Pseudomonas. Clinical problems related to virulence factors and development of resistance.

Pseudomonas aeruginosa has emerged into the limelight mainly as a result of compromised host problems and the development of resistance leading to serious treatment difficulties. The organism possesses virulence factor that produce an effect in certain clinical situations. Changes in local anatomy, often with the presence of foreign bodies, are important (bladder and intravenous catheters, tracheostomy, burns, wounds, and injuries).

Piperacillin in paediatric surgery.

23 infants and children, aged 1 month - 15 years, were treated with piperacillin, a new semi-synthetic penicillin with a broad spectrum of activity. The indications were perforated appendicitis with peritonitis or abscess formation (12 patients), urinary tract infection due to congenital anomalies (3 patients), miscellaneous infections (3 patients) and peroperative prophylactic treatment (5 patients). The clinical response was good.

Aspects on antibacterial treatment of anaerobic infections.

A review is given of current antibiotic treatment of anaerobic infections. It is emphasized that infections with Bacteroides fragilis constitute the main problem, virtually all other anaerobe organisms of clinical significance are sensitive to penicillin. Particularly useful antibiotics for infections with B.

Fatal progressive vaccinia in two immunodeficient infants.

Fatal progressive vaccinia developed in two infants, a girl and a boy, vaccinated at the age of 2 months. Immunodeficiencies comprised both humoral and cell-mediated immunity. In the girl low levels of immunoglobulins and a defect function of lymphocytes was demonstrated.

Review of side-effects of aminopenicillins.

Side-effects of aminopenicillin therapy are reviewed on the basis of nine comparative studies of ampicillin and bacampicillin, and available literature data from investigations with talampicillin, pivampicillin, bacampicillin and amoxycillin. Diarrhoea is more common with ampicillin than with newer aminopenicillins. Exanthema do not appear more frequently with newer aminopenicillins.

Fulminant hepatitis A.

During a small epidemic of infectious hepatitis, a fulminant infection with fatal outcome occurred in a 54-year-old woman. IgM antibody to hepatitis A virus was demonstrated in the serum and large amounts of hepatitis A virus were found in the liver. It is suggested that the pathogenesis may be different for fulminant hepatitis A and B infection.

Myalgia nuchae as a manifestation of epidemic influenza.

Two cases of acute cervical myalgia in connection with symptoms of malaise and fever are presented. Both patients had serologically proven influenza infections, types A and B. No previous reports have been found of any association of the present syndrome with influenza infection.

Successful treatment of pseudomonas aeruginosa--ventriculitis with intraventricular gentamicin in a child with hydrocephalus.

A hydrocephalic child, who was operated with a ventriculo-peritoneal shunt at the age of 1 month, developed ventriculitis due to Pseudomonas aeruginosa at 8 months. After removal of the shunt and successively increasing intramuscular and intraventricular doses of gentamicin the patient was cured and a new shunt could be inserted. As high 24-hour gentamicin level in the cerebrospinal fluid as 76 microgram/ml was reached without any apparent toxic signs.