Martin G. Myers

A placebo-controlled trial of cephalexin therapy in the ambulatory management of patients with cystic fibrosis.

The effects of oral administration of cephalexin were evaluated in a double-blind, placebo-controlled, crossover study in 17 patients with mild to moderate pulmonary disease due to cystic fibrosis. For two years, four-month periods with cephalexin were alternated with four-month placebo periods. Thus, patients served as their own control subjects. Fungal vulvovaginitis occurred in two patients and a cephalexin-resistant Enterobacter cloacae was acquired in the sputum of another patient during cephalexin therapy. During the 2 years of study, the rate of colonization with mucoid strains of Pseudomonas aeruginosa increased and disease severity deteriorated in patients initially colonized with P. aeruginosa . Short-term courses of sputum culture-specific antibiotics improved the course of some patients with mild to moderate pulmonary disease due to cystic fibrosis. Treatment with cephalexin decreased the frequency of respiratory illnesses, respiratory illnesses requiring antibiotics, and hospitalizations for respiratory illnesses in patients initially colonized with Staphylococcus aureus and/or Haemophilus influenzae , and also reduced colonization with these organisms. Improved weight gain in 16 of 17 patients was associated with periods of cephalexin therapy. Pulmonary function tests remained stable or improved in 10 of 14 patients. Disease severity improved in patients not colonized with P. aeruginosa .

Petriellidium (Allescheria) Boydii Orbital and Brain Abscess Treated with Intravenous Miconazole

A previously healthy 4-year-old boy suffered a penetrating injury to his left orbit and left frontal lobe, which resulted in an infection by Petriellidium boydii. The patient was successfully treated with intravenous miconazole and multiple debridements.

Shunt Fluid Aspiration: An Adjunct in the Diagnosis of Cerebrospinal Fluid Shunt Infection

Bacterial isolates were obtained from 42 of 59 cultures of shunt fluid aspirated from patients with infected cerebrospinal fluid shunts. The etiologic agent was recovered from 24 to 25 aspirates from patients who were not receiving antibiotics and from 18 of 34 aspirates from patients who were receiving antibiotics. Aspiration, culture, and Gram stain of shunt fluid should be considered in patients suspected of having a shunt infection.

Toxic Shock Syndrome: A Retrospective Study of 25 Cases from Iowa

We reviewed retrospectively the clinical records of 25 women ages 13 to 41 years who had diagnosed illnesses compatible with toxic shock syndrome (TSS). Cases occurred between January 1976 and October 1980. Fourteen confirmed TSS cases and 11 probable TSS cases were identified.In each case initial symptoms occurred in association with menstrual bleeding and tampon use. All patients were febrile. Hypotension occurred in 20 cases, but five patients with milder illness remained normotensive. An erythematous rash occurred in 20 cases. Desquamation occurred in convalescence in all but two cases. Complications included delirium or coma, acute renal failure, and respiratory distress syndrome. Thirteen patients had recurrences of TSS. S. aureus was isolated from the vagina or cervix in 75% of cases. There is a spectrum of severity associated with TSS. Strict diagnostic criteria established heretofore for epidemiologic studies of TSS may not be met by all cases of TSS.

790 CEPHALEXIN IN CYSTIC FIBROSIS: A PLACEBO-CONTROLLED STUDY

The efficacy of cephalexin monohydrate 50 mg/kg/d was evaluated in a placebo-controlled, double-blind, crossover study of patients with cystic fibrosis. Over a 2 year period, 17 patients with mild-moderate disease were treated for 4 month intervals with either cephalexin or placebo. One patient developed drug-related vulvovaginitis and dropped-out of the study. Although colonization by cephalexin-resistant S. aureus was not observed, 2 patients had an increase in sputum concentration of Ps. aeruginosa during antibiotic therapy.Patients previously colonized with ≥ 106 CFU/ml Ps. aeruginosa of H. influenzae had no alteration in flora. Six of 8 patients colonized with ≥ 106 CFU/ml S. aureus had a decrease in S. aureus concentration to < 104 CFU/ml during treatment with cephalexin. During periods of drug treatment, significantly reduced S. aureus colonization (7% versus 26% of cultures), increased weight gain (1.2 versus 0.2 kg/4 months) and less hospitalizations (2 versus 15) were observed (P < 0.01). There were no differences in pulmonary function tests, chest x-rays, or sputum production during periods of antibiotic or placebo treatment.Cephalexin, when compared to placebo, altered the microbial flora and clinical course of some patients with cystic fibrosis.

793 EVALUATION OF QUANTITATIVE CULTURES OF SPUTUM FROM CHILDREN WITH CYSTIC FIBROSIS

Eighty-three sputa were obtained from 41 children with cystic fibrosis and maintained on ice until culture within 20 minutes. Quantitative cultures (QNC) were made by inoculating serial 10-fold dilutions of the sputum, homogenized with N-acetyl cysteine, onto blood, chocolate, and eosin methylene blue agar plates. The same sputum samples were then cultured qualitatively (QLC) on the same types of agar. An average of 3.9 bacterial species per sample in a concentration of ≥ 104 CFU/ml were recovered by QNC. Organisms which might be considered “normal flora” were recovered from 57 QNC and 80 QLC. Potential pathogens were recovered from 80 QNC and from 74 QLC. S. aureus, present in QNC in a mean concentration of 3.2 × 107/ml, was recovered from 31 sputum pairs and additionally from 1 QNC and 2 QLC. Ps. aeruginosa, present in QNC in an average concentration of 1.9 × 108/ml,was recovered by both methods 55 times, 3 additional times each by QNC and QLC. H. influenzae was present in QNC in a mean concentration of 3.4 × 108/ml and was recovered by both culture techniques 9 times. It was recovered 26 additional times by QNC and 2 additional times by QLC. In 24 of 24 instances, the H. influenzae recovered by QNC was not typable by counter immunoelectropheresis. Routine qualitative sputum cultures underestimate the frequency with which H. influenzae may be recovered from children with cystic fibrosis.

370 MEASLES IN A PARTIALLY IMMUNIZED POPULATION

During the investigation of an outbreak of measles in a partially immunized rural community, a spectrum of illness was observed which ranged in severity from a brief febrile illness to one characteristic of measles. Unimmunized children had more illness (p = 0.009) and more measles (p < 0.001) than immunized children. However, a large proportion of both the immunized and unimmunized children developed a milder illness epidemiologically and serologically associated with measles. The proportion of immunized and unimmunized children who developed the milder, measles-associated illness was not statistically different (p = 0.20).Employing a trichotomous logistic model, it was demonstrated that the probability of developing both measles and measles-associated illness decreased with increasing age of immunization (p < 0.001) but was unaffected by the interval since immunization (p ≥ 0.12). The age at which immunization could be expected to prevent measles in 95% of cases was 5 years. Reimmunization against measles after 5 years of age may be necessary to effect eradication of epidemic measles. Based upon this model, reimmunization would also be expected to reduce the occurence of measles-associated illness.

TAMPON CULTURE FOR CERVICOVAGINAL HERPES SIMPLEX VIRUS

From 101 to 106 TCID50 of herpes simplex viruses types I and II in 0.10 ml volumes can be quantitatively recovered from vaginal tampons in vitro. The distal several centimeters of tampon were extracted in Hanks buffered saline containing fetal calf serum, penicillin, streptomycin and amphotericin B, for end-point titration. Virus could be recovered from 7 brands of tampons.In 5 patients with clinically apparent genital herpes simplex infection, viral cultures were obtained from vulvar vesicles, from direct cervical swabs performed at pelvic examination and from tampons inserted by the patient. Virus was eluted from swabs and tampons and end-point titrations were performed. The cervical viral titers recovered by the 2 methods were similar:Thus, quantitative cervicovaginal cultures can be obtained by tampon culture without pelvic examination.