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Biomedical subjects

J C Arroyo

Publications and source records attributed to J C Arroyo.

At least 19 recordsLinked to original sources
PubMed1988

Upper respiratory tract infection and serum antibody responses in nursing home patients.

Residents of a Veterans Administration nursing home care unit (NHCU) were observed for the development of upper respiratory tract infection (URI) during 12 consecutive months to determine the frequency of sporadic cases or outbreaks of URI and to characterize them clinically and by laboratory means. Fifty-nine episodes of URI occurred in 56 residents during the study period. Serologic testing or virus isolation proved or suggested an etiologic agent on 22 occasions. URI was more common in late Fall and Winter and was caused by various agents, including influenza, Mycoplasma pneumoniae, respiratory syncytial virus, and parainfluenza viruses. A minor outbreak of influenza B in February 1986 contrasted with previous cases of URI in that the patients had a higher mean temperature and abnormal breath sounds, and they were clinically sicker. This suggests that clinical and epidemiologic surveillance during the influenza season may allow the early recognition of influenza in elderly nursing home residents. Over a 4-year period 147 serum antibody responses after influenza infection or influenza vaccination were compiled. Antibody responses to individual influenza vaccine components were measured 75 to 90 days after vaccination. The geometric mean titer (GMT) and the percentage of samples with antibody levels greater than 1:40 were determined for each of the three antigenic subtypes on 3 consecutive years. The GMT to individual vaccine components was consistently greater than 1:40, except to influenza B/Singapore in 1984 and A/Chile and B/U.S.S.R. in 1985, when these subtypes were first included in the vaccine, suggesting the NHCU residents responded less vigorously to unfamiliar vaccine subtypes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Development of Pseudomonas aeruginosa resistance to norfloxacin during therapy.

Two elderly patients diagnosed with Pseudomonas aeruginosa urinary tract infections were treated with oral norfloxacin in the recommended dose of 400 mg q12h. Initially, antimicrobial susceptibility data indicated the organisms were sensitive to norfloxacin. Six to eight days into therapy urine cultures became positive for P. aeruginosa once again; this time, however, susceptibility reports indicated the organisms were now resistant to norfloxacin. Since cross-resistance among norfloxacin, other quinolones, and cephalosporins can occur, we recommend repeated urine cultures during and after norfloxacin therapy in elderly patients with complicated P. aeruginosa urinary tract infections.

Aged↗
PubMed1987

Diversity of plasmids in Achromobacter xylosoxidans isolates responsible for a seemingly common-source nosocomial outbreak.

Achromobacter xylosoxidans, an uncommon yet highly resistant opportunistic pathogen, was isolated from nine hospitalized patients during an 8-month period. It had been isolated from only seven patients with either nonfatal infection or colonization from 1981 to 1984. From June 1985 to January 1986, A. xylosoxidans was isolated 18 times from seven different sites (sputum, 7 times; urine, 4 times; blood, 3 times; and lung, pleural fluid, wound tissue, and tracheal aspirate, 1 time each). Four patients died, including the three with bacteremia. All but two patients had nosocomial infections and either were on the same ward or were cared for by the same staff members. Eleven A. xylosoxidans strains yielded eight distinct plasmids (8, 21, 23, 26, 38, 50, 51, and 64 megadaltons). Whole-cell peptide patterns of 10 of these strains were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Isolates from the same patient contained the same plasmids and had identical peptide patterns but differed from other strains in both parameters. Plasmids were absent from the two community-acquired isolates. Although nosocomial strains showed similar antibiotic resistance patterns (only moxalactam and ticarcillin-clavulanic acid were uniformly active) and cross-contamination was strongly suggested epidemiologically, results of plasmid and peptide analyses did not support the possibility of a single-strain outbreak.

Adult↗
PubMed1986

Impact of aminoglycoside serum assays on clinical decisions and renal toxicity.

To determine whether serum aminoglycoside assays aided clinicians in treating infections and avoiding aminoglycoside nephrotoxicity, we reviewed the charts of patients treated with aminoglycoside antibiotics parenterally. We compared 78 episodes of aminoglycoside-treated infections during which serum assays were done (group B) to 51 episodes without serum assays (group A). The groups of patients were comparable in age, outcome of infection, incidence of aminoglycoside nephrotoxicity, mean total dose of aminoglycosides given, and number of courses. Toxic trough levels of tobramycin (the most frequently used aminoglycoside) were seldom detected before the onset of nephrotoxicity, and peak tobramycin levels were frequently suboptimal. While 71% of decisions to increase or decrease the aminoglycoside dose after serum assays were considered appropriate, only 57% of noninterventions were appropriate. At our hospital, serum aminoglycoside assays did not help improve the outcome of infection or the incidence of nephrotoxicity. Their major clinical contribution was to alert the physician that serum concentrations were low.

Amikacin↗
PubMed1984

Amphotericin B fever in rabbits.

The slow intravenous infusion of amphotericin B (amB) induced a moderate, partially dose-dependent fever in male adult rabbits, whereas the iv bolus injection of the drug was less pyrogenic and only at higher doses. Higher, more sustained fevers occurred with doses of 2.5 and 5.0 mg of amB. The threshold pyrogenic dose of amB in the rabbits tested approached 0.16 mg per Kg (delta T greater than 0.4 degrees C). Endotoxin-tolerant rabbits had a lower increase in rectal temperature when challenged with amB. No fever occurred in mice treated with amB.

Amphotericin B↗
PubMed1984

Influenza A/Philippines/2/82 outbreak in a nursing home: limitations of influenza vaccination in the aged.

The failure of the 1982-1983 influenza vaccine to protect elderly NHCU residents from clinical infection with influenza A/Philippines/2/82 resulted primarily from antigenic drift of the epidemic strain, inasmuch as the attack rates in the vaccinated and nonvaccinated patients were not significantly different. This experience supports the decision to replace A/Bangkok/1/79 with A/Philippines/2/82 virus antigen in the 1983-1984 influenza vaccine.

Adult↗
PubMed1983

Accumulation of vancomycin after intraventricular infusions.

A 50-year-old man with an infected intracerebral hematoma was treated with daily intraventricular infusions containing 10 mg of vancomycin (half the dose suggested by others). A vancomycin level in the ventricular CSF of 606 micrograms/ml after nine days of therapy indicates a potential for accumulation of this drug in patients with extensive brain damage.

Brain Diseases↗
PubMed1983

Vancomycin pharmacokinetics in patients with peritonitis on peritoneal dialysis.

Vancomycin pharmacokinetics were studied in four patients with peritonitis undergoing chronic intermittent peritoneal dialysis. Serum levels exceeding 4.0 micrograms/ml were maintained for 8 and 13 days after a single 1-g intravenous dose. Vancomycin serum concentrations measured before, during, and upon completion of dialysis revealed no appreciable decline. Peritoneal fluid concentrations in two patients exceeded 4.0 micrograms/ml for more than 12 days.

Aged↗
PubMed1980

Hypocomplementemia and Campylobacter fetus infection.

A middle-aged alcoholic man had low C3 levels during two consecutive episodes of bacteremia with Campylobacter fetus, with a return of C3 levels to normal during the interbacteremic period. Total complement levels remained below normal throughout the patient's illness, whereas C4 and C3 activator values were in the normal or supranormal range. A rise and fall in hemagglutinating antibody titers, documenting an immune response, coupled with reasonable antimicrobial therapy were not sufficient to prevent the development of chronic infection. It is suggested that complement may play an important role in the pathogenesis of C fetus infections.

Adult↗
PubMed1979

Gram-negative bacteremia. Two cases in adults with chronic otitis media.

Chronic otitis media was the cause of septicemia in two hospitalized men. The organisms involved, K pneumoniae and B fragilis, are not usually associated with primary infections of the middle ear and would not have been traced to this site had proper cultures not been performed. In adults, the true incidence of bacteremia arising from the middle ear may be higher than suspected.

Aged↗