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Biomedical subjects

S Capewell

Publications and source records attributed to S Capewell.

100 records · Page 6Linked to original sources
PubMed1986

Increase in bronchopulmonary infection due to branhamella catarrhalis.

In a six month prospective study during the winter Branhamella catarrhalis was isolated from the sputum of 63 patients with symptoms of bronchopulmonary infection: 49 isolates were in pure culture and 14 were with another pathogen, Haemophilus influenzae being the commonest (found with 10 of the 14 B catarrhalis isolates). Of 36 patients infected in the community, 26 required admission to hospital. The remaining 27 patients were infected while in hospital. Forty four of the 63 isolates produced beta lactamase; 26 of these had been acquired in the community. As a result 29 patients were treated inappropriately with ampicillin and did not respond to this treatment. beta Lactamase produced by B catarrhalis may also protect other pathogens normally susceptible to beta lactam antibiotics. Most patients had chronic lung diseases or lung cancer, but three otherwise healthy patients who did not smoke developed bronchitis. B catarrhalis contributed to the death of five patients. A survey of the antibiotic prescribing habits of the referring general practitioners together with the sensitivity results of B catarrhalis suggest that changes in antibiotic prescribing habits in the community may be responsible for the increase in B catarrhalis infection.

Adult↗
PubMed1986

Tuberculin reactivity in a chest clinic: the effects of age and prior BCG vaccination.

Heaf tests were performed in 834 adults and children seen during one year in a tuberculosis contact clinic in Edinburgh. All subjects with a past history of tuberculosis, or who subsequently developed evidence of tuberculous infection and 63 subjects of Asian origin were excluded to leave 749 'healthy' adults and children broadly representative of the local caucasian population. All Heaf tests in 178 children without BCG vaccination were negative or grade I whereas 16 (73%) of the 22 children with a history of previous BCG vaccination were positive grade I or II. A strongly positive Heaf test (grade III-IV) in any child with or without previous BCG vaccination seen as a tuberculosis contact implies recent infection and merits consideration for chemoprophylaxis or prolonged follow-up. Two hundred and seventy adults without previous BCG vaccination showed an increasing incidence of strongly positive Heaf tests (grade III or IV) with age reaching a peak of 55% in the 45-65 age group; beyond the age of 65 this fell to 37%. Two hundred and eighty-one adults with previous BCG vaccination showed significantly more Heaf grades I and II, fewer negatives and fewer strong positives than the unvaccinated group. A strongly positive Heaf test (III-IV) is a frequent finding in a healthy adult and has little discriminatory value in the diagnosis of active tuberculosis infection in Edinburgh, and by implication elsewhere in the United Kingdom. Positive tuberculin tests should be viewed in the context of the tuberculin profile of the local population.

Adolescent↗
PubMed1986

The current value of tuberculin testing and BCG vaccination in school children.

We have examined the value of routine tuberculin testing and BCG vaccination in Edinburgh school children from 1970 to 1983. Over 89,000 children were observed for a mean period of 7 years, during which 77 new cases of tuberculosis were notified in Caucasians. The average annual incidence of tuberculosis in the 65,692 children receiving BCG vaccination at school was 7/10(5), significantly less than the 19/10(5) estimated in 12,987 Heaf negative children who missed BCG vaccination, and the 41/10(5) in 5,308 tuberculin positive children (P less than 0.001). The efficacy of BCG vaccination in this study exceeded 60%. The 5,308 tuberculin positive children were offered chest radiographs with an initial yield (new cases of tuberculosis detected/radiographs taken) of 1/555 for Heaf grade II children, 1/75 for grade III, and 1/25 for grade IV (P less than 0.001). During the period of this study approximately 700 BCG vaccinations were necessary to prevent one new case of tuberculosis and this represents considerably greater benefit than in England and Wales during the same period. There may be a case for continuing the schools' BCG programme in Scotland for a number of years longer than in England and Wales. A national BCG survey for Scotland would be valuable.

Adolescent↗
PubMed1986

The diagnosis and management of tuberculosis in common hostel dwellers.

Edinburgh hostel dwellers have been regularly screened for pulmonary tuberculosis since 1957. Sixty-eight cases were notified during the 7 years 1976-1982: 42 (65%) were detected by 4687 hostel survey X-rays, and a further 26 presented with symptoms. Disease was more advanced in the symptomatic hostellers both by radiological and bacteriological criteria with twice as many being sputum smear positive (58% vs. 26%). Full clinical details were available for 65 of the 68. Four were diagnosed at post mortem examination and two had chemotherapy stopped because the disease was considered inactive. Of the remaining 59 eligible for treatment, 47 (80%) received a complete course of adequate chemotherapy; 16 as hospital in-patients, 26 first in hospital and then under out-patient supervision and five simply as supervised out-patients; none relapsed. Twelve (20%) of the 59 defaulted from supervision after a mean follow-up period of 2.4 months.

Ill-Housed Persons↗
PubMed1984

The value of contact procedures for tuberculosis in Edinburgh.

We have reviewed the value of routine contact procedures (CP) in screening for tuberculosis in the Edinburgh area. Nine hundred and forty-seven index cases were notified during the 5-year period 1977-81; of these, 131 (14%) were detected by CP, 78 had previously undetected tuberculous disease and a further 53 required chemoprophylaxis (CPX). None had presented with symptoms, and disease was consequently detected at an earlier stage with fewer being sputum smear positive (10% vs 29% P less than 0.01). The 131 cases were found by CP during the screening of 4445 contacts, an overall yield of 2.9%. The highest yield was 18% for close contacts of sputum smear positive index cases, the yield for the casual contact being only 3%. The overall yield for contacts of smear negative respiratory and non-respiratory index cases was less than 2% in each group. Young contacts were particularly vulnerable and the yield in Asian children was 10.2%, twice that of the 4.9% in non-Asian children (P less than 0.001). The incidence of new cases in contacts who had previous BCG vaccination was significantly lower than that in non-vaccinated contacts (1.15% vs 3.06% P less than 0.001) suggesting a protective effect of 62%. One hundred and twenty-five (95%) of the 131 new cases were diagnosed within 3 months of first attendance, the remaining 5% at 6 months. The workload involved in screening contacts in this series could have been halved by restricting CP to all contacts of sputum smear positive index cases and only the close contacts of all other index cases. This would have resulted in missing 18% of the new cases, or three cases of tuberculosis and two cases requiring CPX per year, in a population of 608 000. Seventy-two (7.6%) of the 947 index cases were of Asian origin. Their disease occurred more in young adults, especially women, and was more frequently extrapulmonary in site (25% vs 12% in non-Asians P less than 0.01). We conclude that contact procedures remain valuable in the detection of new, asymptomatic cases of tuberculosis in Edinburgh and, by implication, in other urban areas of the United Kingdom. Particular efforts should be directed towards children, Asians and those without BCG vaccination, especially if they have been in contact with sputum smear positive index cases.

Adolescent↗