Biomedical subjects
Publications and source records attributed to S G Wright.
Nursing research is often seen as belonging to the world of academics, far removed from the everyday practicalities of clinical practice. By making it accessible and asking nurses to define their response to research, a nursing development unit caused nurses to re-evaluate their practice.
Praziquantel is recommended as the drug of choice for all forms of schistosomiasis. We report the first case (to our knowledge) of exudative effusive polyserositis following treatment of schistosomiasis with this drug. This involved pleura, pericardium, and peritoneum and was associated with acute respiratory failure. The latter preceded the appearance of pleural effusions. We present a brief review of the literature and attract attention to the need for close observation of patients with schistosomiasis who are treated with praziquantel.
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We have reviewed the clinical presentation of 100 consecutive culture positive cases of brucellosis which came under our care during the last two years. Of these, six had atypical presentations and but for the routine practice of sending blood for brucella culture, the diagnosis would have been missed. The unusual presentations included a 19 year old boy presenting as an acute abdomen ending in laparotomy, a 52 year old man presenting with a psoas abscess, a 29 year old woman presenting with a transient perinephric mass, a 75 year old man with an acute flare up of his osteoarthritis, a 65 year old diabetic man presenting in an insulin-resistant diabetic state and a 35 year old man presenting with a cauda equina syndrome.
Analysis of 121 consecutive cases with infection of the nervous system showed that the majority were the granulomatous infections, tuberculosis and brucellosis (53 cases (44 per cent)). Thirty-nine patients had tuberculosis and 14 had brucellosis. The clinical and microbiological pattern of infection differs from that frequently reported from Western countries. Tuberculosis lesions presented with features of intracranial space occupying lesions (14), spinal cord compression (13) and lumbosacral root compression (1 child). Ten adults and one child had tuberculous meningitis. Pyogenic meningitis present in 38 cases (31 per cent), was most common in children. The infecting organism was identified in 26 patients; Gram-positive cocci in 17, Haemophilus influenzae in four and other Gram-negative organisms in five. Eleven patients had brain abscesses, caused by bacterial infection in eight, fungal infection in two and Toxoplasma gondii in one. Nineteen patients had clinical and pathological features of viral meningitis. Fourteen patients (12 per cent) died including six children with pyogenic meningitis.
Giardia lamblia is discussed as the most important parasitic cause of travellers' diarrhoea. The parasitology of this flagellate protozoan is discussed with respect to route of infection, threshold infecting dose, and incubation period. The geographic distribution of giardiasis is widespread, being common in tropical and sub-tropical regions and endemic at a low level in European and North American countries. The predisposing factors are detailed together with clinical manifestations, pathogenesis and diagnosis. Effective therapy may be quinacrine t.i.d. for 5-10 days, metronidazole 200 mg t.i.d. for 14 days or 2 g once daily over 3 days, or a single dose of 1.5 g of tinidazole. Although Entamoeba histolytica is distributed world-wide, it rarely causes travellers' diarrhoea. However, the clinical features, diagnosis and treatment of amoebiasis-related travellers' diarrhoea are detailed.
A comparative evaluation was made of immunofluorescent serum antibodies against Giardia lamblia and enterobacteria isolated from the upper intestine of patients with severe giardiasis. The study was carried out on sera from 51 patients belonging to seven intestinal disease groups. Antibodies against Giardia and against some enterobacteria were present in all eight cases of giardiasis with malabsorption, and absent in all five cases of invasive amoebiasis and in six normal control sera. Bacterial antibodies were found in the other five groups of intestinal disease, in 29 out of 38 cases. Giardia antibodies were found in only two of the other groups, tropical sprue (two cases) and coeliac disease (two cases). Thus Giardia antibodies may not signify active giardiasis but they were of restricted distribution and were sometimes present at relatively high titre. Bacterial antibodies were widely distributed but always at low titre. Absorption experiments indicated that the two types of antibody did not cross-react.
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The bacterial flora of the upper intestine has been examined in symptomatic expatriate adults with mild tropical malabsorption, without steatorrhoea, persisting for many months after return to a western environment. Seven of the 11 patients had enterobacteria in luminal fluid or mucosal samples in numbers ranging from 10(3) to 10(8) per ml or per g. The most common isolate was Klebsiella pneumoniae (in four cases); Citrobacter freundii, Serratia marcescens and Pseudomonas spp. were also detected. The signficance of bacterial colonization in the pathogenesis of mild tropical malabsorption is discussed.
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Anaemia in infancy is a very common clinical problem in the tropics and will continue to be common while infectious disease and poor nutrition prevail. In the diagnosis of anaemia in a child the clinician must expect a number of factors to be involved. On the basis of clinical features it is possible to arrive at a working diagnosis that provides a basis for treatment. Genetically determined abnormalities of haemoglobin, haemoglobin synthesis and red cell enzymes are common in the tropics. Though laboratory tests are required to confirm their presence these conditions can be suspected clinically and often managed without laboratory facilities.
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Nine of 14 cases of giardiasis and severe malabsorption were found to have numerous bacteria adjacent to the mucosa and within luminal fluid samples from the upper jejunum. Three species of enterobacteria (Klebsiella pneumoniae, Enterobacter cloacae and E. hafniae) were cultured from eight patients and from only one were Bacteroides isolated. Enterobacteria were not cultured from seven of eight patients who had giardiasis but only mild malabsorption (of xylose only) nor from seven patients without malabsorption. Intestinal colonization by enterobacteria may make an important contribution to the development of malabsorption in patients with giardiasis.
1. Vitamin B12 absorption was measured in 18 patients with tropical malabsorption. 2. Absorption was particularly impaired in patients with severe mucosal lesions. 3. Sequential measurements with 57Co- and 58Co-labelled vitamin B12 were made before and 48 h after the start of tetracycline therapy. A rapid improvement (on average 22% increase in absorption) occurred in four of six patients with marked mucosal lesions. Further improvement occurred in four of five patients measured after 4 weeks' tetracycline, including the two who failed to improve initially. 4. These rapid changes in vitamin B12 absorption after antibiotics occur too early to be due to mucosal recovery and suggest that bacterial metabolism is an important factor in the malabsorption in these patients.