with culture proved non-tuberculous mycobacterial lymph node infections who also had differential avian and human skin testing performed over a 10 year period from 1986 to 1996. RESULTS: One hundred and twenty four patients had non-tuberculous mycobacteria isolated from lymph nodes over this period, 59 of whom had differential skin testing performed. The sensitivity of a response of >/= 10 mm to the avian precipitin was 58 of 59. No patient had both a negative human and avian Mantoux. The sensitivity of the human Mantoux alone for diagnosing non-tuberculous mycobacterial infection was 81% for a response of >/= 5 mm and 66% for >/= 10 mm. Ten patients had a 0 human response. Fifty five of the 59 patients had an avian response at least 2 mm greater than the human response. CONCLUSION: The avian Mantoux is a very sensitive method of diagnosing non-tuberculous mycobacterial infection in children. The human Mantoux is not sensitive enough to be used alone as a surrogate to diagnose non-tuberculous mycobacterial infection.
Outbreak of extended spectrum beta lactamase producing Klebsiella pneumoniae in a neonatal unit.
An outbreak of extended spectrum beta lactamase producing Klebsiella pneumoniae (ESBLKp) in a neonatal unit was controlled using simple measures. Normally, the control of such infections can be time consuming and expensive. Seven cases of septicaemia resulted in two deaths. ESBLKp isolates were subtyped by pulsed field gel electrophoresis, and four of the five isolates typed were identical. Control of the outbreak was achieved by altered empiric antibiotic treatment for late onset sepsis and prevention of cross infection by strict attention to hand washing. Widespread colonisation of babies in the unit was presumed, so initial surveillance cultures were not performed. No further episodes of sepsis occurred.
Immunisation of preterm infants.
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Management and prevention of meningococcal disease. Penicillin or third-generation cephalosporin in doctors' bags?
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Tuberculosis in children in Australia: strategies for control. Paediatric Special Interest Group of the Australasian Society for Infectious Diseases and the Australasian Paediatric Respiratory Group.
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A comparison of IL-2 levels in nasopharyngeal and endotracheal aspirates of babies with respiratory syncytial viral bronchiolitis.
BACKGROUND: Cytokines such as IL-2 are thought to be important in the pathogenesis of respiratory tract inflammation. Cytokine levels in nasopharyngeal aspirates (NPAs) have been used as a measure of respiratory inflammation in children with viral infections, but it is unclear whether they reflect levels in the lower respiratory tract. OBJECTIVE: We sought to assess the correlation between IL-2 levels in the nasopharyngeal and endotracheal secretions of children intubated with respiratory syncytial virus (RSV)-positive bronchiolitis. METHODS: NPA and endotracheal aspirates were collected concurrently from intubated infants with RSV-positive bronchiolitis. IL-2 levels were assayed by ELISA, and the results were compared according to collection site. RESULTS: Nine paired specimens were collected. IL-2 levels ranged from 31 pg/mL to 8040 pg/mL. No significant difference was found in the geometric mean IL-2 values from the 2 collection sites. The intraclass correlation coefficient between NPA IL-2 levels and endotracheal aspirate IL-2 levels was 0.83. CONCLUSION: IL-2 levels in NPAs are comparable with those in the lower respiratory tracts of infants with RSV-positive bronchiolitis. NPA cytokine levels provide a simple and useful means of assessing respiratory tract inflammation.
A cluster of cases of neonatal coxsackievirus B meningitis and myocarditis.
Three babies were referred with enteroviral meningitis and myocarditis during a 4-month period. During this same period there was an increased frequency of coxsackievirus B type 2 isolates reported to the National Centre for Disease Control. Myocarditis was simultaneous with meningitis in one baby, but delayed by 10 weeks in another, in whom myocarditis mimicked myocardial infarction. Two of the three mothers experienced abdominal pain, one with antepartum haemorrhage, which has been described previously with coxsackievirus infection in pregnancy. Diagnosis was made in two babies by polymerase chain reaction on cerebrospinal fluid.
Swabbing computers in search of nosocomial bacteria.
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Brothers with fever and abdominal pain.
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