Showing papers by "Charles W. Hoge published in 1993"

Defining the Group A Streptococcal Toxic Shock Syndrome: Rationale and Consensus Definition

Abstract: GROUP A streptococcus (Streptococcus pyogenes) may cause a variety of illnesses ranging from very common, usually clinically mild conditions such as pharyngitis and impetigo to less common severe infections including septicemia and pneumonia. In 1987, Cone et al1described two patients with severe group A streptococcal infections having clinical features similar to the staphylococcal toxic shock syndrome. This syndrome, designated the "streptococcal toxic shock—like syndrome" or the "toxic streptococcal syndrome,"2was further characterized by Stevens et al3in a series of 20 patients. Most patients included in this series were less than 50 years old and otherwise healthy. All had invasive group A streptococcal infections characterized by signs including shock, multi—organ system involvement, and rapidly progressive, destructive soft-tissue infection (necrotizing fasciitis). The case-fatality rate was 30% even though most patients received appropriate antimicrobial therapy, supportive care, and, where necessary, surgical debridement. Ten available isolates were serotyped and

The Changing Epidemiology of Invasive Group A Streptococcal Infections and the Emergence of Streptococcal Toxic Shock-like Syndrome: A Retrospective Population-Based Study

Abstract: Objective. —To determine disease incidence and changes in the epidemiology of invasive group A streptococcal infections in a community in Arizona. Design and Setting. —We retrospectively surveyed microbiology records from all 10 hospitals in Pima County, Arizona, to identify patients who had Streptococcus pyogenes isolated from blood, sterile body fluid, or tissue biopsy specimens between April 1985 and March 1990. Demographic and clinical information was abstracted from the medical records of these patients. Patients. —A total of 128 patients with a median age of 53.5 years (range, 6 months to 96 years). Outcome Measures. —Racial/ethnic differences in disease incidence; mortality and changes in the clinical spectrum of disease over the study period. Results. —The annual age-adjusted incidence was 4.3 per 100 000 but was 46.0 per 100000 among Native Americans. Advanced age, age less than 5 years, hypotension, and multi-organ system involvement were significantly associated with increased mortality. From 1985 to 1990, the proportion of infections with hypotension, rash, desquamation, renal impairment, and gastrointestinal involvement increased significantly (χ 2 for trend P ≤.02 for each feature). A toxic shock—like syndrome occurred in 8% of infections since 1988, compared with none of the infections between 1985 and 1987 ( P =.04). Patients with the syndrome were younger than patients with other invasive infections (median age 15 vs 54 years, P =.02), and were less likely to have underlying medical conditions ( P =.008). Conclusions. —Significant changes occurred in the spectrum of invasive group A streptococcal infections in Pima County, Arizona, between 1985 and 1990. Native Americans were at increased risk of acquiring these infections. Patients with the streptococcal toxic shock—like syndrome had epidemiologic features that distinguished them from patients with other invasive infections, including younger age and less underlying illness. ( JAMA . 1993;269:384-389)

Detection of Shigellae and Enteroinvasive Escherichia coli by Amplification of the Invasion Plasmid Antigen H DNA Sequence in Patients with Dysentery

Abstract: Detection of Shigella organisms and enteroinvasive Escherichia coli (EIEC) by polymerase chain reaction (PCR) was evaluated in 20 patients with dysentery before and in 17 of the 20 after treatment with ciprofloxacin. DNA sequences coding for IpaH antigen, a multiple copy sequence found on the chromosome, and the invasion plasmid locus (ial) was detected after DNA amplification in 13 stools from patients from whom shigellae or EIEC were isolated but not in 21 nondysenteric stools containing other enteric bacteria. Although shigellae or EIEC were not isolated from any patient with dysentery after ciprofloxacin treatment, IpaH and ial sequences were found after PCR amplification in 7 patients after treatment with ciprofloxacin. IpaH sequences alone were detected in 4 patients; DNA augmentation of IpaH in stools in a specific way to identify Shigella or EIEC infection in persons from whom cultures cannot be obtained promptly after the onset of diarrhea or who have received antibiotics.

Ciprofloxacin and Loperamide in the Treatment of Bacillary Dysentery

Abstract: Objective: To compare the safety and efficacy of loperamide plus ciprofloxacin with those of ciprofloxacin alone in the treatment of bacillary dysentery. Design: Double-blind, placebo-controlled, r...