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Biomedical subjects

J R Starke

Publications and source records attributed to J R Starke.

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

Intrathoracic tuberculosis in children.

After decades of decline, tuberculosis case rates are increasing again in the United States. Primarily because of increases in tuberculosis among persons of child-bearing years and diminished performance by some health departments, substantial increases in reported cases of tuberculosis in children have occurred since 1985. Although the clinical/radiographic presentation of intrathoracic tuberculosis in children has not changed significantly, major changes have occurred in the treatment of tuberculous disease over the past decade. This article will review the current epidemiology, diagnosis, and treatment of childhood tuberculosis.

Adolescent↗
PubMed1996

Nontuberculous mycobacterial disease in children.

In most developed countries infections with nontuberculous mycobacteria are causing an increasing proportion of all mycobacterial infections in children. The major clinical syndromes caused by these ubiquitous organisms include pulmonary infections, lymphadenitis, otologic infections, skin and soft tissue infections, indwelling catheter infection, and disseminated infections. Of these, cervical lymphadenitis is the most frequently encountered entity in children, whereas pulmonary infection is rare in this age group. Chronic otorrhea caused by nontuberculous mycobacteria has recently been described. Because many of these infections are similar in presentation to tuberculosis, it is imperative to exclude this diagnosis. The clinical manifestations and management of these infections in children are discussed in this article.

Child↗
PubMed1995

Nontuberculous mycobacterial mastoiditis.

Although nontuberculous mycobacterial (NTM) infections are recognized as an important cause of cervicofacial lymphadenopathy in children, NTM mastoiditis is rare. Further, NTM mastoiditis may be difficult to distinguish clinically from tuberculous mastoiditis since both may present with chronic, painless otorrhea and exuberant middle ear granulation tissue. The treatment of tuberculous mastoiditis is antituberculosis chemotherapy; however, most NTM infections are resistant to antituberculous agents, and the preferred treatment of NTM mastoiditis is mastoidectomy. We report a recent case of mastoiditis caused by Mycobacterium avium complex in an infant who presented with a temporal bone mass.

Child↗
PubMed1995

Clinical and public health aspects of tuberculous meningitis in children.

To define the clinical and public health aspects of tuberculous meningitis, we conducted a 10-year retrospective review of patients with central nervous system (CNS) tuberculosis, investigated health department records of contact investigations involving our patients, and assessed prospective follow-up of patients. Thirty-one cases of CNS tuberculosis (8.6% of all pediatric patients with tuberculosis) were reviewed. Three patients had tuberculomas, 23 had meningitis, and five had both. Cranial nerve involvement, basilar meningitis, and hydrocephalus were common clinical and radiographic findings. Sixty-eight percent had been examined by a physician in the preceding month, and 13% had been hospitalized. Symptoms related to tuberculosis averaged 17 days before admission. For 15 patients (47%) there was no initial family history of tuberculosis, but an adult with tuberculosis was discovered after the child's symptoms became evident. Tuberculosis had been diagnosed in an adult in close contact with nine of the patients (38%) before the child became ill. Eight of these adult source cases already had been reported to the health department, and more rapid examination of contacts may have prevented meningeal tuberculosis in the child. The diagnosis of CNS tuberculosis should be considered in all children with neurologic signs and symptoms of, and risk factors for, tuberculosis.

Adolescent↗
PubMed1995

Drug-resistant tuberculosis in pediatrics.

As the incidence of tuberculosis in the United States has increased over the past 10 years, the number of cases caused by drug-resistant organisms has risen dramatically. The genetic mechanisms of resistance, which could lead to better methods of diagnosis and treatment, are being determined. Treatment of drug-resistant tuberculosis is complex, requiring the use of several toxic drugs over 9 to 18 months. At present, drug resistance is fairly localized and can be avoided in most communities if appropriate public health measures are taken. Stronger attention to treatment regimens and adherence with treatment will prevent further emergence of drug-resistant tuberculosis.

Antitubercular Agents↗
PubMed1995

Tuberculosis in children.

The World Health Organization estimates that 90 million cases of tuberculosis will occur throughout the world in the 1990s, and 30 million people will die from the disease. Although traditional epidemiology suggested that 90% of tuberculosis cases arise from reactivation of remote infection, urban studies in the United States using DNA fingerprinting techniques imply that up to 40% of current cases are due to recent acquisition, a finding that will alter some basic approaches to tuberculosis control. Drug resistance is emerging as a major obstacle to tuberculosis control in the United States and the world. New studies focusing on the genetic basis of drug resistance may lead to better diagnostic techniques and new drugs. New trends in treatment center on shorter but more intense and directly observed therapy to maintain adherence. The new emphasis in developed countries is to concentrate control efforts selectively on those individuals, with the greatest risk factors for development of tuberculosis infection and disease.

Antitubercular Agents↗
PubMed1994

Nontuberculous mycobacterial infections of the head and neck.

OBJECTIVE: To review the treatment and outcome of patients with nontuberculous mycobacterial infections of the head and neck. DESIGN: Retrospective examination of the medical records of patients treated by several surgeons during a 5-year period with a minimum 6-month follow-up. SETTING: Large teaching children's hospital. PATIENTS: Twenty-six children hospitalized for treatment of nontuberculous mycobacterial infections of the head and neck. MAIN OUTCOME MEASURES: Resolution of infection, recurrence, and need for additional surgical intervention for cure. RESULTS: Eleven patients initially were treated by incisional biopsy or incision and drainage procedures; eight patients developed recurrence or a draining sinus tract, necessitating a second surgical procedure. In contrast, 15 patients initially underwent complete excision; only one developed a recurrence (P < .01). Thus, eight (31%) of 26 patients required at least two surgical procedures owing to inadequate initial treatment. CONCLUSIONS: Excisional biopsy is both the diagnostic procedure and treatment of choice for nontuberculous mycobacterial adenitis.

Adolescent↗
PubMed1994

Clinical features, diagnosis, and treatment of tuberculosis in infants.

OBJECTIVE: Despite the recent resurgence of tuberculosis among children in the United States, no series of infants < 1 year of age with tuberculosis has been reported in the last 20 years. This study was undertaken to describe the epidemiology, clinical, and radiographic manifestations, and response to therapy in infants < 1 year of age with tuberculous disease. METHODS: The medical records were reviewed for all infants age 12 months or less with a diagnosis of tuberculosis and cared for at the Children's Tuberculosis Clinic at Ben Taub General Hospital in Houston, Texas between January 1, 1985 and June 30, 1992. RESULTS: Of the 47 infants identified, 51% were female. The median age at diagnosis was 8 months (range 3.5 to 12 months). Fifty-one percent of the infants were African-American and over one-third were Hispanic. All patients were born in the United States. Diagnosis resulted from the examination of an ill infant in 79% of cases, a case contact investigation of an adult suspected of having tuberculosis in 19%, and routine tuberculin skin testing in 2%. An adult with infectious tuberculosis who had contact with the infant was identified in 68% of cases. Intrathoracic disease alone was present in 70% of cases. Fourteen (30%) infants had extrapulmonary tuberculosis (11 central nervous system disease, 2 disseminated disease, and 1 cervical adenitis). Gastric aspirate cultures yielded Mycobacterium tuberculosis from 75% of the infants with isolated intrathoracic disease. Forty-five infants successfully completed therapy and only one death was directly related to tuberculosis. Forty-eight percent of the infants with pulmonary tuberculosis were treated with a 6-month regimen consisting of isoniazid and rifampin supplemented during the first 2 months by pyrazinamide. Eighteen infants received some twice weekly directly observed therapy mainly due to documented or suspected nonadherence. Treatment was well-tolerated; one patient (2%) developed hepatotoxicity due to isoniazid. No infant had a relapse or recurrence of disease in 6 months to 7 years follow-up for a median of 3 years (range, 6 months to 7 years). CONCLUSION: Most infants with tuberculosis are symptomatic at the time of diagnosis, and bacteriologic confirmation was obtained in 70% of cases. A contact investigation of the household should be initiated immediately when an infant is suspected of having tuberculosis because valuable information needed to establish the diagnosis and guide therapy in the infant may be obtained. Intensive 6-month and twice weekly directly observed therapy appear to be well-tolerated and effective for the treatment of pulmonary tuberculosis in infants.

Drug Therapy, Combination↗
PubMed1994

Infectious disease of public health significance among children and adolescents in Texas.

In the past decade, many infectious diseases in children that were perceived to have been almost eliminated have returned with a vengeance in Texas. Across the state, vaccination rates are exceptionally low, and outbreaks of measles, mumps, and pertussis have been identified. Tuberculosis cases in children increased 77%, and cases of congenital syphilis increased 578% between 1987 and 1991. The new epidemic of HIV infection has placed additional strain on an already overburdened, inadequate public health system in Texas. This article identifies some of the major infections of public health significance among the children of Texas. A common theme for most of these problems is that they are preventable diseases that are not being prevented. Many children in Texas will suffer now and in the future if these public health problems remain ignored.

Adolescent↗
PubMed1994

Chronic otitis media after tympanostomy tube placement caused by Mycobacterium abscessus: a new clinical entity?

Infections with nontuberculous mycobacteria (NTM) are being identified with increasing frequency, but the otologic manifestations of NTM infection are not well defined. Mycobacterium abscessus is a ubiquitous rapidly growing mycobacterium (RGM) known to cause disease by inoculation after trauma. Though reported following open heart and breast augmentation surgery, it is not recognized as a cause of sporadic post-tympanostomy tube otorrhea. This report presents detailed clinical information on six sporadic cases and partial information on 15 additional cases of ear infection caused by RGM over the past 7 years. Of these, 20 of 21 cases (95%) were attributable to M. abscessus, 14 of 21 (67%) subjects lived in a southern coastal state and 16 of 16 with available histories had previously undergone placement of tympanostomy tubes. Each isolate exhibited resistance to many antibiotics, with 50 percent exhibiting high level mutational resistance to aminoglycosides related to prior topical aminoglycoside use. Therapy was difficult, requiring debridement and prolonged antibiotic therapy. M. abscessus is a problematic infection requiring specific diagnosis and treatment and should be sought as a cause of refractory post-tympanostomy tube otorrhea.

Abscess↗
PubMed1993

Tuberculosis in children.

The dramatic resurgence and increase in the total number of cases of tuberculous infection and disease in children is alarming in the United States. With poverty, poor access to health care, overcrowding (predominantly in inner-city areas), and an increase in immigration from areas with high endemic rates of TB, the problem in children will continue to increase. If the impact of coinfection with HIV and M. tuberculosis becomes significant in children, as it has in adults in the United States, the increase in the total number of cases of tuberculous disease in children could be staggering. The impact of multidrug-resistant strains of M. tuberculosis and the current crises in availability of effective anti-TB drugs will need a similar resurgence.

AIDS-Related Opportunistic Infections↗
PubMed1993

Routine tuberculin screening of children during hospitalization.

Harris County, TX, which includes Houston, has one of the highest childhood tuberculosis case rates in the United States. For an 11-week period in the spring of 1988 all children admitted to the medical service of the Ben Taub General Hospital in Houston, TX, received a Mantoux skin test consisting of tuberculin purified protein derivative. The purpose was to assess the impact of routine tuberculin screening during hospitalization for acute medical care and to determine whether tuberculin screening in this setting is an effective means of identifying children with asymptomatic tuberculous infection. Of the 432 patients skin tested, 50% were younger than 1 year of age and only 304 were evaluable at 48 hours. Two new positive skin tests were discovered for a positive tuberculin rate of 0.66%. We conclude that even in a high risk region, routine tuberculin screening of all children admitted to the hospital may not be effective.

Adolescent↗