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Biomedical subjects

H M Feder

Publications and source records attributed to H M Feder.

At least 37 records · Page 2Linked to original sources
PubMed1996

Addition of rifampin to cephalexin therapy for recalcitrant staphylococcal skin infections--an observation.

We report two pediatric patients with recalcitrant staphylococcal infections whose infections resolved when rifampin was added to standard antistaphylococcal therapy. One patient had a post-varicella staphylococcal ulcerative lesion and did not respond to cephalexin alone but did respond when rifampin was added. A second patient had staphylococcal bullous impetigo and did not respond to dicloxacillin or cephalexin but did respond when rifampin was added to the cephalexin. If a patient fails to respond to traditional antistaphylococcal therapy, the addition of rifampin may be beneficial.

Cephalexin↗
PubMed1995

Pitfalls in the diagnosis and treatment of Lyme disease in children.

OBJECTIVE: To define pitfalls of diagnosis and treatment of Lyme disease in children. DESIGN: Case series. SETTING: A university Lyme disease clinic in a Lyme disease endemic area. PATIENTS: A total of 146 pediatric patients (mean age, 9.9 years) referred with possible Lyme disease. MAIN OUTCOME MEASURES: Of the 146 patients, 56 (38%) were overdiagnosed, 12 (8%) were underdiagnosed, and 75 (51%) were correctly diagnosed with Lyme disease. Treatment errors were made for 19 (25%) of these 75 patients. In addition, three patients (2%) with tick bites were misdiagnosed or mistreated. Frequent pitfalls included misidentifying rashes as erythema migrans, ascribing nonspecific symptoms to Lyme disease, failing to ascribe fleeting objective symptoms to Lyme disease, and inappropriate antibiotic therapy for patients with Lyme disease. CONCLUSIONS: Errors in the diagnosis and treatment of Lyme disease in children are common.

Adolescent↗
PubMed1995

Misdiagnosis of erythema migrans.

BACKGROUND: Erythema migrans is a clinical diagnosis that carries possible long-term repercussions. Despite widespread awareness of the clinical presentation of erythema migrans, incorrect diagnosis occurs. PATIENTS AND METHODS: We describe 13 cases in which erythema migrans was misdiagnosed and discuss some pitfalls in diagnosis. These cases were seen at a tertiary referral center in Connecticut, a state where Lyme disease is endemic. The patients selected for inclusion were those who most clearly illustrate potential difficulties involved in making the diagnosis of erythema migrans. RESULTS: The diagnosis of erythema migrans was missed in 5 patients due to atypical presentations. Eight patients with skin eruptions closely mimicking erythema migrans were incorrectly diagnosed with erythema migrans. CONCLUSIONS: There are pitfalls associated with the diagnosis of erythema migrans that may result in overdiagnosis or underdiagnosis.

Adult↗
PubMed1995

Acyclovir-induced neutropenia in an infant with herpes simplex encephalitis: case report.

A newborn infant whose condition was diagnosed as herpes simplex encephalitis and who had subsequent recurrences of skin disease had repeated episodes of neutropenia while receiving therapy with intravenous (30 mg/[kg.d]) or oral (30 mg/]kg.d]) acyclovir. The neutropenia did not recur when the dosage of oral acyclovir was reduced to 10 mg/(kg.d). This case represents the first well-documented report of acyclovir-induced neutropenia.

Acyclovir↗
PubMed1995

Prospective assessment of Lyme disease in a school-aged population in Connecticut.

To determine the incidence and cumulative frequency of Lyme disease in a school-aged population in an area in which Lyme disease is endemic, serum specimens were obtained before and after the 1990-1992 tick seasons from 410 middle and high school students in southeastern Connecticut. Sera were tested for serologic evidence of infection with Borrelia burgdorferi, and students were questioned about physician-confirmed episodes of clinical Lyme disease. At enrollment, 29 (7%) students had a history of Lyme disease, and of these, 12 (41%) were seropositive for B. burgdorferi infection. Seronegative students (397) were followed prospectively over a total of 796 person years. At enrollment, 381 students (93%) had no history of Lyme disease, and of these, 1 (0.3%) was seropositive. During this period, 8 students developed clinical Lyme disease and 3 had asymptomatic infections with B. burgdorferi. The incidences of clinical Lyme disease and asymptomatic B. burgdorferi infection were 10.1 and 3.8 cases/1000 person-years, respectively. Lyme disease is an important health problem in school-aged children living in southeastern Connecticut.

Adolescent↗
PubMed1994

Outcome of 48 pediatric patients with chronic fatigue. A clinical experience.

OBJECTIVE: To define outcomes of pediatric patients with chronic fatigue. DESIGN: Cohort study with a mean follow-up of 3.8 years. SETTING: Outpatient pediatrics department at a university health center. PATIENTS: Patients 21 years old and younger referred by their private physicians for evaluation of unexplained fatigue lasting at least 3 months. INTERVENTION: Patients were seen from January 1986 through April 1990 and were telephoned in April 1992 to determine outcome. RESULTS: Of the 55 patients who were evaluated from 1986 to 1990, an organic cause of the fatigue, sinusitis, was found for one. Of the 54 patients with unexplained fatigue, 48 were contacted in 1992. The mean age of these 48 patients was 15 years; 73% were female. Fatigue was present a mean of 7 months before evaluation, and in 78% an acute illness preceded the fatigue. Most patients believed their fatigue had an organic cause. In general, laboratory studies were not helpful. All patients were encouraged to resume normal functioning despite their symptoms. At follow-up, 65% reported resolution of symptoms, 29% reported improvement, and 6% were unchanged. CONCLUSIONS: In pediatric patients with chronic fatigue, diagnostic and therapeutic interventions should be based on positive findings; with simple encouragement, the prognosis is excellent. Based on this experience, we suggest a structured approach to the management of pediatric patients with chronic fatigue.

Adolescent↗
PubMed1994

Treatment of chronic neutropenia with chloramphenicol.

We describe a patient with chronic congenital idiopathic neutropenia whose neutropenia resolved on four occasions during chloramphenicol therapy. This is the second report of chloramphenicol-responsive chronic neutropenia. Chloramphenicol, in addition to its antimicrobial action, has immune-modulating activity, which may explain the reversal of neutropenia.

Child↗
PubMed1993

Early Lyme disease: a flu-like illness without erythema migrans.

The existence of a form of early Lyme disease characterized by a flu-like illness without erythema migrans is controversial. To confirm the existence and define the clinical characteristics of the flu-like illness without erythema migrans of localized Lyme disease, the authors studied patients from a Lyme disease endemic area of Connecticut who visited their primary care physicians with an undefined flu-like illness. Patients kept a diary of their symptoms. Acute and convalescent sera were obtained. The diagnosis of Lyme disease was based on the appearance of IgM or IgG antibodies to Borrelia burgdorferi as demonstrated by both enzyme-linked immunosorbent assay and immunoblot assay. Twenty-four untreated patients were studied. In five patients acute serologic evidence of Lyme disease developed. The flu-like illness in these five patients was characterized by fever and fatigue and resolved spontaneously in 5 to 21 days. Symptoms recurred in three of these five patients. The existence of a flu-like illness without erythema migrans of early Lyme disease has been clearly established. Prospective, controlled studies are needed to better define its incidence, characteristics, and prognosis so that appropriate diagnostic and therapeutic strategies can be developed.

Acute Disease↗
PubMed1992

A controlled trial of antimicrobial prophylaxis for Lyme disease after deer-tick bites.

BACKGROUND: Borrelia burgdorferi, which causes Lyme disease, is transmitted by deer ticks (lxodes dammini) in the northeastern and midwestern United States. Although deer-tick bites are common in areas in which the disease is endemic, there is uncertainty about how to manage the care of persons who are bitten. METHODS: To assess the risk of infection with B. burgdorferi and the efficacy of prophylactic antimicrobial treatment after a deer-tick bite, we conducted a double-blind, placebo-controlled trial in an area of southeastern Connecticut in which Lyme disease is endemic. Children and adults who had been bitten by deer ticks were randomly assigned to receive either amoxicillin or placebo for 10 days. Subjects were followed for one year for clinical manifestations of Lyme disease. Serum samples obtained at enrollment and six weeks and three months later were tested for antibodies against B. burgdorferi. RESULTS: Of the 387 subjects, 205 (53 percent) were assigned to receive amoxicillin and 182 (47 percent) to receive placebo. Of 344 deer ticks submitted and analyzed by the polymerase chain reaction, 15 percent were infected with B. burgdorferi. Erythema migrans developed in two subjects, both of whom had received placebo. There were no asymptomatic seroconversions and no late manifestations of Lyme disease. The risk of infection with B. burgdorferi in the placebo-treated subjects was 1.2 percent (95 percent confidence interval, 0.1 to 4.1 percent), which was not significantly different (P = 0.22) from the risk in the amoxicillin-treated subjects (0 percent; 95 percent confidence interval, 0 to 1.5 percent). CONCLUSIONS: Even in an area in which Lyme disease is endemic, the risk of infection with B. burgdorferi after a recognized deer-tick bite is so low that prophylactic antimicrobial treatment is not routinely indicated.

Adult↗