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Biomedical subjects

W Marget

Publications and source records attributed to W Marget.

At least 19 recordsLinked to original sources
PubMed1988

Listeria monocytogenes infections--therapeutic possibilities and problems.

Listeriosis in humans is a rare disease, which, however, is known to be epidemic and endemic. The prognosis has remained unsatisfactory up to today, the fatality being at least 10% and often considerably higher depending on the clinical features of the disease and the patient's age. Three population groups are at risk: pregnant women, fetuses and newborn infants. Furthermore, immunosuppression in older patients due to disease, therapy, or age also plays a role. The incidence of Listeria infections in patients over 45 is clearly increasing. Due to the nature of the pathogen (in vivo bactericidal concentrations of antibiotics are often not attainable; intracellular growth) a high dosage of ampicillin is recommended. Although the present therapeutic possibilities are not satisfactory, a combination of ampicillin and an aminoglycoside appears to be the best therapy at present. Other combinations such as rifampicin and beta-lactam antibiotics have exhibited in vitro antagonism. The preferred therapy, ampicillin, can only be recommended with reservations because it is not optimally effective.

Adult↗
PubMed1988

Antibiotic therapy of early European Lyme borreliosis and acrodermatitis chronica atrophicans.

In a study on 121 consecutive patients with erythema migrans, 65 patients obtained oral penicillin, 36 tetracyclines, and 20 amoxicillin-clavulanic-acid. Follow-up was carried out for a median of 29, 17, and 7 months, respectively. In another limited trial on 29 patients with acrodermatitis chronica atrophicans (ACA), 14 patients received oral penicillin, 9 parenteral penicillin, and 6 tetracyclines. There was no statistically significant difference among treatment groups in both therapeutic trials, with the exception of different follow-ups due to the nonrandomized study design and different occurrence of the Jarisch-Herxheimer reaction in patients with erythema migrans. Later extracutaneous manifestations developed in 27% of the patients with erythema migrans and in 47% of the patients with ACA despite antibiotic therapy. We could not prove the superiority of any antibiotic tested in either early or late European Lyme borreliosis.

Acrodermatitis↗
PubMed1987

Relevance of vesico-ureteric reflux in development of lipid A antibodies in recurrent urinary tract infections in children--a preliminary study.

The serum titres of IgG and IgM antibodies to lipid A were measured in 24 children with chronic pyelonephritis (PN), 55 with recurrent lower urinary tract infections (LUTI), 13 with gram-negative sepsis (S), and in 50 control children using an enzyme-linked immunosorbent assay (ELISA). Children ranged in age from 1 month-17 years. Patients with PN were differentiated by the presence or absence of an acute infectious episode and/or vesico-ureteric reflux (VUR). During an acute episode in PN and LUTI, IgG titres were significantly higher than in controls, but only PN patients with an acute infectious episode also had significantly elevated IgM titres. Overall, children with LUTI showed a significantly lower frequency of detectable IgG lipid A antibodies (27%) than in PN (63%). In PN children with VUR not accompanied by an infectious episode, lipid A antibody was found at relatively low titres, while an episode not accompanied by VUR displayed significantly elevated IgG titres, and an episode accompanied by VUR showed elevation of both IgG and IgM anti-lipid A antibody titres.

Adolescent↗
PubMed1987

[Lipoid A antibody titer in humans].

Lipid A is the toxic component of endotoxin in gram-negative bacteria. Antibodies to lipid A are not usually found in healthy persons (or only at a low titer) without a corresponding history of infection. Even gram-negative septicemia is found to be accompanied by only low titers. A completely different situation is seen in patients with chronic or recurrent infections due to Enterobacteriaceae and other gram-negative bacteria. Here it is notable that the antibody titer varies with the type of disorder (e. g. cystitis and pyelonephritis). A severe would infection, e. g. due to Pseudomonas aeruginosa, also leads to measurable lipid A antibody titers. Varying antibody titers can be observed in cystic fibrosis, Crohn's disease, and severe surgical infections. One can conclude that a significantly elevated antibody titer develops during an extensive tissue involvement of long duration and indeed is caused by tissue inhibition by endotoxin. Based on clinical experience, it can be assumed that lipid A antibodies present in the body have a protective effect in septic shock.

Adolescent↗
PubMed1987

[Antibody to lipoid A in the treatment of septic shock].

The protective effect of high-titer anti-lipid A hyperimmune globulin with respect to the course of the disease and the mortality rate was studied in patients with septicemia verified by positive blood cultures. Six patients were treated with anti-lipid A in an open study. Dramatic improvement in fever curves and clinical condition in some of the patients encouraged us to start a randomized double blind study. So far, 17 patients have entered the study, 16 of whom were evaluable. Immediately after a positive blood culture was found, patients received either high doses of anti-lipid A or placebo (saline solution) on two subsequent days. Before and after each infusion blood samples were taken in order to assess serum bactericidal activity and anti-lipid A titers. Because of the still small numbers of patients the results of both studies were summarized. In all patients treated with anti-lipid A clear-cut increases in anti-lipid A titers were shown. Patients with repeated gram-negative infections showed higher median anti-lipid A titers than patients without such a history. The patients treated with anti-lipid A immune globulin ran a significantly milder course than the placebo group. The severe signs of septic shock were reversed in seven of 15 patients on anti-lipid A compared to two of seven patients treated with placebo. In the anti-lipid A-treated group, three of 15 patients died, and in the placebo group two of seven. This difference is not statistically significant.

Antibody Formation↗
PubMed1987

What is the role of lipid A in the development of pyelonephritis? A hypothesis.

From the studies of Westenfelder et al. and our own studies of the presence of lipid A antibodies in the upper and lower urinary tract infections, it can be concluded that chronic pyelonephritis is a lipid A induced disease. This hypothesis is based on the distinct statistically different antibody production in upper urinary tract infection in contrast to lower urinary tract infection, the persistence of lipid A in renal tissue, as well as the induction of lipid A nephritis in puppies. These observations should be considered in future studies to proceed in the clarification of these diseases.

Animals↗
PubMed1986

[A cross-over study on the effectiveness of ofloxacin and ciprofloxacin administered orally].

Efficacy of Oral Ofloxacin and Ciprofloxacin. Cross-over Study. The efficacy of the 4-quinolones ciprofloxacin (CPX) and ofloxacin (OFX) was studied in a cross-over study. Twenty out-patients with cystic fibrosis and chronic colonization of the respiratory tract with Pseudomonas aeruginosa were treated for ten days with OFX, then another ten days with CPX, and vice versa. Drug concentrations in serum and sputum were assayed. The patients' clinical and laboratory parameters were monitored. The side-effects that appeared did not require interrupting treatment. The serum and sputum concentrations were found to be above the minimal inhibitory concentration. Although P. aeruginosa was not eliminated by the therapy, two-thirds of the patients showed improvement during the infection that could be observed clinically and in laboratory measurements. Oral treatment with OFX and CPX is efficacious.

Administration, Oral↗
PubMed1984

[Bacterial adhesion to buccal epithelial cells as a permanent indicator of recurrent urinary tract infections].

Adhesion of a 3H-thymidine-labeled reference strain of enterococci to epithelial cells of buccal mucosa from 20 young female patients with rec. UTI (aged 3 to 15 years) and 19 urologically healthy girls was investigated. Bacterial attachment in children with rec. UTI was significantly higher statistically than in the healthy control group and did not show any alteration when tested separately during acute UTI (14 cases) and infection-free intervals (17 cases). There was no difference in adherence between patients with rec. UTI connected with diverse anomalies of the urinary tract (12 girls) and UTI patients without anomalies (8 girls). Within the patient group 3 cases under antimicrobial prophylaxis with co-trimoxazole showed bacterial adhesion similar to that in healthy controls. Our examination results lead to the assumption that attachment of enterococci to buccal epithelial cells can be used as a diagnostic criterion for rec. UTI.

Adolescent↗
PubMed1980

Intravenous cefotaxime in children with bacterial meningitis.

Thirteen children with meningitis due to Haemophilus influenzae, beta-haemolytic streptococcus group B, Streptococcus pneumoniae, Staphylococcus epidermidis, Neisseria meningitidis, Escherichia coli, or Pseudomonas aeruginosa and who had been unsuccessfully treated with other antibiotics or had causative organisms which were resistant to available antibiotics were treated with intravenous cefotaxime. Nine children were cured; in one case infection (with a different organism) recurred but a further course of cefotaxime was successful; one child died, with sterile CSF; one child died from his underlying disease (astrocytoma); and one child was cured with sequelae (hydrocephalus). A further child with meningitis caused by E. coli had been treated unsuccessfully by intravenous and intraventricular chloramphenicol and gentamicin; intravenous and intraventricular cefotaxime was successful. The agent was well tolerated. CSF levels were measured in seven children and ranged from 300 to 27 200 microgram/l; published and unpublished in-vitro studies suggest that minimum inhibitory concentrations for cefotaxime against the organisms commonly causing bacterial meningitis are usually well below 250 microgram/l.

Biological Availability↗
PubMed1979

[Endocarditis therapy with high doses of oral doxycycline: Part II: Clinical study (author's transl)].

Nineteen patients previously treated unsuccessfully, usually with bactericidal antibiotics, received large doses (average: 15-20 mg/kg/day) of oral doxycycline (Vibramycin) after suitable testing for resistance. The good therapeutic results -- complete cure in eleven cases, great improvement in one, doubtful response to doxycycline in four, three failures -- justifies the observation that high oral doses of doxycycline can be considered as an important addition to the possibilities for treatment of endocarditis.

Administration, Oral↗
PubMed1979

[Nosocomial infections (author's transl)].

Within 3 years 2546 nosocomial infections were registered among 18 897 hospitalised patients of a gynaecological-obstetric university hospital, Results were obtained in a prospective study on the use of nurses specially trained in hygiene. The incidence of nosocomial infections was 13.5% including predominantly asymptomatic bacteriurias and 3.9% without bacteriurias. It was higher after major surgical intervention and lowest in pregnant women, postnatal patients, vaginal deliveries and minor operations. Bacteriurias were the most common infection in all patient groups. They made up 71% of the total, followed by postoperative pelvic infections (7.3%), phlebitis at the site of infusion (6.5%) and abdominal wound infection (4.2%). During the control programme, introduction and reinforcement of various hygienic measures and continuous instruction and control of the wards and treatment rooms by the specially trained nurses the incidence of all nosocomial infections decreased by 48.1% and of urinary tract infections by 42.7%.

Bacteriuria↗