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Biomedical subjects

J D Nelson

Publications and source records attributed to J D Nelson.

At least 145 records · Page 8Linked to original sources
PubMed1981

Genital tract infection with Chlamydia trachomatis in prepubertal children.

Oculogenital strains of Chlamydia trachomatis are important causes of a wide range of genital tract infections in adults, but their recognized role in pediatric infections has been limited to neonatal inclusion conjunctivitis and interstitial pneumonia. We examined 23 prepubertal children with nongonococcal urethritis and vaginitis, and 31 with gonococcal anogenital infection. C. trachomatis was not found in 12 males and 11 females with nongonococcal urethritis or vaginitis. Nine of 33 episodes (27%) of gonorrhea were complicated by concurrent or subsequent chlamydial infection, including postgonococcal urethritis, vulvovaginitis, and asymptomatic anogenital colonization. C. trachomatis complicates gonococcal genital infections in prepubertal children at an incidence comparable to that seen in adults. The diagnostic and therapeutic approach to a prepubertal child with postgonococcal genital discharge should include consideration of this pathogen.

Age Factors↗
PubMed1981

Pharmacokinetics of erythromycin ethylsuccinate and estolate in infants under 4 months of age.

We studied the pharmacokinetics of erythromycin estolate and ethylsuccinate suspensions in infants under 4 months of age who were being treated for chlamydial infections or pertussis. We conducted our studies after the initial dose of 10 mg/kg and subsequently during steady-state treatment. The estolate preparation resulted in higher peak concentrations in sera, and its absorption and elimination half-lives were longer. Peak concentrations occurred 3 h after a dose with the estolate preparation and 1 h after a dose with the ethylsuccinate preparation. The area under the curve for the estolate preparation was about three times greater than that for the ethylsuccinate preparation. Based on these findings, we recommend that erythromycin estolate suspensions be given to young infants at 8- or 12-h intervals (30 mg/kg per day in three divided doses or 20 mg/kg per day in two divided doses) and that erythromycin ethylsuccinate is best given at 6-h intervals (40 mg/kg per day in four divided doses).

Chlamydia Infections↗
PubMed1981

Relation of arginine-lysine antagonism to herpes simplex growth in tissue culture.

In the studies conducted, arginine deficiency suppressed herpes simplex virus replication in tissue culture. Lysine, an analog of arginine, as an antimetabolite, antagonized the viral growth-promoting action of arginine. The in vitro data may be the basis for the observation that patients prone to herpetic lesions and other related viral infections, particularly during periods of stress, should abstain from arginine excess and may also require supplemental lysine in their diet.

Arginine↗
PubMed1981

Recrudescence and relapse in bacterial meningitis of childhood.

Antibiotic therapy of bacterial meningitis in children may be complicated by reappearance of bacteria in cerebrospinal fluid during therapy (recrudescence) or within three weeks after therapy is stopped (relapse). Clinical and laboratory features of six children with recrudescence and of 21 children with relapse were reviewed. These complications occurred mainly in infants less than 2 years of age and comprised less than 1% of all cases of bacterial meningitis. Neither the initial nor the follow-up CSF findings were predictive of recrudescence or relapse. Prolonged or secondary fever was unrelated to these complications. Recrudescence was usually caused by inappropriate therapy whereas relapse after adequate therapy of bacterial meningitis was usually ascribed to persistence of infection in meningeal or parameningeal foci. Relapse did not become manifest until three or more days after discontinuation of therapy. It is concluded that routine examination of CSF at the end of adequate anti-microbial therapy is not necessary or useful when the patient has exhibited a satisfactory clinical response. Furthermore, the commonly recommended observation period of 48 hours in the hospital after discontinuation of therapy is not justified for a patient who has had an uneventful course.

Anti-Bacterial Agents↗
PubMed1981

Cefuroxime therapy of gonorrhea and coinfection with Chlamydia trachomatis in children.

Twenty-seven episodes of gonorrhea occurring in children less than 15 years of age were treated with an intramuscular injection of cefuroxime, 25 mg/kg. Gonococci were eliminated from genital, pharyngeal, and anal sites in all cases. Cefuroxime was well tolerated and no side effects were observed. Coinfection with Chlamydia trachomatis was found in nine patients (33%). Among the seven patients with chlamydial genital infection, postgonococcal symptoms persisted in three children (43%). On patient of the five with chlamydial anal infections were successfully treated with trisulfapyrimidines.

Adolescent↗
PubMed1980

Acute pulmonary exacerbations in cystic fibrosis. A double-blind trial of tobramycin and placebo therapy.

To determine the effect of antimicrobial therapy on acute pulmonary exacerbations in cystic fibrosis, a randomized, double-blind trial of tobramycin and placebo was carried out. Clinical responses were satisfactory in all 11 children given tobramycin and in seven of 11 given placebo. Two patients in the placebo group died. No patient given placebo had improved results on pulmonary function studies, whereas improvement of 15% or more occurred in four of the six patients given tobramycin who could cooperate with the testing. Quantitative cultures of sputum showed a decrease of 1 logarithm or greater in Pseudomonas sp concentrations in six of seven patients in the tobramycin group and in two of eight in the placebo group. No difference in staphylococcal colonization was found. Several features indicate that children with severer disease were randomly assigned to the placebo group; nevertheless, the trend toward improved response in patients given tobramycin suggests that empirical therapy with antibiotics is beneficial for patients with acute pulmonary exacerbations in cystic fibrosis.

Adolescent↗
PubMed1980

Spectinomycin therapy for gonorrhea in prepubertal children.

Twenty-six episodes of gonococcal urethritis or vulvovaginitis in 24 prepubertal patients were each treated with a single intramuscular (IM) dose of spectinomycin hydrochloride. Twenty-five episodes were treated successfully, and there were no side effects from this therapy. All tested isolates of Neisseria gonorrhoeae were susceptible in vitro to spectinomycin, and all serum levels one hour after therapy were in at least two-fold excess of the observed minimum inhibitory concentrations. Two patients had symptomatic and two had asymptomatic postgonococcal anogenital infections with Chlamydia trachomatis. A single dose of IM spectinomycin is a safe and efficacious regimen for uncomplicated gonococcal infection in prepubertal children who are penicillin-allergic or who have infections unresponsive or resistant to other antimicrobials, but it is not effective against incubating syphilis or chalmydial infection.

Adolescent↗
PubMed1980

Determining gentamicin dosage in infants and children with renal failure.

Gentamicin half-life values based on pharmacologic calculations were determined in 23 infants and children with diminished renal function. The half-life times correlated significantly with serum creatinine concentrations in patients who had steady-state creatinine levels (Y = 0.379 + 3.841 X, R = 0.951, P less than 0.001). This relationship provides a basis for formulating gentamicin dosage in pediatric patients with renal failure. The half-life of gentamicin is estimated by multiplying the serum creatinine concentration by four; three-quarters of the loading dose is administered every two half-lives. When renal function is unstable and changing daily, gentamicin half-life cannot be reliably predicted from the serum creatinine value.

Bacterial Infections↗
PubMed1980

Synthesis of syn and anti isomers of 6-[[(hydroxyimino)phenyl]methyl]-1-[(1-methylethyl)sulfonyl]-1H-benzimidazol-2-amine. Inhibitors of rhinovirus multiplication.

The synthesis and antirhinovirus activity of syn and anti isomers of 6-[[(hydroxyimino)phenyl]methyl]-1-[(1-methylethyl)sulfonyl]-1H-benzimidazol-2-amine (4 and 5) are reported. The structural assignments of 4 and 5 are based upon 13C NMR spectra of both isomers and also X-ray analysis of 5. The anti-isomer 5 was more potent than the syn-isomer 4 when compared as an inhibitor of rhinovirus multiplication in vitro. Both isomers inhibited multiplication of 15 different serotypes of rhinovirus.

Antiviral Agents↗
PubMed1980

In vitro susceptibility of gram-negative bacilli from pediatric patients to moxalactam, cefotaxime, Ro 13-9904, and other cephalosporins.

Moxalactam, Ro 13-9904, cefotaxime, cefoperazone, older cephalosporins, and four aminoglycosides were tested in vitro against 432 strains of gram-negative bacteria isolated from pediatric patients. The new drugs were uniformly active against coliform bacilli obtained from patients with meningitis and against aminoglycoside-resistant coliform bacilli.

Bacteria↗
PubMed1980

Acute mastoiditis in infants and children.

During a 25-year period, 57 cases of acute mastoiditis occurred in infants and young children who ranged in age from 2 months to 12 years of age. All patients had abnormalities of the tympanic membrane and most had fever and localized edema and redness of the overlying skin. Fifty per cent of the infants who were less than one year of age had swelling primarily above the involved ear pushing the pinna out and down. By contrast, older children had swelling of the skin overlying the mastoid process which produced the classical finding of an elevated earlobe. Mastoid roentgenograms were a useful adjunct to diagnosis, revealing concurrent osteomyelitis in 9 patients. A diagnosis of specific bacterial etiology was made in 80 per cent of the patients in whom cultures were performed. Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes were the bacteria most frequently isolated. Unusual manifestations or serious complications occurred in 53 per cent of the patients, including one death (due to meningitis). These data indicate that the frequency of serious complications from acute mastoiditis has not declined over the past 3 decades.

Acute Disease↗
PubMed1980

Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin, or placebo.

In a randomized, prospective, double-blind study infants and children with uncomplicated Salmonella gastroenteritis were treated with ampicillin (15 patients), amoxicillin (15 patients), or placebo (14 patients). The dosage of antibiotics was 100 mg/kg/day in four equally divided doses given for five days. There was no significant benefit from antibiotic therapy on the duration of diarrhea (means 8.8, 7.3, and 7.2 days, respectively) or on the duration of recovery of Salmonella from stool cultures (means 41.3, 37.0, and 20.9 days, respectively). Bacteriologic relapse was not observed in placebo-treated patients but eight patients given ampicillin (53%) and eight given amoxicillin (53%) had relapse (P = .003). Salmonella isolated in relapse were still susceptible in vitro to the antibiotics. Of the 16 patients with bacteriologic relapse six (38%) had concomitant recurrence of diarrhea. It is concluded that ampicillin or amoxicillin therapy provides no benefit to patients with uncomplicated Salmonella gastroenteritis and substantially increases the risk of bacteriologic and symptomatic relapse.

Amoxicillin↗
PubMed1980

Pyogenic arthritis of the sacroiliac joint in pediatric patients.

Clinical manifestations, diagnostic studies, and management of pyogenic sacroiliitis were reviewed in 77 pediatric patients. This infection occurs primarily in late childhood, is more common in boys, and has a subacute onset in about two thirds of cases. Recognition of the characteristic signs and symptoms of sacroiliac involvement coupled with radioisotope bone scanning substantially reduces the delay in correct diagnosis that averaged 3.9 weeks in all patients (4.8 weeks in those without and 1.7 weeks in those with bone scans performed). Joint aspiration under biplane fluoroscopic control and culture of the aspirated material is indicated in establishing the specific etiologic agent which is Staphylococcus aureus in most cases. Adequate management of pyogenic sacroiliitis consists of appropriately monitored antibiotic treatment and, if present, evacuation of pus. The use of spica cast immobilization offers no apparent beneficial effect. Indications for surgery include drainage of pus and removal of sequestered bone. With adequate management the prognosis of suppurative sacroiliitis in pediatric patients is excellent, despite persistent abnormal radiographic findings in most patients.

Adolescent↗