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400
| 5,599
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The prevalence of cardiac valvular pathosis in patients with systemic lupus erythematosus.
The purpose of this study was to determine the prevalence of valvular pathosis in a population of patients with SLE, to assess the candidacy of such patients for antibiotic prophylaxis before dental treatment.
The hospital records of 112 patients with SLE were reviewed and screened for endocarditis, heart murmurs, and other valvular pathosis.
Two of the 112 patients had confirmed cases of bacterial endocarditis.
This prevalence is comparable to endocarditis prevalence rates in patients with prosthetic valves and is also three times that in patients with rheumatic heart disease.
The high prevalence of endocarditis in this population of patients with SLE suggests that according to present perspectives on patient management, patients with SLE should be considered for antibiotic prophylaxis before dental therapies associated with formation of a bacteremia.
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C01
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401
| 9,888
|
Low gastric acid as a risk factor for cholera transmission: application of a new non-invasive gastric acid field test.
Although gastric acid is thought to be an important host defense against certain enteric infections, field studies of the role of gastric acid in preventing enteric infections have been hampered by the lack of a suitable non-invasive test.
Because low gastric acid output (GAO) is an established risk factor for cholera, we assessed after validation, whether a new non-invasive test which estimates GAO by measuring breath hydrogen excess after ingestion of magnesium and a stimulant of gastric acid secretion, could discriminate between persons at high and at low risk of developing cholera.
Fifteen age-matched pairs, participants in the field trial of two oral cholera vaccines in rural Bangladesh, were tested.
In each pair the "case" was a person who had recovered from severe cholera at least 6 months before testing and the "control" was a person who resided in the home of a cholera patient but remained uninfected.
The stimulated breath hydrogen was higher in controls (median hydrogen excess = 369 mumol/80 min) than in cases (median hydrogen excess = 150 mumol/80 min) (p less than 0.05) and was higher in controls in 12 out of 15 pairs.
The results, which are consistent with past invasive assessments of the association between hypochlorhydria and cholera, suggest that this non-invasive test may be useful in evaluating GAO in epidemiological field studies.
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402
| 5,508
|
Streptococcus bovis meningitis: report of 2 cases.
We describe 2 cases of Streptococcus bovis meningitis and review the 9 cases previously reported.
This microorganism is a rare cause of meningitis in which there are no distinctive clinical or laboratory features.
The Gram stain of the CSF is usually negative.
Ten of the 11 cases had some underlying disease or comorbid condition that predisposed to S bovis infection: gastrointestinal disorder, endocarditis, CSF leak, polymyalgia rheumatica, and mandibular block.
Treatment with high-dose penicillin is usually adequate.
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C01
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403
| 6,316
|
Bacteremia in an ambulatory setting. Improved outcome in children treated with antibiotics.
We undertook a study of 414 bacteremic patients (167 with Haemophilus influenzae and 247 with Streptococcus pneumoniae bacteremia) to evaluate their clinical presentation, laboratory and clinical results, and subsequent outcomes.
Patients with H influenzae bacteremia were more likely to have soft-tissue foci, poorer clinical appearance at presentation, and be at higher risk for subsequent serious focal infections, persistent bacteremia, and subsequent hospital admissions than patients with S pneumoniae.
Patients with H influenzae bacteremia had a 21.1-fold increase in risk of meningitis (95% confidence interval [CI] of 3.8 to 78.0) compared with those with S pneumoniae.
The odds ratio for initial lumbar puncture was 5.25 (95% CI [1.1-23.6]).
Ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft-tissue infections, persistent bacteremia, or to require subsequent hospital admissions than untreated patients.
The effect of treatment was greater for patients with S pneumoniae than those with H influenzae.
Careful follow-up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft-tissue infections.
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C01
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404
| 884
|
European experience with itraconazole in systemic mycoses.
Since January 1985 more than 100 patients with deep fungal infections have been treated with itraconazole (200 to 400 mg/day) in Northern Italy.
Evaluation of the drug efficacy and tolerance was possible in one patient with sporotrichosis, in 34 with aspergillosis, and in 36 with cryptococcosis (mainly patients positive for human immunodeficiency virus).
Response to itraconazole alone was obtained in the case of sporotrichosis and in 24 of 34 patients with different forms of aspergillosis (of the 18 patients with invasive pulmonary aspergillosis, 15 were cured).
Patients with cryptococcosis received itraconazole for active infection and/or for prevention of relapse.
Active infection was treated successfully with itraconazole alone in 9 of 12 patients and with itraconazole plus flucytosine in 8 of 10 patients.
Of the 31 patients who received itraconazole maintenance therapy for up to 27 months, 4 (13%) had relapses; 14 (45%) did not have relapses, and decline of serum antigen was detected in 12 of them; and 13 (42%) were completely cured (serum antigen titer dropped to zero).
With the exception of hypokalemia in one patient, itraconazole was well tolerated even in patients who received the drug for several months or years.
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405
| 9,169
|
Helicobacter pylori infection in patients with acquired immune deficiency syndrome.
A controlled study was conducted on patients with human immunodeficiency virus (HIV) infection referred for upper endoscopy to evaluate the prevalence of Helicobacter pylori (H.
pylori) infection.
Four different stains and culture for H.
pylori were performed on biopsy specimens from the gastric antrum.
Sixteen (40%) of 40 patients with acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC) were diagnosed to be infected with H.
pylori versus 14 (39%) of 36 age-matched control patients.
Eight of 15 AIDS/ARC patients without AIDS-related esophagogastroduodenal findings (53%) were infected with H.
pylori versus 8/25 (32%) with endoscopic findings typical of AIDS.
No invasion of the lamina propria by H.
pylori was noted in any patient.
Active chronic gastritis was present in 60% of AIDS/ARC patients and 61% of controls.
Fifty-eight and 59%, respectively, of active chronic gastritis cases were infected with H.
pylori.
All the H.
pylori infections, except one, were found in patients with chronic gastritis.
In AIDS/ARC patients, H.
pylori infection and active chronic gastritis are as common as in other patients referred for upper endoscopy.
They may play a pathogenic role, especially when endoscopic AIDS-related findings are lacking.
Cell-mediated immune deficiency does not appear to increase the risk of infection with H.
pylori.
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406
| 5,168
|
Positive Lyme serology in subacute bacterial endocarditis. A study of four patients.
Lyme borreliosis is a multisystem inflammatory disorder caused by the tick-borne spirochete Borrelia burgdorferi.
Clinical manifestations are protean, involving the skin, joints, peripheral and central nervous systems, and the heart.
However, the presentation of Lyme disease often overlaps with that of other conditions.
We describe four patients from a region endemic for Lyme disease who had elevated levels of antibodies reactive to B burgdorferi and whose signs and symptoms were initially attributed to Lyme borreliosis but whose subsequent blood cultures established a diagnosis of nonspirochetal subacute bacterial endocarditis.
Although immunoblots on serum samples from three of the four patients were consistent with prior infection from B burgdorferi, a positive immunoblot does not establish active infection.
Similarly, seropositivity to B burgdorferi only indicates possible exposure to this organism.
The occurrence of positive serologies to B burgdorferi in the presence of other diseases can lead to diagnostic confusion.
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407
| 4,628
|
Platelet-activating factor or a platelet-activating factor antagonist decreases tumor necrosis factor-alpha in the plasma of mice treated with endotoxin.
When L-platelet-activating factor (PAF) or alprazolam (a PAF antagonist) was administered to lipopolysaccharide (LPS)-treated mice, the level of plasma tumor necrosis factor (TNF alpha) determined by either ELISA or a cytotoxic assay using WEHI cells was significantly lowered.
The inactive stereoisomer, D-PAF, was not effective in lowering plasma TNF alpha levels in LPS-treated mice.
The decrease in plasma TNF alpha induced by L-PAF or alprazolam was partly reversed by indomethacin.
Despite a decrease in plasma TNF alpha, L-PAF or alprazolam caused an increase in the amount of TNF alpha mRNA present in the kidneys and the livers of LPS-treated mice, suggesting that a posttranscriptional event leading to the synthesis or release of TNF alpha was inhibited by these agents.
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408
| 2,878
|
Beta-lactamase production and susceptibilities to amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole of 320 non-Bacteroides fragilis Bacteroides isolates and 129 fusobacteria from 28 U.S. centers.
beta-Lactamase production (nitrocefin disk method) and agar dilution susceptibility of amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole were determined for 320 Bacteroides species (not Bacteroides fragilis group) and 129 fusobacteria from 28 U.S.
centers.
Overall, 64.7% of Bacteroides species and 41.1% of fusobacteria were beta-lactamase positive.
Among the Bacteroides species, positivity rates were highest for B.
bivius (85.0%), followed by B.
splanchnicus (83.3%), B.
eggerthii (77.8%), and B.
oralis (77.1%); 54.5% of black-pigmented Bacteroides species were beta-lactamase positive.
Among the fusobacteria, Fusobacterium mortiferum showed the highest rate of beta-lactamase positivity (76.9%).
MICs of amoxicillin (128 micrograms/ml) and ticarcillin (64 micrograms/ml) for 90% of all beta-lactamase-positive strains were reduced to 4 and 2 micrograms/ml, respectively, with the addition of clavulanate.
MICs of amoxicillin and ticarcillin for 90% of all beta-lactamase-negative strains were 1 and 4 micrograms/ml, respectively, and greater than or equal to 98.4% of the strains were susceptible to the beta-lactams tested.
Of the beta-lactamase-producing strains, 45.9% were susceptible to amoxicillin at less than or equal to 4 micrograms/ml and 93.4% were susceptible to ticarcillin at less than or equal to 64 micrograms/ml; the addition of clavulanate raised the rates to 90.4 and 100%, respectively.
All strains were susceptible to cefoxitin, imipenem, and metronidazole.
The activity of amoxicillin against 29 beta-lactamase-producing strains (10 Bacteroides species and 19 fusobacteria) was not enhanced by the addition of clavulanate; however, 82.7% of these strains were susceptible to amoxicillin, and all were susceptible to ticarcillin.
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409
| 8,315
|
Approach to the patient with genital ulcer disease.
The three major diseases characterized by genital ulcers--genital herpes, syphilis, and chancroid--are common, with genital herpes being most common in industrialized countries and chancroid being most common in developing countries.
One fourth to one half of patients with genital ulcers have no diagnosed cause for their illness despite diagnostic efforts.
The bulk of these cases is probably constituted by one of the three diseases for which diagnostic tests are falsely negative.
There is accumulating evidence that genital ulcers facilitate the transmission of human immunodeficiency virus (HIV), and they may also be markers of high-risk behavior for acquisition of HIV.
Appropriate therapy of patients with genital ulcers (as well as their sexual partners) depends on accurate diagnosis.
Patients with genital ulcers, particularly those with syphilis or chancroid, should be encouraged to undergo testing for HIV infection.
|
C01
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410
| 8,314
|
Approach to men with urethritis and urologic complications of sexually transmitted diseases.
The most important causes of urethritis, and epididymitis in younger men, are C.
trachomatis and N.
gonorrhoeae.
Management of these syndromes requires a thorough sexual history, genital examination, evaluation for objective and laboratory evidence of infection, antimicrobial therapy directed toward the major etiologies, and evaluation and treatment of sexual partners.
Treatment of N.
gonorrhoeae requires use of a single-dose regimen active against this organism, plus a 7- to 10-day tetracycline regime active against C.
trachomatis and nongonococcal urethritis.
With recommended regimens, microbiologic failure is infrequent in compliant patients.
Recurrent urethritis is frequent, however.
The management of patients with persistent or recurrent symptoms requires careful reevaluation of the patient, documentation of urethritis, and re-treatment with antimicrobials if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leukocytes in urethral secretions.
Additional treatment beyond this point usually is not indicated, even though a proportion of men will remain symptomatic and some of these will have increased numbers of polymorphonuclear leukocytes in urethral secretions.
The most important causes of prostatitis, and epididymitis in older men or men with urethral structural abnormalities, are classical urinary tract pathogens rather than sexually transmitted pathogens.
Management of these infections includes documentation of the infection and treatment directed toward the specific pathogen.
Men with symptoms of "prostatitis" must be evaluated using both urine and prostatic secretions to document infection and inflammation.
The majority of men with such symptoms do not have an infection that can be documented.
These men respond poorly to medications.
Men with documented chronic bacterial prostatitis require long courses of antimicrobials to effect cure.
In some cases, however, the disease is intractable, and chronic suppression with antimicrobials may be necessary.
|
C01
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411
| 4,618
|
The role of human immunodeficiency virus infection in pneumococcal bacteremia in San Francisco residents.
Human immunodeficiency virus (HIV) is an important risk factor for invasive pneumococcal disease, but information on clinical course and infecting serotypes is limited.
To help develop strategies to reduce the morbidity due to invasive pneumococcal disease, episodes of pneumococcal bacteremia were identified by retrospective review of microbiology records (November 1983-November 1987) at 10 San Francisco hospitals and, for patients 20-55 years old living in San Francisco, HIV antibody status was determined by review of medical records.
Pneumococcal isolates from one hospital were serotyped.
Of 294 patients with pneumococcal bacteremia identified, 32 (11%) had AIDS at the time pneumococcal bacteremia was diagnosed and another 43 (15%) were HIV-infected but did not have AIDS; 12 HIV-infected patients developed AIDS after the episode of pneumococcal bacteremia.
The rate of pneumococcal bacteremia in AIDS patients was estimated to be 9.4/1000 patient-years.
Serotypes of 27 (82%) of 33 pneumococcal isolates from HIV-infected patients and 107 (90%) from 119 patients without known HIV infection were among the 23 serotypes included in the currently available polysaccharide vaccine.
The rate of pneumococcal bacteremia is approximately 100-fold greater in AIDS patients in San Francisco than rates reported before the AIDS epidemic, but more than half the episodes of pneumococcal bacteremia in HIV-infected patients occurred in patients without AIDS.
Data on pneumococcal serotypes causing invasive disease in HIV-infected patients suggest that the current pneumococcal vaccine, if effective in this population, could provide significant protection against pneumococcal disease.
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412
| 7,167
|
Sexually transmitted diseases of the colon, rectum, and anus. The challenge of the nineties.
During the past two decades, an explosive growth in both the prevalence and types of sexually transmitted diseases has occurred.
Up to 55 percent of homosexual men with anorectal complaints have gonorrhea; 80 percent of the patients with syphilis are homosexuals.
Chlamydia is found in 15 percent of asymptomatic homosexual men, and up to one third of homosexuals have active anorectal herpes simplex virus.
In addition, a host of parasites, bacterial, viral, and protozoan are all rampant in the homosexual population.
Furthermore, the global epidemic of AIDS has produced a plethora of colorectal manifestations.
Acute cytomegalovirus ileocolitis is the most common indication for emergency abdominal surgery in the homosexual AIDS population.
Along with cryptosporidia and isospora, the patient may present to the colorectal surgeon with bloody diarrhea and weight loss before the diagnosis of human immunodeficiency virus (HIV) disease.
Other patients may present with colorectal Kaposi's sarcoma or anorectal lymphoma, and consequently will be found to have seropositivity for HIV.
However, in addition to these protean manifestations, one third of patients with AIDS consult the colorectal surgeon with either condylomata acuminata, anorectal sepsis, or proctitis before the diagnosis of HIV disease.
Although aggressive anorectal surgery is associated with reasonable surgical results in some asymptomatic HIV positive patients, the same procedures in AIDS (symptomatic HIV positive) patients will often be met with disastrous results.
It is incumbent upon the surgeon, therefore, to recognize the manifestations of HIV disease and diagnose these conditions accordingly.
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413
| 7,907
|
Adult respiratory distress syndrome due to blastomycosis during pregnancy.
A 23-year-old healthy woman in her third trimester of pregnancy developed adult respiratory distress syndrome secondary to Blastomyces dermatitides.
Pregnancy-related immunosuppression was believed to be responsible for the fungal infection.
Following emergency delivery of the infant and a full course of amphotericin B therapy, the patient made an uneventful recovery.
Although the fetal and maternal sides of the placenta demonstrated fungal spores, the child remained healthy.
To our knowledge, this is the first report of blastomycosis-associated adult respiratory distress syndrome occurring during pregnancy.
|
C01
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414
| 2,906
|
Management of gastroenteritis.
Childhood gastroenteritis remains a common reason for admission to British paediatric units, although the severity of the disease appears to be diminishing in recent years.
We studied 215 infants and children with gastroenteritis admitted consecutively to four paediatric units in South Wales in order to determine the severity of the disease, the organisms isolated, the frequency of complications, and the adequacy of management before admission.
Stool pathogens were isolated in 125 (58%) patients (viruses in 65, bacteria in 30, and protozoa in 19, with multiple infection found in 11).
There was a low incidence of morbidity and complications, but prolonged diarrhoea (postenteritis syndrome) was present in 24 (11%) cases and 77 (36%) had received inappropriate treatment before admission.
Contemporary gastroenteritis is thus a relatively mild disease in the acute phase, but management before admission to hospital is often inadequate, and prolonged diarrhoea may be a feature in a considerable number of cases.
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415
| 436
|
Gastrointestinal tuberculosis. Report of four cases.
Gastrointestinal tuberculosis is a rare disease in the United States.
Correct identification is often delayed because it is not considered early on in the differential diagnosis.
Four patients with gastrointestinal tuberculosis and the symptoms, diagnosis, complications, and treatment of the disease are discussed.
Gastrointestinal tuberculosis should be considered in Asian immigrant patients who present with symptoms and signs of inflammatory bowel disease.
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416
| 4,629
|
Protective effects of polyclonal sera and of monoclonal antibodies active to Salmonella minnesota Re595 lipopolysaccharide during experimental endotoxemia.
Mice were passively immunized with sera from blood donors active for rough lipopolysaccharides (LPS), the J5 (Rc chemotype) mutant of Escherichia coli O111:B4, and the Re595 (Re chemotype) mutant of Salmonella minnesota.
All protected the mice against lethal challenge with smooth E.
coli WF96 LPS, E.
coli and Salmonella rough mutant LPS, or free lipid A.
Epitopes recognized by monoclonal antibodies (MAbs) reacting with the LPS of S.
minnesota Re595 or lipid A were localized in the 2-keto-3-deoxy-D-manno-octulosonic acid (KDO) region and on lipid A.
Core-reactive MAbs reacted with their homologous Re LPS and with free lipid A.
One, GL11, cross-reacted with the KDO alone.
MAbs GL6, GL11, L.4, L.6, and L.8 protected the actinomycin D-sensitized mice against the lethal effects of LPS from E.
coli WF96, Salmonella enteritidis, E.
coli J5, S.
minnesota Re595, and free lipid A.
The GL11 antibody was also protective when injected after LPS challenge.
These results indicate that antibodies directed against the core glycolipid of S.
minnesota Re595 LPS may be useful as an additive form of therapy that may enable decreased mortality during gram-negative bacterial sepsis.
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417
| 2,917
|
An unusual cause of thoracic mass.
A previously well 10 year old boy presented with scoliosis, a mass in the chest wall, and a pleural effusion.
Chest radiography showed the triad of chronic consolidation, pleural effusion, and rib periostitis.
Investigations confirmed thoracic actinomycosis.
Tissue spread was evaluated by computed tomography.
It was successfully treated with benzylpenicillin, which was later replaced by clindamycin.
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C01
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418
| 5,921
|
Pneumococcal endometritis and neonatal sepsis.
A recent case of postpartum maternal endometritis and neonatal sepsis due to Streptococcus pneumoniae prompted this report and a review of previous citations.
Although this rare presentation of pneumococcal infection is potentially fatal to both mother and child, early empiric antibiotic coverage for the most frequent etiologic agents of this syndrome, group B streptococci, was and is adequate for systemic pneumococcal infections.
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C01
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419
| 6,441
|
Pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects.
Between June 26, 1985, and Feb.
24, 1989, 101 seropositive pregnant women and 129 seronegative pregnant women from the same prenatal clinics in Brooklyn and the Bronx were recruited into a prospective study of human immunodeficiency virus infection in pregnant women and their offspring.
This report details the course of pregnancy and short-term neonatal outcomes of 91 seropositive women and 126 seronegative women who gave birth during the study period.
Seropositive mothers were significantly more likely to have sexually transmitted diseases (17.6% vs 7.1%, p = 0.017) and medical complications (43.0% vs 25%, p = 0.006) during pregnancy.
No other obstetric complications (e.
g., chorioamnionitis, endometritis, toxemia, or placental problems) were associated with serologic status.
After controlling for confounding variables (drug use, tobacco use, age of mother, and clinic), we found that the mother's serologic status was not significantly associated with birth weight, gestational age, head circumference, or Apgar scores among live infants.
For example, after adjustment on confounders we found that children born to seropositive mothers weighed about 7 gm more than children of seronegative mothers (95% confidence interval, -180 to 194 gm).
We conclude that in this population human immunodeficiency virus infection has little demonstrable impact on the status at birth of live neonates.
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420
| 3,996
|
Host response to mycobacterial infection in the alcoholic rat.
Animals, chronically treated with alcohol, were inoculated with mycobacteria (bacillus Calmette-Guerin, 10.2 x 10(6) organisms) into the spleen to produce a granulomatous hepatitis.
Before infection, chronic alcohol ingestion was associated with a depressed skin test response to phytohemagglutinin, 71.7% of baseline (P = 0.009).
Mycobacterial (bacillus Calmette-Guerin) infection stimulated phytohemagglutinin skin test response to 417% of baseline in controls and 299% in alcoholics (P less than 0.001).
The hepatic granuloma response was altered with smaller but more numerous granulomas (mean +/- SEM, 81.2 +/- 1.5 microns2 of area with a frequency of 1.8 granulomas per field in alcoholics vs.
129.8 +/- 5.71 microns2 and 1.2 granulomas per field in controls; P less than 0.001).
These changes were associated with a 10-fold increase in colony-forming units per gram of liver (54.5 +/- 18.2 in alcoholics vs.
5.6 +/- 1.83 in controls; P = 0.0006).
This model offers precise parameters for host response to infection and indicates that alcohol significantly impairs the clearing capacity for mycobacteria from the liver.
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421
| 5,341
|
Coccidioidomycosis during human immunodeficiency virus infection. A review of 77 patients.
Through a retrospective review, we identified 77 previously unreported cases of coccidioidomycosis during HIV infection.
Patients were classified into 1 of 6 categories based on their primary clinical presentation: 20 had focal pulmonary disease (Group 1), 31 had diffuse pulmonary disease (Group 2), 4 had cutaneous coccidioidomycosis (Group 3), 9 had meningitis (Group 4), 7 had extrathoracic lymph node or liver involvement (Group 5), and 6 has positive coccidioidal serology without a clinical focus of infection (Group 6).
Coccidioidal serologies were positive on initial testing in 83% of the patients in whom such serologic testing was performed.
Sera from 39% of patients were positive for TP antibodies while 74% had CF antibodies.
Eleven of 12 seronegative patients had pulmonary disease (Group 1 or 2).
Serologic results of other patients sent to a single reference laboratory were similar, with 26% positive for immunodiffusion TP antibodies and 79% positive for immunodiffusion CF antibodies.
For the 77 patients in this study, the CD4-lymphocyte count was below 0.250 X 10(9) cells/L in 46 of the 55 patients who had this test performed, and a low CD4 count was significantly associated with mortality (p less than 0.01).
At the time of follow-up, 32 of the 77 patients (42%) had died.
There were significantly more deaths in those with diffuse pulmonary disease (Group 2) than in other groups (p less than 0.001).
Amphotericin B, ketoconazole, fluconazole, and itraconazole were all used as antifungal therapies.
Outcome could not be related to the therapy used.
Of note, 3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions.
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422
| 9,361
|
Disseminated Conidiobolus infection with endocarditis in a cocaine abuser.
A crack cocaine abuser developed disseminated infection caused by a species of Conidiobolus not known to cause disease in vertebrates.
The fungus gained entry via skin abrasions on the lower extremities, spread through the hematogenous route, and caused endocarditis.
There was evidence of fungal infection in the lungs, heart, kidneys, skeletal muscles, and brain.
An additional complication was extensive rhabdomyolysis, with a marked elevation of creatine kinase of up to 1.2 million U/L.
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423
| 4,312
|
Use of latex agglutination technique for detecting Legionella pneumophila (serogroup 1) antibodies.
Following the outbreak of Legionnaires' disease in Stafford in 1985, 500 serum samples were submitted to the indirect immunofluorescence antibody test and a latex agglutination.
Latex agglutination using ultrasonically disrupted Legionella pneumophila antigens coupled to latex particles, proved a rapid, simple method for detecting circulating antibodies to L pneumophila in a one minute slide latex agglutination test.
There was good correlation with the indirect immunofluorescence antibody test (IFAT), and the specificity and sensitivity with respect to a diagnostic result were 98.3% and 97.6%, respectively, using a series of well characterised sera.
The latex agglutination test seems well suited as a screening test for presumptive cases of Legionnaires' disease; the latex reagent is easy to prepare and seems to remain stable at 4 degrees C for up to six months.
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424
| 5,929
|
Primary meningococcal conjunctivitis: report of 21 patients and review.
Neisseria meningitidis is an uncommon cause of acute bacterial conjunctivitis.
Twenty-one cases of primary meningococcal conjunctivitis (PMC) are reported herein and 63 cases published in the literature since 1899 are reviewed.
In the 84 cases of PMC available for analysis, the male-to-female ratio was 1.76:1; nine of the patients were neonates, 55 were children, and 20 were adults.
Conjunctivitis was unilateral in 66.3% of the patients.
Gram stain of conjunctival exudate disclosed gram-negative diplococci in all cases in which it was done.
Culture of the conjunctival exudate yielded N.
meningitidis in all cases, and 44% of the isolated meningococci belonged to serogroup B.
Ocular complications, which occurred in 15.5% of the patients, most frequently were corneal ulcers.
Systemic meningococcal disease developed in 17.8% of the patients; the overall mortality was 13.3% for patients with PMC complicated by systemic disease.
Development of systemic disease was significantly more frequent in patients receiving only topical therapy than in those treated with systemic therapy (31.71% vs.
2.38%; P = .001).
Gram-negative diplococci observed in conjunctival exudate are an indication for systemic antibiotic therapy because of the risk of systemic complications associated with the use of topical therapy alone.
When properly treated, patients with PMC have a favorable prognosis.
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425
| 4,339
|
Treatment of chronic tinea pedis (athlete's foot type) with topical terbinafine.
Twenty-seven patients with chronic tinea pedis, athlete's foot type, were enrolled in a randomized, double-blind trial of topical treatment with terbinafine 1% cream versus its vehicle (placebo).
Patients were examined weekly during 4 weeks of twice-daily treatment and at follow-up 2 weeks after the conclusion of therapy.
No adverse events were reported in either treatment group.
Drug efficacy was evaluated in 22 patients, of whom nine (41%) were treated with terbinafine and 13 (59%) with placebo.
Analysis of combined mycologic and clinical results showed that terbinafine was significantly more effective than placebo at the end of therapy (78% vs zero) and at the 2-week follow-up (89% vs zero) (p less than or equal to 0.001 at both intervals.
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426
| 334
|
Febrile infants less than eight weeks old. Predictors of infection.
Febrile infants less than eight weeks old frequently are admitted and receive parenteral antibiotics for treatment of possible sepsis.
The authors assess 52 infants less than eight weeks old with a rectal temperature of 38.1 degrees C or higher as having either a readily identifiable focus of infection by physical examination, appearing "toxic" without a focus, or appearing well.
The authors screened patients by using white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and chest radiographs in addition to blood, cerebrospinal fluid and urine cultures.
The authors found a 9.6% incidence of bacteria in the 52 infants evaluated, with a 4.3% incidence in those febrile infants who appeared well.
Five patients had positive blood cultures with Group B B Hemolytic streptococcus (four patients), and Viridans streptococcus (one patient).
A clinical assessment of toxicity and a total band count greater than or equal to 0.5 x 10(3) cells/uL together were sensitive indicators of bacteremia, as were toxicity and a positive CRP.
A "toxic" appearance, a WBC count greater than or equal to 15 x 10(3) cells/uL and an ESR greater than 30 were specific indicators of bacteria.
Based on these data, identification of bacteremia in febrile infants may be possible with clinical assessment and screening laboratory tests.
Because of the relatively small sampling size of this study, the authors feel that evaluation of a larger number of patients is warranted to evaluate these sensitivities in a more diffuse patient population.
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427
| 8,316
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Vaginal infections in adult women.
Often trivialized by the medical profession, vaginitis in adult women is not only extremely common but is the source of considerable distress and often results in marked suffering.
Epidemiologic studies described in this article indicate the high prevalence of vaginitis and the large number of causes.
Although the majority of infections in women are due to bacterial vaginosis, VVC, and trichomoniasis, it is clear that many other causes exist, and we have yet to discover the etiology of many clinical syndromes.
Considerable progress has been made in understanding the pathogenesis of the three common vaginitides.
Although excellent progress has been made by the pharmaceutical industry in providing new drugs for vaginitis, any further progress will require a better understanding of etiology and pathogenesis.
Vaginitis causes major symptoms and is more than a nuisance problem.
Clinicians owe it to their patients to attempt to make an accurate diagnosis and not to rely on empiric therapy.
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C01
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428
| 2,517
|
Association of Helicobacter pylori infection with dyspeptic symptoms in patients undergoing gastroduodenoscopy.
PURPOSE: To determine the prevalence of Helicobacter pylori in patients with non-ulcer dyspepsia and ulcer disease as well as in a control population undergoing endoscopic retrograde cholangiopancreatography (ERCP) for suspected pancreatic or biliary disease.
PATIENTS AND METHODS: Forty-six eligible patients undergoing upper endoscopy at Massachusetts General Hospital were studied over a period of 18 months, as well as 24 patients undergoing ERCP for presumed pancreatic or biliary disease.
Two biopsy specimens from the fundus and two from the antrum were taken for microbiologic and histopathologic analysis.
Sera were examined by enzyme-linked immunoabsorbent assay.
All specimens were processed in a blind fashion.
Chi-square test with Yates' correction was used for statistical analysis.
RESULTS: H.
pylori was found in 31 of 46 (67%) study patients and in six of 24 (25%) control patients (by microbiologic or histologic techniques) (p less than 0.01).
H.
pylori was found in all patients with peptic ulcer disease and in 60% of patients without ulcers.
No association between H.
pylori and any specific gastrointestinal symptom was observed.
H.
pylori was identified in the fundus as often as in the antrum, although in the antrum the organism was more often associated with histologic gastritis.
Compared with histology, serologic assays for IgG and IgA antibodies to H.
pylori had sensitivities of 100% and 94%, and specificities of 86% and 76%, respectively.
Reexamination of selected specimens without knowledge of their identity revealed that the specificity of serology exceeded 94% while the sensitivity of histologic and microbiologic studies may have been closer to 80%.
CONCLUSIONS: H.
pylori was more common in dyspeptic patients than in our control subjects undergoing ERCP.
Multiple biopsy sites from fundus and antrum are required to exclude infection.
Serologies of IgG and IgA were sensitive and specific for H.
pylori, suggesting a possible role for non-endoscopic diagnosis of this infection.
The frequent association of H.
pylori with active inflammation rather than with quiescent gastritis is consistent with a pathologic role of this organism.
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C01
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429
| 3,821
|
Infections in alcoholic patients.
Alcoholic patients have an increased susceptibility to certain bacterial infections.
Among the more important of these infections are pneumonia, tuberculosis, spontaneous peritonitis, and bacteremia.
This susceptibility is caused by alteration of immune function and mechanical defenses and are the sequel of chronic alcoholism, most notably cirrhosis.
In many infections, morbidity is increased in alcoholics, with the course of the illness being more severe and complications more frequent.
Assessment of the alcoholic patient with suspected infection should, therefore, be thorough and treatment prompt.
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C01
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430
| 6,674
|
Toxic streptococcal syndrome.
The streptococcal toxic shocklike syndrome is a recently recognized, multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome, but is caused by toxins elaborated by group A beta-hemolytic Streptococcus.
We describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome (fever, hypotension, multisystem dysfunction, and diffuse macular erythroderma followed by desquamation) and who demonstrated serologic evidence suggesting streptococcal infection.
In patients presenting with clinical findings consistent with a toxic shocklike syndrome, the emergency physician should consider streptococcal infection as a potential etiology.
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C01
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431
| 4,663
|
Tumor necrosis factor-alpha plays a role in host defense against Histoplasma capsulatum.
Tumor necrosis factor-alpha was detected in supernatants collected from BALB/c mouse peritoneal macrophages incubated continuously with Histoplasma capsulatum.
The levels of TNF alpha measured by actinomycin D bioassay peaked within hours after exposure and then greatly declined by 24 h.
TNF alpha was also measured in bronchoalveolar lavage fluid from BALB/c mice challenged intranasally with H.
capsulatum.
Lavage fluid TNF alpha levels exhibited the same pattern as the in vitro supernatants; they peaked within hours after challenge and lower levels were detected at 24 h.
Treatment of mice with anti-TNF alpha antibody accelerated mortality in response to systemic infection and significantly increased tissue colony counts in the liver and spleen.
In the murine model, TNF alpha is produced in response to H.
capsulatum and appears to play some role in host defense to infection.
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C01
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432
| 7,858
|
Femoral artery cannulation for monitoring in critically ill children: prospective study.
Seventy-seven attempted percutaneous femoral artery cannulations were prospectively evaluated in 74 children.
Artery cannulation was successfully accomplished in 73 (95%) cases and lasted for a mean of 6 days.
Sixty percent of the catheters were inserted on the first attempt.
Fifty-two (71%) patients weighed less than 10 kg and 55 (75%) patients were less than 12 months old.
Fifty-one (70%) patients received inotropic support at the time of cannulation, and 27 (37%) eventually died from causes unrelated to catheter insertion.
There was one episode each of line-associated infection and transient distal ischemia not resulting in tissue loss, and two episodes of catheter malfunction.
In eight (11%) patients, signs of distal vascular insufficiency developed shortly catheter placement and resolved after catheter removal.
The development of this complication correlated significantly (p less than .05) with younger age (5.5 vs.
22.3 months).
We conclude that femoral artery cannulation has a high degree of success in very small, critically ill children.
It should be considered an acceptable alternative to small-vessel cannulation when the latter is not technically achievable, or in the unstable patient where rapid establishment of reliable arterial access is necessary.
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C01
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433
| 7,597
|
Lung function in children following empyema.
Spirometry was performed and response to exercise was measured in 15 children following recovery from empyema to evaluate the impact of pleural infection on subsequent lung function.
Seven children underwent chest tube drainage; eight did not.
The two groups were similar in age (mean +/- SD, 6 +/- 5 years), sex distribution, bacterial pathogen-producing empyema, and age at follow-up evaluation (12 +/- 5 years).
Only one child reported recurrent respiratory symptoms.
No child had restrictive spirometric changes (total lung capacity, less than 80%; vital capacity, less than 80% predicted) but seven of 15 had a reduced forced expiratory volume in 1 second (less than 80% predicted) or forced expiratory flow during the middle half of the vital capacity (less than 75% predicted), suggesting mild airway obstruction.
No child demonstrated reduced exercise tolerance due to restrictive ventilatory limitations.
Mild obstructive abnormalities in lung function were identified with equal frequency in children treated with and without chest tube drainage.
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C01
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434
| 9,183
|
Liver abscess complicating intratumoral ethanol injection therapy for HCC.
We report a patient who developed multiple liver abscesses and sepsis caused by lactobacilli after the percutaneous intratumoral injection of ethanol for hepatocellular carcinoma.
We diagnosed the liver abscess at an early stage because of a the finding of gas on ultrasound and computed tomography.
Blood cultures grew Gram-positive rods, which were of the Lactobacillus species.
The patient responded to the administration of antibiotics, and his hepatic tumors have not recurred in the 7 months since treatment.
This is the first report of liver abscess following percutaneous ethanol injection therapy.
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C01
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435
| 5,915
|
Resolution of lung abscess due to Pseudomonas aeruginosa with oral ciprofloxacin: case report.
A case of lung abscess due to Pseudomonas aeruginosa is presented that did not resolve with the use of conventional antipseudomonal antibiotics, including tobramycin with ticarcillin-clavulanate and ceftazidime with gentamicin and ticarcillin-clavulanate.
Oral ciprofloxacin was administered for 12 weeks, and the infection was resolved.
No resistance occurred, and there was no recurrence of abscess within 18 months following therapy.
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C01
|
436
| 834
|
Serum pepsinogen I and gastrin concentrations in children positive for Helicobacter pylori.
Serum pepsinogen I, serum gastrin concentration, and inflammatory scores were measured in a population of 71 children undergoing upper gastrointestinal endoscopy for investigation of upper abdominal pain.
Forty four were initially colonised with Helicobacter pylori.
The indices were measured before treatment (in 71 children), one month (in 41 children), and six months (in 21 children) after stopping treatment.
Before treatment there was a significant correlation between serum pepsinogen concentration, total inflammatory score, and H pylori state, but no correlation between serum gastrin concentrations and H pylori state.
Similarly, the total inflammatory score and serum pepsinogen concentrations were significantly correlated.
There was no such correlation in children negative for H pylori.
After treatment the inflammatory score improved in those patients in whom H pylori had been eradicated.
There was also a significant fall in serum pepsinogen I and serum gastrin concentration in those patients in whom H pylori had been eradicated.
These results were similar to those found six months after treatment had been stopped.
These findings suggest that the serum pepsinogen I concentration could be considered a useful marker for gastritis and can be used as an index of severity of gastritis in H pylori positive subjects.
The measurement of serum gastrin concentrations does not give useful information.
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C01
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437
| 8,952
|
Surgical wound infection and cancer among the elderly: a case control study.
Surgical wound infection occurs in fewer than 5% of operations.
Nevertheless, it represents the second most common type of hospital-acquired infection and results in increased morbidity and mortality.
As with all nosocomial infections, the rate of surgical wound infection increases with age.
Patients over 65 years of age run an approximately 15% risk of surgical wound infection.
Two-thirds of patients with invasive cancer other than non-melanotic skin cancer are aged 65 years and over.
Over half of them are treated surgically for their cancer.
Cancer and other chronic diseases have been cited as possible causes of the increased risk of nosocomial infection among the elderly.
Using the Foothills Hospital Wound Study Data Base as the sampling frame, we conducted a case-control study of surgical wound infection and cancer among the elderly.
Cancer was found not to be a risk factor for surgical wound infection.
The results are discussed in relation to the role of immunity in both disorders.
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C01
|
438
| 6,736
|
Human intestinal tissue antibiotic concentrations. Clindamycin, gentamicin, and mezlocillin.
An antibiotic, to be effective for prophylaxis in abdominal trauma, should quickly achieve high concentrations in the intestinal wall and at enough inhibitory levels to kill most aerobic and anaerobic bacteria that are potential contaminants at the site of surgical incision.
Therefore, we studied the intestinal tissue levels of clindamycin, gentamicin, and mezlocillin to see whether the tissue levels achieved by these antibiotics in the intestinal tissue were adequate.
A single dose of mezlocillin, 4 grams; clindamycin, 600 mg and gentamicin, 80 mg; quickly reached the desired concentrations, i.e., 52.3, 9.69 and 6.1 micrograms/gram of intestinal tissue respectively.
These levels were high enough to inhibit the growth of most isolates of E.
coli and B.
fragilis, common pathogens involved in intra-abdominal abscess.
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C01
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439
| 391
|
Resolution of the adult respiratory distress syndrome following colectomy and liver transplantation.
A 32-year-old woman with liver failure from end-stage cirrhosis and ulcerative colitis developed septicemia and severe ARDS.
Subtotal colectomy and a successful liver transplantation resulted in complete resolution of the ARDS.
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C01
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440
| 9,283
|
Severe anemia is an important negative predictor for survival with disseminated Mycobacterium avium-intracellulare in acquired immunodeficiency syndrome [published erratum appears in Am Rev Respir Dis 1991 Feb;143(2):451]
Disseminated Mycobacterium avium-intracellulare (MAI) in patients with the acquired immunodeficiency syndrome (AIDS) is usually unresponsive to antimycobacterial therapy.
We examined clinical and laboratory characteristics of MAI organisms and their relationship to the length of survival.
We studied factors influencing survival and compared these in 76 patients with AIDS with and without MAI.
Serum levels of p24 antigen and erythropoietin, and CD4-positive helper T-lymphocytes in blood were assessed in 36 additional patients with various clinical stages of HIV infection.
In patients with MAI infection, survival was significantly related only to total lymphocyte count, hematocrit, platelet count, and sex.
Of these, hematocrit and total lymphocyte count were the only linear predictors of survival.
Anemia was significantly more profound in patients with AIDS and MAI than in the other patients.
This anemia in patients with MAI could not be ascribed to increased peripheral destruction of red cells, deficient nutritional factors, or erythropoietin production, HIV viral or bacterial load, or a general effect on other blood elements such as neutrophils or platelets.
The influence of MAI on survival in patients with AIDS did depend upon whether the MAI occurred as an index infection or was preceded by other opportunistic infections.
Patients with other preceding opportunistic infection lived for a much shorter duration from the time of diagnosis of MAI.
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C01
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441
| 8,323
|
Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis.
72 adults with erythema migrans (early Lyme borreliosis) were enrolled in a randomised prospective trial comparing amoxycillin 500 mg plus probenecid 500 mg three times a day with doxycycline 100 mg twice a day for 21 days.
These antibiotic regimens were chosen because of the known in-vitro sensitivity of Borrelia burgdorferi, the antibiotic tissue penetration, the pharmacokinetics of the drugs, and because the organism can disseminate early in the course of infection.
72 patients were evaluable (35 in the doxycycline group and 37 in the amoxycillin/probenecid group).
The two regimens were equally effective for treatment of erythema migrans.
Mild fatigue or arthralgia were the only post-treatment complaints, which resolved within 6 months.
None of the patients needed further antibiotic treatment for Lyme borreliosis.
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C01
|
442
| 4,343
|
Treatment of chronic moccasin-type tinea pedis with terbinafine: a double-blind, placebo-controlled trial.
Terbinafine is an orally and topically active fungicidal drug of the allylamine series.
Its oral efficacy at 125 mg taken twice daily was evaluated in a randomized, double-blind, placebo-controlled study in moccasin-type tinea pedis.
The study was conducted simultaneously in two centers and consisted of 41 evaluable cases (23 terbinafine, 18 placebo).
Mycologic cure and near to complete clearing of signs and symptoms were obtained in 59% of the terbinafine-treated patients after 6 weeks of treatment and in 65% at 2 weeks after treatment.
Corresponding efficacy for placebo-treated patients was zero at both evaluations.
Side effects in both groups were minimal.
We conclude that terbinafine is well tolerated and highly effective in moccasin-type tinea pedis.
|
C01
|
443
| 9,641
|
Surgical presentation of Kawasaki disease (mucocutaneous lymph node syndrome).
Five patients with Kawasaki disease (mucocutaneous lymph node syndrome) are reported whose varied presentations included acute abdominal pain, peripheral arterial aneurysms, digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo-obstruction.
As the complications of the disease can usually be managed without resort to surgery, which is associated with a mortality rate of up to 25 per cent, the recognition of Kawasaki disease will prevent hazardous and unnecessary laparotomy.
|
C01
|
444
| 6,979
|
Does survival depend on the amount of autotransplanted splenic tissue?
Susceptibility to Streptococcus pneumoniae infection was studied in 11 groups of rats allocated to sham operation, splenectomy, or splenic autotransplantation of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% of the removed spleen.
Three months later, all rats were exposed intravenously to type 1 Streptococcus pneumoniae (median lethal dose, LD50, for control group).
Survivors were killed 13 days after the bacterial challenge.
Autopsy showed that more splenic tissue was recovered in rats that received less than 50% splenic tissue compared with those that received 50% or more.
More survivors were found among sham-operated rats (47.5%; 95% confidence intervals, 32 to 68) and rats that had 40% splenic tissue implanted (35%; confidence interval, 20 to 54) or those that were found to have regenerated 40% splenic tissue.
We conclude that 40% of the spleen should be autotransplanted to protect the rat optimally against infection after splenectomy.
|
C01
|
445
| 4,658
|
Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group.
A prospective, laboratory-based surveillance project obtained accurate data on meningitis in a population of 34 million people during 1986.
Haemophilus influenzae was the most common cause of bacterial meningitis (45%), followed by Streptococcus pneumoniae (18%), and Neisseria meningitidis (14%).
Rates of H.
influenzae meningitis varied significantly by region, from 1.9/100,000 in New Jersey to 4.0/100,000 in Washington state.
The overall case fatality rates for meningitis were lower than those reported in several studies from the early 1970s, suggesting that improvements in early detection and antibiotic treatment may have occurred since that time.
Concurrent surveillance was also performed for all invasive disease due to the five most common causes of bacterial meningitis.
Serotypes of group B streptococcus other than type III caused more than half of neonatal group B streptococcal disease and mortality, suggesting that an optimal vaccine preparation must be multivalent.
Of the organisms evaluated, group B streptococcus was the second most common cause of invasive disease in persons greater than 5 years old.
|
C01
|
446
| 6,578
|
Role of surgery in antibiotic-induced pseudomembranous enterocolitis.
With the increased use of prophylactic and broad-spectrum antibiotics, pseudomembranous colitis has emerged as a significant clinical problem.
Management with specific anti-Clostridium difficile therapy (vancomycin or metronidazole) has reduced mortality to less than 2%.
Nevertheless, the disease may progress to a fulminant toxic colitis or colonic perforation.
Additionally, another subset of patients will present with a dramatic clinical picture, suggesting acute peritonitis, eventuating in unnecessary laparotomy.
This report reviews both the medical and surgical literature during the past 15 years of patients treated for pseudomembranous colitis.
Analysis of this clinical data has provided us with the opportunity to both define the role of surgery in this disorder and illustrate the necessity for a combined medical and surgical cooperative approach in the early management of this iatrogenic disease.
|
C01
|
447
| 6,168
|
HIV disease: a review for the family physician. Part II. Secondary infections, malignancy and experimental therapy.
The first part of this two-part article included recommendations for the initial evaluation of patients suspected of having HIV infection, the Centers for Disease Control's classification scheme for HIV disease and current recommendations for the use of zidovudine.
In this second part, secondary infections and malignancy are reviewed, and various experimental therapies are briefly discussed.
|
C01
|
448
| 5,639
|
Clinical features of adenovirus enteritis: a review of 127 cases.
We retrospectively analyzed the clinical features of 127 hospitalized pediatric patients whose fecal samples were positive for adenovirus (Ad) by electron microscopy during an 18-month period.
Serotyping results obtained by microneutralization tests and restriction endonuclease analysis were available for 105 of 127 cases.
There were 69 males and 58 females and 94% of patients were less than 4 years of age.
The average body temperature was 38 degrees C rectal (range, 36.2-40.8 degrees C) with an average duration of fever of 1.6 days.
The average duration of clinical illness was 8.8 days (range, 1 to 32 days).
Although Ad 40 and Ad 41 were isolated in the majority of cases (59 of 105 (56%], Ad 31 was associated with 18 of 105 cases (17%).
Of the 18 cases associated with Ad 31, 14 were nosocomial and associated with diarrhea.
Our survey confirms the importance of fastidious enteric Ad in infantile diarrhea (Ad 40, Ad 41) and suggests that Ad 31 produces a clinical syndrome indistinguishable from that caused by Ad 40 and Ad 41.
The occurrence of Ad enteritis in patients admitted for unrelated illnesses well after initial hospitalization suggests that Ad is also an important cause of nosocomial enteritis in our hospital.
|
C01
|
449
| 7,419
|
A randomized prospective study of topical antimicrobial agents on skin grafts after thermal injury.
We prospectively studied 52 consecutive patients who were treated by early tangential excision and grafting following thermal injury.
The usefulness of two topical antimicrobial agents--0.5% silver nitrate (Ag) and neomycin (1 gm/liter) plus bacitracin (50,000 units/liter) (NB)--was compared with the effectiveness of Ringer's lactate (RL) for prevention of autogenous skin-graft loss due to infection.
Graft loss of 10 percent or more occurred in 17 patients (33 percent)--due to infection in 16.
Skin-graft loss was a minor problem in patients with less than 20 percent total body surface area (TBSA) burn (Ag: 0 of 6, NB: 1 of 6, RL: 1 of 5).
The use of either antimicrobial (Ag or NB) resulted in less graft loss (1 of 14) than RL (4 of 6; p less than 0.05) in the 20 to 40 percent TBSA burn group.
Large burns (greater than 40 percent) had a very high incidence of at least 10 percent graft loss (67 percent) regardless of treatment.
Infection in the area of graft loss was caused by antibiotic-resistant organisms or yeast in 50 percent of the Ringer's lactate group and the entire neomycin plus bacitracin group.
No graft infections were caused by resistant organisms or yeast in the silver nitrate group.
This study demonstrates that topical antimicrobial agents reduce infection-related skin-graft loss in patients with medium-sized (20 to 40 percent TBSA) burns and that neomycin plus bacitracin is associated with rapid emergence of drug-resistant organisms whereas silver nitrate is not.
|
C01
|
450
| 5,447
|
Chronic Lyme disease with an expansive granulomatous lesion in the cerebellopontine angle.
Expansive granulomatous lesions in the posterior cranial fossa are rare and have not been reported in conjunction with Lyme disease.
We report a patient with verified Borrelia burgdorferi infection who developed a tumor in the cerebellopontine angle.
Rapid growth of the tumor led to signs of cerebral compression and to hydrocephalus.
Surgical intervention was required despite florid meningitis.
The histological examination showed inflammatory, nonspecific granulation tissue.
The origin of this tissue is almost certainly causally related to the B.
burgdorferi infection.
Signs of inflammation resolved rapidly after subtotal resection.
The clinical, radiological, and biochemical course is documented.
This is the first report of an expansive cerebral lesion in the chronic phase of Lyme disease.
|
C01
|
451
| 7,839
|
Simplified two-stage below-knee amputation for unsalvageable diabetic foot infections.
A simplified two-stage below-knee amputation for unsalvageable diabetic foot infections was done on 19 limbs with 84% good results for healing.
The first stage was the standard below-knee amputation with a long posterior flap in which the fascia and skin were closed in the central portion with the medial and lateral portions of the wound left open for drainage.
The second stage was delayed until closure of the open wounds three to seven days after the first stage.
Wagner's classification of diabetic foot lesions was used to stratify these cases.
Grades 3 and 4 foot infections had a uniformly good prognosis for healing with this surgical technique.
Grade 5 foot infections had a poor prognosis for healing, especially if associated with renal failure and dialysis, even with an initial guillotine amputation.
|
C01
|
452
| 4,186
|
Treatment of infection after total knee arthroplasty by debridement with retention of the components.
Thirty-one total knee arthroplasties were followed by infection in twenty-seven patients who were subsequently treated with debridement, retention of the components, and intravenous administration of antibiotics.
The results were reviewed retrospectively in an effort to evaluate the function of the prostheses that had been salvaged successfully and to identify the causes of failure of those around which an infection had recurred.
At the most recent follow-up (average duration, 8.8 years), infection had recurred around twenty-four (77 per cent) of the thirty-one arthroplasties.
Seven knees (23 per cent) remained free of infection.
Function remained satisfactory, although revision was subsequently needed in two knees for reasons other than infection.
One cause of failure was the duration of the infection before debridement.
This averaged twenty-one days for the seven knees in which the prosthetic arthroplasty had been salvaged and thirty-six days for the twenty-four knees in which treatment had failed.
Another cause of failure was the type of organism: Staphylococcus aureus had caused the infection in fourteen (58 per cent) of the twenty-four knees in which the treatment failed but in only two of the seven knees in which the prosthetic arthroplasty was salvaged.
In addition, eight infections in the first group were resistant to penicillin, whereas both infections in the second group were sensitive to penicillin.
The four infections with gram-negative organisms in the series were all in knees in which the treatment failed.
All six hinged prostheses that were used failed.
|
C01
|
453
| 6,533
|
HIV seroprevalence among male IVDUs in Houston, Texas.
HIV seroprevalence was 8.4 percent in a sample of 921 heterosexual male intravenous drug users in Houston, Texas who were not in drug treatment at the time of the study.
Males who were Black, injected drugs daily, or had a history of syphilis had greater odds of being HIV positive than participants without those characteristics.
|
C01
|
454
| 7,518
|
How and why aztreonam works.
Aztreonam is the first monocyclic beta-lactam antibiotic (monobactam) to be tested clinically.
Its synthetic structure determines specific areas of activity, including enhanced activity against Pseudomonas species, exceptional activity against gram-negative bacteria, stability to beta-lactamases and lack of activity against gram-positive bacteria--all of which can be directly related to its chemical composition.
Aztreonam has a high affinity for the protein-binding protein 3 (PBP-3) of aerobic gram-negative bacteria.
Most of these organisms are inhibited and killed at low concentrations of the drug.
Aztreonam binds poorly to PBP sites of the aerobic gram-positive and anaerobic bacteria and consequently has relatively poor inhibitory effects against these bacteria.
In vitro, minimum inhibition concentration (MIC) values against almost all of the Enterobacteriaceae and against Neisseria and Haemophilus strains are typically below 1 microgram per milliliter.
MIC values against Pseudomonas aeruginosa of 8 micrograms per milliliter are comparable with those of other antipseudomonal beta-lactams and the acylureidopenicillins.
As combination therapy with amino-glycosides, aztreonam acts in synergy against P.
aeruginosa, Acinetobacter and gentamicin-resistant gram-negative rods.
Aztreonam is widely distributed in the body tissues and fluids, and the average elimination half-life is 1.7 hours.
Intramuscular dosing results in peak serum levels in approximately one hour, while intravenous dosing results in peak levels within five minutes.
After a 2 gram dose given intravenously, MIC90 values for most of the Enterobacteriaceae are exceeded for eight hours, and those for P.
aeruginosa, for almost six hours.
The steady-state volume of distribution is approximately 0.18 liter per kilogram.
Concentrations above the MIC90 for most gram-negative bacteria are also present within bone, prostate and cerebrospinal fluid.
Between 60 and 70 per cent of the drug is excreted unchanged in the urine, resulting in concentrations approximating 3,000 micrograms per milliliter two hours after a 1 gram dose given intravenously.
Serum clearance of aztreonam is directly proportional to creatinine clearance.
Dosage adjustment must, therefore, be made in the presence of reduced clearance.
Dosing varies between 0.5 and 2.0 grams every six to 12 hours, depending on the severity of the infection.
The characteristics of aztreonam suggest that it is a useful nonnephrotoxic drug for treatment of aerobic gram-negative infection.
|
C01
|
455
| 8,767
|
Urinary infection following out-patient flexible cystoscopy.
Of 161 flexible cystoscopies performed in an out-patient endoscopy suite, the incidence of urinary tract infection was 7.5%.
Infection rates were higher in patients with a history of previous urinary tract infection or where an additional procedure was also performed.
No difference was noted between the infection rates in men and women.
|
C01
|
456
| 2,174
|
Pulmonary disease following intravesical BCG treatment.
Bacillus Calmette-Guerin (BCG) is an attenuated strain of Mycobacterium bovis that has been used in the treatment of malignant disease for over 20 years and for the treatment of bladder cancer since 1976.
Major complications of this treatment are infrequent.
We report two cases of systemic illness with pulmonary manifestations after treatment with intravesical BCG.
|
C01
|
457
| 6,548
|
South American blastomycosis: ophthalmic and oculomotor nerve lesions.
A case of South American blastomycosis began with an oropharyngeal lesion which was followed by a granulomatous uveitis.
The patient was treated with Amphotericin B and showed a clinical regression.
Four months later, he developed a right 3rd cranial nerve palsy, aggravating the clinical aspect with a severe generalized involvement of the central nervous system and death.
Necropsy showed blastomycotic meningoencephalitis.
|
C01
|
458
| 881
|
Treatment of vaginal candidiasis: orally or vaginally?
Vaginal candidiasis continues to be the most common cause of vaginal discharge.
A large variety of topical drugs and a selection of orally active antifungals are currently available.
The choice between the use of oral drugs or intravaginal agents will depend on the therapeutic results obtained with the different agents, side effects, pregnancy status, and patient preference.
The results obtained in the Maria Hospital, Tilburg, The Netherlands, and a review of foreign data suggest the following: (1) For acute infection oral and topical agents produce equivalent results.
(2) For chronic infections oral medication is preferred.
(3) Oral therapy should not be given to pregnant patients or to patients not using reliable contraceptive measures.
(4) Half the patients prefer oral medication; only 5% prefer intravaginal therapy, and the others had no clear preference.
|
C01
|
459
| 5,932
|
Quinolone antibiotics in the treatment of Salmonella infections
The 4-fluoroquinolones are a new class of antimicrobial agents that possess broad in vitro antibacterial activity, including efficacy against enteric pathogens such as Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio species.
These drugs are clinically effective against both drug-sensitive and multiresistant strains of Salmonella typhi and Salmonella paratyphi that cause enteric fever.
In salmonella enterocolitis, the quinolones--unlike older antimicrobial agents that may have little impact on the duration of symptomatic illness and can in fact prolong fecal carriage of salmonellae--actually shorten the course of clinical disease and terminate excretion of these organisms in the stool.
Similarly, for chronic carriers of both typhoidal and nontyphoidal Salmonella strains, the quinolones are effective in eradicating biliary and fecal reservoirs of infection.
Immunosuppressed persons with salmonellosis, such as those with AIDS, may benefit from both short-term treatment and prolonged prophylaxis with a quinolone antibiotic.
The optimal agent, dose, and duration of quinolone therapy for all salmonella syndromes remain to be determined by larger controlled trials.
|
C01
|
460
| 2,814
|
Ceftazidime/clindamycin versus tobramycin/clindamycin in the treatment of intra-abdominal infections.
In order to assess the efficacy and toxicity of ceftazidime as a substitute for aminoglycosides in the treatment of intra-abdominal sepsis, a prospective randomized trial was conducted.
Ninety-four patients (49% trauma) were randomized to receive ceftazidime/clindamycin (CAZ/C) (n = 47) or tobramycin/clindamycin (T/C) (n = 47).
CAZ (2.0 gm) and C (0.9 gm) were administered intravenously every 8 hours while T dosage was adjusted to maintain peak (5-8 mg/L) and trough (less than 2 mg/L) concentrations.
Age, sex, baseline serum creatinine, and etiology of infection were comparable in the two groups.
Clinical cure was similar in culture-positive and culture-negative patients who received CAZ/C (94% vs 88%).
The clinical cure rate however was significantly lower in the T/C culture positive (73%) than in the culture negative patients (100%) (P = 0.016).
Pathogenic organisms were eradicated in 100% (30/30) and 76% (13/17) of CAZ/C and T/C patients, respectively (P = 0.0006).
Nephrotoxicity Nephrotoxicity or ototoxicity was observed in none of the CAZ/C patients and in one and two T/C patients, respectively.
CAZ/C more effectively eradicated the bacteria isolated from these patients and no significant difference in clinical response was observed in culture-positive patients.
These findings plus the lack of toxicity suggest that CAZ/C is an effective alternative for treatment of IAI.
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C01
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461
| 9,174
|
Comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis.
The conventional method of ascitic fluid culture detects bacteria in only 50% of cirrhotic patients with neutrocytic ascites and suspected spontaneous bacterial peritonitis (SBP).
We have prospectively compared two ascites culture methods in cirrhotic patients with spontaneous bacterial peritonitis: 1) conventional (on chocolate agar, blood agar, Mac Conkay agar, and thioglycolate broth), and 2) modified [inoculation of 10 ml of ascites in a tryptic soy broth (TSB) blood culture bottle at the patient's bedside].
In a 21-month period, 70 episodes of SBP were diagnosed according to our criteria in 60 cirrhotic patients.
Both culture methods were performed simultaneously.
The conventional grew bacteria in 40 episodes (57%), whereas the modified grew bacteria in 54 episodes (77%), a significantly higher sensitivity (p = 0.0001).
In 16 cases (23%), ascitic culture was negative by both methods.
The mortality rate was higher among patients with culture-positive SBP than those with culture-negative SBP (46% vs 37%), but did not reach statistical significance.
We conclude that ascitic fluid inoculated into a TSB blood culture bottle at the patient's bedside should be used routinely for ascites culture in cirrhotic patients.
|
C01
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462
| 7,406
|
Postneonatal infectious disease mortality: the French situation.
Mortality caused by infectious and parasitic diseases represents a limited part of all postneonatal deaths in France, which have been stable for the past decade.
This component is worthy of careful analysis because it is at least partially preventable.
Statistics are presented and interpreted, with discussion on which disorders should be included in assessing the impact of infection on morbidity and mortality.
Figures and international rankings change according to the inclusiveness of the definition chosen.
There is need for epidemiologic and statistical research to make comparisons of mortality more clear.
Morbidity is also important because of high incidence, frequent hospitalization, and a heavy social cost.
Policy and services in France that relate to control and treatment of infection are described, as are shortcomings that call for further efforts.
|
C01
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463
| 2,798
|
Epidemiology of infection by nontuberculous mycobacteria IX. Evidence for two DNA homology groups among small plasmids in Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium scrofulaceum.
A 12.9 kb plasmid, pVT2, from a clinical Mycobacterium avium isolate, MD1, was cloned and radiolabeled for use as a DNA probe to examine the relatedness of plasmids in M.
avium complex.
That probe hybridized with plasmids isolated from M.
avium complex strains from the environment (7 of 16) and from non-acquired immunodeficiency syndrome (AIDS) (10 of 17) and AIDS (5 of 6) clinical isolates.
The similarity of plasmids from the environment with those from patients supports the hypothesis that the environment is a source of human M.
avium complex infection.
More striking was the observation that pVT2 hybridized with every plasmid (13 of 13 clinical and 5 of 5 environmental isolates) of 13.5 kb or smaller.
A second probe, consisting of a 15.3 kb plasmid (pLR7) from another clinical isolate of the M.
avium complex, hybridized with plasmids of 15.3 to 25 kb from environmental and clinical (AIDS and non-AIDS) isolates.
There was no hybridization between pVT2 and pLR7.
Thus, these two probes define two different groups of small mycobacterial plasmids.
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C01
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464
| 9,904
|
Castanospermine vs. its 6-O-butanoyl analog: a comparison of toxicity and antiviral activity in vitro and in vivo.
Inhibitors of glycoprotein processing, such as castanospermine (1,6,7,8-tetrahydroxyoctahydroindolizine), have been shown previously to inhibit human immunodeficiency virus type 1 (HIV-1) with acceptable toxicity in cultured human cells.
In prior experiments, we have tested the toxicity and antiviral efficacy of castanospermine in mice infected with the Rauscher murine leukemia virus (RLV).
When compared with 3'-azido-3'-deoxythymidine (AZT, zidovudine), castanospermine was less effective and more toxic.
Since the 6-O-butanoyl analog of castanospermine was previously found to have a more favorable activity profile than the parent compound against HIV-1 in cultured cells, we compared the antiviral efficacy of both compounds in parallel in vitro and in vivo in the RLV system.
Plaque formation in the XC assay was inhibited with a 50% inhibitory concentration (IC50) of 2.4 microM for the 6-O-butanoyl analog of castanospermine, as compared to 9 microM for castanospermine.
For both compounds, concentrations resulting in significant cytotoxicity were about ten times higher.
Both compounds significantly decreased HIV-1 env-induced syncytium formation in a novel in vitro assay.
In RLV-exposed mice, the 6-O-butanoyl analog showed no advantage over the parent compound: both curves for toxicity as well as antiviral efficacy were super-imposable.
We conclude that the 6-O-butanoyl analog of castanospermine as well as castanospermine itself are active antiviral agents in mice and that prolonged oral administration is tolerable.
However, in comparison to AZT, their antiviral activity profiles are less favorable.
|
C01
|
465
| 8,312
|
Common nonvenereal genital lesions.
There are a wide variety of local and systemic skin diseases that produce lesions in the genitoanal region.
These lesions may resemble those produced by sexually transmitted microorganisms.
The purpose of this article is to make physicians aware of the common skin diseases that produce lesions on the genitalia to avoid the inappropriate diagnosis of a sexually transmitted disease.
|
C01
|
466
| 9,488
|
Peritoneal macrophage beta-2 microglobulin production and bacterial peritonitis in CAPD patients.
To evaluate the role of bacterial peritonitis in peritoneal macrophage (PM) Beta-2 Microglobulin (B2M) production, and its relationship with PM Interleukin-1 (IL-1) and Leukotriene B4 (LTB4) release, the authors studied 20 CAPD patients (10 with peritonitis): 1.
in vivo plasma and peritoneal dialysis effluent (PDE) B2M, IL-1, and LTB4 levels; 2.
in vitro B2M, IL-1, and LTB4 release by PM.
Values were compared with those seen in the plasma or with peripheral blood monocytes of 30 hemodialysis (HD) patients (10 treated with Cuprophan [CU]; 10 with Polyacrylonitrile [PAN]; and 10 with Cellulose Acetate [CA]).
Results showed that in CAPD patients with bacterial peritonitis B2M, IL-1 and LTB4 concentrations in the PDE were significantly higher than those seen in CAPD patients without peritonitis, or in the plasma of HD patients treated with PAN or CA, but were similar to those seen in HD patients treated with CU.
At the same time, in vitro PM from CAPD patients with bacterial peritonitis produced more B2M, IL-1, and LTB4, than did PM from CAPD patients without peritonitis, or peripheral blood monocytes from HD patients treated with PAN or CA.
The authors conclude that in CAPD patients, bacterial peritonitis is able to induce PM B2M production, probably via a cytokine mediated process, which may be analogous to what occurs with peripheral blood monocytes of HD patients treated with CU.
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C01
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467
| 9,945
|
The systemic septic response: concepts of pathogenesis.
Following resuscitation from shock, the clinical phase of persistent hypermetabolism is entered from which a substantial number of patients transcend into progressive organ failure and expire.
The available epidemiologic, physiologic, and metabolic data are consistent with the position that a persistent degree of microcirculatory hypoxia, although it may be present in amounts that are below the sensitivity of current detection systems, becomes an increasingly less important etiologic factor as the organ failure disease progresses.
Rather, aerobic metabolism appears to be the dominant mechanism of meeting the increased work loads and energy demands.
There is an increasing body of evidence that cytokine release systemically, and increased cell-cell interaction through cytokines and prostanoids locally, may alter not only parenchymal function in the proximity of these mononuclear cells, but organ function at distant sites.
If this latter hypothesis continues to be substantiated, it implies that the underlying cell and organ dysfunction may indeed be reversible if appropriate counter-regulatory mechanisms could be developed and the appropriate timing of their application understood.
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C01
|
468
| 5,758
|
A rhesus monkey model for sexual transmission of a papillomavirus isolated from a squamous cell carcinoma.
Recently we molecularly cloned and characterized a papillomavirus from a lymph node metastasis of a primary penile carcinoma found in a rhesus monkey; this virus species, rhesus papillomavirus type 1 (RhPV-1), is similar to oncogenic human papillomaviruses (HPVs), such as HPV-16 or HPV-18, in that the RhPV-1 DNA was found to be integrated in the tumor cell DNA.
To compare the sexual transmission and oncogenic nature of RhPV-1 with these HPVs, we undertook an extensive retrospective study of a group of rhesus monkeys whose sexual mating and offspring histories were known.
These animals had mated directly with the index male mentioned above or were secondarily exposed to this virus through intermediate sexual partners.
This study combines cytological, histopathological, and several complementary hybridization and DNA amplification techniques on multiple tissue samples to demonstrate the sexually transmitted nature of RhPV-1.
The oncogenic potential of RhPV-1 is suggested in several of the infected animals by the presence of various degrees of neoplasia including squamous cell cancer of the cervix.
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C01
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469
| 4,820
|
Early hospital discharge of children with cancer treated for fever and neutropenia: identification and management of the low-risk patient.
Children with leukemia and solid tumors are often hospitalized for empiric broad-spectrum antibiotic therapy because of fever during periods of chemotherapy-induced neutropenia.
Conventional practice dictates that parenteral antibiotics be continued until the patient is afebrile and has recovered from neutropenia, ie, until the absolute neutrophil count (ANC) exceeds 500 cells per cubic millimeter.
However, the practice in our center has been to discontinue parenteral antibiotic therapy and discharge many such patients before resolution of neutropenia.
Since the feasibility and safety of this approach has not been studied, we reviewed the records of 114 consecutive hospitalizations for fever and neutropenia in 61 patients during a 13-month period.
Seventy-seven children (68%) were discharged to their homes while still neutropenic after they had been afebrile for 1 to 2 days on parenteral antibiotics, had negative blood cultures, appeared well, and usually had some evidence of bone marrow recovery.
Five patients (4.4%) developed recurrent fever and required rehospitalization within 7 days of discharge.
Only three of the 77 patients (3.9%) who were sent home with neutropenia had recurrent fever.
Each had a brief and uneventful second hospitalization.
Two of the 37 children discharged with an ANC over 500 cells per cubic millimeter required rehospitalization.
A declining ANC and advanced malignancy were risk factors in predicting recurrence of fever following discharge.
A rising monocyte count was a predictor of imminent recovery from neutropenia.
These results suggest that "early" discharge of an afebrile yet still neutropenic patient is safe when the patient is in remission, has no evidence of serious infection, appears clinically stable, and has indications of bone marrow recovery.
The conventional approach of routinely continuing the hospitalization until resolution of neutropenia may be unnecessary in such low-risk patients.
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C01
|
470
| 9,168
|
Helicobacter pylori infection: a simplified diagnostic approach.
We evaluated the diagnostic accuracy of endoscopic finding of nodular antritis and rapid urease test (RUT) in order to simplify the approach to the diagnosis of Helicobacter pylori (H.
pylori) infection.
Forty-four consecutive patients (mean age 7.9 yr, range 6-13 yr) referred because of recurrent abdominal pain as the main symptom, were prospectively investigated for the presence of H.
pylori.
H.
pylori positivity or negativity was defined as the concordance of two of the following tests: RUT, microbiologic culture, and histologic examination on bioptic samples.
RUT sensitivity was 100%, whereas specificity was 87.5%.
The presence of nodular antritis had a sensitivity of 96.4% and specificity of 87.5% in H.
pylori infection diagnosis.
The predictivity value of combined RUT and nodular antritis, whether positive or negative, was 100%.
Only in case of discordance do we suggest the utilization of other expensive tools for diagnosis of H.
pylori infection.
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C01
|
471
| 2,892
|
Comparison of cilofungin and amphotericin B for therapy of murine candidiasis.
We compared the efficacies of cilofungin and amphotericin B treatment in a murine model of disseminated candidiasis.
Three different dosages of each drug plus controls were evaluated.
Statistically improved survival was noted only among mice treated with 1 mg of amphotericin B per kg of body weight (P less than 0.05).
While all amphotericin B regimens and the two lower-dosage cilofungin regimens significantly reduced yeast cell counts in kidneys compared with the controls, the amphotericin B-treated mice had a significantly higher percentage of sterile kidneys following therapy compared with those treated with cilofungin (P = 0.0001).
|
C01
|
472
| 9,620
|
The role of indium-labelled leukocyte imaging in pyrexia of unknown origin.
Indium-111-labeled white blood cell scanning is often used in the investigation of pyrexia of unknown origin (PUO) to locate an otherwise occult source of sepsis.
From a series of 166 white blood cell studies performed for sepsis, 28 cases of true PUO were identified and reviewed.
The sensitivity was 60% and specificity 70%, with a positive predictive value of 38% and negative predictive value of 90%.
Only 11% of studies revealed a pyogenic cause for PUO.
These results are discussed and the potential role of gallium scanning in PUO is raised.
|
C01
|
473
| 8,802
|
Helicobacter pylori and gastric carcinoma. Serum antibody prevalence in populations with contrasting cancer risks.
This investigation examined the correlation between Helicobacter pylori (HP) infection, as reflected in immunoglobulin G serum antibodies, and the risk of gastric cancer.
Serum samples were obtained from populations with contrasting gastric cancer risks.
The highest prevalence of HP infection, 93%, was observed in the adult population at highest gastric cancer risk, the residents of Pasto, Colombia.
In the lower risk Colombian city of Cali, a 63% overall prevalence rate was found.
Both children and adults were sampled in New Orleans, Louisiana, where gastric cancer rates are high for blacks but not for whites.
The prevalence of HP infection was significantly higher in black than in white adults, 70% versus 43%, P = 0.0001.
A higher prevalence was also detected in black compared with white children, 49% versus 32%, P = 0.01; however, an even greater disparity was noted when comparing children from two hospitals, regardless of race, which serve different socioeconomic groups.
A prevalence rate of 54% was found at Charity Hospital compared with 24% (P = 0.0001) at Children's Hospital.
Our findings indicate that socioeconomic conditions, known to influence gastric cancer risk, are also important determinants of HP infection.
|
C01
|
474
| 6,398
|
Epidemiology of Lyme disease in Virginia.
Prior to January 1986, only one case of Lyme disease was reported from Virginia.
In 1986-87, however, the Virginia Department of Health observed an increase in reports of suspected Lyme disease by physicians, despite the fact that Ixodes dammini is not highly prevalent in the Virginia tick population.
Twenty-eight cases of Lyme disease were identified in Virginia, of which eight cases occurred in 1986 and 20 in 1987.
Lyme disease appears to be increasing in frequency in Virginia and moving southward along the Eastern Atlantic Seaboard.
|
C01
|
475
| 4,742
|
Causes of death in hospitalized intravenous drug abusers.
The authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital.
There were 127 who died from diseases unrelated to intravenous drug abuse, and in 41% of these, chronic alcoholism was implicated.
Deaths from overdose syndromes and drug-related organ pathology comprised only 11% of all cases.
The mean age at death was 39 years.
There was a male/female ratio of 3.6:1.
Half of all patients died from infection--72 from acquired immunodeficiency syndrome (AIDS) alone.
These findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that AIDS and chronic alcoholism are significant problems.
Emphasis should be placed upon detecting "hidden" intravenous drug deaths to provide more accurate statistical information.
|
C01
|
476
| 7,675
|
Group B streptococcus endocarditis following second-trimester abortion.
An 18-year-old woman who underwent an elective second-trimester abortion developed Streptococcus agalactiae (group B streptococcus) endocarditis characterized by a large, pedunculated vegetation involving a previously normal tricuspid valve.
Polyarthritic symptoms, as well as multiple pulmonary emboli, were experienced, and cure followed a course of treatment using intravenous penicillin G potassium combined with gentamicin sulfate.
Endocarditis caused by this pathogen usually occurs among individuals compromised by underlying chronic disorders and, today, is a rare sequela of pregnancy and abortion.
When planning therapy, consideration should be given to the possibility of tolerance among clinical isolates and the need for operative intervention in selected patients.
|
C01
|
477
| 5,627
|
Thrombocytosis after pneumonia with empyema and other bacterial infections in children.
Thrombocytosis is seen in association with many conditions, including infectious diseases.
We studied thrombocytosis after severe bacterial infections, particularly pneumonia with empyema in children.
A systematic survey of the phenomenon was conducted.
Twenty-seven children admitted for pneumonia with empyema were studied.
Thrombocytosis (platelet counts greater than 500 x 10(3)/microliters) was present in 92.5%.
Platelet counts reached their maximum at 15.1 +/- 3.7 days (range, 7 to 25) and declined to normal after 3 weeks of illness.
Compared with a healthy control group, significant thrombocytosis, but of lower incidence, was also noted in children with lobar pneumonia without pleural effusion, bacterial meningitis and osteomyelitis.
Platelet functions were examined in seven of the children but no abnormalities were observed.
Bone marrow aspiration of three children with pneumonia and empyema showed megakaryocytic hyperplasia.
We found no correlation between thrombocytosis, neutrophilia, fever, the clinical course, complications, prognosis or treatment.
Neither thromboembolic nor hemorrhagic phenomena were observed.
|
C01
|
478
| 8,289
|
Vaginitis emphysematosa. A report of four cases.
It has been hypothesized that vaginitis emphysematosa is a manifestation of trichomonal or Gardnerella infection.
In support of this etiologic concept, four cases of the disorder are described showing the apparent curative effect of treating the associated infection.
The linkage of these and other reported cases with conditions of impaired immunity suggests that immunologic factors are involved in the pathogenesis.
|
C01
|
479
| 7,870
|
Risks of human immunodeficiency virus infection to patients and healthcare personnel.
The risk of nosocomial human immunodeficiency virus (HIV) infection among hospitalized patients comes almost exclusively from transfusion of fresh blood products.
Current estimates of the risk of HIV infection from the transfusion of blood or components vary from 1/40,000 to 1/250,000 (0.0025% to 0.0004%), with the most probable likelihood estimated to be 1/153,000 (0.0007%).
The major route of transmitting such HIV infection is via blood collected during the interval between infection of the donor and development of a detectable circulating antibody level to the AIDS virus (i.e., the "window period").
The current risk to hemophiliacs receiving treated coagulation factor concentrates is negligible.
The risk to healthcare personnel of acquiring HIV infection from accidental puncture wounds and from handling HIV-infected blood or body fluids is 0.42% per episode.
Most reported seroconversions have resulted from penetrating injuries with sharp objects contaminated with HIV-positive blood.
The degree of risk to healthcare workers will vary with the community, the patient population served, and the frequency of penetrating injuries.
|
C01
|
480
| 6,692
|
Erythromycin failure with subsequent Pasteurella multocida meningitis and septic arthritis in a cat-bite victim.
We report the case of a 75-year-old woman who developed Pasteurella multocida meningitis and septic arthritis while being treated for a cat-bite wound infection with erythromycin.
Review of the literature revealed that erythromycin has poor in vitro activity against this bacterium and has been associated with serious clinical failures.
We recommend that erythromycin not be prescribed for empiric therapy of established animal-bite infections.
Suggestions for optimal empiric therapy of animal-bite infections and the differential diagnosis of severe cat-bite-associated sepsis are discussed.
|
C01
|
481
| 5,909
|
Early postoperative care of the cardiac transplantation patient: routine considerations and immunosuppressive therapy.
The authors have attempted to outline the current state of the art with respect to the early postoperative management of the cardiac transplant recipient with special attention to immunosuppressive therapies.
The commonly used agents, as well as the most successful combination regimens, have been described along with the current levels of expectation regarding rates of rejection and infection.
Much has been learned regarding the management of these problems.
Much remains to be learned to further decrease the incidence of postoperative infection and rejection and, equally if not more importantly, studies to investigate the etiology of transplant coronary artery disease need to be undertaken such that measures to delay or prevent its occurrence and/or arrest its progression can be instituted.
|
C01
|
482
| 5,072
|
Fatal sepsis following intravesical bacillus Calmette-Guerin administration for bladder cancer.
Intravesical administration of bacillus Calmette-Guerin has been shown to be highly effective treatment of superficial bladder cancer.
Complications from bacillus Calmette-Guerin therapy are usually minor but serious and even fatal reactions can occur.
Five recent cases illustrate the gravity of bacillus Calmette-Guerin sepsis.
One man with severe debility and the organic brain syndrome died acutely with a fever of 40 C.
Two men had frank sepsis that progressed to multiorgan failure and death.
Sepsis progressed despite the use of isoniazid, rifampin and streptomycin.
Two men who had equally progressive sepsis with intravesical bacillus Calmette-Guerin survived with the use of cycloserine for the first 72 hours of treatment.
Triple antituberculous antibiotics, including cycloserine, may be lifesaving.
Sepsis resulted from intravenous absorption through inflamed or disrupted urothelium.
Bacillus Calmette-Guerin treatment should not be administered in the presence of severe cystitis or after grossly traumatic catheterization.
|
C01
|
483
| 5,261
|
Impact of active immunisation against enteritis necroticans in Papua New Guinea.
Enteritis necroticans, known locally as pigbel, has been a major cause of illness and death among children in the highlands of Papua New Guinea.
After a successful trial of active immunisation against the beta toxin of the causative organism, Clostridium perfringens type C, immunisation of children was begun in 1980.
The effects of the immunisation programme on pigbel admissions in 3 of the 5 major highland hospitals were assessed.
In each of the centres studied the proportion of admissions due to enteritis necroticans dropped significantly after immunisation was introduced (p less than 0.001) and hospital admissions for pigbel in 1984-86, when immunisation was well established, were less than one fifth of previous figures.
|
C01
|
484
| 9,948
|
Altered Ca2+ homeostasis and functional correlates in hepatocytes and adipocytes in endotoxemia and sepsis.
Decreased cytosolic [Ca2+] and impaired Ca2+ release in response to an IP3 challenge are among perturbations in hepatocyte Ca2+ homeostasis associated with endotoxemia and sepsis.
These changes are consistent with the accompanying alterations in appropriate physiologic functions, e.g., activation of glycogen phosphorylase and gluconeogenesis, mediated by [Ca2+]c and defective phosphorylation of relevant enzymes.
Attenuation of IP3 binding to the subcellular fractions that are imputed to be targets of IP3 and a decrease in the size of the IP3-sensitive pool of releasable Ca2+ are underlying components of the mechanism of the reduced Ca2+ release upon IP3 stimulation and its metabolic sequelae.
ET treatment leads to a significant increase in Ca2+ associated with the cell surface compartment of adipocytes, a reduction in 45Ca2+ uptake by endoplasmic reticulum and higher cytosolic [Ca2+] under basal conditions and upon ACTH stimulation than that observed in cells of control rats.
The reduced 45Ca2+ uptake is also manifest in adipocytes of septic rats.
Alterations in adipocyte metabolism induced by ET include increased oxidation of glucose to CO2 (an insulin-like effect) and increased lipolysis upon NE and ACTH stimulation.
|
C01
|
485
| 7,271
|
Isolation of HIV-1 from the blood of seropositive adults: patient stage of illness and sample inoculum size are major determinants of a positive culture. The Walter Reed Retroviral Research Group.
Results of HIV-1 blood cultures from 609 seropositive adults across all stages of illness at the Walter Reed Army Medical Center were reviewed.
HIV-1 was isolated by coculturing of patient peripheral blood mononuclear leukocytes (PBMCs) with normal blood donor target PBMCs that had been stimulated with phytohemagglutinin and interleukin-2.
The HIV-1 isolation success rate at Walter Reed increased progressively each year from 1986 to 1989.
In 1989, HIV-1 was isolated from a single blood specimen from patients in Walter Reed stages 1-2, 3-4, and 5-6 in 75% (49/65), 90% (37/41), and 97% (30/31) of cases, respectively.
None of 22 blinded negative control specimens was positive.
PBMC cultures from late stage patients regularly became positive within 7 days (92%), compared to only 46% of positive cultures from early stage patients.
For most patients, the lowest number of serially diluted PBMCs that resulted in a positive culture was 30,000 patient PBMCs, but the range was 300 to 3 million cells.
HIV-1 was isolated less frequently from plasma (5/18, 28%).
Plasma viremia was detected only in patients with relatively high titers of infected PBMCs.
Forty-six blood specimens from "at-risk" seronegative adults were also cocultured; none was positive.
|
C01
|
486
| 883
|
Itraconazole treatment of phaeohyphomycosis.
Nineteen patients with phaeohyphomycosis were treated with itraconazole.
Of these, 17 were assessable for clinical outcome.
Of these, two had received no prior therapy, five had failed amphotericin B therapy, four had failed ketoconazole or miconazole therapy, and five had failed both amphotericin B and azole therapy.
One patient had received only prior surgical intervention.
Fungi of seven different genera caused disease of the skin in nine patients, soft tissue in nine, sinuses in eight, bone in five, joints in two, and lungs in two.
Itraconazole was given in dosages ranging from 50 to 600 mg/day for 1 to 48 months.
Clinical improvement or remission occurred in nine patients.
Two patients have had stabilization of disease.
Six patients failed treatment, one had a relapse after initially successful treatment.
Itraconazole appears to be highly effective in some patients with phaeohyphomycosis, including patients refractory to other antifungal agents.
|
C01
|
487
| 6,843
|
Thoracoplasty: current application to the infected pleural space
Thoracoplasty, once commonly used in the management of cavitary pulmonary disease, continues to find application in the obliteration of infected pleural spaces.
This study reports a series of 13 patients receiving thoracoplasty between 1976 and 1989.
Five patients had chronic apical empyema spaces without prior resection of lung tissue.
Two of the empyemas were due to tuberculosis, two were due to atypical mycobacteria, and one was due to postpneumonic empyema.
All patients had extensive destruction of upper lobe tissue.
Eight patients had undergone prior pulmonary resection; 3 had persistent infected spaces in the early postoperative period, 3 had development of empyemas and bronchopleural fistulas late (5 to 19 years) after pulmonary resection, and 2 had postpneumonectomy empyema.
All patients had rigid cavity walls preventing space obliteration by rib removal alone and required concomitant resection of the thickened pleura and intercostal muscle tissues.
Bronchopleural fistulas were present in 11 patients and were closed with adjacent nonintercostal muscle.
All patients survived and had successful obliteration of the infected spaces with acceptable physiological and cosmetic results.
We conclude that thoracoplasty remains a useful procedure in the management of the infected pleural space in select patients.
|
C01
|
488
| 718
|
Mechanical cardiopulmonary support for refractory cardiogenic shock.
From February 1982 to February 1990, 38 patients (30 male patients and 8 female patients) ranging in age from 10 to 78 years (mean 49.4 years) have been supported with arteriovenous extracorporeal membrane oxygenation (ECMO) at St.
Louis University Medical Center as a resuscitative system for cardiac arrest or cardiogenic shock.
All patients were unresponsive to conventional resuscitative measures including an intraaortic balloon pump in 25 patients.
Patients were resuscitated in the intensive care unit, cardiac catheterization laboratory, or the emergency department.
Diagnosis varied from acute myocardial infarctions (12 patients), ischemic disease (15 patients), end-stage cardiomyopathy (7 patients), congenital heart disease (3 patients), or postoperative cardiac transplant graft rejection (1 patient).
Three patients could not be resuscitated with ECMO because of low flow, but the remaining 35 (92%) achieved hemodynamic stability with ECMO flows greater than 2 L/min/m2.
Duration of support ranged from 0.5 to 130 hours (mean 28 hours).
Twenty-four patients were successfully weaned from ECMO support after coronary artery bypass (five patients), cardiac transplantation (two patients), or ventricular assist device insertion (eight patients), or with inotropic support (nine patients).
Of the 14 patients not weaned, three were inadequately resuscitated, two had percutaneous transluminal coronary angioplasty while receiving ECMO, and nine were not candidates for further intervention.
Nine (24%) patients were discharged and are long-term survivors.
Our results indicate that resuscitative ECMO is useful for intervals of 12 to 24 hours and can best be applied with (1) patients younger than 60 years of age; (2) patients having acute events (failed percutaneous transluminal coronary angioplasty) amenable to surgical intervention; and (3) candidates for cardiac transplantation who could be switched to more sophisticated devices within 12 to 24 hours of ECMO insertion.
With these criteria, ECMO, when used as a resuscitative system, can result in increased survival in selected patients with refractory cardiogenic shock or cardiac arrest.
|
C01
|
489
| 4,341
|
Efficacy and tolerability of topical terbinafine in the treatment of tinea cruris.
Thirty men with clinical and mycologic evidence of tinea cruris were enrolled in a controlled, randomized, double-blind trial comparing terbinafine 1% cream and its cream vehicle as placebo.
Patients applied the test medications to the affected area twice daily for 2 weeks.
Therapeutic response was evaluable in 18 patients after each week of treatment and at a follow-up visit 2 weeks after therapy ended.
At each visit, terbinafine was found to be more effective than the cream vehicle in the reduction of the signs and symptoms of infection and in the conversion of culture and microscopy findings to negative or normal.
At the end of treatment, therapy was effective in 67% of the nine terbinafine-treated patients compared with only 11% of the nine placebo-treated patients.
At the follow-up examination, efficacy rates were 78% in the terbinafine treatment group and 33% in the placebo group--a difference of borderline statistical significance (p = 0.077).
Possible reasons for this result may include the higher incidence of chronic disease in the terbinafine group and the large number of patients who were classified as delayed exclusions because of negative initial culture for dermatophytes.
No side effects or significant alterations in laboratory or hematologic tests were observed in either treatment group.
|
C01
|
490
| 7,667
|
Clindamycin vs penicillin for anaerobic lung infections. High rate of penicillin failures associated with penicillin-resistant Bacteroides melaninogenicus.
Thirty-seven adult patients with anaerobic lung infections (27 lung abscesses and 10 necrotizing pneumonias) were submitted to transthoracic needle-aspiration and/or bronchoscopic specimen brush cultures before therapy and thereafter in all cases considered to be failures.
Patients were randomly assigned to receive either clindamycin, 600 mg intravenously every 6 hours, or penicillin G, 2 million U every 4 hours for no less than 8 days, until clinical and radiological improvement became apparent.
Treatment was continued orally with clindamycin, 300 mg every 6 hours, or penicillin V, 750 mg every 6 hours, until completing a minimum of 4 weeks.
Ten of the 47 anaerobes initially isolated from the lung (nine Bacteroides melaninogenicus and one Bacteroides capillosus) were resistant to penicillin, but none were resistant to clindamycin.
Five of the nine patients harboring these penicillin-resistant Bacteroides received penicillin, and all failed to respond to therapy.
Overall, eight of the 18 patients in the penicillin group and one of 19 in the clindamycin group failed to respond to therapy.
These drugs were equally well tolerated in both groups.
The presence of penicillin-resistant Bacteroides is a frequent cause of penicillin failure in patients with anaerobic lung infections.
In this setting, clindamycin appears to be the current therapy of choice for initial treatment.
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491
| 2,546
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High infectious morbidity in pregnant women with insulin-dependent diabetes: an understated complication.
Patients with insulin-dependent diabetes are prone to infection, possibly related to poor metabolic control.
Relative immune deficiency exists in pregnancy.
We hypothesized that pregnant patients with insulin-dependent diabetes are at an increased risk for infection and that infection is related to poor glycemic control.
We matched 65 pregnant women with insulin-dependent diabetes to 65 nondiabetic pregnant controls.
At least one episode of infection before delivery occurred in 83% of the women with insulin-dependent diabetes (26% in control group).
The rate of postpartum infection was five times higher in the group with insulin-dependent diabetes and they were susceptible to more kinds of infections.
Although there was no overall difference among the indices of glycemic control, hemoglobin A1 obtained before the infection was higher than during infection.
We conclude that a high rate of infection exists in pregnant women with diabetes; infection and poor glycemic control may be associated, but it is unclear whether improvement in metabolic control will reduce this high infection rate.
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492
| 761
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The modified Schollner costoplasty.
The modified Schollner costoplasty is a cosmetic procedure for the correction of rib prominence deformity in scoliosis.
We present the results of the procedure in 21 patients who had previously undergone spinal fusion for scoliosis.
We found the procedure to be well tolerated without major complications.
Objective cosmetic improvement was achieved in all but one case.
All but one patient considered the procedure to have been of cosmetic benefit.
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C01
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493
| 8,108
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Why use drains?
There is no firm published evidence to support the use of closed suction drains.
Over 20 years ago, large studies by the Public Health Laboratory Service and the National Research Council found that drains were risk factors for wound infection.
A prospective randomised study of the use of closed suction drains after surgery for fractured neck of femur in 70 patients failed to show that drains improved wound healing.
Drained cases had more complications.
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494
| 2,988
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Desensitization in the management of vancomycin hypersensitivity.
Vancomycin is the preferred antimicrobial agent in the treatment of methicillin-resistant staphylococcal infections.
One of the well-known hypersensitivity reactions to this agent is the "red-man syndrome," which is believed to involve drug-induced histamine release in certain individuals.
Although rate and/or dose reductions may be effective in some cases, some hypersensitivity reactions necessitate the discontinuation of vancomycin.
In this article one patient is described who developed vancomycin-associated reactions consistent with the red-man syndrome despite having tolerated vancomycin administration previously.
This case was managed by sequential increments in vancomycin administration over several days that allowed for therapeutic doses of the drug to be administered.
Prior to desensitization, vancomycin administration at a lowered rate and dose was unsuccessfully attempted, despite the presence of combination antihistamine therapy.
A loss of skin prick test reactivity to vancomycin was demonstrated after successful desensitization.
This desensitization method may be useful in managing certain refractory cases of vancomycin hypersensitivity.
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495
| 9,300
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A rat model of prolonged pulmonary infection due to nontypable Haemophilus influenzae.
Pulmonary colonization and infection with nontypable (unencapsulated) Haemophilus influenzae (NTHI) occurs commonly in the setting of chronic lung diseases.
Because the study of NTHI pulmonary infection in animal models has been limited by the rapid clearance of organisms, a model of persistent pulmonary infection was developed.
Groups of rats were inoculated by transtracheal instillation of viable NTHI suspended in broth or semisolid agar.
Some rats had received hexamethylphosphoramide (HMP) in drinking water before inoculation to cause respiratory epithelial mucosal damage.
Groups of animals were sacrificed serially.
Lungs were cultured quantitatively and their gross and microscopic anatomy examined.
NTHI was recovered in small quantities from few broth-inoculated rats after the first day of infection and in none after Day 7.
In contrast, NTHI was recovered from the majority of animals and in greater amounts through 2 wk after agar-borne inoculation.
HMP pretreatment further enhanced recovery through 4 wk after inoculation with an agar vehicle.
The pulmonary inflammatory reaction was brief in broth-inoculated rats.
The longer persistence of gross and histologic changes seen in agar-infected lungs paralleled the enhanced recovery of NTHI.
Abscess formation occurred at 7 to 14 days in some agar-inoculated animals.
Thus pulmonary inoculation of NTHI in a viscous vehicle resulted in perpetuation of infection and inflammatory response, and previous damage to respiratory mucosal epithelium induced by HMP further enhanced such infection.
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C01
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496
| 8,310
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Human papillomavirus infections of the genital tract.
Infection of the genital tract by HPV is a sexually transmitted disease of increasing prevalence.
The association of HPV infection with genital tract malignancies is of great concern, and further studies are needed to clarify this association.
Few investigators believe at this time that proof of a direct causative role exists for HPV in these cancers, but indirect evidence of such a role is abundant.
There are many clinical forms of HPV infection of the genital tract, and few clinicians can easily recognize them all.
Treatment of condyloma acuminatum is difficult and frustrating.
Cryotherapy with liquid nitrogen is the safest and most effective therapy for most forms of condyloma acuminatum.
Recurrence of condyloma acuminatum is common with all presently used forms of therapy, probably owing to latent HPV infection in normal-appearing skin.
No form of treatment is ideal for all forms of condyloma acuminatum, but without continued efforts to find better therapeutic modalities and preventative measures, the epidemic of genital HPV infection will continue unchecked.
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497
| 8,653
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Helicobacter pylori and associated duodenal ulcer.
Twenty three children with coexistent duodenal ulcer and Helicobacter pylori infection were treated with either two weeks of amoxycillin (25 mg/kg/day) in addition to six weeks of cimetidine, or cimetidine alone.
Endoscopy with antral and duodenal biopsies for urease test, microaerophilic culture, and histological studies were performed at entry, six weeks, 12 weeks, and at six months.
Children with persistent H pylori infection at six weeks were given a further two weeks' course of amoxycillin.
H pylori persisted in all children not receiving amoxycillin treatment but cleared in six of the 13 children (46%) treated with amoxycillin.
With failure of H pylori clearance at six months, only two out of six (33%) ulcers had healed and 50% of patients had experienced ulcer recurrence.
In contrast, when H pylori remained cleared all ulcers healed and no ulcer recurred.
Persistent H pylori infection was associated with persistent gastritis and duodenitis despite endoscopic evidence of ulcer healing.
Detection and eradication of H pylori deserves particular attention in the routine management of duodenal ulceration in children.
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498
| 8,993
|
Endophthalmitis after placement of a Molteno implant.
I report a case of early postoperative endophthalmitis following placement of a Molteno implant.
Excellent results were obtained by immediate removal of the implant and surgical management of the infection, followed by replacement of the implant.
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499
| 3,728
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Quality of well-being before and after antibiotic treatment of pulmonary exacerbation in patients with cystic fibrosis.
General quality of life has only recently been measured with an objective tool in patients with cystic fibrosis (CF), and there have been no reported attempts to document changes in patients' overall well-being over time, as patients deteriorate or respond to intervention.
We applied the Quality of Well-Being scale (QWB) in 28 patients with CF before and after a two-week course of oral ciprofloxacin used to treat pulmonary exacerbations.
There were significant correlations between changes in QWB and various pulmonary function test results; QWB vs FEV1: r = 0.4, p less than 0.03; QWB vs FVC: r = 0.5, p less than 0.01; and QWB vs SaO2: r = 0.4, p less than 0.05.
Thus, the QWB can track changes in general well-being in CF patients over a brief time and detect changes associated with pulmonary exacerbation and its treatment.
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