ABSTRACT
Group A streptococcus (GAS) is considered to be a major pathogen of bacterial tonsillopharyngitis in children. Although GAS is generally susceptible to penicillin, macrolides are often used as the second-line treatment. Over the last several decades, the rising macrolide resistance of GAS has been detected in several countries. With the current study, we aimed to determine the development of macrolide resistance at our paediatric centre. From March 2006 to May 2009, 350 GAS isolates were tested for susceptibility to erythromycin, azithromycin, clindamycin, penicillin and cefotaxime. Macrolide-resistant isolates were screened for the presence of genes related to macrolide resistance (mefA, ermB, ermTR, prtF1). In comparison to a prior study at our hospital, the erythromycin resistance rate decreased significantly from 13.6 to 2.6%. This effect may be attributable to a more restrictive use of macrolides in children in our region.
Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial , Macrolides/pharmacology , Streptococcal Infections/epidemiology , Streptococcus pyogenes/drug effects , Adolescent , Child , Child, Preschool , Clindamycin/pharmacology , Drug Utilization/statistics & numerical data , Female , Genes, Bacterial , Germany/epidemiology , Humans , Infant , Male , Prevalence , Streptococcal Infections/microbiology , Streptococcus pyogenes/genetics , Streptococcus pyogenes/isolation & purification , beta-Lactams/pharmacologyABSTRACT
BACKGROUND: Primary immunodeficiencies are potentially life-threatening diseases. Over the last years, the clinical phenotype and the molecular basis of an increasing number of immunological defects have been characterized. However, in daily practice primary immunodeficiencies are still often diagnosed too late. Considering that an early diagnosis may reduce morbidity and mortality of affected patients, an interdisciplinary guideline for the diagnosis of primary immunodeficiencies was developed on behalf of the Arbeitsgemeinschaft Pädiatrische Immunologie (API) and the Deutsche Gesellschaft für Immunologie (DGfI). METHODS: The guideline is based on expert opinion and on knowledge from other guidelines and recommendations from Germany and other countries, supplemented by data from studies that support the postulated key messages (level of evidence III). With the contribution of 20 representatives, belonging to 14 different medical societies and associations, a consensus-based guideline with a representative group of developers and a structured consensus process was created (S2k). Under the moderation of a representative of the Association of the Scientific Medical Societies in Germany (AWMF) the nominal group process took place in April 2011. RESULTS: The postulated key messages were discussed and voted on following a structured consensus procedure. In particular, modified warning signs for primary immunodeficiencies were formulated and immunological emergency situations were defined.
Subject(s)
Cooperative Behavior , Immunologic Deficiency Syndromes/diagnosis , Interdisciplinary Communication , Adult , Child , Early Diagnosis , Evidence-Based Medicine , Germany , Humans , Opportunistic Infections/diagnosisSubject(s)
5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase/genetics , Blood Pressure/genetics , Polymorphism, Genetic , Adult , Aged , Alleles , Antihypertensive Agents/therapeutic use , Aspartic Acid , Carotid Artery Diseases/enzymology , Carotid Artery Diseases/genetics , Carotid Artery Diseases/physiopathology , Carotid Artery, Common/physiopathology , Female , Genetic Predisposition to Disease/genetics , Genotype , Glycine , Humans , Hypertension/drug therapy , Hypertension/enzymology , Hypertension/genetics , Hypertension/physiopathology , Male , Middle AgedABSTRACT
Methotrexate (MTX) is a folate antagonist inhibiting nucleic acid and methionine synthesis. Methionine is necessary for CNS myelination. In 42 patients with primary CNS lymphoma (PCNSL) treated with a systemic and intraventricular high-dose MTX-based polychemotherapy, the presence of a risk haplotype defined by polymorphisms influencing methionine metabolism referred a relative risk for CNS white matter changes of 4.7 (p = 0.001). The authors conclude that methionine metabolism influences MTX neurotoxicity.
