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Biomedical subjects

F Allerberger

Publications and source records attributed to F Allerberger.

At least 91 records · Page 5Linked to original sources
PubMed1995

Infection of the pancreatic duct following pancreas transplantation with bladder drainage.

Combined kidney-pancreas transplantation represents a widely accepted therapy for endstage diabetic nephropathy. Drainage of the pancreatic juice into the urinary bladder is the preferred surgical technique in most centers. Between January 1987 and December 1994 a total of 85 pancreas transplantations with pancreatocystostomy were performed at the Innsbruck University Hospital. In all cases a polyvinylcatheter was placed into the pancreatic duct and drained transvesically to the exterior. During several weeks after transplantation pure pancreatic juice was harvested for immunological and microbiological monitoring. Whenever a patient required antibiotic treatment, antibiotic concentrations in pancreatic juice, urine or serum were determined by means of a biological test system using Bacillus subtilis. Nine different ATCC bacterial strains were incubated in pancreatic juice collected from transplant recipients and tested for their multiplication rate. Thirteen patients acquired an infection of the pancreatic duct. Non-fermentative bacteria, gram-negative rods, Enterococcus spp. and Candida spp. were the most often isolated organisms. The in vitro tests revealed that Pseudomonas aeruginosa, Acinetobacter calcoaceticus and Escherichia coli grew very well whereas Streptococcus agalactiae was unable to multiply in pancreatic juice. Ampicillin/sulbactam was found to be excreted in high concentrations into the pancreatic juice. Many other tested antibiotics (cephalosporins, carboxypenicillins and aminoglycosides) achieved levels below the minimum inhibitory concentrations (MICs) for most bacteria. Antibiotic treatment was required for up to 5 weeks to eliminate the pathogens from the pancreas but was successful in 11 out of the 13 patients at the end. The results of this study led to changes in our antibiotic policy and helped to improve the results after pancreatic transplantation.

Adult↗
PubMed1995

HIV-testing of health care workers: unethical request or moral obligation?

Transmission of HIV from physician to patient is possible. Physicians should help the public understand the low level of this risk and put it in the perspective of other medical risks, while acknowledging public concern. Nevertheless, there is a clear need for national guidelines which give unambiguous, practicable guidance about HIV-testing of health care workers performing invasive procedures and consequences of positive results. It is an ethical obligation of us physicians to come forward with such distinct recommendations and clearly have identified "exposure-prone" procedures which might necessitate HIV-screening. Infection with HIV does not in itself justify restrictions on the practice of an otherwise competent health care worker, but seropositive physicians should place themselves under the guidance of an expert review panel, which should determine whether practice restrictions are appropriate.

AIDS Serodiagnosis↗
PubMed1995

[Gas gangrene as a manifestation of endogenous Clostridium septicum infection].

Endogenous, nontraumatic clostridial myonecrosis has a frequent association with colon carcinoma, leukemia, diabetes mellitus, and drug-induced immunosuppression. We present two cases of Clostridium septicum myonecrosis. An 18-year-old girl developed severe abdominal pain on day 7 after hospitalization for cytostatic treatment of acute lymphoblastic leukemia. Blood cultures yielded Clostridium septicum and histopathological exam of muscle tissue showed extended myonecrosis. Eventually the patient recovered with antibiotics and surgical therapy. A 72-year-old diabetic woman was treated as an outpatient with an intramuscular injection of steroidal antiphlogistics for "acute lumbar disc disease". The next morning persistence of hip pain and discoloration of the right thigh caused hospitalization under the suspected diagnosis "fracture of the neck of the femur". Clostridium septicum was cultured from intraoperatively taken swabs. At autopsy, in addition to the gangrene, there was an adenocarcinoma of the cecum, which had not been diagnosed during life.

Adolescent↗
PubMed1995

[Cat scratch disease caused by Bartonella henselae].

Bartonella henselae is an etiologic agent of cat-scratch disease and, in immunocompromised patients, of bacillary angiomatosis and other severe syndromes. Cat-scratch disease usually presents as lymphadenopathy, which resolves spontaneously within 2-4 months. The utility of antibiotic therapy remains controversial. In Tyrol four cases of human cat-scratch disease were diagnosed in children in 1994, yielding a prevalence of 0.7/100,000 per year. A 3-year-old boy had lymphadenitis coli since one year despite antituberculosis therapy which was initiated because of the histopathological picture and a positive tuberculin reaction (despite negative mycobacteria-cultures and -PCR). Two girls, age 9 and 13 years, had lymphadenitis at upper or lower extremities after cat-scratches from kittens. A 13-year-old boy presented with febrile illness and right hip pain, computer tomography revealed an osteolytic lesion; symptoms subsided within 3 weeks. Diagnosis of cat-scratch disease is based on cat contact, negative studies for other similar diseases, characteristic histopathologic features (if available), and results of an indirect immunofluorescence test (antigen: Houston-1 isolate, ATCC 49882). We believe that the availability of this serological test will increase the number of diagnosed cases of human Bartonella henselae infections.

Adolescent↗
PubMed1994

Molecular epidemiology of tuberculosis in Austria.

The incidence of pulmonary tuberculosis among newspaper vendors, tram operators, and other exposed groups leads to repeated discussions about the importance of single cases for the spread of tuberculous infection. We subjected 36 strains of Mycobacterium tuberculosis, isolated in 1992 from 31 patients, to restriction fragment length polymorphism analysis using PvuII and an insertion element 986 probe. Only two isolates obtained from a married couple showed the same DNA fingerprinting pattern, all the other strains had unique and clearly distinguishable banding patterns. Our investigation revealed no dominating strains except in the case of one married couple, where the chain of infection was obvious (the wife being diagnosed during the course of testing of her alcoholic and tuberculous husband's contacts). The main emphasis in the fight against tuberculosis still rests on securing the availability of diagnostic and therapeutic means for all patients with tuberculosis. The importance of single infected source cases for the spread of tuberculosis should not be overestimated.

Adult↗
PubMed1994

Control of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) by hygienic measures in a general intensive care unit.

Infections are a major cause of death in critically ill patients. As gram-positive organisms are more widespread and methicillin-resistant staphylococci (MRSA, MRSE) are easily distributed in overcrowded Intensive Care Units (ICU), extended hygienic procedures for infection control are most important. We hypothesize that strict regulations and educational programs for medical and nursing personnel are able to control the spread of resistant bacteria. In a four-room 16-bed medico-surgical ICU, we reinforced hygienic procedures and introduced the separation of clean postoperative and multiply injured patients from those with infectious complications, subsequent to an outbreak of MRSA in 1991. MRSA and MRSE isolated from surveillance cultures of bronchial secretions were reduced from an annual rate of 60.0% to 37.7% and 36.4% to 6.2% respectively between the years 1991 and 1992. Accordingly, the number of lower respiratory tract infections and the crude mortality could be reduced. We conclude that prompt implementation of control measures and continuous education of medical personnel are able to control an outbreak of infection with resistant staphylococci in an ICU setting.

Cause of Death↗
PubMed1994

Legionella pneumonia in transplant recipients: a cluster of cases of eight years' duration.

Infection with Legionella is often encountered in immunosuppressed patients, especially in recipients of renal allografts. From January 1985 until April 1993 14 cases of nosocomial legionella pneumonia were diagnosed (four by culture, 10 by serological methods) on the surgical transplantation unit of Innsbruck University Hospital. All isolates from patients and from the building's hot water were found to be Legionella pneumophila serogroup 1. They were indistinguishable from each other by monoclonal antibody subtyping and restriction fragment length polymorphism pattern and thus indicated a series of infections originating from the same source during a period of more than 8 years. Repeated efforts to control Legionella by raising the temperature in the hot water lines failed to bring permanent success. Replacing the central hot water supply with small electric water heaters installed in the patient rooms on the transplant ward now seems to have reduced the incidence of legionellosis on this unit. However, further infections occurring in transplant patients in other surgical departments in the same building indicate that a major renovation of the whole surgical building's hot water system is necessary.

Adult↗
PubMed1994

[Occurrence of swimmer's itch in Tyrol].

Cercariae from trematodes of birds are capable of penetrating human skin causing a dermatitis, called swimmer's itch. In 1992, after a hot dry summer there was a marked increase in the incidence of cercarial dermatitis in Austria. Although the increased incidence of this complaint can be quite worrisome for the population, the occurrence of swimmer's itch can, in fact, generally be seen as harmless. Cercarial dermatitis responds well to treatment with topical antihistamines or cortisone; even without medication the skin rash heals within 2-3 weeks. The effectiveness of various preventive measures (such as protective sun cream or patting the skin dry) is controversial. The use of molluscicides is definitely contraindicated due to the inoffensive nature of this dermatitis. While it is usually easy to recognize swimmer's itch when there is an increased incidence, the diagnosis is often missed when it occurs sporadically, due to its unspecific characteristics.

Adolescent↗
PubMed1994

[Microbiological diagnosis of tuberculosis].

The increased incidence of tuberculosis as well as the availability of new diagnostic testing methods clearly have various implications for the routine microbiology laboratory: samples must be sent to the microbiology lab for testing immediately after being taken and microscopically investigated the same day. In other countries, difficult to treat, multi-resistant Mycobacterium tuberculosis strains have occurred. Thus decisive hygienic measures must be taken early on in cases of highly infectious patients (i.e. patients with microscopically positive sputum). Liquid media (MB Check Roche, Bactec) as well as Löwenstein Jensen media must be inoculated in the lab. Liquid media allow both faster detection of certain atypical mycobacteria and increased accuracy. Classification of culturally established agents through commercial genetic probes (AccuProbe Mycobacterien) or with high pressure liquid chromatography is possible within hours when acid-fast rods are present. Time consuming identification by determination of biochemical and culture morphological characteristics should be reserved for reference labs. Today, rapid tests like analysis of tuberculostearic acid or polymerase chain reaction are already useful for special questions like ruling out tuberculous meningitis. In most cases, however, these rapid tests cannot replace identification of microbes with culture techniques.

AIDS-Related Opportunistic Infections↗
PubMed1993

Vero cytotoxin-producing Escherichia coli O157 infections in Austria.

To determine the prevalence of Vero cytotoxin-producing Escherichia coli (VTEC) serotype O157 associated diarrhea in the Austrian patient population, we surveyed all stool specimens of liquid consistency submitted to the Federal Public Health Laboratory (FPHL) in Innsbruck for 2 years for this organism. This laboratory serves a population of approximately 1 Million people. Of 5,265 stool specimens, 7 yielded O157 VTEC. Five isolates of E. coli O157 phage type 32, VT2 were cultured from specimens received during a three day period from residents in the county of Schwaz. During the investigation of this "outbreak" E. coli O157 strains were also isolated from two household contacts. Only 1 out of 8 persons with E. coli O157 diarrhea had bloody stools, although 5 of 7 tested specimens (= 71%) also yielded Campylobacter jejuni. None of our patients received antimicrobial therapy directed against E. coli O157 (one child had josamycin). There were no fatalities and no cases of hemolytic uremic syndrome (follow up period: 6 months). Consumption of hamburger, roast beef, and unpasteurized milk was not confirmed in this study. In Austria, no O157 VTEC strain was isolated till June 1992, although at the FPHL in Innsbruck stool specimens of liquid consistency were cultured for this organism since January 1991.

Adult↗
PubMed1993

Antimicrobial susceptibility pattern of Neisseria gonorrhoeae in western Austria.

From January to October 1992 24 Neisseria gonorrhoeae isolates from clinical specimens were collected at the Federal Public Health Laboratory in Innsbruck (Austria) and screened for resistance to penicillin G, erythromycin, tetracycline, spectinomycin, ceftriaxone, cefuroxime, ciprofloxacine, and silver nitrate. Patients originated from the Austrian provinces Salzburg, Tirol, and Vorarlberg, and presented with manifest gonorrhoea. Two of 24 isolates were penicillinase-producing N. gonorrhoeae. Both strains were isolated from men who had just returned from Thailand or Kenya. The isolate from Africa was also resistant to tetracycline. Five of 24 infections were acquired abroad, sex tourism being involved in four cases. The antimicrobial resistance pattern found in gonococci in western Austria revealed that topical silver nitrate and erythromycin are equally acceptable for use in prophylaxis of neonatal ophthalmia. Penicillin is still the drug of choice in the treatment of endemic infections. If gonorrhoea has been acquired abroad, especially in Asia or Africa, ceftriaxone, spectinomycin or ciprofloxazine are recommended for therapy.

Adolescent↗