Biomedical subjects
Publications and source records attributed to F B Spencker.
Streptococcus pneumoniae as a cause of cellulitis is rarely reported in children and adults. We report on an infant with facial cellulitis due to pneumococci and review already described cases since 1975. The main features of this infection, underlying diseases and problems of diagnostics and therapy are discussed.
Clinical infectiology had passed through a marked transformation in the past, it is changing in the present time and will do so in the future. The most important factors for these changes are: the change of the living standard of the people, the increased number of persons with dispositions for infections, a better knowledge about the microbial etiology of infections and new possibilities of diagnostics and therapy of infectious diseases. The importance of these changes are in Germany inadequately reflected not only in the clinical practice but also in medical teaching and research. The reintegration of the infectiology as an important medical specialty in the Germany's medicine is urgently indicated.
Clinical microbiology is a facet of medical microbiology which is dedicated to all aspects of human infectious disease diagnosis, especially in patients treated in hospitals. The specific tasks of such a laboratory can be solved at best, if it is integrated in the hospital and if there is close co-operation with clinical specialists. Different methods for susceptibility testing of isolated bacteria are possible: agar diffusion test, agar dilution test, bouillon dilution test etc., the results of which need to be interpreted considering further aspects. During antimicrobial chemotherapy certain tests are also necessary or useful. The objective of future developments is to avoid the need of cultures and to establish antibiotic profiles within hours to provide the clinician with relevant results.
In 21 low birth weight infants with two regimens of antibiotic therapy during the first 3 days of life possible hepatotoxic side effects were studied 8 days after the last administration of the tested drugs. Fourteen of the infants were treated with ampicillin/gentamicin and 7 received cefotaxime/gentamicin. The serum concentrations of total bile acids, the activities of transaminases in serum and the cumulative 15N excretion in urine after administration of 3 mg of 15N-labeled methacetin/kg of body weight were used as markers of hepatotoxic side effects. Neither the concentrations of total bile acids (22.6 +/- 12.1 and 19.4 +/- 10.8 mM, respectively) nor the activities of transaminases (alanine aminotransferase, 0.27 +/- 0.06 vs. 0.30 +/- 0.09 mumol/second/liter; aspartate aminotransferase, 0.46 +/- 0.11 vs. 0.49 +/- 0.10 mumol/second/liter) were different between the two groups. In contrast the cumulative 15N excretion in urine was significantly lower in the group treated with cefotaxime/gentamicin than in the group treated with ampicillin/gentamicin (17.2 +/- 6.4 vs. 33.0 +/- 5.1% of intake; P less than 0.01) and also lower than the reported age-related reference values. On the 28th day of life no differences could be found between the cumulative 15N excretion in the urine of the infants treated with cefotaxime/gentamicin and the reported age-related reference values of this test. The results indicate a limited capacity of the monooxygenase system of the liver of low birth weight infants during the first weeks of life and a specific reversible influence of cefotaxime on this hepatocellular system. Further investigations are required to evaluate the clinical relevance of this drug-specific inhibition of the hepatic monooxygenase pathway.
The necrotizing enterocolitis is a severe and frequently fulminant disease with a considerable mortality. The main event is the enteral septicemia. Only prompt diagnostics and adequate therapy permit the survival of the newborns. The most important aspects of signs and symptoms, diagnostics and therapy as well as course of disease and prophylaxis are delineated, whereas the problems of pathogenesis are excluded.
This is an overview of modern aspects concerning diagnostics and therapy in children with acute hematogenous osteomyelitis. A close cooperation of pediatricians, pediatric surgeons, microbiologists and radiologists in this field is essential.
This overview presents the most important topics of etiology, pathogenesis, diagnostics, differential diagnostics and treatment of septic arthritis in children. A child with bacterial arthritis is always a case of emergency. Only immediate and adequate treatment can avoid permanent sequelae. Medical care for these patients should be done always in close cooperation of pediatricians, pediatric surgeons, radiologists, and sometimes orthopedists.
Iron is one of the most important metals for living organisms. There are many different reasons for an iron deficiency, which can lead to an iron deficiency anemia and can be treated by iron-containing drugs. But there are also some reasons leading to an iron overload, which can impair the defense against bacterial infections. An anemia in the course of an infection is usually not a result of iron deficiency but a physiological reaction against the invading microorganisms. A treatment with iron-containing drugs is only indicated in the case of an undoubtedly proven iron deficiency.
Because of the rare incidence of liver abscess in childhood and of extremely rare observed Aeromonas hydrophila as pathogen of such a disease we report on a 14 7/12 year old girl with a liver abscess. For the last 4 years she had to be enrolled in chronic hemodialysis. The treatment comprised opening of the abscess cavity and drainage, and antibiotic therapy with cefotiam. We were unable to isolate Aeromonas hydrophila in the environment of the hemodialysis center. Some aspects of clinical importance of liver abscess in childhood and of Aeromonas spp. as pathogens in human infections are discussed.
The present paper gives a survey about bacteriological examinations, which had proved worthwhile in relation to own experiences and to the literature. Besides methods of preliminary diagnostics cultural examinations of samples from normally sterile body sites are in the center of discussion. The value of body surface cultures, however, especially swabs used for possible prediction of threatening infection is also discussed.
From eight neonates and children suspicious for suffering from septicemia and/or meningitis, coagulase negative staphylococci (CNS) were isolated from multiple blood cultures and from cerebrospinal fluids originating from different punctures. S. epidermidis was the predominant species. By a further typing using plasmid-profiles and exoprotein patterns besides the resistance phenotype, contaminants could be discriminated from the isolates as the probable etiologic agent exhibiting unique reaction patterns. CNS isolated from cases of septicemia together with other bacterial pathogens or from cases of presumed but not confirmed septicemia revealed as different.
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Human milk banking has a longstanding tradition in the GDR. We report on the main data of a survey carried out in 1987, actualized in 1989. Whereas human milk banking was widespread during the 1950s, it reached it's lowest level in 1972. In 1988 the amount of collected milk was nearly 200,000 litres (60 milk banks). Thus, the supply met the demand approximately. The development of the human milk banks is characterized by an increase of the number of milk banks (mostly the banks are affiliated to a children's hospital) and the collecting capacity. Half of the milk banks carries out the collection on a daily basis. This makes it possible to provide fresh milk with it's clear-cut advantages, especially in immunological respect. Otherwise the milk is stored after boiling, freezing or pasteurization. The feeding of very low birth weight newborns with fresh human milk is steadily increasing with corresponding consequences for the quality control of donated milk and the management of milk banks.
The authors give a review of patients with bacterial cardiac disease treated in the Paediatric Clinic of Karl-Marx-University Leipzig between 1971 and 1987. During this period 32 patients were observed, which amounts to about 2 to 3 patients per year. The majority of patients had congenital heart disease. Despite antibiotic therapy the prognosis of this infection is still serious: One third of the patients died, and diagnosis is made with considerable delay in some cases. Problems and diagnostic and therapeutic approaches are discussed.
The authors report on an infant with meningitis caused by Pasteurella multocida. The problems of aetiology, diagnosis, and therapy of these infections are discussed with reference to this patient and other cases of P. multocida infection.
The authors describe their experiences with the treatment of 3 newborns with meningitis due to B-streptococci,, and give a review of the problems of etiology, clinical symptoms, diagnosis and therapy of infections with B-streptococci in newborns. Furthermore, the article deals withthe frequency of the ocurrence of these bacteria in mothers, children and in the medical personal staff as well as with the possible ways of transmission. The relations between infections with B-streptococci and respiratory distress syndrome in newborns are discussed with the problems of differential diagnosis and therapy.
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