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Biomedical subjects

A M Yinnon

Publications and source records attributed to A M Yinnon.

At least 55 records · Page 3Linked to original sources
PubMed1997

Emergence of drug-resistant tuberculosis in Jerusalem: ten-year retrospective review.

Drug-resistant tuberculosis (TB) has emerged as a worldwide problem. The annual incidence of TB has increased in Israel in the last decade, mainly due to successive waves of immigration. Few data are available on drug-resistant TB in Israel A 10-year retrospective review was conducted on all patients who had been infected with culture-proven Mycobacterium tuberculosis and had been admitted to our hospital. Forty-seven patients had culture-positive TB; 27 (57%) were male, 20 (43%) were female; mean age (+/- SD) was 56 +/- 23 years. Twenty patients (43%) had pulmonary TB. Three patients (6.4%) had single-drug resistance; 4 patients (8.5%) had multi-drug resistance. Six of the seven patients (86%) with drug-resistant TB had been diagnosed after 1990. Six of the 20 patients (30%) with pulmonary TB had drug-resistant organisms. Six of the 7 patients (86%) with drug-resistant TB had pulmonary infection, as compared to 15/40 (37%) of the patients with drug-susceptible TB (p < 0.001). Six of the 7 patients (86%) with drug-resistant TB had a history of TB. Fifteen percent (14.9%) of all new cases diagnosed with TB in our hospital in the last 10 years had drug-resistant M. tuberculosis. Thirty percent of patients with pulmonary TB had drug-resistant organisms. Drug-resistant TB has evidently emerged in Israel and poses a serious clinical and social threat. A strong case for directly-observed treatment in Israel should be made, especially since the incidence of TB here is still small.

Adolescent↗
PubMed1996

Serologic response to treatment of syphilis in patients with HIV infection.

BACKGROUND: Much controversy exists concerning the manifestations, therapy, and response to treatment of syphilis in patients coinfected with the human immunodeficiency virus (HIV). OBJECTIVE: To assess the effect of HIV infection on the serologic response to treatment of patients with syphilis. METHODS: Sixty-four HIV-seropositive patients with syphilis were matched with 64 patients with syphilis who were HIV negative. Matching criteria included age (+/- 5 years), sex, race, initial rapid plasma reagin (RPR) titer (+/- 1 dilution), and stage of syphilis at entry. There were 26 matched patients with early syphilis, 26 matched patients with late syphilis, and 12 matched patients with biological false-positive RPR. The HIV-positive patients with early syphilis received three doses of penicillin G benzathine. All other patients received treatment as recommended by the Centers for Disease Control and Prevention, Atlanta, Ga. Our study's major end points were clinical and serologic response to treatment. RESULTS: All 16 patients with symptomatic syphilis were cured. No patient developed clinical signs of neurosyphilis during the 12-month follow-up period. Twenty-nine (56%) of 52 HIV-positive patients with early or late syphilis did not have a fourfold decrease in RPR titer 6 months after treatment compared with 20 (38%) of 52 matched controls (P = .06). No unique characteristics identifying patients who did not respond serologically could be established. The HIV-positive patients with initial RPR less than 1:32 experienced a significantly slower decrease in RPR at 12 months than did the controls (P < .001). CONCLUSIONS: Patients with syphilis who are HIV positive are less likely to experience serologic improvement after recommended therapy than are patients with syphilis who are HIV negative. Patients with HIV infection who contract syphilis should receive intensive and prolonged follow-up, and consideration should be given to designing alternative regimens.

Adult↗
PubMed1996

Comparison of four laboratory tests for diagnosis of Clostridium difficile-associated diarrhea.

Four different laboratory tests for diagnosis of Clostridium difficile-associated diarrhea were compared to determine the optimal one for management of patients with hospital-acquired diarrhea. Stool samples from 231 patients with diarrhea were tested by the following methods: culture for Clostridium difficile with subsequent determination of exotoxin production, with a toxigenic Clostridium difficile positive (TCP) result considered truly positive; enzyme immunoassay (EIA); latex agglutination test; and an immunobinding blot assay. The rates of positive results were as follows: EIA 5.5%, TCP 7.3%, latex agglutination 16.7%, and immunobinding blot assay 26.1%. Compared to the TCP results, the sensitivity and specificity were, respectively, 61 and 98% for EIA, 47 and 85% for latex agglutination, and 60 and 76% for the immunobinding blot assay. Samples from patients with > or = 6 stools/day were TCP and EIA positive in 27 and 17% of cases, respectively, whereas in patients with < 6 stools/day, these percentages decreased to 2 and 3%, respectively (p < 0.001). In hospitalized patients with > or = 6 stools/day, EIA appears to be the optimal test for diagnosis of Clostridium difficile-associated diarrhea, with a 73% positive predictive value and a 97% negative predictive value. However, in patients with < 6 stools/day, the prevalence of Clostridium difficile is low, and laboratory detection of this organism remains problematic.

Anti-Bacterial Agents↗
PubMed1996

Klebsiella bacteraemia: community versus nosocomial infection.

In the period 1988-1993, 241 patients had Klebsiella bacteraemia at our medical centre. The annual number of patients with positive blood cultures increased from 306 in 1988 to 622 in 1993, representing a 4.5-6% positivity rate of drawn cultures. After E. coli, Klebsiella was the leading cause of Gram-negative bacteraemia. During this period, the absolute number of Klebsiella bacteraemia increased from 25 in 1988 to 84 in 1993; this represents a true increase in Klebsiellaa bacteraemia, from 6-7% of positive cultures in the late 1980s to 12-13% in more recent years. There were 210 cases with K. pneumoniae and 31 with K. oxytoca. A representative sample of 80 records was retrieved and subdivided into two groups: community-acquired Klebsiella bacteraemia (CAKB) vs. hospital-acquired Klebsiella bacteraemia (HAKB). Urinary tract infection was the underlying source of 58% of CAKB vs 28% of HAKB (p < 0.01); pneumonia occurred significantly more often in HAKB (25%) than in CAKB (7%) (p < 0.01). In HAKB, as compared to CAKB, serious manifestations of illness were more common, e.g. shock (65% vs. 37%, p < 0.046) and respiratory failure (45% vs. 20%, p < 0.046). Overall mortality was 32%, 22% of patients with CAKB died vs. 42% of those with HAKB (p < 0.05). Multiple drug resistance was very common: only 57% of all Klebsiella strains were susceptible to gentamicin, 66% to ceftriaxone, 70% to ciprofloxacin, and 83% to amikacin. The susceptibility rates of Klebsiella spp isolated from patients with HAKB were significantly lower (p < 0.001). Sepsis due to multiple-drug-resistant Klebsiellaa has become frequent, carrying significant morbidity and mortality. Restriction of broad-spectrum antimicrobials in the hospital and the community as well as implementation of infection control measures are needed to contain this problem.

Aged↗
PubMed1996

Impact of the resin blood culture medium on the treatment of critically ill patients.

OBJECTIVE: To assess the relevance, both clinical and bacteriologic, of the use of resin-containing blood culture media in blood cultures taken from critically ill patients receiving antibiotics. DESIGN: A prospective, open clinical trial. SETTING: The mixed medical surgical intensive care unit (ICU) of a 550-bed urban hospital. PATIENTS: All ICU patients admitted during a 3-month period (n = 49) with suspected sepsis requiring blood cultures as part of their laboratory investigations. INTERVENTIONS: The use of an aerobic resin-containing blood culture medium, in addition to the regular aerobic and anaerobic media for all blood cultures taken. MEASUREMENTS AND MAIN RESULTS: Each blood culture result was classified as to its clinical significance. Changes in patient management were recorded. Culture sets in which the resin-containing bottle provided the information central to the change in patient management were identified. Bacteriologically, the results from the resin-containing medium were compared with the results from the aerobic and anaerobic media. Of 266 blood culture sets, 103 (39%) were positive, growing 278 bacterial and fungal isolates. Clinically, the resin-containing medium alone provided relevant data leading to changes in patient management on three occasions. On two of these occasions, cultures from the regular media provided the same data within 72 hrs. Bacteriologically, 77 (29%) aerobic bottles, 55 (21%) anaerobic bottles, and 89 (33%) resin-containing bottles were positive (statistical comparison of percentages: aerobic vs. resin-containing bottles, nonsignificant; aerobic vs anaerobic bottles, p < .046; anaerobic vs. resin-containing bottles, p < .0027). A similar proportion of pathogens was isolated from the resin-containing bottles only (9%) and aerobic bottles only (6%). A higher proportion of contaminants was isolated from the resin-containing bottles only than the aerobic bottles only in the various sets (17% vs. 7%, p < .046). The resin-containing bottle showed a trend toward increased detection of Staphylococcus aureus and Pseudomonas aeruginosa bacteremia. CONCLUSIONS: The resin-containing medium offers little clinical benefit to the majority of ICU patients. Bacteriologically, it seems to have a similar overall sensitivity as the regular aerobic medium (with the possible exception of a higher sensitivity for the isolation of S. aureus and P. aeruginosa), but a lower specificity. The wide-spread use of the resin-containing bottle cannot be recommended.

Anti-Bacterial Agents↗
PubMed1996

Polyarteritis nodosa and drug abuse: is there a connection?

Drug abuse has been controversially linked to polyarteritis nodosa. A 28-year-old man with a history of drug abuse with inhaled heroin presented with an enigmatic illness consisting of refractory fever, bilateral pleural effusions, migratory polyarthritis, and a leukaemoid reaction. An abdominal angiography confirmed the diagnosis of polyarteritis nodosa, and treatment with both prednisone and cyclophosphamide resulted in significant clinical and laboratory improvement.

Adult↗
PubMed1996

Changes in the natural history of invasive pulmonary aspergillosis in neutropenic leukemic patients.

We describe five patients with acute leukemia who during the period of chemotherapy-induced neutropenia developed invasive pulmonary aspergillosis. Amphotericin B was initiated early in the febrile neutropenic episode at a dose of 1-1.5 mg/kg per day. Four of the five patients had normal chest films at the time amphotericin B was started and only later developed infiltrates, which subsequently progressed to cavitation formation with resolution of the infiltrates around the cavitations. This is compatible with primary aspergilloma or invasive pulmonary aspergillosis. The patients experienced partial (2 patients) or complete resolution (3 patients) of the process, and none died of the fungal infection. In the past, infection with invasive aspergillosis carried a high mortality. We believe that this positive outcome constitutes a change in the natural history of invasive pulmonary aspergillosis in neutropenic patients as a result of the early initiation of high dose amphotericin B. We recommend the early empiric use of amphotericin B therapy in febrile neutropenic patients not responding to broad-spectrum antibiotics, and that the minimal initial dose be 1 mg/kg per day especially in institutions carrying a high incidence of aspergillosis.

Adult↗
PubMed1996

Antibiotic prophylaxis in umbilical and incisional hernia repair: a prospective randomised study.

OBJECTIVE: To find out if preoperative prophylaxis would reduce infection rates after umbilical and incisional hernia repair. DESIGN: Randomised controlled trial. SETTING: Teaching hospital, Israel. SUBJECTS: 35 Patients who presented with umbilical (n = 19) or incisional (n = 16) hernias during a period of 8 months. INTERVENTIONS: Cefonicid 1 g was given by intravenous infusion to alternate patients 30 minutes before the operation. MAIN OUTCOME MEASURES: Wound infection. RESULTS: The groups were comparable for age, body mass index, grade of surgeon, operating time, and size of hernial ring. The wound infection rates were 0/8 compared with 4/8 for incisional hernia repairs (p = 0.08) and 1/9 compared with 4/10 for umbilical hernia repairs (p = 0.3). The overall rate was 1/17 compared with 8/18 (p = 0.02). CONCLUSIONS: Single dose antibiotic puphylaxis seems to exert a beneficial effect on the wound infection rate after umbilical and incisional hernia repair.

Adult↗
PubMed1995

Streptococcal group C bacteremia. Survey in Israel and analytic review.

BACKGROUND: Data concerning group C streptococcal bacteremia come mainly from case reports; thus, population-based studies from different geographic areas are needed to validate these findings. METHODS: Eight years of data on group C streptococcal infection in Israel and cases of bacteremia in five hospitals were reviewed. We compared data from our survey as well as from other population-based studies with multiple cases published as case reports. RESULTS: The organisms were isolated in 78 cases (excluding pharyngitis); 16 had bacteremia. Ten cases of bacteremia were reviewed in five hospitals; none of the patients reported exposure to animals, and nine had severe underlying diseases. The clinical syndromes included four cases of primary bacteremia, four cutaneous infections, and one case each of meningitis and pneumonia. There were two deaths, one patient underwent amputation of a toe, one had a stroke, and one had a relapse. We compared 80 cases published as case reports with 59 cases reported in five population-based studies from different countries. We found higher rates of underlying diseases, alcohol abuse, liver diseases, and cutaneous infections, and lower rates of exposure to animals or raw products, endovascular infections, and central nervous system infections in population-based studies. Morbidity and mortality were 20% to 30% each in both types of studies. CONCLUSIONS: Group C streptococcal bacteremia affects patients with underlying diseases; exposure to animals is variable and less frequent than previously reported. Morbidity and mortality are high and probably reflect the patients' underlying state as well as the severity of the infection.

Adolescent↗
PubMed1995

Salmonella mycotic aneurysm of the aortic arch: case report and review.

Salmonella mycotic aneurysms of the thoracic aorta are exceedingly rare. We describe what we believe is only the third reported case involving the aortic arch. The patient was treated with surgical intervention and a prolonged course of antibiotics, which resulted in long-term survival. We review 13 previously reported cases of salmonella mycotic aneurysms of the thoracic aorta. The overall outcome was abysmal, with 10 of 13 patients dying within 1 month after the diagnosis was made. We discuss the pathogenesis, clinical presentation, diagnostic approach, and management (including surgical intervention and duration of antibiotic therapy) of this condition on the basis of the findings in these cases.

Adult↗
PubMed1994

The changing clinical spectrum of liver abscess: the Jerusalem experience.

A retrospective study was conducted of all 31 patients with liver abscess admitted to Shaare Zedek Medical Center between 1979, the year computed tomographic scan and ultrasound were introduced, and 1992. Fever and abdominal pain were the most common symptoms. Duration of symptoms was short: 81% of patients had symptoms for < or = 5 days and none had symptoms for more than 3 weeks. Amoebic abscess was found in one patient only, the remainder were pyogenic. Biliary tract pathology remains the most common cause of liver abscess (39%). The diagnosis was made by ultrasound in 22/31 (71%) and by computed tomographic scan in 9/31 (29%) of patients. Treatment consisted of intravenous antibiotics and percutaneous drainage under ultrasound guidance in 24/31 patients (77%). Four patients died (13%), three of whom had underlying malignancies. Clinical features were compared with those from a similar series of 36 cases with liver abscess reported from Jerusalem predating ultrasound and computed tomographic scan (1967-1977). Several major changes have occurred. First, the relative incidence of amoebic abscess has dramatically decreased. Second, ultrasound and computed tomographic scan have facilitated earlier diagnosis and percutaneous drainage, contributing to improved survival and lower morbidity.

Adolescent↗
PubMed1994

Mycotic aneurysm of the external carotid artery.

Mycotic aneurysms of the extracranial carotid arteries are extremely rare. A case is reported of an external carotid artery aneurysm that developed in a patient with infective endocarditis. We review 15 previously reported cases of mycotic aneurysms of the cervical carotid arteries, one of which occurred in a patient with infective endocarditis. None of them occurred in the external carotid artery. Most cases were due to local trauma, a contiguous focus of infection or bacteremia. Surgical resection and appropriate antibiotic treatment lead to cure in most cases.

Aged↗
PubMed1993

Cryptococcal peritonitis: report of a case developing during continuous ambulatory peritoneal dialysis and review of the literature.

A patient developed cryptococcal peritonitis with systemic dissemination during continuous ambulatory peritoneal dialysis (CAPD). This case prompted a search of the literature for cases of cryptococcal peritonitis; 19 previously reported cases were identified. On the basis of their clinical characteristics, these cases were divided into two groups. Group 1 included 10 cases developing during CAPD. Treatment consisted of removal of the peritoneal dialysis catheter and administration of a short course of amphotericin B. Eight of the 10 cases had a benign course, and nine patients survived. Group 2 comprised 10 cases developing in patients with severe underlying illnesses, such as chronic liver disease, AIDS, systemic lupus erythematosus, and leukemia. Disseminated cryptococcosis was documented in eight of the nine patients in this group for whom relevant information was available. Seven patients died, some despite antifungal therapy. Cryptococcal disease may have protean manifestations and an insidious course. Accordingly, the diagnosis of cryptococcal peritonitis may well be delayed. An awareness of this entity may lead to earlier diagnosis and treatment and possibly to improved outcome.

Amphotericin B↗