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M R Hammerschlag

Publications and source records attributed to M R Hammerschlag.

At least 109 records · Page 6Linked to original sources
PubMed1988

False positive results with the use of chlamydial antigen detection tests in the evaluation of suspected sexual abuse in children.

The presence of rectal or genital infection with Chlamydia trachomatis in children is frequently considered an indicator of sexual abuse. The diagnosis of chlamydial infection in these children has been complicated by the use of antigen detection methods instead of culture. We report five cases in which the use of chlamydial antigen detection tests in the evaluation of suspected child abuse gave false positive results. An enzyme immunoassay was used in two cases (Chlamydiazyme; Abbott Diagnostics) and a direct fluorescent antibody test was used in the remaining three cases (Microtrak; Syva). The sites examined were the urethra, vagina and rectum. In all cases chlamydial cultures obtained several days later with no interim antibiotic therapy were negative. Four of the five children examined were probably victims of sexual abuse. The enzyme immunoassay and direct fluorescent antibody tests have been evaluated primarily for urethral and cervical cultures from adults; neither test has been approved or evaluated for rectal or genital sites in children. At these sites use of both tests may be associated with a large proportion of false positives caused by contamination with fecal flora which can cross-react with the antibodies used in the test. These tests also have limited utility in populations where the prevalence of chlamydial infection is low (less than 10%), as has been reported for sexually abused children. Because of the medicolegal implications only "gold standard" methods (i.e. culture) performed by a competent laboratory should be used in evaluating chlamydial infection in sexually abused children.

Antigens, Bacterial↗
PubMed1987

Comparison of enzyme immunoassay and culture for diagnosis of chlamydial conjunctivitis and respiratory infections in infants.

The efficacy of Chlamydiazyme (Abbott Laboratories, North Chicago, Ill.) in detecting neonatal conjunctival and respiratory infections caused by Chlamydia trachomatis was determined by comparison of this enzyme immunoassay (EIA) with the method of isolation of chlamydiae in tissue culture. The sensitivity and specificity of Chlamydiazyme for detecting C. trachomatis in conjunctival specimens from infants with conjunctivitis were 98 and 94%, respectively. For nasopharyngeal infection in infants with conjunctivitis, the sensitivity and specificity were 87 and 92%, respectively. There were nine nasopharyngeal specimens that were Chlamydiazyme positive and culture negative. All of these specimens demonstrated the presence of typical fluorescing chlamydial elementary bodies when pellets of the original specimens were examined with a fluorescein-conjugated monoclonal antibody. When the EIA was performed on nasopharyngeal specimens from infants with suspected chlamydial pneumonia, 6 culture-positive and 10 culture-negative specimens were correctly identified.

Chlamydia Infections↗
PubMed1987

Rapid diagnosis of pneumonia in children.

Antigen detection techniques are available for the identification of bacterial polysaccharides, viruses, and chlamydia. Viruses and chlamydia are detected by direct immunofluorescence (DFA) or enzyme immunoassay (EIA). Bacterial polysaccharides are detected by latex agglutination or staphylococcal coagglutination of serum or concentrated urine. Most studies have not compared these techniques to the gold standard of lung puncture, so the role of dual infections with bacteria and viruses cannot be adequately determined. The sensitivity of any of these techniques is dependent on the quality of the antisera used. Monoclonal sera are now available for the detection of most viruses and seem to be as sensitive as polyclonal sera. DFA or EIA may offer equal sensitivity but their advantages and disadvantages must be considered by the local diagnostic laboratories. Most DFA and EIA systems have a sensitivity of 90% when compared with viral cultural for the identification of the organism. Agglutination reagents are available commercially for the detection of pneumococcal and Hemophilus influenzae type b polysaccharides. The sensitivity and specificity of each brand should be determined on serum or urine from patients known to have positive blood cultures and those free of disease. The brand chosen should be the one that has reasonable sensitivity and specificity. Rapid diagnostic techniques are helpful if they are used within a clinical context and they are positive. Negative tests do not rule out infection.

Antigens, Bacterial↗
PubMed1987

Diagnostic methods for Chlamydia trachomatis disease in neonates.

Chlamydia trachomatis is an obligate intracellular parasite responsible for many clinical syndromes, including neonatal conjunctivitis and pneumonia. The gold standard of diagnosis has been isolation in cell culture. However, this requires days of processing. Several rapid diagnostic tests are available. Giemsa staining of conjunctival smears, enzyme immunoassay, and the fluorescein-conjugated monoclonal antibody test. Both the EIA and the FA tests show promise as ideal rapid diagnostic tests. Treatment of chlamydial conjunctivitis must focus upon the eradication of nasopharyngeal carriage as well as cure of ophthalmic symptoms. The need for nasopharyngeal eradication is underscored by the fact that it is the source for chlamydial pneumonia as well as for conjunctival re-infection. Clinical studies have shown that oral erythromycin estolate or ethylsuccinate suspension 50 mg/kg/day twice-daily or four times a day for 14 to 21 days are the therapeutic regimens of choice. Neonatal ocular prophylaxis is currently under study. One per cent silver nitrate does not prevent chlamydial conjunctivitis but preliminary studies do show favorable results with topical erythromycin. Nevertheless, neither 1 per cent silver nitrate nor topical erythromycin eradicate nasopharyngeal carriage, elimination of which is necessary for the prevention of neonatal chlamydial pneumonia.

Conjunctivitis, Inclusion↗
PubMed1985

The effect of Chlamydia trachomatis on luminol-dependent chemiluminescence of human polymorphonuclear leukocytes: requirements for opsonization.

The factors involved in the in vitro interaction of two strains of Chlamydia trachomatis with polymorphonuclear leukocytes were studied by employing the technique of luminol-dependent chemiluminescence. Unopsonized, partially purified elementary bodies of chlamydia failed to induce a significant chemiluminescence response when compared with serum-activated zymosan (less than 90%). Opsonization of the chlamydia with human sera greatly enhanced the chemiluminescence response. This enhancement was independent of the presence or absence of antibody specific for chlamydia or of complement. Primate serum had 77% of the activity of human serum; nonprimate sera (sheep, cow, horse, and rabbit) demonstrated substantially less activity. The magnitude of the chemiluminescence response observed with opsonized chlamydia was also dependent on the chlamydia-to-polymorphonuclear leukocyte ratio, with the greatest effect seen at 10:1. Chlamydia opsonized with human sera containing less than 100 mg of IgG/dl did not stimulate chemiluminescence more than did unopsonized chlamydia. These results suggest that human IgG may interact with C. trachomatis independent of specific antibody-binding sites.

Animals↗
PubMed1985

Ultrastructural analysis of the effect of trimethoprim and sulphamethoxazole on the development of Chlamydia trachomatis in cell culture.

Folic acid antagonists have been demonstrated to cause gross changes in the morphology of chlamydial inclusions in cell culture. The ultrastructural changes were examined by electron microscopy in cultures of Chlamydia trachomatis treated with trimethoprim and sulphamethoxazole. Examination of these cultures demonstrated a failure of the reticulate bodies to develop into normal elementary bodies. These changes were seen in cultures treated with either compound, although sulphamethoxazole was more active by weight, and suggest that both drugs ultimately interfere with nucleic acid synthesis.

Chlamydia trachomatis↗
PubMed1985

Clinical efficacy and safety of cefmenoxime in children.

Cefmenoxime, an investigational semisynthetic cephalosporin, was evaluated in 18 pediatric patients with a variety of infections. There were seven patients with urinary tract infections, two with wound infections, two with osteomyelitis, two with abscess infections, one with cervical adenitis, one with hidradenitis, one with pneumonia and sepsis, one with periorbital cellulitis, and one with ventriculitis. A total of 16 (88%) patients had a satisfactory clinical response demonstrated by improvement in clinical signs and symptoms. A total of 12 (67%) patients demonstrated eradication of their infecting organisms. Of the pathogens isolated in these patients, 16 isolates were susceptible to cefmenoxime. One patient developed a generalized urticarial rash that resolved within 24 h after cessation of cefmenoxime therapy. Mean peak level in serum after intravenous infusion was 55 micrograms/ml.

Bacterial Infections↗
PubMed1985

Nonspecific vaginitis following sexual abuse in children.

Nonspecific vaginitis, one of the most common causes of vaginitis in adults, is a polymicrobial infection in which vaginal anaerobes act synergistically with Gardnerella vaginalis. The diagnosis is made by examination of the vaginal secretions for clue cells, the development of a fishy odor after the addition of 10% KOH to vaginal secretions, and a vaginal pH greater than 4.5. To determine whether nonspecific vaginitis occurs in sexually abused children, we obtained vaginal washes from 31 abused and 23 nonabused children, 21/2 to 13 years of age. A child was considered to have definite nonspecific vaginitis if her wash contained both clue cells and odor; she was considered to have possible nonspecific vaginitis if her wash contained either clue cells or odor. We did not use vaginal pH as a diagnostic criterion because the normal range has not been standardized in prepubertal girls. Possible nonspecific vaginitis (odor only) was found in only 1/23 (4%) of nonabused children. This girl was asymptomatic and findings from her examination were normal. Only one of the 31 abused children had possible nonspecific vaginitis (odor) detected at the initial examination, less than 48 hours after the episode of abuse, whereas 4/31 (13%) developed definite, and 4/31 (13%) possible nonspecific vaginitis at the follow-up visit more than seven days after the episode of abuse or rape. Five of these eight girls developed either a new vaginal discharge or dysuria; three were treated with metronidazole with resolution of their symptoms and reversion of the vaginal wash to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗