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In summary we are confronted with the awareness that Salmonella organisms of various species have developed simultaneous resistance to ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole. These strains are now widespread throughout much of Asia and the Middle East and have caused outbreaks of disease in man and animals in many different countries. Several reports document the appearance of these clinically resistant organisms in the United States, usually as a result of importation from abroad. Since most of the reported cases have been in infants, and given the duration of carriage and the impossibility of adequate hygienic precautions in this age group, secondary spread is to be expected. In this regard the Centers for Disease Control have already noted increased reports of S. mbandaka and S. alachua isolates from the states of Minnesota, Oregon and Washington and have attributed this increase to the infected infants adopted from India. Furthermore current patterns of international social mobility would seem to dictate the inevitability of continued importation of such multiply resistant organisms, especially from Third-World countries. In addition to immigration from abroad the selective pressure of antimicrobial usage in this country might contribute to the emergence of similar resistance patterns. Resistance to ampicillin and chloramphenicol has significantly increased in recent years, and one would expect to see more frequent resistance to TMP-SMX as this drug is used more commonly for the management of otitis media, urinary tract infections and other diseases of high prevalence.(ABSTRACT TRUNCATED AT 250 WORDS)
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Coumermycin was the most active agent in vitro against methicillin-resistant Staphylococcus aureus when compared with fusidic acid, imipenem, rifampin, trimethoprim-sulfamethoxazole, and vancomycin. The MICs of coumermycin ranged from 0.002 to greater than 4 micrograms/ml and from 0.5 to greater than 4 micrograms/ml for inocula of 10(4) and 10(6) CFU/ml, respectively. The combination of coumermycin with either cephalothin or ciprofloxacin showed some synergy; antagonism was found with gentamicin.
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Patients with human immunodeficiency virus (HIV) infection are at increased risk for bacterial pneumonia in addition to opportunistic infection. However, the risk factors for bacterial pneumonia and its incidence in this population are not well defined.
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This study demonstrates rotavirus as the main etiological agent in pediatric diarrhea in Burkina Faso, and further shows the great severity of rotavirus-induced diarrhea in undernourished children in Burkina Faso.
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In human fertilization, sperm centrosome function is essential for male and female pronuclear movement and fusion. In this study, we investigated the possibility of restoring human sperm centrosomal function in sperm exhibiting abnormalities in microtubule organization.
A total of 34 cases of PCP in patients with CTD were studied (Wegener's granulomatosis, n = 12; systemic lupus erythematosus, n = 6; polyarteritis nodosa, n = 4; poly/dermatomyositis, n = 5; others, n = 7). The majority of patients (25/34 patients; 74%) presented PCP during the first 8 months following the diagnosis of CTD. At the time of diagnosis of PCP, most patients (32/34; 94%) were receiving corticosteroids (mean prednisone equivalent dose: 1.2 mg/kg/day) associated in 24 cases with cytotoxic agents (cyclophosphamide, n = 19; methotrexate, n = 5). Most patients were lymphocytopenic at the onset of PCP: 91% (31/34) of patients had fewer than 1.5 x 10(9)/l circulating lymphocytes and 76% (26/34) had fewer than 0.8 x 10(9)/l. The mean duration of prodromal symptoms was 6 days: this is much shorter than for AIDS associated PCP. Half the patients required intensive care for respiratory failure. Mortality was high (11/34 patients; 32%) although deaths were partly due to infections acquired in intensive care units. Among the 23 survivors, 10 (43%) received secondary prophylaxis for PCP and 13 (57%), received the usual therapeutic regimen. No relapse has been observed in either group with a mean followup of 22 months.
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This is thought to be the first reported case of reversible myoclonus, tremor, and asterixis induced by high dose TMP-SMX in the spinal cord injury population. Early recognition of TMP-SMX induced complications were of key importance as they negatively impacted the rehabilitation process. We also recommend consideration of symptomatic treatment with levetiracetam for the duration of required TMP-SMX therapy as it appeared to mitigate the severity of our patient's movement disorders.
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The efficacy of trimethoprim-sulfamethoxazole (TMP-SMZ; 80 mg of TMP and 400 mg of SMZ per tablet; nine tablets taken once daily for three days; total, 27 tablets) was compared with the U.S. Public Health Service recommended regimen of 2 g of tetracycline daily for five days for the treatment of uncomplicated genital gonorrhea. Fourteen (3%) of the 461 patients treated with tetracycline and 24 (5%) of the 477 patients treated with TMP-SMZ failed to be cured; the difference between the two groups was not significant. Treatment of patients with TMP-SMZ was more likely to fail if the isolates of Neisseria gonorrhoeae had MICs of > or = 0.5 microgram of TMP/ml and > or = 9.5 micrograms of SMZ/ml. Adverse effects were more often reported by patients receiving TMP-SMZ. The results show that TMP-SMZ is an effective therapy for uncomplicated gonococcal infections in men and women and may also eliminate agents causing postgonococcal urethritis. The utility of this drug combination may be limited by the adverse effects that are associated with the large dose used.