Reviews of infectious diseases
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Comparative Study
Bacteremia in narcotic addicts at the Detroit Medical Center. II. Infectious endocarditis: a prospective comparative study.
For one year all narcotic addicts admitted to the Detroit Medical Center with infectious endocarditis (74 cases) were compared with a control group of bacteremic addicts who had other infections (106 cases). Endocarditis was caused by Staphylococcus aureus (60.8% of cases), streptococci (16.2%), Pseudomonas aeruginosa (13.5%), mixed bacteria (8.1%), and Corynebacterium JK (1.4%). S. aureus endocarditis most frequently involved the tricuspid valve; streptococci infected left-sided valves significantly more often than other organisms (P = .001). ⋯ Polymicrobial bacteremia in the nonendocarditis group was associated with markedly increased morbidity. Mild hyponatremia occurred in 41% of all patients and was also associated with significantly increased morbidity. Analysis of the two groups disclosed similarities and differences with implications for the pathophysiology and treatment of addicts with bacteremic infection.
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Travelers' diarrhea in Asia has been studied among Peace Corps volunteers in Thailand, Japanese travelers, foreign residents in Bangladesh, guests in hotels, and members of various tour groups. Rates of diarrheal attack of greater than 50% during four- to six-week sojourns were reported for these groups. Among travelers with diarrhea, the most commonly isolated pathogen was enterotoxigenic Escherichia coli (20%-34%), followed by Salmonella (11%-15%), Shigella (4%-7%), Campylobacter (2%-5%), and Vibrio parahaemolyticus (1%-13%). ⋯ Among Japanese travelers, Salmonella was more commonly acquired in the Far East; Shigella and Campylobacter, in the Indian subcontinent; and V. parahaemolyticus, in Southeast Asia. Aeromonas hydrophila and Plesiomonas shigelloides were commonly isolated from ill travelers in Thailand but less frequently from other travelers. Protozoa and Vibrio species other than V. parahaemolyticus were isolated in less than 5% of episodes.
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Review Clinical Trial
Role of aerobic gram-negative bacilli in endometritis after cesarean section.
Endometritis is considered to be a polymicrobial infection, involving aerobes, anaerobes, and genital mycoplasmas. Aerobic gram-negative rods make up 7%-25% of all genital isolates, but findings from studies in which special collection techniques were used suggest that many of these may be contaminants from the lower genital tract. Bacteremia occurs in 4%-30% of patients with endometritis, and aerobic gram-negative rods account for approximately 25% of blood isolates. ⋯ Klebsiella pneumoniae and Proteus mirabilis rank next, followed by Enterobacter species. Pseudomonas species account for fewer than 0.6% of genital isolates. Overall, aerobic gram-negative rods are causally involved in 10%-20% of cases of endometritis following cesarean section.
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Recent developments that influence patterns of antibiotic prescription for obstetric-gynecologic patients include a better understanding of the multibacterial dimensions of pelvic infections, the introduction of new antibiotics, and the pressures for cost-containment in medical care. Prophylaxis has become established as effective for prevention of infection following vaginal hysterectomy and cesarean section, but its success in abdominal hysterectomy has been less uniform. For patients with pelvic infections, the poorest clinical response occurs in those whose infection is well established before initiation of therapy. ⋯ Both metronidazole and clindamycin meet these criteria. Controlled studies of infections seen early in the clinical course are few. The initial selection of agents effective against gram-negative anaerobes seems important in the treatment of endomyometritis following cesarean section, whereas curettage seems the most significant therapy for infections following abortion.
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The meaning of eradication, which is an irreversible conclusion, is considered primarily to distinguish it from elimination, which is reversible from outside the area. Poliomyelitis and measles are at present the diseases for which conditions most favor an attempt to produce eradication. Poliomyelitis has now reached a frequency in the developing world as high as it was in the prevaccine era of the United States. ⋯ Following determined efforts to achieve immunization of at least 95% of the population, the United States is now nearing the state of complete freedom from the transmission of measles virus. The use of diploid cells for making vaccine has enabled the virus to be given as an aerosol to babies less than six months of age and would be of particular value in developing countries. The high transmissibility of measles makes a severe demand for vaccine, but so long as the uptake of vaccine reaches at least 90%, the successful elimination of measles is extremely probable.