Scalp abscess secondary to fetal scalp electrode.
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Biomedical subjects
Publications and source records attributed to H M Feder.
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Chloramphenicol has certain notable characteristics: it penetrates reliably into the central nervous system; it is usually bacteriostatic, but is bactericidal for Hemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis; it is metabolized in the liver, and levels of drug in serum need to be monitored in patients with liver disease and in neonates. Potential toxicity limits the use of this drug. It has been estimated that death from aplastic anemia occurs in oe of 24,500-40,800 courses of treatment. The incidence of aplastic anemia after parenteral therapy is unknown; however, only a few cases have been reported. The gray baby syndrome occurred in premature and newborn infants receiving high or unmodified doses of chloramphenicol. This condition can be avoided by reduction of dosage and by monitoring levels of drug in the serum of these infants. The most common toxicity is a reversible, dose-related bone marrow suppression, which is identified by serial monitoring of reticulocyte and complete blood cell counts. Many of the indications for use of this drug are still controversial because studies comparing the toxicity and efficacy of chloramphenicol and of alternative antibiotics have not been done.
Nongonococcal, nonmeningococcal neisseriae are part of the normal respiratory flora and infrequently cause disease. These organisms include Neisseria lactamica, Neisseria mucosa, Neisseria sicca, Neisseria flavescens, Neisseria subflava , Neisseria perflava , Neisseria flava , and Branhamella catarrhalis (previously classified as Neisseria catarrhalis). Blood cultures positive for these bacteria have been associated with serious infections, including endocarditis, septicemia, and meningitis. In a retrospective survey of a 10-year period, 1970-1980, eight patients were identified at Hartford Hospital (Hartford, Conn.) whose blood cultures were positive for nongonococcal, nonmeningococcal neisseriae. In four patients, the neisseria blood isolates were associated with serious infections: two with endocarditis, one with sepsis, and one with meningitis. In four other patients, the neisseria blood isolates were contaminants.
Bacteroides fragilis is a rare cause of bacterial meningitis. In the antibiotic era nine cases have been reported. Seven of these nine cases occurred in premature infants and neonates. Of the nine patients with B. fragilis meningitis, two died, four survived with neurologic sequelae, and three survived without sequelae. Predisposing conditions included abdominal sepsis, chronic otitis media, and ventriculoatrial shunt infection. Metronidazole, which is bactericidal, has been the most effective therapy for B. fragilis meningitis.
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Polymerase chain reaction was used to detect herpes simplex virus (HSV) specific deoxyribonucleic acid (DNA) sequences in acute and convalescent cerebrospinal fluid (CSF) and brain tissue of a 78-year-old man and in CSF of a neonate who died of complications owing to herpes simplex virus encephalitis (HSVE). Polymerase chain reaction (PCR) was carried out for 35 cycles with a set of primers that bracketed a 92 base pair segment unique to the HSV DNA polymerase gene. Amplified DNA was electrophoresed on 3 percent agarose gel, blotted onto a nylon membrane, and probed with 32p-labeled oligonucleotide internal to the primers. The HSV specific DNA sequences were detected in the specimens from both patients. No HSV specific DNA was detected in CSFs from 20 patients with suspected Lyme disease or neurosyphilis. Polymerase chain reaction is a rapid and noninvasive technique for the diagnosis of HSVE.