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S J Eykyn

Publications and source records attributed to S J Eykyn.

At least 37 records · Page 2Linked to original sources
PubMed1997

Culture-negative endocarditis: contribution of bartonella infections.

Two cases of bartonella endocarditis are described: one in a 55 year old homeless alcoholic man, caused by Bartonella quintana; the other in a 41 year old male with a history of exposure to cat fleas, caused by B henselae. Serological testing and polymerase chain reaction of the excised valves were used to identify the organisms. False positive serology for chlamydia was detected in one case.

Adult↗
PubMed1997

Streptococcus pyogenes bacteraemia: a 27-year study in a London teaching hospital.

The clinical and epidemiological features of 120 episodes of Streptococcus pyogenes bacteraemia in St. Thomas' Hospital between 1970 and 1997 were analysed. One-third of episodes were nosocomial. M1 was the most common serotype, and 29% of strains were non-typable. There was a variety of presenting features, but nearly half of the patients had cellulitis, 15% were shocked, and 6% had necrotic infections. There was no focus of infection in 13%. 54% of patients had an underlying disease, and 23% of infections were associated with a medical procedure or device. The mortality rate was 19%, and was associated with shock, coma, no focus of infection, and underlying disease. Since 1989, the annual incidence has more than doubled, and M1 strains and necrotic infections have increased, but the mortality rate and the proportion of patients presenting with shock have decreased, and the increase in cases involved many different M-types.

Bacteremia↗
PubMed1996

Delay in the diagnosis of bacteraemic urinary tract infection in elderly patients.

Collaboration between clinicians and microbiologists revealed that many patients with subsequently proven urinary tract infection (UTI) present with symptoms suggestive of chest infection. A retrospective analysis was performed on patients over 50 years old with community acquired bacteraemic UTI proven by blood cultures. The main presenting features were confusion (30%), cough (27%), dyspnoea (28%) and new urinary symptoms (20%). The initial clinical diagnosis was UTI in 43% and chest infection in 24%. Chest infection was diagnosed more often in those over 70 years old than those aged 50-70 years old (chi 2 = 7.2, p = 0.007). The majority had pyuria but less than half of the urine samples arrived in the laboratory on the day of admission, fewer from the older patients than the younger (chi 2 = 2.57, p = 0.10). These results demonstrate that UTI frequently presents with respiratory features and that the diagnosis of UTI is often delayed. Sampling the urine with a catheter may be justified to enable diagnosis on the day of admission.

Aged↗
PubMed1996

Serogroup-specific epidemiology of Streptococcus pneumoniae: associations with age, sex, and geography in 7,000 episodes of invasive disease.

A study sample of 7,010 episodes of invasive Streptococcus pneumoniae disease was obtained by combining 13 existing datasets. Disease episodes due to each of 12 pneumococcal serogroups (1, 3-9, 14, 18, 19, and 23) were then compared with episodes in a constant internal control group to describe serogroup-specific variations in disease frequency by age, sex, and geographic origin. The results are presented as odds ratios (with 95% confidence intervals) derived by logistic regression, with adjustment for the major confounders, including dataset of origin. Variation in the male:female ratios between serogroups is small, suggesting that capsular characteristics are an unlikely explanation for the male preference of S. pneumoniae. Serogroups associated with higher nasopharyngeal prevalence (e.g., 19 and 24) are relatively more common in Europe and North American, while the invasive serotypes 1 and 5 are much more common in South America. The custom of reporting serogroup frequencies in two age groups, children and adults, conceals much of the variation in the age distributions across the whole span of life. The reduction of risk associated with serogroups 6, 14, 18, 19, and 23 beyond childhood follows different gradients, being most abrupt in serogroups 14 and most gradual in serogroup 18. The relative risk of disease with serotype 1 declines steadily throughout life, while with serotypes 3 and 8 it increases over middle age. Serogroups 7 and 23 are found unusually frequently in the third decade of life. Because of the wide differences in the epidemiology of individual serogroups of S. pneumoniae, it is questionable whether pneumococcal infection should continue to be classified as a single disease entity.

Adolescent↗
PubMed1995

Identification and ribotypes of Staphylococcus caprae isolates isolated as human pathogens and from goat milk.

We report five cases of human infection with Staphylococcus caprae. Two were community acquired (one case each of endocarditis and urinary tract infection); the other three were acquired in a hospital (two cases of bacteremia associated with intravenous access and one case of urinary tract infection). Analysis of human isolates and goat isolates from eight herds showed that they could be misidentified by some commercial identification systems but were clearly identified as S. caprae by ribotyping, according to their species-specific ribotype. Phylogenetic methods applied to the ribotypes did not reveal two distinct lineages corresponding to the goat and human origins of the isolates, although human ribotypes were clearly distinguishable by the presence of a core of four specific bands. The latter observation may reflect some degree of evolutionary change within the species between human and goat isolates.

Adult↗
PubMed1995

Enteric media: pre-poured or in-house?

AIMS: (1) To evaluate the performance of in-house and pre-poured commercially available enteric agar by challenge with a large number of positive clinical specimens. (2) To set the standard (critical independent evaluation) which new products should reach. (3) To publish this information, so that others can make informed decisions about enteric media. METHODS: Thirteen media of anonymous source were challenged with "known" positive stool samples. RESULTS: In-house desoxycholate citrate agar performed best for overall pathogen isolation rates, for shigella isolation rates, and for most pathogens available on primary culture. CONCLUSIONS: Desoxycholate citrate agar made by our own laboratory yielded the most pathogens and proved the most effective.

Agar↗
PubMed1994

Mycobacterium chelonei keratitis: a case report and review of previously reported cases.

A 56-year-old woman who wore hard contact lenses developed a keratitis due to Mycobacterium chelonei. The organism was only sensitive to imipenem and partially to ciprofloxacin and erythromycin. After an initial response to topical therapy with these antibiotics the infection relapsed and a penetrating keratoplasty was performed, with resulting cure. M. chelonei has not previously been reported as a cause of keratitis associated with hard contact lens wear; neither has its treatment with imipenem and/or ciprofloxacin. A detailed photographic record showing the natural history of the keratitis is presented. Previously reported cases of M. chelonei keratitis are reviewed.

Ciprofloxacin↗
PubMed1994

Campylobacter fetus endocarditis: two case reports and review.

We report two cases of Campylobacter fetus endocarditis. The first case involved a bicuspid native aortic valve in a 60-year-old woman, and the second involved a prosthetic aortic valve in a 76-year-old woman. No source of infection was identified in either case. Despite antibiotic therapy, hemodynamic deterioration necessitated valve replacement; both patients recovered completely. C. fetus is an uncommon cause of human infection but may be responsible for severe illnesses such as endocarditis and thrombophlebitis because of its tendency to attack the vascular endothelium. Review of the literature revealed 21 cases of endocarditis caused by this organism, usually involving the aortic valve. To our knowledge, there are only two reported cases of prosthetic valve endocarditis. Our second patient is the oldest one encountered so far with this condition.

Aged↗
PubMed1994

Septicaemia in the newborn and elderly.

Analysis of 5304 episodes of septicaemia at St Thomas' Hospital showed that both the elderly (> 65 years) and neonates accounted for increasing proportions between 1969 and 1992. In particular the increase was greatest for patients aged over 84 years who accounted for 3% of episodes in adults with community-acquired septicaemia in the 1970s compared with 13% in the 1990s. The change may be explained partly by demographic factors. The majority (85-90%) of elderly patients presented with fever, or leucocytosis or both. The urinary and gastrointestinal tracts were the most common foci for the elderly and they were less likely than other adults to have iv access associated sepsis. Among neonates Escherichia coli septicaemia became less common whereas there was little changes in the incidence of group B streptococcal septicaemia; coagulase-negative staphylococcal infection became more common. Overall mortality declined for both neonates and elderly patients. Poor outcome appeared related to the focus of infection, febrile response and age in the elderly and to the time of onset and organism in neonates.

Adolescent↗
PubMed1994

Stool culture: are you getting value for money?

AIMS: To assess the best medium for primary isolation of enteric pathogens; to determine the need for a second primary culture medium; and to gather information on stool culture media used in 20 other randomly selected laboratories. METHODS: Specimens were cultured on desoxycholate citrate agar (DCA), Hektoen enteric agar (Hektoen), and xylose lysine deoxycholate agar (XLD). Non-lactose fermenters were screened with Rapidec Z (bio-Mérieux) and identified with API 10S (bio-Mérieux) where appropriate. Shigellas were identified with API 20E (bio-Mérieux) and serology, and salmonellas biochemically and by serology. A telephone survey was carried out to enquire into different culture practices and whether they had been evaluated for cost effectiveness. RESULTS: The isolation rate of enteric pathogens on primary stool culture media was 97% on DCA, 88% on XLD, and 76% on Hektoen. Seventeen of 18 shigellas grew on DCA, 13 of 18 on XLD, and 14 of 18 on Hektoen. DCA missed one Salmonella, XLD three, and Hektoen 13. XLD and Hektoen both missed Yersinia enterocolitica. The telephone survey revealed a diverse range of both primary and subculture plates. There was little evidence of evaluation of stool media, but firm personal convictions concerning the advantages and disadvantages of each type of medium at each stage of culture. CONCLUSIONS: DCA performed best and was the most cost effective of the three media. Neither XLD nor Hektoen were satisfactory as primary culture media because they grew fewer pathogens than DCA.

Cost-Benefit Analysis↗