Biomedical subjects
Publications and source records attributed to A Felten.
Several cases are reported of cervico-facial suppuration of buccodental origin, the infection being due to Eikenella corrodens, a facultative anaerobic germ that is difficult to culture. Conditions appropriate to the growth of these germs are discussed with respect to etiological, bacteriological and clinical factors. Therapy is outlined and a selective bibliography proposed.
The first case report concerns a 31 year old woman presenting clinically and electrocardiographically as an anteroseptal myocardial infarction complicated by cardiogenic shock with equalization of right heart diastolic pressures. Coronary angiography performed under circulatory assistance was normal. The patient recovered, and clinical examination 4 years after the acute episode is absolutely normal. The second case was a 37 year old man admitted in cardiogenic shock thought to be due to a large anterior myocardial infarct. Catheterisation showed equalization of right heart diastolic pressures. Pericardial aspiration was negative and the most likely diagnosis appeared to be a localised rupture of the heart. The patient underwent emergency cardiac surgery but no infarct scar was observed and opening the pericardium did not improve the haemodynamics. Coronary angiography was carried out at the 24th hour under circulatory assistance and was found to be normal. The diagnosis was corrected to that of acute myocarditis and 5 months after the acute episode clinical cure was confirmed by normal echocardiography and angiography. The only positive aetiological finding in this case was the serology to chlamydia trachomatis which as strongly positive at increasing titres. Chlamydia was isolated from the patient's urethra and a chlamydia trachomatis exocervicitis was also found in the partner. This appears to be the first reported case of chlamydia trachomatis acute myocarditis in the adult.
The authors report the case of a 35 year old female hospitalised for gonococcal endocarditis with mitral valve vegetations infecting pre-existing asymptomatic rheumatic mitral incompetence. Apyrexia was rapidly obtained with antibiotic therapy; the valvulopathy was well tolerated from the hemodynamic viewpoint; the echocardiographic appearances of the vegetations were stable. However, the patient died during the third week of a cerebral haemorrhage, probably due to rupture of a mycotic arterial aneurysm. The authors suggest that the difficulties encountered in the fight against sexually transmitted diseases may result in a recrudescence of this type of disseminated gonococcal infection.
Most of intracranial suppurations, especially those from E.N.T. origin, are secondary to anaerobic germs, which can be cocci Gram (+) or Gram (-), in association or not with aerobic bacteria. 97 cases have been observed between 1968 and 1979 at Lariboisière Hospital. When the bacteriological study was realised in correct conditions, anaerobic germs were found in more than 60% of cases, and less than 10 % of cultures were negative. A lower mortality (11 %) and morbidity (34 %) rates follow an improvement in bacteriological diagnosis. Anaerobic bacteria stay very susceptible to antibiotics, such as the association Penicilline-Metronidazole; now, we prescribe immediately such a therapeutic, and eventually modify it after having received the antibiogram. As a conclusion, the treatment of brain abscesses could be simplified: CT scan and a rigourous bacteriology make possible an accurate control and follow-up of the suppuration after simple punction.
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The chemiluminometric sandwich immunoassay, Magic Lite Chlamydia by Ciba Corning (Medfield, MA), using one Chlamydia trachomatis-specific monoclonal antibody conjugated with acridinium ester and one polyclonal immobilized to magnetic particles, was compared to cell culture in 291 urogenital specimens from 92 men and 102 women tested both in the cervix and urethra. The proportion of patients with positive culture results ranged from 11.8% among the women to 15% among the men, using microculture plates and peroxidase-antiperoxidase staining procedure with genus-specific monoclonal antibody (Orthodiagnostics, Raritan, NJ). The chemiluminometric method for detecting Chlamydia trachomatis antigen showed an overall sensitivity of 72.4%, specificity of 97.7%, positive predictive value of 77.7%, and negative predictive value of 96.9%. A higher sensitivity of Magic Lite was found in clinical specimens yielding more than 10 inclusions by well in cell culture. The newly developed chemiluminometric test, easy to perform, had the same limits in terms of sensitivity and positive predictive value than the other widely-used existing tests for detecting Chlamydia trachomatis antigen from urogenital specimens.