Infectious exanthems and unusual infections.

Invasive disease due to group A beta-hemolytic streptococci (GABHS) can be divided into 3 categories of disease: streptococcal toxic shock syndrome (strepTSS), necrotizing fasciitis, and other invasive GABHS disease. Patients with strepTSS may have multiorgan failure within hours of presentation. Clindamycin and penicillin G should be used in combination for treatment of invasive GABHS disease. The mortality rate for menstrual staphylococcal toxic shock syndrome has decreased with early recognition and treatment, and removal of hyperabsorbent tampons from the market. Kawasaki syndrome (KS) is the most common cause of acquired heart disease in children in the U. S., and atypical forms have a higher mortality rate than typical KS. Hantavirus pulmonary syndrome is a zoonosis with an 80% mortality rate if the diagnosis is not made on first presentation and patients return to the hospital in shock. Children and adolescents with Lyme disease have an excellent prognosis and respond well to antimicrobial therapy. Cat scratch disease (CSD) is caused by Bartonella henselae and is transmitted by flea-infested kittens. CSD lymphadenopathy typically resolves spontaneously in 2ñ3 months; however, there is a 50% likelihood of resolution in 1 month if patients receive a 5-day treatment course with azithromycin.

Vasopressin gene expression in rat choroid plexus.

Vasopressin (VP) levels in cerebrospinal fluid (CSF) change in response to physiological stimuli and under various pathological conditions. The sources of CSF VP have yet to be clarified, however. In the present study, we provide evidence indicating that VP is synthesized in the choroid plexus, the primary site of CSF formation. All experiments were performed on adult male Sprague-Dawley rats. The presence of VP mRNA in choroid plexus epithelium was demonstrated by in situ hybridization histochemistry using the 35S-labeled riboprobe that was complementary to cDNA fragment of rat VP encoding the C-terminus part of proVP. In situ hybridization findings were confirmed by reverse transcriptase-polymerase chain reaction analysis. Immunohistochemistry for VP-associated neurophysin (VP-NP), a polypeptide component of proVP, revealed subapical accumulation of VP-NP-immunopositive product in choroidal epithelial cells. Immunoprecipitation and immunoblotting of choroidal protein extracts with anti-VP-NP antibody demonstrated the presence of a approximately 10-kD polypeptide that was also detected in hypothalamus. We hypothesize that the choroid plexus-derived VP exerts autocrine and/or paracrine effects on tissues near the CSF system.

Diphyllobothriasis after eating raw salmon.

An 11-year-old boy in Hawaii passed mucus and a moving object in his stool. The object was identified as a segment of the fish tapeworm Diphyllobothrium species which is not indigenous to Hawaii. Diphyllobothrium ova were also found in the stool. The only raw fish he recalled eating in previous months were tuna sushi and lomi-lomi salmon which usually contains raw but previously frozen salmon. Of these two fish, only salmon which is not native to Hawaiian waters, has been incriminated as a significant source of diphyllobothrium fish tapeworm infection. Freezing kills this parasite, however, we speculate that the raw fish in the lomi-lomi salmon that our patient had eaten had not been pre-frozen or was not adequately pre-frozen. Eating raw salmon without certainty that it has been adequately pre-frozen carries the risk of diphyllobothriasis or fish tapeworm infection.

Multiple lobster tubulin isoforms are encoded by a simple gene family.

Microtubule proteins isolated from pleopod tegumental gland (PTG) tissue of the American lobster, Homarus americanus, reveal a complex tubulin (Tub) profile. To determine whether Tub heterogeneity in PTG is due to expression of a large tub gene family or the result of post-translational modification, a PTG cDNA library was constructed. Clones coding for both alpha- and beta-Tub were isolated, sequenced and found to contain open reading frames (ORFs) of 451 amino acids (aa). Alignments reveal phylogenetic clustering with other arthropods and identify unique changes in primary structure which may have functional significance. These clones, when used to probe restriction enzyme-digested lobster genomic DNA in transfer-hybridization experiments, revealed a simple banding pattern indicating a lobster tub gene family of limited complexity. Lobsters appear to make use of a small tub gene family and fulfill the varied functional requirements imposed upon cellular microtubules through post-translational modifications of relatively few gene products.

Antimicrobial liquid formulations: a blind taste comparison of three brands of penicillin VK and three brands of amoxicillin.

OBJECTIVE: To rate the perception of taste, texture, smell and aftertaste of various brands of penicillin VK and amoxicillin. DESIGN: Oral, liquid formulations of three brands of penicillin VK (PenVee K, V-Cillin-K, VeeTids) and three brands of amoxicillin (Amoxil, Trimox, Wymox) were evaluated for smell, texture, taste, and aftertaste by 30 volunteers in a blind study. Each category was scored on a scale of 1 to 5. The order in which the drugs were sampled was randomized for the first three groups of five participants. The order then was reversed for the remaining three groups of participants. SETTING: A 537-bed US Army teaching hospital. PARTICIPANTS: Participants included 30 healthy adult volunteers from the Departments of Pediatrics, Nursing, and Pharmacy. MAIN OUTCOME MEASURES: Drugs received cumulative scores in each category, as well as an overall total score ranking. The data were analyzed using one-way ANOVA for repeated measures with a post hoc Duncan's multiple range test to determine significant differences between individual means. RESULTS: Overall, Trimox and Amoxil scored significantly higher than the remaining drugs. Although V-Cillin-K scored highest in the smell category, its score was significantly below those of Trimox and Amoxil in the texture, taste, aftertaste, and overall categories. Overall, the three penicillin VK solutions scored lower than the three amoxicillin suspensions, with PenVee K ranking the lowest. Among the penicillin VK solutions, V-Cillin-K scored significantly higher overall than the other two penicillin VK solutions. CONCLUSIONS: Overall, all three amoxicillin oral, liquid suspensions that were studied scored significantly better than the three penicillin VK solutions.

Cat-scratch disease in Hawaii: etiology and seroepidemiology.

OBJECTIVE: To study the etiology and seroepidemiology of cat-scratch disease (CSD) in Hawaii. METHODS: Blood and fine-needle aspirate (FNA) from the lymph nodes of 39 consecutive patients with clinical CSD were cultured for Bartonella henselae, and blood samples from index cats, stray cats, and dogs were cultured and their sera were tested by indirect fluorescence antibody test for antibodies to B. henselae and Afipia felis. Sera from age- and sex-matched human subjects without cat exposure served as controls. RESULTS: Warthin-Starry staining showed positive results in only 4 of 32 FNAs, and B. henselae was isolated from only one FNA specimen. All of 38 patients who had two or more sera tested had elevated titers of antibody to B. henselae. Only 1 of 48 human control sera had antibody to B. henselae. Of 31 kittens, 21 had positive blood culture results and elevated antibody titers to B. henselae. Of three adult cats, all had negative blood culture results, but they had serologic evidence of past infection. Of 23 adult stray cats, 18 had elevated titers of antibody to B. henselae, but in only one was the blood culture result positive. Results of IFA tests were marginally positive for A. felis in 1 of 29 patients with CSD and in one adult stray cat and one dog. CONCLUSIONS: This study shows that the B. henselae IFA test is both highly sensitive and specific for the detection of infection caused by B. henselae and for the laboratory diagnosis of CSD, and that FNA is seldom helpful in confirming the diagnosis. We further demonstrated that CSD in Hawaii is due to B. henselae and that infection is directly linked to the scratch or bite of a kitten. Older cats seldom have bacteremia but often have serologic evidence of past infection. Our study fails to implicate dogs in the epidemiology of CSD in Hawaii, and A. felis was not etiologically implicated in CSD in the human subjects and animals we studied.

Antimicrobial drug suspensions: a blinded comparison of taste of twelve common pediatric drugs including cefixime, cefpodoxime, cefprozil and loracarbef.

We conducted a blinded taste test evaluating 12 antimicrobial suspensions by smell, texture, taste, aftertaste and overall acceptance. Drugs received cumulative scores in each category as well as a total score ranking. Overall Lorabid scored highest but not significantly higher than Keflex, Suprax and Ceclor, all of which score higher than the other test drugs. Cefzil and Augmentin scored just below this group of drugs and higher than all other test drugs. Vantin was inferior to these drugs primarily because of its low score in aftertaste. It was ranked along with V-Cillin-K, Veetids, Sulfatrim and Pediazole, the lowest scoring group of drugs other than Dynapen which scored lower than all other test drugs. No difference overall was detected between the two penicillin VK suspensions evaluated, V-Cillin-K and Veetids.

Tutorial: implementing hoshin planning at the Vermont Academic Medical Center.

Hoshin planning is a systems approach to strategic planning. It is a step-by-step process for building consensus on the vital few strategic areas within which breakthroughs must occur if an organization is to meet and exceed the needs of its customers. The seven management and planning tools are the implements of the hoshin process. They provide the means for generating, deploying, and auditing the strategic work of the organization. This tutorial describes the use of hoshin planning and the seven management and planning tools to build a strategic plan for the Vermont Academic Medical Center, including lessons learned and plans for improvement.

Effect of sodium saccharin and L-tryptophan on rat urine during bladder carcinogenesis.

We examined several parameters of urine excretion during a two-year initiation-promotion experiment in male Fischer rats using four weeks of N-[4-(5-nitro-2-furyl)-2-thiazoly]formamide at 0.2% of the diet as the initiating agent and either 5% sodium saccharin or 2% L-tryptophan in the diet as promoting agents. Rats fed sodium saccharin increased their intake of water; this was accompanied by diarrhea and an increased urinary volume. Osmolality was decreased slightly. The total amount of sodium excreted was increased, although the concentration in the urine was similar to that of the controls or slightly increased. No abnormalities were observed in urinary potassium, calcium, urea, or other parameters measured except for the pH, which was slightly increased during the first three months of the experiment. There was no increase in the size or concentration of crystals in the urine of rats fed sodium saccharin, and no calculi were observed. Hypoglycemia and hypoglycosuria were present in sodium saccharin-fed rats and to a lesser extent in L-tryptophan-fed rats. No other abnormalities were seen in the urine of rats fed L-tryptophan. These data suggest that none of the urinary factors measured in our experiment, including crystal and calculus formation, correlated with the induction of urinary bladder lesions by sodium saccharin.