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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rotavirus infections are a common cause of childhood gastroenteritis but are rarely severe enough to justify radiographs. However, there appears to be a small subset of children in whom a rotavirus-induced diarrheal illness accompanied by bloody stools is sufficiently severe and protracted to warrant barium studies. We have observed spasm and minute mucosal ulcerations of the colon in three of these children. These findings, under other circumstances, would have prompted the diagnosis of ulcerative colitis. These children also had a variety of other findings, such as osteomyelitis, intraocular mycetoma, and positive blood cultures. We suggest that when bloody diarrhea follows or accompanies a typical viral illness, rotavirus particles or antibodies be sought. This may prevent misdiagnosis of ulcerative colitis and unnecessary treatment with steroids.
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PMID:The radiographic findings in severe rotavirus-induced colitis. 609 Apr 66

Salmonellosis in older children and adults is usually a self-limited disease, but the risk of complications in infants is not well-defined. We performed a retrospective review of 52 patients. 90 days of age or less, seen at the St. Louis Children's Hospital between 1975 and 1981 with stool cultures positive for salmonella. Sixteen were 30 days old or less (neonates), 21 were 31- 60 days of age, and 15 were 61-90 days old. Among patients in whom blood cultures were done initially, bacteremia was most frequent in neonates: 5/11 (45%), compared to 2/18 (11%) in older infants. All seven infants presenting with bacteremia received 10 or more days of antibiotic therapy: yet complications (osteomyelitis, fatal meningitis or chronic diarrhea) developed in three of five neonates and one of two older infants. Complications also developed in seven of 22 patients who initially had negative blood cultures, including two infants in whom sepsis later developed and two infants who required intravenous hyperalimentation because of chronic diarrhea and malnutrition. The group of 23 patients who did not have blood cultures all did well. Salmonellosis is not necessarily a self-limited infection in young infants. Even in the absence of bacteremia, clinicans would appear to be justified in using antimicrobial therapy in infants 3 months of age or les with salmonella gastroenteritis, particularly neonates of older infants with symptoms of dysentery or failure to thrive.
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PMID:Salmonella gastroenteritis in the first three months of life. A review of management and complications. 714 Jan 21

During the last few years atypical forms of human salmonellosis were observed in 27 patients. Most frequent were acute gastroenteritis with bacteraemia or septicaemia, abscess formations in various organs and septic infections with gastroenteritis Salmonellae but no demonstrable gastroenteritis. In addition there were cases of osteomyelitis, peritonitis, one case of infected hip replacement, one of infected adrenal cortical tumour, and one of infected aortic aneurysm. In 24 of the 27 patients there was an underlying disease likely to have favoured the development of such infections. Diabetes mellitus, cholelithiasis and malignant tumours were the most frequent condition. Isolation of the positive organism was obtained from various materials (blood, abscess pus, gallbladder smear, operative specimen). Chemotherapy is definitely indicated in such Salmonella infections. Often additional surgical measures, e.g. to control spread of septic foci, were necessary. Prophylactic chemotherapy is recommended for patients with risk factors in order to prevent bacteraemic-metastatic events.
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PMID:[Atypical course of human salmonellosis (author's transl)]. 741 26

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.
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PMID:Fluoroquinolones. 749 Apr 40

Salmonella infections in man can be divided in five clinical groups: enteric fever, septicaemia without localization, focal disease, gastroenteritis and the carrier state. Salmonella typhi is mostly associated with enteric fever and the carrier state. Bone infections due to S. typhi have been reported relatively seldom. They usually occur as the result of metastatic spread during septicaemia or, more rarely, after direct inoculation. Two patients with S. typhi osteomyelitis of the forearm without evidence of a primary infection or direct inoculation are presented here.
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PMID:Salmonella typhi osteomyelitis. 791 19

The role of the genus Edwardsiella in human illness is reviewed. Of the three recognized species, only Edwardsiella tarda has been demonstrated to be pathogenic for humans. Chief infections associated with this species include bacterial gastroenteritis, wound infections such as cellulitis or gas gangrene associated with trauma to mucosal surfaces, and systemic disease such as septicemia, meningitis, cholecystitis, and osteomyelitis. Risk factors that are associated with E. tarda infections include exposure to aquatic environments or exotic animals (e.g., reptiles or amphibia), preexisting liver disease, conditions leading to iron overload, and dietary habits (e.g., raw fish ingestion). Although studies indicate that this bacterium is susceptible to most commonly prescribed antibiotics, fatal gastrointestinal and extraintestinal infections have been described.
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PMID:Infections associated with the genus Edwardsiella: the role of Edwardsiella tarda in human disease. 826 59

The fluoroquinolones represent an important addition to the antimicrobial armamentarium. They are, however, commonly overused. It is estimated that in 1989, ciprofloxacin was prescribed for 1 in every 44 Americans. This observation demonstrates not only the overusage, but the economic incentive for development of additional fluoroquinolones. In some situations, oral fluoroquinolone therapy can reduce costs by eliminating the need for parenteral therapy and reducing the need for or the duration of hospitalization. In most situations where oral antimicrobial agents are being considered, however, the fluoroquinolones are among the most expensive alternatives. In addition to concerns about cost factors, it is important to reiterate concern that widespread overuse of these agents will promote the development of microbial resistance and ultimately limit their usefulness. The clinical usefulness of the fluoroquinolones is summarized in Table 4. As can be seen, the fluoroquinolones are the "possibly preferred agent" in very few infections: complicated urinary tract infections due to Gram-negative bacilli resistant to other oral antimicrobial agents, severe bacterial gastroenteritis, exacerbations of lower respiratory tract infection in patients with cystic fibrosis, osteomyelitis due to Gram-negative bacilli sensitive to the fluoroquinolones, and invasive external otitis. They are alternative agents in a number of other infections when sensitive Gram-negative bacilli are the identified pathogens. A considerable literature exists on using these agents in these and other circumstances, but one must remain wary of limited reports of efficacy in comparison to known efficacy of established and less expensive agents.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Symposium on antimicrobial therapy. VII. The fluoroquinolones. 838 6

Quality health care has been defined as the maximization of desired outcomes while minimizing undesirable consequences. Therefore, the optimal antimicrobial agent for a given clinical condition will be one that is the most rapidly effective, produces the least patient discomfort, results in minimal disruption of the patient's or hospital flora, and causes minimal dissatisfaction with the treatment program and its attendant costs. The clinical utility of antimicrobials is generally judged on the basis of in vitro activity, kinetic disposition, resistance trends, safety, and cost. Fluoroquinolones possess characteristics in each of these areas; for example, broad, potent gram-negative spectrum coupled with excellent oral absorption and tissue penetration, and relative safety and reduced cost compared with parenteral therapy. Drawbacks include the emergence of resistance among certain bacteria, particularly staphylococci and Pseudomonas aeruginosa, drug interactions that may compromise efficacy, and greater cost than other potentially useful oral antimicrobial agents. Indications for the agents' use can be categorized as appropriate (gram-negative osteomyelitis, complicated urinary tract infection, prostatitis, certain sexually transmitted diseases, bacterial gastroenteritis), potential (gastrointestinal tract decontamination in granulocytopenic patients, exacerbations of chronic obstructive pulmonary disease, nosocomial pneumonia and bacteremia, eradication of certain bacterial carrier states), or inappropriate (community-acquired pulmonary infections, especially aspiration pneumonitis, serious gram-positive infections, uncomplicated urinary tract infection, surgical prophylaxis except prostatic surgery). Gram-negative osteomyelitis serves as a model to demonstrate the fluoroquinolones as agents for quality health care. Current and future investigations should focus on the cost effectiveness and cost utility of the agents.
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PMID:Therapeutic decisions: assessing clinical fit. 847 33

The emergence of antibiotic-resistant bacteria has prompted interest in alternatives to conventional drugs. One possible option is to use bacteriophages (phage) as antimicrobial agents. We have conducted a literature review of all Medline citations from 1966-1996 that dealt with the therapeutic use of phage. There were 27 papers from Poland, the Soviet Union, Britain and the U.S.A. The Polish and Soviets administered phage orally, topically or systemically to treat a wide variety of antibiotic-resistant pathogens in both adults and children. Infections included suppurative wound infections, gastroenteritis, sepsis, osteomyelitis, dermatitis, empyemas and pneumonia; pathogens included Staphylococcus, Streptococcus, Klebsiella, Escherichia, Proteus, Pseudomonas, Shigella and Salmonella spp. Overall, the Polish and Soviets reported success rates of 80-95% for phage therapy, with rare, reversible gastrointestinal or allergic side effects. However, efficacy of phage was determined almost exclusively by qualitative clinical assessment of patients, and details of dosages and clinical criteria were very sketchy. There were also six British reports describing controlled trials of phage in animal models (mice, guinea pigs and livestock), measuring survival rates and other objective criteria. All of the British studies raised phage against specific pathogens then used to create experimental infections. Demonstrable efficacy against Escherichia, Acinetobacter, Pseudomonas and Staphylococcus spp. was noted in these model systems. Two U.S. papers dealt with improving the bioavailability of phage. Phage is sequestered in the spleen and removed from circulation. This can be overcome by serial passage of phage through mice to isolate mutants that resist sequestration. In conclusion, bacteriophages may show promise for treating antibiotic resistant pathogens. To facilitate further progress, directions for future research are discussed and a directory of authors from the reviewed papers is provided.
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PMID:Bacteriophages show promise as antimicrobial agents. 951 62

Fluoroquinolones have a broad spectrum of activity against gram-positive, gram-negative, and mycobacterial organisms as well as anaerobes, Mycoplasma, Chlamydia, Ureaplasma, and Legionella spp. They have excellent oral bioavailability, with good tissue penetration, and long elimination half-lives. The experience with fluoroquinolones in paediatrics has been limited because of concerns about arthropathy, based on findings in animal models. However, there has not been a definitive fluoroquinolone-associated case of arthropathy described in the literature. We believe that there are a number of specific paediatric infections in which the clinical efficacy and tolerability of the fluoroquinolones should be further investigated. These include patients with cystic fibrosis who have repeated infections with Pseudomonas spp., patients with pseudomonal and other gram-negative infections such as urinary tract infections and osteomyelitis, and febrile neutropenic patients. Meningeal infections caused by multiple drug-resistant Streptococcus pneumoniae and gram-negative organisms, gastroenteritis due to enteric pathogens, and mycobacterial infections are other potential conditions where fluoroquinolones should be studied in paediatric patients.
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PMID:Fluoroquinolones in paediatrics. 1055 4


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