Biomedical subjects
Publications and source records attributed to A A Harris.
A pseudoepidemic due to Salmonella typhimurium occurred in the clinical microbiology laboratory of a university hospital and involved 10 patients. One patient received "unnecessary" antibiotics. Investigation of the events implicated a contaminated rubber pipette bulb. Such bulbs should be considered as a possible source of false-positive cultures.
24 patients admitted to hospital between December 1, 1977 and March 3, 1978 with cultural or serological evidence of influenza A infection were retrospectively analyzed for evidence of elevated creatine phosphokinase (CPK) levels. 14 patients had elevated CPK levels not attributable to usual causes. Muscle biopsies from 2 patients showed focal necrosis and myopathic changes. Influenza A/Texas/1/77 was isolated from the biopsy specimen of 1 patient. Patients with elevated CPK levels tended to have greater per day hospital costs and more complications than patients with normal CPK levels. Elevated CPK levels are relatively common in hospitalized patients with influenza and may be due to influenza virus involvement of skeletal muscle.
Aeromonas hydrophila myonecrosis with gas gangrene and bacteremia developed in an elderly patient after minor trauma from a fishbone. Despite aggressive medical and surgical therapy, she experienced a rapidly fatal outcome. Literature on Aeromonas muscle infection is reviewed and implications for therapy are discussed.
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Thirty-five patients underwent 38 treatment courses with cefotaxime. Documented infections included 11 bacteremias, 7 cases of nosocomial pneumonia, 6 surgical wound infections, 3 bone infections, 1 biliary infection, and 1 urinary tract infection. Granulocytopenic patients with fever received 15 courses of empiric cefotaxime therapy alone; in 8 courses, no definite site of infection or pathogen was isolated. Broad-spectrum antibiotics had been administered to 23 patients before cefotaxime. Thirty-seven bacterial pathogens were isolated from 25 patients. Three such pathogens were resistant to cefotaxime and required alternative therapies. Pathogenic isolates included 13 Serratia marcescens, 12 Pseudomonas aeruginosa, 4 Escherichia coli, 2 Klebsiella pneumoniae, 2 Providencia stuartii, 1 Enterobacter cloacae, 1 Haemophilus influenzae, 1 Enterococcus, and 1 Staphylococcus aureus. Of the treatment courses, 25 of 38 resulted in a favorable response to cefotaxime, including 9 of 15 in granulocytopenic patients. Superinfection was seen in one patient. The emergence of resistance was documented in another patient. Of 15 patients with multiply resistant pathogens, 12 improved with cefotaxime. Of 12 patients with Pseudomonas aeruginosa, 6 favorably responded. Possible complications of cefotaxime were observed in 14 of 42 treatment courses. Cefotaxime is most useful in treatment of infections due to multiply resistant, gram-negative pathogens other than Pseudomonas aeruginosa.
The use of trimethoprim-sulfamethoxazole in the treatment and prophylaxis of Pneumocystis cariniii is well established. Treatment failure with this regimen has been ascribed to inadequate antibiotic serum concentrations. We describe an immunosuppressed patient with recurrent Pneumocystis carinii pneumonia who failed to respond to trimethoprim-sulfamethoxazole therapy despite high antibiotic serum concentrations. Subsequently, a response to pentamidine isethionate was obtained. The reason for failure and therapeutic implications in patients with Pneumocystis carini pneumonia who have received trimethoprim-sulfamethoxazole are discussed.
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Influenza A/Texas/1/77 was isolated from a muscle biopsy specimen from a patient with muscle weakness and increased serum creatine phosphokinase level. The patient was seen during an outbreak of influenza A/Texas/1/77 that was associated with myopathy. Isolation of this virus from this patient's muscle specimen suggests that the myopathy associated with influenza may be due to direct infection of skeletal muscle.
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During a 17 month period, 25 hospitalized adult patients had blood cultures reported as positive for Pseudomonas maltophila. Review of the hospital records suggested that these were contaminants and that blood for coagulation studies and for cultures that were subsequently positive had been drawn simultaneously. The source of contamination appeared to be black-top evacuated collection tubes used for coagulation studies in adults. Cultures of the liquid anticoagulant tubes yielded a pure growth of greater than 10(5) colony forming units (CFU)/cc of Ps. maltophilia on blood agar. Mock trials demonstrated that following venipuncture by syringe, inoculation of contaminated black-top tubes prior to inoculation of blood culture bottles would yield false-positive blood cultures (pseudosepticemia). One patient being treated for streptococcal prosthetic valve endocarditis and having frequent coagulation studies with blood obtained via direct venipuncture into evacuated collection tubes was found to have superinfection of his prosthetic valve with Ps. maltophilia at autopsy. Prosthetic valve infection may have occurred after reflux of contaminated anticoagulant from an evacuated collection tube directly into the vein. Contaminated evacuated collection tubes are a potential source of confusion in the diagnosis of infection as well as a potential source of true infection.
Reported is a patient with associated papilledema and syphilitic meningitis. The clinical picture initially suggested an intracranial mass lesion. The cause of the papilledema in this patient was not clear; it did not appear to be related to increased intracranial pressure. Patients with syphilitic meningitis should receive prompt penicillin therapy to avoid serious neurologic sequelae.
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In 1985, Illinois experienced a large milkborne outbreak of Salmonella typhimurium with over 16,000 cases. During this year, 49.4% of United States and 86.4% of Illinois salmonellae were S. typhimurium. In 1986, 1133 microbiologically confirmed and serotyped cases of salmonellosis were reported in the City of Chicago, comprising 37% of the 3034 cases reported for the State of Illinois. The most frequent serotypes were S. typhimurium (21.3%), Salmonella heidelberg (18.2%), Salmonella enteritidis (10.7%), and Salmonella braenderup (7.7%), similar to the state as a whole. Nationally, excluding Illinois, the most frequent serotypes in 1986 were S. typhimurium (26.1%), S. enteritidis (14.7%), and S. heidelberg (13.0%). S. braenderup comprised 0.9% of the non-Illinois total. Regional variations in the epidemiology of salmonellae are probable and may reflect detected or undetected outbreaks. Within a year of the nation's largest Salmonella outbreak, there was no trace of any effect on the frequency of isolation of Salmonella spp.