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Biomedical subjects

R D Meyer

Publications and source records attributed to R D Meyer.

At least 109 records · Page 6Linked to original sources
PubMed1980

Prospective comparative study of efficacy and toxicity of netilmicin and amikacin.

Eighty patients were treated with either amikacin or netilmicin in a prospective randomized study of serious gram-negative bacillary infections, including 11 due to gentamicin-resistant pathogens. Thirty-six treated with netilmicin and 35 treated with amikacin were evaluable for efficacy or toxicity, or both. The overall groups differed significantly only in age. There were no significant differences in efficacy of the two drugs. There were no statistically significant differences at the 95% level between the netilmicin group and the amikacin group with respect to nephrotoxic reactions (38 versus 28%, respectively) or ototoxic reactions (9 versus 25%, respectively). Further comparative trials of netilmicin and other aminoglycosides appear warranted before it is widely used.

Adult↗
PubMed1980

Susceptibility of Legionella pneumophila to twenty antimicrobial agents.

Thirty-three isolates of Legionella pneumophila, all except one of which were clinical isolates, were tested against 20 antimicrobial agents by using an agar dilution technique. Erythromycin, rifamp]in, and rosaramycin were the most active agents tested. Aminoglycosides, chloramphenicol, and cefoxitin also inhibited the organisms at low concentrations. Other agents, including moxalactam, cefoperazone, and cephalosporins, exhibited moderate to little activity. Tetracycline, doxycycline and minocyeline were apparently inactivated by charcoal-yeast extract medium. There was slight inoculum dependence noted with most of the antimicrobials tested, particularly the beta-lactam agents. There was no consistent difference in susceptibility between Center for Disease Control-supplied stock strains and recent clinical isolates, but there were marked differences with some agents. Susceptibility testing needs to be standardized in view of the influence of inoculum size, strain variation, and the medium used.

Anti-Bacterial Agents↗
PubMed1980

Legionnaires' disease.

Legionella pneumophila infections frequently manifest themselves as a multisystem disease with acute pneumonia. Certain clinical and laboratory features are helpful in diagnosis but none are pathognomonic. Diagnosis frequently must be made clinically and erythromycin given presumptively because of the delay in seroconversion but culture and direct fluorescent antibody testing are quite useful for rapid diagnosis. Epidemiologic and laboratory investigations will undoubtedly yield considerable information about this fascinating bacterial disease.

Air Conditioning↗
PubMed1980

Laboratory diagnosis of Legionnaires' disease.

Legionnaires' disease was diagnosed in 32 patients with nosocomially acquired pneumonia by using direct immunofluorescence examination of respiratory tract secretions, indirect immunofluorescence determinations of antibody titer, and/or culture of Legionella pneumophila from respiratory tract secretions. Cultures of specimens for Legionella pneumophila were positive for 13 of 21 patients for whom appropriate specimens were submitted. Using a positive culture as a definition of Legionnaires' disease, the sensitivity of direct immunofluorescence examination was 62%; that of indirect immunofluorescence serologic studies, 75%. Using any positive test as a definition of Legionnaires' disease, the sensitivity of direct immunofluorescence examination of respiratory tract secretions was 50%, that of indirect immunofluorescence serologic studies (using all 4 serogroups), 80%; that of culture, 65%. A negative control group of 21 patients without Legionnaires' disease was used to estimate the specificity of the tests. The specificity of direct immunofluorescence examination was 94%; that of indirect immunofluorescence serologic studies, 75%. Culture of specimens was necessary to diagnose some cases of Legionnaires' disease because the other 2 tests were negative. All 3 tests should be performed for optimal sensitivity and specificity.

Antibodies, Bacterial↗
PubMed1980

Legionnaires' disease: unusual clinical and laboratory features.

During a nosocomial epidemic of Legionnaires' disease, clinical and laboratory observations led to the recognition of remarkable aspects in six patients. Features included two episodes of disease, dual or sequential infections with Legionella pneumophila and other pathogens; transient deafness with erythromycin therapy, and Legionnaires' disease with a pleural effusion but no pulmonary infiltrate. Expectorated sputum culture yielded two serogroups of L. pneumophila in one patient. Cultures of transtracheal and endotracheal aspirates and of blood led to the diagnosis, permitted evaluation of confounding potential pathogens, and confirmed Legionnaires' disease in the absence of seroconversion. Although many manifestations of Legionnaires' disease were quite typical in this outbreak, these additional unusual features expand the spectrum and illustrate the value of rapid diagnostic methods.

Aged↗
PubMed1980

Legionnaires' disease: report of sixty-five nosocomially acquired cases of review of the literature.

Sixty-five cases of nosocomially acquired Legionnaires' disease are reported and the world literature is reviewed. The etiologic agent, Legionnella pneumophila, has been isolated from several environmental sources at outbreak sites. Legionnaires' disease appears to be acquired by inhalation and is primarily manifested by severe, potentially fatal, pneumonia. Characteristic clinical disease consists of high fever with relative bradycardia, dry cough, chills, diarrhea, and pleuritic pain. Although no single feature is pathognomonic, the clinical presentation is usually sufficiently characteristic to suggest the diagnosis. The diagnosis of Legionnaires' disease during acute illness may be established by culture of Legionella pneumophila, or by demonstration of the bacterium using special stains. However, in most instances, the physician must make a presumptive diagnosis based on the clinical presentation in order to institute appropriate antimicrobial therapy. Retrospective confirmation of the diagnosis may be made by serologic studies in most instances. Erythromycin is, at this time, the drug of choice for the treatment of Legionnaires' disease. A prompt salutory response following institution of erythromycin therapy is typical.

Adult↗
PubMed1979

[Legionaire's disease (author's transl)].

In a review of all cases of legionaire's disease known so far the epidemiology, diagnosis and therapy of this disease are discussed. Risk factors have been shown to be stays in hotels and hospitals, especially if the rooms were subject to faulty air conditioning, water containers or to earthworks. Furthermore, the male sex and an immunosuppressive therapy were established as risk factors. The diagnosis can only be confirmed by increased titer in the indirect fluorescence test. Erythromycin and Rifampicin (as a supplementary medication) have proved the antibiotics of choice.

Air Pollutants↗
PubMed1979

Radiographic features of Legionnaires' disease.

Serial chest radiographs of 35 patients with confirmed Legionnaires' disease were evaluated. A unilateral, unilobar alveolar infiltrate was, in general, the initial radiographic finding. Progression to consolidation or to new areas of involvement was typical. Every lobe was involved, but lower lobe involvement was most common. Pleural effusion was often present. Cavitation was not seen. Radiographic progression for several days following institution of therapy, and despite clinical response, was noted. In patients who survived, radiographic improvement of abnormalities was usually apparent within two weeks of therapy. Aradiographic spectrum exists and, although many features are typical, no single feature is pathognomonic.

Aged↗
PubMed1979

Nosocomial Legionnaires' disease: a continuing common-source epidemic at Wadsworth Medical Center.

Forty-nine cases of Legionnaires' disease were identified from May 1977 through July 1978 in patients and employees at Wadsworth Medical Center. Cases clustered in October and November 1977. Fifteen patients died. All Legionnaires' disease (LD) patients were in the hospital before onset of illness (median time from admission to onset, 17 days; range, 3 to 276 days). Twenty patients were immunosuppressed or compromised by malignancy. In 1977, six of 12 renal-homograft recipients acquired LD pneumonia in contrast to three of 22 during the preceding 3 years (P = 0.031, Fisher's exact test). In a prospective survey of 1658 consecutive hospital admissions, seven cases of Legionnaires' diseases occurred (0.4%), including six among 14 patients who seroconverted to the LD bacterium. Prevalence of a reciprocal titer of 128 or above in Wadsworth employees was significantly greater than in a nearby control population (P = 0.044, Fisher's exact test). Exposure to the external hospital environment may be an important factor, and soil may be a reservoir for the LD bacterium. Legionnaires' disease at Wadsworth may be a nosocomial pneumonia affecting a small group of patients with particular risk factors.

Antibodies, Bacterial↗
PubMed1978

Isolation of a new serotype of legionnaires' disease bacterium.

A new serotype of the legionnaires' disease bacterium has been isolated. The strain appears to be identical with the Philadelphia strain except for the cell-wall antigens as tested by a direct fluorescent antibody technique. Demonstration of a new serotype brings into question the diagnostic specificity of currently used reference strains.

Bacteria↗
PubMed1978

Legionnaires' disease in renal-transplant recipients.

Legionnaires' disease is reported in five renal-transplant recipients. All had febrile respiratory illnesses with pulmonary infiltrates and one died. The diagnosis was made on clinical features and by indirect fluorescent antibody titres. Symptoms started after maximum immunosuppressive therapy.

Adult↗
PubMed1978

Group G streptococcal endocarditis.

The group G streptococcus may be a more common human pathogen than previously recognized. A case of group G streptococcal endocarditis is reported and the 11 cases reported previously are reviewed. Group G endocarditis may have significant clinical and prognostic differences from endocarditis caused by the more commonly identified viridans or group D streptococci. Routine serologic grouping of beta-hemolytic streptococcal isolates from serious infections is warranted.

Diagnosis, Differential↗
PubMed1978

Susceptibility of cephalothin-resistant gram-negative bacilli to piperacillin, cefuroxime, and other selected antibiotics.

The in vitro antibacterial activity of piperacillin and cefuroxime against 180 isolates of cephalothin-resistant Enterobacteriaceae and of piperacillin against 46 isolates of Pseudomonas aeruginosa was determined. Amikacin, gentamicin, carbenicillin, cefoxitin, and cefamandole were included for comparison. The activities of piperacillin and carbenicillin against Enterobacteriaceae were comparable. Piperacillin was appreciably more active against Pseudomonas than carbenicillin and was equivalent in activity to amikacin on a weight basis. The following beta-lactam agents were the most active against the indicated organisms (in parentheses): cefoxitin (indole-positive Proteus spp.), cefuroxime and cefoxitin, (Klebsiella spp.), piperacillin (Enterobacter spp.), cefuroxime and cefoxitin (E. coli), piperacillin and cefoxitin (Serratia spp.), and cefoxitin (Providencia spp.). Amikacin inhibited 98% of Enterobacteriaceae at clinically achievable serum levels.

Amikacin↗