Biomedical subjects
Publications and source records attributed to B Lorber.
Three patients are described in whom a putrid breath odor was the only or fist manifestation of anaerobic infection of the lung. Fever, productive cough, and pleuritic pain, common findings in anaerobic pulmonary infection, were not initally present. "Bad breath" may be an early due to the presence of anaerobic pulmonary infection.
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Hematogenous nocardial endophthalmitis is a rare but devastating infection. Of a total of 10 cases (one described for the first time and nine reported previously in the English-language literature), the lung appeared to be the primary focus of infection in eight (80%). Six (60%) of the cases occurred in individuals receiving corticosteroid therapy; these individuals had undergone renal transplantation (two cases) or cardiac transplantation (one case) and had underlying conditions that included lymphoma (two cases) and chronic active hepatitis (one case). In two immunocompetent individuals, infection followed dissemination from traumatic wounds. Common clinical findings were a rapid decrease in visual acuity and eye pain. All nine of the previously reported cases resulted in total blindness of the involved eye; five patients died not long after diagnosis. In the present report (the first in a cardiac transplant recipient), a favorable outcome with restoration of vision followed early diagnosis through the recently developed technique of fine-needle retinal biopsy.
In 1987 an outbreak of illness due to Listeria monocytogenes occurred in Philadelphia. In contrast to previously studied outbreaks, no source of infection or vehicle of transmission could be identified, and several listerial strains were found to be involved. A hypothesis that was developed and eventually published suggests that clinical listeriosis may occur when individuals who are asymptomatic for listerial infection but whose gastrointestinal tract has been colonized by Listeria organisms become infected with another pathogen. The case of a farmer who developed a brain stem abscess due to L. monocytogenes following an episode of acute enteritis due to Shigella sonnei lends support to this hypothesis.
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Listeria monocytogenes is an uncommon cause of brain abscess. Of a total of 14 cases of L. monocytogenes brain abscess (one described for the first time and 13 reported previously in the English-language literature), seven (50%) occurred in patients with leukemia and recipients of renal transplants; four (29%) of the cases occurred in previously healthy individuals. Common clinical findings were similar to those in brain abscess due to other causes and included fever (57%), headache (57%), and focal neurologic signs (64%). Distinctive, however, was the unusually high frequency of associated meningitis and bacteremia; blood cultures were positive in all eight cases in which they were performed. Eight (57%) of the 14 patients died. L. monocytogenes should be included in the differential diagnosis of brain abscess in patients with leukemia and in renal transplant recipients. Listerial brain abscess is highly unlikely when blood culture results are negative.