Biomedical subjects
Publications and source records attributed to C H Lu.
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Attempts were made to determine the lethality of Formosan snake venoms in mice by various inoculation routes. No matter what inoculation routes (s.c. i.p. i.v.) and which mouse strains (ICR, NIH) were used, statistical analysis revealed that the lethality (LD50) of B. multicinctus venom was the greatest followed by N.n. atra, Tr. gramineus, Tr. mucrosquamatus and Agk. acutus venom. The i.v. inoculation resulted in the highest lethality of haemorrhagic venoms (Tr. gramineus, Tr. mucrosquamatus, Agk. acutus) and the i.p. was the next, while in the case of neurotropic venoms (B. multicinctus, N.n. atra) the results were reversed, moreover, the s.c. was the lowest. The reproducibility of different inoculation routes on determining the lethality of venom was expressed by coefficient of variation (S.D./mean). The i.p. was the best inoculation route for haemorrhagic and N.n. atra venoms and the i.v. was the best for B. multicinctus venom. The results obtained from mouse ICR strain seemed to be more reproducible than that obtained from NIH strain. The best method for determining the neutralizing capacity of B. multicinctus antivenin was the i.p. inoculation in ICR mouse.
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Findings on cranial computed tomography (CT) were correlated with autopsy findings in 58 cases with 129 lesions to determine CT reliability. When only CT scans of good quality were considered, there were no false positive cases. The number of false negative studies varied directly with lesion size: one of 42 lesions larger than 2.5 cm; four of 12 lesions between 1.5 and 2.5 cm; 12 of 15 between 0.5 and 1.5 cm; and all 21 of those smaller than 0.5 cm. Lesion size was undetermined in the remaining 18 casesbecause of the nature of the disease. While the series is small, these results suggest that the current detector threshold for CT may be in the range of 0.5-1.5 cm, although smaller lesions may be seen if there is substantial surrounding edema.
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Ninety-three patients with gram-negative bacillary meningitis (GNBM) were identified at Kaohsiung Chang Gung Memorial Hospital, over a period of 12 years. Among them, eight showed resistance to third-generation cephalosporins, accounting for 9% of the total GNBM cases and 29% of the postneurosurgical GNBM cases. The resistant pathogens included Acinetobacter baumannii, Klebsiella pneumoniae, Citrobacter freundii and Morganella morganii. These eight patients, six males and two females aged 18-61 years, all had nosocomially acquired meningitis associated with head trauma and/or postneurosurgical states. Six patients received imipenem/cilastatin treatment; five survived and one died. The other two expired because they did not receive appropriate antibiotic treatment. Although third-generation cephalosporin-resistant GNBM is rare, its incidence has been increasing over the past 5 years. In patients with nosocomially-acquired postneurosurgical GNBM, the presence of third-generation cephalosporin resistance should therefore be highly suspected. The appropriate choice of antibiotic is essential for their survival.
BACKGROUND: We analyzed the clinical manifestations and therapeutic outcomes of Klebsiella brain abscesses. PATIENTS AND METHODS: The clinical data of 15 patients with Klebsiella brain abscesses, retrospectively collected over a 14-year period, were studied. RESULTS: The 15 patients included 13 cases of Klebsiella pneumoniae infection and two cases of Klebsiella oxytoca. All but one case were community-acquired infections. Locations of all of these abscesses were supratentorial. 12 cases involved a single abscess, and three involved multiple abscesses. Gas formation was also found in two cases (13%). Common predisposing factors included metastatic spread, chronic otitis media and neurosurgical procedures. Among these 15 patients, 11 were treated surgically and four received antibiotics alone. In total, 11 patients survived and four died, with an overall mortality rate of 26.7%. CONCLUSION: The clinical presentations and therapeutic outcomes varied according to the different Klebsiella species. While debilitating diseases were common in K. pneumoniae infections, they were not common in K. oxytoca infection. And while metastatic septic abscess is a well-known, devastating complication of K. pneumoniae septicemia, usually seen as a brain abscess with a gas-forming appearance, all of these K. oxytoca infections had both otogenic infections and more favorable outcomes.
BACKGROUND: The clinical characteristics of Enterobacter infection in adult bacterial meningitis were defined. PATIENTS AND METHODS: The clinical manifestations and therapeutic outcomes of ten adult patients with Enterobacter infections in acute bacterial meningitis were analyzed. RESULTS: Enterobacter infection was found in 4.5% (10/223) of our adult patients with culture-proven bacterial meningitis. The ten patients comprised seven men and three women aged between 16-69 years (mean 47 years). Coinfections with other pathogens were found in 50% of the cases, the most common pathogen being Klebsiella pneumoniae. Nine of the ten patients had a history of neurosurgery, and seven patients contracted the infection nosocomially. Multiple antibiotic-resistant strains, including resistance to third-generation cephalosporins, were found in three patients with polymicrobial infections. These three patients received iv imipenem/cilastin therapy. The therapeutic results showed that two of the ten patients died; five of the eight surviving patients had neurological sequelae. CONCLUSION: The predominant coinfection with Enterobacteriaceae in adult Enterobacter meningitis may reflect the fact that most of the cases of polymicrobial Enterobacter infections have a potential gastrointestinal source. A postneurosurgical state was the most important predisposing factor for the development of Enterobacter infection in adult bacterial meningitis in our patients. The strains of the Enterobacter species in adult polymicrobial Enterobacter meningitis were commonly resistant to multiple antibiotics, including third-generation cephalosporins. In light of the high incidence of multiple antibiotic-resistant Enterobacter strains in adult polymicrobial Enterobacter meningitis, the choice of initial empiric antibiotics may include carbapenem (imipenem/cilastin or meropenem). Although the mortality rate was not high in this group of patients, most survivors suffered neurological sequelae.
12 adult patients suffering from bacterial meningitis caused by mixed infection were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 13 years (1986-1998), and they accounted for 6.5% (12/184) of our culture-proven adult bacterial meningitis. The 12 cases included seven males and five females, aged 17-74 years. Six of the 12 cases had community-acquired infections and the other six had nosocomially-acquired infections. Ten of the 12 cases had associated underlying diseases, with head trauma and/or neurosurgical procedure being the most frequent. Both gram-negative and gram-positive pathogens were identified in these 12 cases with gram-negative pathogens outnumbering the gram-positive ones. The implicated pathogens, starting with the most frequent, included Enterobacter species (Enterobacter cloacae, Enterobacter aerogenes), Klebsiella species (Klebsiella pneumoniae, Klebsiella oxytoca), Escherichia coli, Staphylococcus species (Staphylococcus aureus, Staphylococcus haemolyticus), Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus, Serratia marcescens, Citrobacter diversus, Proteus mirabilis, Streptococcus viridans and Neisseria meningitidis. Six of the 12 cases were found to have multi-antibiotic-resistant strains, which included E. cloacae in one, A. baumannii in one, K. pneumoniae in one and S. aureus in three. The management of these 12 cases included appropriate antibiotics and neurosurgical procedures including shunt revision. Despite the complexity of implicated pathogens and the high incidence of emergence of resistant strains, the overall mortality rate (8.3%, 1/12) was not higher than that in adult bacterial meningitis. However, complete recuperation was difficult in adult patients with mixed bacterial meningitis.
Community-acquired Acinetobacter meningitis in adults is an extremely rare infection of the central nervous system (CNS). Here we report one adult case of this rare CNS infection and review the clinical data of another seven cases reported in the English language literature. In total, eight patients (six men and two women) aged between 19 and 63 years were studied. The causative pathogen in our patient was Acinetobacter baumannii; in the other reported cases they were most likely Acinetobacter Iwoffii, Acinetobacter johnsonii, Acinetobacter junii, a genomic species 3 or 6. No underlying disease was found in seven of the eight cases and six of the eight patients acquired the infections before the age of 30 years. Fever and consciousness disturbance were the most common clinical manifestations. Waterhouse-Friderichsen syndrome (WFS) was found in two cases. Unlike the Acinetobacter strains found in nosocomial infections, the strain of Acinetobacter meningitis in the community-acquired case did not show multiple antibiotic resistance. Most adult patients with community-acquired Acinetobacter meningitis can be saved by timely therapy with appropriate antibiotics before deterioration of the systemic condition and impairment of consciousness.
Intrathecal injection of subanalgesic doses of morphine (7.5 nmol) and dynorphin-A-(1-13) (1.25 nmol) in combination resulted in a marked analgesic effect as assessed by tail flick latency in the rat. The analgesic effect of the composite dynorphin/morphine was dose-dependent in serial dilutions so that a composition of 1/8 of the analgesic dose of dynorphin and 1/3 that of morphine produced an analgesic effect equipotent to full dose of either drug applied separately. The analgesic effect induced by dynorphin/morphine mixture was not accompanied by motor dysfunction and was easily reversed by a small dose (0.5 mg/kg) of naloxone. Contrary to the augmentatory effect of dynorphin on morphine analgesia in the spinal cord, intracerevroventricular (ICV) injection of 20 nmol of dynorphin-A-(1-13) exhibited a marked antagonistic effect on the analgesia produced by morphine (120 nmol, ICV). The theoretical considerations and practical implications of the differential interactions between dynorphin-A-(1-13) and morphine in the brain versus spinal cord are discussed.
We evaluated the association between measures of dampness in daycare centers (N = 56) in the Taipei area and symptoms of respiratory illness in 612 employees. Dampness was found in 75.3% of the centers, visible mold in 25.8%, stuffy odor in 50.0%, water damage in 49.3%, and flooding in 57.2%. Furthermore, prevalence of sick building syndrome symptoms in the daycare workers was statistically significant among those who worked in centers that had mold or dampness. Also, the observed numerous incidences of dampness or mold in centers were very common in this subtropical region, and dampness was a strong predictor of sick building syndrome symptoms.
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