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Biomedical subjects

C R Huang

Publications and source records attributed to C R Huang.

42 records · Page 3Linked to original sources
PubMedDate not supplied

Adult Enterobacter meningitis: a high incidence of coinfection with other pathogens and frequent association with neurosurgical procedures.

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.

Acute Disease↗
PubMedDate not supplied

Mixed infection in adult bacterial meningitis.

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.

Adolescent↗
PubMedDate not supplied

Community-acquired Acinetobacter meningitis in adults.

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.

Acinetobacter↗
PubMedDate not supplied

Neuroimages of disseminated neurotuberculosis: report of one case.

We report a 38-year-old male patient with rare concurrent intracranial and intramedullary tuberculoma demonstrated by serial magnetic resonance image (MRI) and confirmed by a pathological study. The involvement of the middle cerebral artery is also shown by magnetic resonance angiography. These findings have a good correlation with the clinical features including cranial nerve involvement, stroke-like symptoms, and paraplegia.

Adult↗
PubMedDate not supplied

Multiple fluorescence lifetimes for oligonucleotides containing single, site-specific modifications at guanine and adenine corresponding to trans addition of exocyclic amino groups to (+)-(7R,8S,9S,10R)- and (+)-(7S,8R,9R,10S) -7,8-dihydroxy-9,10-epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene.

Fluorescence decay profiles of four oligonucleotide duplexes, [table: see text] ((+)- and (-)-trans-1) and [table: see text] ((+)- and (-)-trans-2), in which an exocyclic amino group of deoxyadenosine (A*) or deoxyguanosine (G*) has been alkylated by trans opening at C-10 of the epoxide group of either the (+)-(R,S,S,R)- or (-)-(S,R,R,S)-enantiomer of (+/-)-7 beta,8 alpha-dihydroxy-9 alpha,10 alpha-epoxy-7,8,9,10- tetrahydrobenzo[a]pyrene (BPDE in which the benzylic 7-hydroxy group and the epoxide oxygen are trans), exhibit more than one fluorescence lifetime. Decay profiles of the oligomers, measured at 15 degrees C with excitation and emission wavelengths of 335 and 400 nm, respectively, have been analyzed using a triple-exponential decay law. Results for (+)- and (-)-trans-1 and -2 have been compared with results for the modified, single-stranded oligonucleotides ((+)- and (-)-trans-SS-1, and (+)- and (-)-trans-SS-2) and for the cis and trans opened products formed on alkylation at the 6-amino group of 2'-deoxyadenosine 5'-phosphate by (+)-(R,S,S,R)-BPDE ((+)-trans- and (+)-cis-A). The profiles of (+)-trans- and (+)-cis-A are well represented by single-exponential decay laws with lifetimes of 86 and 110 +/- 3 ns, respectively. For the single- and double-stranded oligomer adducts, which exhibit at least three fluorescence lifetimes, two of the lifetimes are short (0.5-14 +/- 1 ns) and one is long (35-59 +/- 3 ns). The fluorescence lifetimes and the amplitudes of the long-lived components in the decay profiles of the double-stranded oligomer adducts are generally smaller than those for the corresponding single-stranded adducts. The data provide evidence that the double-stranded oligomer adducts exist as multiple conformations. Previously reported NMR results suggest that the short lifetime fluorescence components are due to major adduct conformations in which the pyrenyl group is intercalated ((+)- and (-)-trans-1) or lies in the minor groove ((+)- and (-)-trans-2). The observation of long lifetime fluorescence species for the double-stranded oligomers is consistent with the presence of minor conformations (approximately 1-5%) in which the double-stranded oligomer either is locally denatured or is a mixture of locally denatured double-stranded conformations and equilibrium concentrations of single-stranded oligomers.

7,8-Dihydro-7,8-dihydroxybenzo(a)pyrene 9,10-oxide↗