Biomedical subjects
Publications and source records attributed to A J Weinstein.
Invasive aspergillosis developed in a patient without preexisting lung disease or immunosuppression, after she had received only a one-month course of corticosteroid therapy. Surgical excision, without antifungal therapy, resulted in eradication of the infection.
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Prolonged hospitalization for therapy of some infections may be economically and emotionally costly to patients. A multidisciplinary team was organized at the Cleveland Clinic Hospital to coordinate the selection, education, and follow-up of patients receiving parenteral antibiotic therapy at home. Forty-eight patients were trained to mix and administer antibiotics and to care for the intravenous access device. Most patients had infections of the bones, joints, or soft tissues and received an average of 19 days of therapy at home. Beta-lactam antibiotic agents were administered to most patients and were well tolerated. The infection was eradicated in 87% of patients. The average saving in cost for each course of treatment was $5728.
Cephalexin is an oral cephalosporin which is widely used in the treatment of urinary tract infections. It is readily absorbed from the gastrointestinal tract and achieves high concentrations in the urine, where it retains its full activity against the organisms commonly responsible for urinary tract infections. It also achieves adequate serum levels. Cephalexin is essentially nontoxic at recommended doses, and its clinical efficacy in urinary tract infections has been repeatedly documented in numerous studies since 1971.
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A patient with granulomatous mediastinitis due to Aspergillus flavus is described. A 22 year old black man presented with cough, fever and a right hilar mass. Mediastinal biopsies revealed granulomatous fibrosing mediastinitis with fungal elements compatible with aspergillus species. A flavus was isolated on culture of this material and later from sputum and bronchial washings. Studies of the patient's immune status revealed normal humoral and cellular immunity. No underlying neoplasm was found. The patient was treated with amphotericin B and 5-fluorocytosine but esophageal and superior vena caval compression developed and he died. This is the first reported case of granulomatous mediastinitis due to A. flavus in a patient whose immune responses were not suppressed (nonimmunosuppressed patient). Infection with Aspergillus species should be considered in the differential diagnosis of granulomatous mediastinitis.
A distinction between "acute" osteomyelitis and "chronic" osteomyelitis is difficult on both clinical and histopathologic grounds. The classification of osteomyelitis into three groups (hematogenous osteomyelitis, osteomyelitis secondary to a contiguous focus of infection, and osteomyelitis associated with vascular insufficiency) allows the physician to clearly distinguish among the types of infection on the bases of (1) the pathogenesis, (2) the bones involved, (3) the microorganisms responsible, and (4) the therapy. When antimicrobial agents are administered to a patient with any form of osteomyelitis, a bactericidal antibiotic should be employed, if possible. If feasible, a parenteral route of administration should be utilized, and therapy should be administered for a prolonged period of time. When more than one bactericidal antibiotic has been demonstrated to be effective against the isolated microorganisms, the least toxic agent should be selected.
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Fatal Mycoplasma pneumoniae infection in a 30-yr-old woman is described. After 9 days of symptoms, the patient developed severe respiratory distress, rapidly progressive pneumonia, cardiovascular collapse, and acute renal failure. Death occurred 24 h after hospital admission. Postmortem examination demonstrated a diffuse membranous laryngotracheobronchitis, massive bilateral pneumonia, disseminated intravascular coagulation with widespread renal involvement, and hemorrhagic necrosis of the adrenal glands. Mycoplasma pneumoniae was isolated from the trachea, lungs, kidney, and brain, indicating hematogenous dissemination of the organism from its portal of entry in the respiratory tract.
The cephalosporin antibiotics have been employed with increasing frequency since their introduction into clinical practice in the early 1960s. With the exception of cephaloridine, cephalosporin compounds are not associated with the production of significant untoward effects. The availability of newer cephalosporins, both oral and parenteral, with enhanced antibacterial activity, has expanded the clinical indications for administration of these antibiotics.
CT-guided procedures were attempted in 103 patients suspected of having abscesses. CT-guided procedures were performed for diagnostic specimens in 70 patients; they were successful in 30 of 34 sterile collections and 33 of 36 abscesses. In another 33 patients, diagnostic aspiration was performed and percutaneous drainage was attempted; aspirations were successful in 33 of 33 and drainage in 28 of 33 cases. Of the five not drained, four were undrainable because of anatomic extent or high viscosity of the purulent material. The fifth was a necrotic, squamous cell tumor erroneously thought to be an abscess. No complications were encountered. CT-guided procedures are an effective method for obtaining diagnostic specimens in selected patients.
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Treatment of bacterial infections in pregnancy requires an understanding of the unique problems related to the administration of antibacterial agents to pregnant women. The clinician must be aware not only of the antibiotic-associated untoward effects which may develop in the mother, but also of the possibility that adverse reactions may occur in the fetus. Precise knowledge of the microbial aetiology of those infections which occur during pregnancy and an understanding of the intricacies of antibiotic administration to pregnant women will assure the greatest likelihood that bacterial infections in pregnancy will be effectively, and safely, treated.
Bacterial endocarditis developed following dental manipulation in a child with mitral valve prolapse. Antibiotic prophylaxis is recommended for patients with this cardiac abnormality who undergo procedures that may be associated with bacteremia.
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