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PubMed1991

Preventing group B streptococcal infection in newborns.

Group B streptococci, commonly found in the maternal gastrointestinal and genitourinary tracts, can be transmitted to the neonate at the time of rupture of membranes and during delivery. Current management strategies include early detection of group B streptococcal carriers and the administration of intrapartum prophylactic antibiotics to prevent maternal fetal transmission. Several tests are now available to rapidly identify group B streptococcal carriers. Physicians should be able to recognize patients at high risk for colonization and the situations in which prophylactic antibiotics should be employed. Proper use of antibiotics during labor can eliminate group B streptococcal sepsis in neonates. Early group B streptococcal meningitis carries a mortality rate of almost 50 percent, despite medical support from neonatal intensive care units.

Carrier State↗
PubMed1987

Biology of human papillomavirus (HPV) infections and their role in squamous cell carcinogenesis.

Current data implicating the role of human papillomavirus (HPV) infections in squamous cell carcinogenesis may be summarised as follows: animal models have shown that PVs can induce malignant transformation; HPV involvement in both benign and malignant human squamous cell tumours has been demonstrated by morphological, immunohistochemical and DNA hybridisation techniques; HPV infections in the genital tract are venereally transmitted and are associated with the same risk factors as cervical carcinoma; the natural history of cervical HPV lesions is similar to that of CIN, namely, they have the potential to develop into carcinoma in situ; malignant transformation of PV-induced lesions seems to depend on virus type and the physical state of its DNA, e.g., whether or not it is integrated in the host cell DNA; malignant transformation most probably requires synergistic actions between the PVs and chemical or physical carcinogens, or other infectious agents; genetic disposition (at least in animals) significantly contributes to malignant transformation; immunological defence mechanisms of the host are probably capable of modifying the course of PV infections (efficacy in man remains to be elucidated). Many details of the molecular mechanisms, however, still remain to be clarified. Although BPV1 is capable of transforming fibroblasts, the way that papillomaviruses transform epithelial cells is unclear. Which gene is capable of inducing the limited cell proliferation in benign lesions? No model systems exist to provide the answer nor to elucidate the progression to malignant cells and then to invasive cancer. Improved tissue culture systems for in vitro differentiation of keratinocytes should help in elucidating the biology of papillomaviruses and their interaction with cell division and differentiation.

Animals↗
PubMed1995

Fluoroquinolones.

Since the introduction of the floroquinolones for clinical use in the late 1980s, they have been used successfully for a large number of clinical situations. As experience accumulates, the indications and optimal use of these agents gradually become more clear. Unfortunately, two of the pathogens for which these agents were most promising--methicillin-resistant S. aureus and P. aeruginosa--have developed resistance. Currently, the quinolones are excellent agents for the treatment of complicated urinary tract infections, including those caused by P. aeruginosa. In addition, they should be considered as initial therapy for the treatment of severe bacterial gastroenteritis. The quinolones should also be considered when attempting to eradicate the chronic stool carriage of S. typhi. These agents also offer significant advantages in the treatment of osteomyelitis and prostatitis caused by gram-negative bacilli that frequently require prolonged antimicrobial therapy. Treatment of STDs, especially gonorrhea, is another clear indication for their use. Ciprofloxacin should be considered as initial therapy in patients with malignant otitis externa and in cystic fibrosis patients with exacerbations secondary to P. aeruginosa in the sputum. The role of the quinolones for soft tissue and respiratory tract infections is less clear and their use probably should be limited to certain situations in which there is a clear advantage over beta-lactams, macrolides, and trimethoprim-sulfamethoxazole. The new quinolones, fleroxacin, perfloxacin, sparfloxacin, and tosufloxacin, which are being developed and tested for clinical use, will offer advantages in once-a-day dosing and better gram-positive antimicrobial activity. Because the inappropriate or heavy use of the fluoroquinoles has resulted in considerable development of resistance, it is imperative that they be used only when there is a distinct advantage over conventional therapy in terms of efficacy, safety, or cost. Otherwise, the rapid development of resistance will jeopardize the potentially bright future for this entire class of compounds.

Anti-Infective Agents↗
PubMed1993

[Fluoroquinolones, 10 years later].

During the last few years the fluoroquinolone class has been profoundly reshaped. The development of mutation-acquired resistance, principally from staphylococci and Gram-negative bacteria responsible for nosocomial infections has restricted the use of these antibiotics as first-line monotherapy to some community-acquired infections (urinary tract, gastrointestinal, sexually transmitted infections), while defects in their antibacterial spectrum (pneumococci, streptococci and anaerobes) have reduced the possibility of use against respiratory infections. Future developments concern compounds that are active against Gram-positive cocci and some intracellular bacteria (e.g. mycobacteria) and possibly against certain parasites. Problems of tolerance are important in clinical trials of the new compounds.

Anti-Infective Agents↗
PubMed1994

Ciprofloxacin: an oral quinolone for the treatment of infections with gram-negative pathogens. Committee on Antimicrobial Agents. Canadian Infectious Disease Society.

OBJECTIVE: To optimize the use of ciprofloxacin, a synthetic fluoroquinolone, in community and hospital practice, and to minimize overprescribing by providing an overview of the literature and recommendations for appropriate use. OPTIONS: First-line treatment for infections in which ciprofloxacin is shown to be effective, treatment with oral ciprofloxacin rather than parenteral therapy with another drug, and step-down therapy with oral ciprofloxacin after initial parenteral treatment. OUTCOMES: In order of importance: efficacy, side effects and cost. EVIDENCE: A MEDLINE search of articles concerning ciprofloxacin, including in-vitro and pharmacokinetic studies using recognized standard methods with appropriate controls and published in recognized peer-reviewed journals, and randomized, controlled, double-blind clinical trials. VALUES: The Committee on Antimicrobial Agents of the Canadian Infectious Disease Society (CIDS) and a recognized expert (T.J.L.) recommended use of ciprofloxacin to treat infections against which it has proved effective both in vitro and in randomized controlled trials. They took into account its value as an oral replacement for other drugs given parenterally and development of resistance. BENEFITS, HARMS AND COSTS: With more appropriate use of ciprofloxacin there will be less development of resistant pathogens. For certain infections patients who would otherwise require admission to hospital could be treated at home and patients initially admitted for parenteral therapy could be discharged sooner on oral therapy with ciprofloxacin. RECOMMENDATIONS: Ciprofloxacin may be considered as first-line treatment for a number of infections in which gram-negative pathogens are proven or strongly suspected, including complicated urinary tract infections, bacterial prostatitis, bacterial diarrhea, selected bone and joint infections, malignant otitis externa, bronchopulmonary infections in patients with cystic fibrosis and selected pneumonia cases. VALIDATION: The paper was prepared, reviewed and revised by the Committee on Antimicrobial Agents of the CIDS. It was then reviewed and revised further by the Council of the CIDS. SPONSOR: The CIDS is solely responsible for developing, funding and endorsing these guidelines.

Administration, Oral↗
PubMedDate not supplied

Prescribing considerations in fluoroquinolone therapy.

Comparative trials have shown that the new oral fluoroquinolones are as effective as parenteral cephalosporins and other broad-spectrum agents in treating infections of the urinary tract, lower respiratory tract, and skin and skin structure caused by most gram-negative and selected gram-positive pathogens. The agents are also effective in the treatment of prostatitis and osteomyelitis. Sequential parenteral to oral therapy has also proved useful, even in patients who are severely ill and are in intensive care units. This allows patients to be transferred out of intensive care earlier, reduces hospital stay and pharmacy costs, and improves quality of life. Because of the high bioavailability (> 95%) of ofloxacin, oral and parenteral doses are identical.

Anti-Infective Agents↗
PubMed1997

Transmission of uropathogens between sex partners.

Epidemiologic evidence and several case reports suggest that Escherichia coli causing urinary tract infection (UTI) may be transmitted between sex partners. In order to test this hypothesis, urinary, vaginal, and fecal E. coli isolates from 19 women with UTI were compared with E. coli found in random initial voids from their most recent male sex partner. E. coli was isolated from 4 of 19 male sex partners. In each case, the E. coli isolated from the man was identical by pulsed-field gel electrophoresis and bacterial virulence profile to the urinary E. coli from his sex partner.

Adult↗
PubMed1994

Office laboratory procedures, economics of practice, patient and parent education, and urinary tract infection.

This review highlights recent advances in four major areas that are relevant to office practice: office laboratory procedures, economics of practice, adolescent risk-taking behavior in terms of sexually transmitted diseases, and urinary tract infections. Who should be screened for diseases and where these screening tests should be done are addressed, keeping the practicing pediatrician in mind. Next we review current office economics, including whether professional courtesy should be continued, how our practices are going to be increasingly influenced by guidelines developed by the American Academy of Pediatrics, the Clinical Laboratory Improvement Amendments, and the new Clinton Health Plan if it survives Congress, and finally how all of these issues will affect our expected income in the years ahead. As pediatricians strive to retain adolescent patients in their practices, they will need to find appropriate ways of counseling these patients concerning risk behaviors that could result in sexually transmitted diseases or HIV infections. Should we leave the comfortable confines of our offices to participate in these counseling programs for adolescents, and are there lessons from existing successful International Health Programs that we can use? Finally, urinary tract infections (UTIs) continue to be a common cause of childhood infections with possible serious long-term sequelae. Can we do a better job of diagnosing UTIs, has improved treatment become available, and is prevention of recurrences possible? Once the diagnosis has been made, how can we best evaluate these children with UTIs for underlying urologic abnormalities? It is our hope that the practicing pediatrician will be better prepared to face these issues having read this review.

Adolescent↗
PubMedDate not supplied

Illnesses in travelers returning from the tropics: a prospective study of 622 patients.

BACKGROUND: Although between 8 and 19% of travelers consult a doctor after returning from the tropics, the full spectrum of health complaints is unknown. METHODS: We analyzed the relative frequency of travel-associated health complaints in all travelers (immigrants returning from visiting their home countries, expatriates, business travelers, and tourists) consulting our department between November 2002 and May 2003. RESULTS: A total of 622 patients were studied (256 women, 366 men; median age 38 yr; 45.3% tourists, 33.8% immigrants, 14.1% expatriates, 6.7% business travelers). The median duration of travel was 36.9 days. The main destinations were Africa (57.6%) and Asia (26.4%). A total of 637 diseases were diagnosed, distributed as follows: skin diseases (23.4%), gastrointestinal infections (19.1%), respiratory tract infections (11.5%), malaria (8.8%), schistosomiasis (7.2%), viral hepatitis (4.1%), urinary tract infections (3.5%), sexually transmitted infections (3.5%), tuberculosis (2.7%), dengue fever (2.5%), and others (13.8%). Malaria and intestinal tract infections accounted for 21% and 23% of diagnoses in the 257 febrile travelers, respectively. Overall, 230 diagnoses (36.1%) corresponded to imported tropical diseases, the main imported diseases being malaria, schistosomiasis, amebiasis, gastrointestinal disorders caused by intestinal nematodes, and dengue fever. CONCLUSIONS: Tropical diseases are not the leading cause of consultation in travelers returning from the tropics. Immigrants are the travelers most at risk of common tropical diseases, with the noteworthy exceptions of dengue fever and invasive schistosomiasis.

Adolescent↗
PubMedDate not supplied

Fluoroquinolone antibiotics: properties of the class and individual agents.

The broad spectrum of activity and bactericidal nature of the fluoroquinolones, together with their excellent absorption, rapid distribution, and high tissue concentration, make them excellent therapeutic agents for the management of a number of complicated community-acquired and nosocomial infections of the urinary tract, bone and soft tissue, gastrointestinal tract, and prostate, as well as some respiratory tract infections and sexually transmitted diseases. Data are presented and reviewed concerning the in vitro activity, pharmacology, and clinical use of ciprofloxacin, norfloxacin, and ofloxacin, which have been available for some time, and lomefloxacin and temafloxacin, which are recently approved agents. The comparable qualities and differences in activity and clinical applications of these agents are considered. For many infections in selected patients, quinolones are excellent substitutes for parenteral agents. In general, adverse effects have been infrequent and rarely require drug discontinuation. Significant interactions, such as with theophylline and caffeine, have occurred but are quinolone dependent. Antacids can markedly impair the absorption of all quinolones. Because emerging resistance to Pseudomonas and Staphylococcus species have been observed, the improper use of the quinolones must be avoided, and the clinician must be aware that an unfavorable response may signal resistance. The development of future agents with better gram-positive activity, improved gram-negative coverage, and activity against unusual pathogens such as Chlamydia species and Mycobacterium species, will make these oral agents invaluable. Assessing the usefulness and safety of these antibiotics in children is an ongoing challenge.

4-Quinolones↗
PubMed1994

Characterization of T lymphocytes and antigen-presenting cells in the murine male urethra.

The male lower urogenital tract is exposed to sexually transmitted pathogens and is therefore a strategic site of immune defense. To further define the immunodynamics of this region, we studied the histology, immune cell distribution, and draining lymph nodes of the murine male lower urogenital tract. The external surface of the foreskin was covered by skin composed of keratinized stratified epithelium containing numerous hair follicles and sebaceous glands. Immunologically the penile foreskin was characterized by the presence of few T lymphocytes and macrophages. Numerous Langerhans cells, however, were detected within the epithelium. The penile urethra was composed of stratified columnar epithelium, with a meatus lined by keratinized squamous epithelium preceding the opening proper. The most abundant immune cells of the penile urethra were macrophages. In young adult, virgin males, these were found primarily underlying the urethral epithelium, but in older, mated mice, they were usually intraepithelial in location, and were more abundant. Langerhans cells could not be specifically identified in the urethral mucosa. T lymphocytes were found underlying and occasionally within the epithelium of the urethral mucosa, with CD4+ cells more abundant than CD8+ cells. The majority of lymphocytes observed around the urethra were positive for the integrin beta 7 alpha M290, which is selectively expressed by mucosal lymphocytes, providing indirect evidence that the urethra is part of the common mucosal system. Lymphocytes expressing the gamma delta T cell receptor and IgA-positive plasma cells were not detected. The primary draining nodes for the vas deferens and urethra were the lumbar nodes. Lymphatic drainage from the rectum also involved the lumbar nodes. Information obtained in this study should help to elucidate optimal genital tract vaccination strategies for defense of the male urogenital tract against sexually transmitted pathogens.

Animals↗
PubMed1997

Clinical and echocardiographic correlates of mitral E-wave transmission inside the left ventricle: potential insights into left ventricular diastolic function.

The mitral inflow wave is initially directed to the left ventricular apex and then turns around facing the left ventricular outflow tract. The E and A waves are transmitted to the left ventricular outflow tract where they are registered as Er and Ar waves, respectively. We hypothesized that the E-wave transit time to the left ventricular outflow tract recorded as the E-Er interval may depend on left ventricular early diastolic performance such as relaxation. This hypothesis was tested in clinical settings known to have abnormal left ventricular relaxation. Mitral E and left ventricular outflow tract Er waves were recorded with pulsed wave Doppler technique in 63 subjects: 25 healthy subjects, 18 patients with secondary left ventricular hypertrophy, and 20 patients with hypertrophic cardiomyopathy. The E-Er interval was measured from the onset of E wave to the onset of Er wave timed to the R wave of the electrocardiogram. The E-Er interval ranged from 45 to 300 msec: 96 +/- 28 msec in the controls, 127 +/- 46 msec in patients with left ventricular hypertrophy (p = 0.0091 versus controls), and 179 +/- 57 msec in patients with hypertrophic cardiomyopathy (p < 0.0001 versus controls). It correlated with left ventricular free wall thickness (r = 0.42, p = 0.0006), thickness of the ventricular septum (r = 0.43, p = 0.0004), left ventricular end-diastolic diameter (r = -0.38, p = 0.0022), left ventricular end-systolic diameter (r = -0.55, p < 0.0001), left ventricular isovolumic relaxation time (r = 0.39, p = 0.0063), RR interval (r = 0.28, p = 0.045), mitral E/A velocity ratio (r = -0.33, p = 0.010), and E-wave deceleration time (r = 0.38, p < 0.0044) but not with age. Multivariate analysis with all the previously mentioned variables and the group the patient belonged to as the dichotomous variable showed that the grouping variable was the sole independent determinant of the E-Er interval (multiple r = 0.74). The E-Er interval is an easily measurable Doppler parameter which is increased in left ventricular hypertrophy and hypertrophic cardiomyopathy. It is related to left ventricular wall thickness, left ventricular isovolumic relaxation time, mitral E/A velocity ratio, and E-wave deceleration time and may provide useful insight into left ventricular early diastolic performance-possibly the relaxation process.

Aged↗
PubMed1990

Routine neonatal circumcision: a reappraisal.

Routine neonatal circumcision has long been a controversial subject. The American Academy of Pediatrics has recently outlined a new position on circumcision that is a marked departure from its previous stance. Neonatal circumcision has many potential advantages: The procedure helps prevent urinary tract infections, penile cancer, sexually transmitted diseases and, perhaps, acquired immunodeficiency syndrome. The risk of complications from the procedure is low. Fewer penile problems occur in circumcised boys than in uncircumcised boys. It is more economical to perform the procedure early in life, rather than later. No evidence shows that penile hygiene alone is as beneficial as circumcision.

Circumcision, Male↗
PubMed1994

Relationship between AIDS and family planning programmes: a rationale for developing integrated reproductive health services.

This paper examines the potential links between family planning and maternal and child health programmes and the emerging needs of the global AIDS epidemic; and assesses the feasibility of organizing comprehensive reproductive health programmes in developing countries to include the prevention and control of reproductive tract infections including sexually transmitted infections as well as HIV/AIDS. The paper discusses arguments opposing the integration of programmes against sexually transmitted infections within family planning and MCH programmes, as well as the programmatic and epidemiological reasons for considering such integration. It is important to determine what elements can be realistically integrated within programmes of varying organizational capacity without compromising their effectiveness.

Communicable Disease Control↗
PubMed2003

Regulation of innate and adaptive immunity by the female sex hormones oestradiol and progesterone.

Women mount more vigorous antibody- and cell-mediated immune responses following either infection or vaccination than men. The incidence of most autoimmune diseases is also higher in women than in men; however, during pregnancy many autoimmune diseases go into remission, only to flare again in the early post-partum period. Successful pregnancy requires that the female immune system tolerate the presence of a semi-allogeneic graft for 9 months. Oral contraceptive use can increase susceptibility to certain genital tract infections and sexually transmitted diseases in women. Moreover, treatment of mice and rats with female sex hormones is required to establish animal models of genital tract Chlamydia, Neisseria and Mycoplasma infection. This review describes what is currently known about the effects of the female sex hormones oestradiol and progesterone on innate and adaptive immune responses in order to provide a framework for understanding these sex differences. Data from both human and animal studies will be reviewed.

Autoimmunity↗
PubMed2001

Mucosal immunity in the lung and upper airway.

The mucosal surfaces of the lungs and upper airways are common sites for infection. Extensive studies of the mechanisms associated with immune responses in the respiratory tract have found that understanding the system is challenging and involves many complex interactions to prevent and eliminate infection. Immune protection against diseases transmitted through the respiratory tract requires an understanding of the important aspects associated with beneficial, detrimental or ineffective immune responses. Two critical aspects of an immune response against a pathogen are that of the inductive stage, either induced by vaccination or primary infection, and the effector stage, the ability to recognise, respond to and eliminate the infection without detriment to the host. An immunisation strategy must not only have a measure of the induced antigen specific response, but this response must also be protective.

Animals↗
PubMed1992

Can fluoroquinolones be considered once-daily therapy?

Fluoroquinolone antimicrobial agents inhibit most Enterobacteriaceae at extremely low concentrations, less than or equal to 0.5 microgram/mL. The half-lives of the agents range from 4 to 18 hours. Most of the available fluoroquinolones can be administered once daily to treat urinary tract and diarrheal infections. Newer agents with long half-lives that inhibit gram positive organisms at lower concentrations than the older fluoroquinolones, less than or equal to 1 microgram/mL, and have a long post-antibiotic effect have the potential to be used once daily as treatment of respiratory, skin-structure and selected bone infections as well. Careful clinical studies are needed to establish the efficacy of once daily use of fluoroquinolones, to determine that clinical efficacy is equivalent to multiple doses, and that once-daily dosing does not select more resistant bacteria. Single-dose therapy with quinolones would be an improvement in cost and patient compliance.

4-Quinolones↗