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D P Dooley

Publications and source records attributed to D P Dooley.

At least 19 recordsLinked to original sources
PubMed1996

Validation of catheter semiquantitative culture technique for nonstaphylococcal organisms.

The catheter semiquantitative culture roll tip technique has been validated as a discriminator between non-catheter-related bacteremias and catheter-related bacteremias (CRBs) caused by Staphylococcus species. However, this technique has not been specifically validated when used for the evaluation of catheters infected with organisms other than staphylococci. We reviewed catheters that had been submitted for semiquantitative roll tip culture as well as hospital records to determine clinical correlates of infection. Local infection and CRB were defined by standard criteria. Catheter-related sepsis (CRS) was defined as fever, leukocytosis, or hypotension which resolved with catheter removal, without another source of infection. For 195 catheters from 93 patients, gram-negative rods and enterococci were present on 36, fungi were on 25, Corynebacterium species were on 5, Bacillus species were on 3, Staphylococcus species were on 79, and 41 demonstrated no growth. Of 21 episodes of CRB or CRS due to nonstaphylococcal organisms, only 1 (questionable) episode was due to a catheter with < 15 CFU (P < 0.05). Eleven of these 21 episodes of CRB or CRS were due to gram-negative rods and enterococci, of which only the questionable episode was due to a catheter with < 15 CFU. Nine of these 21 episodes of CRB or CRS were due to fungi, none of which were associated with a catheter with < 15 CFU. The data for Staphylococcus species recapitulated published data (none of 21 CRB or CRS episodes were associated with catheters with < 15 CFU) and validated this retrospective technique. The data presented in this study validate the use of the semiquantitative culture technique for the evaluation of catheter-related infections caused by organisms other than staphylococci.

Bacteremia↗
PubMed1995

Purulent pericarditis caused by Candida species: case report and review.

Purulent pericarditis caused by Candida species is a rare and often undiagnosed disease. We recently treated a patient in whom purulent pericarditis due to Candida albicans developed following thoracic surgery. The patient survived after receiving a combination of surgical and medical therapy. A literature review revealed 24 additional cases of purulent pericarditis caused by Candida species. Twenty-one of the patients either had undergone thoracic surgery or had had disseminated candidiasis. None of the 12 patients described before 1980 survived, whereas six (46%) of the 13 patients described after 1980 survived. No patient survived without pericardiectomy (five of six survivors) or at least pericardiocentesis (one survivor). All survivors received full courses of amphotericin B therapy. An increased utilization of echocardiography, along with an increased recognition of the patient populations at risk, has been instrumental in early detection and improved outcome of purulent pericarditis. A combination of prolonged amphotericin B therapy and pericardiectomy appears to be the best approach for achieving a cure.

Aged↗
PubMed1995

Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era.

Pylephlebitis usually occurs secondary to infection in the region drained by the portal venous system. We describe a case of pylephlebitis at our institution and examine 18 other cases culled from the literature since 1979, reviewing diagnostic and management issues. A precipitating focus of infection (most commonly diverticulitis) was identified in 13 (68%) of the cases. Bacteremia (often polymicrobial) was present in 88% of the patients. The most common blood isolate was Bacteroides fragilis. Overall mortality was 32%, but most of the patients who died had severe sepsis prior to the initiation of antibiotic therapy. In no case was improvement in a patient's clinical status clearly attributable to the use of heparin, but some beneficial effect of anticoagulation could not be ruled out. This report is the first to examine the published experience with pylephlebitis during the era of antibiotics and modern imaging and is also the first to review critically the role of anticoagulation in the management of this disease.

Anti-Bacterial Agents↗
PubMed1994

Cytokine induction in human coccidioidomycosis.

To investigate the immune response to human infection with the fungus Coccidioides immitis, we measured cytokine production from peripheral blood mononuclear cells (PBMC) and plastic-adherent monocytes/macrophages (Mphi) isolated from healthy subjects who were skin test positive to spherulin, healthy subjects who were skin test negative, and patients with active coccidioidomycosis. PBMC and Mphi from all these donor groups secreted increased levels of tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6 in response to stimulation with formalin-killed spherules (FKS), as measured by enzyme-linked immunosorbent assays. Viable C. immitis spherules also stimulated PBMC and Mphi from healthy subjects and patients to secrete tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6, although at levels lower than those induced by FKS. The production of these acute inflammatory cytokines may contribute to the immunopathogenesis of active coccidioidomycosis and could account for the toxicity of the FKS vaccine in humans.

Coccidioidomycosis↗
PubMed1994

Misidentification of clinical yeast isolates by using the updated Vitek Yeast Biochemical Card.

The Vitek Yeast Biochemical Card (YBC) is widely used as a rapid identification (RI) (within 48 h) system for clinical yeast isolates. We compared the RI results obtained by the YBC technique with matched results obtained with the API 20C system. The RI of germ tube-negative yeasts isolated from 222 clinical specimens was performed with the YBC system, and the results were compared with those of standard identifications obtained by using the API 20C system and morphology, with additional biochemical reactions performed as required. Commonly isolated yeasts (Candida albicans [n = 29], Candida tropicalis [n = 40], Torulopsis [Candida] glabrata [n = 28], Candida parapsilosis [n = 12], and Cryptococcus neoformans [n = 14]) were generally well identified (115 of 123 [93%] identified correctly, with only C. albicans, C. tropicalis, and C. neoformans mis- or unidentified more than once). The RI of less commonly isolated yeasts included in the YBC database, however, was less successful (54 of 99 [55%] correct). The YBC card failed to identify 42% (10 of 24) of Candida krusei isolates, 80% (4 of 5) of Candida lambica isolates, 88% (7 of 8) of Trichosporon beigelii isolates, and 83% (10 of 12) of Cryptococcus isolates (non-C. neoformans species). For most identification failures (79%; 42 of 53) there was no identification by the end of 48 h; the other identification failures (21%; 11 of 53) gave definite but incorrect identifications. Of eight rare clinical yeast isolates not included in the Vitek database, six were correctly, not identified, while two (25%) were falsely assigned a definite RI (one Hansenula fabianii isolate was identified as Rhodotorula glutinis, and one Hansenula isolate [non-Hansenula anomala] was identified as Hansenula anomala). While the Vitek YBC rapidly and adequately identifies common yeast isolates, it fails in the RI of more unusual organisms.

Evaluation Studies as Topic↗
PubMed1994

Syphilitic pneumonitis in an HIV-infected patient.

Pneumonitis and symptomatic hepatitis are very rare complications of syphilis. Symptomatic hepatitis and subclinical reticulonodular pulmonary infiltrates were observed when an HIV-infected patient presented with secondary syphilis. The Jarisch-Herxheimer reaction included a flare of hepatitis symptoms, resembling cholangitis. In a patient with syphilis, it may be appropriate to delay an aggressive evaluation for suspected pneumonitis or cholangitis pending the outcome of specific antitreponemal therapy.

Adult↗
PubMed1993

Coccidioidomycosis: a persistent threat to deployed populations.

The world-wide deployability of aircrew members exposes them to a peculiar array of medical problems. Non-immune populations, upon deployment to endemic areas, may present to the deployed flight surgeon with acute, poorly recognizable syndromes, such as acute coccidioidomycosis. Alternatively, the acquisition of the chronic progressive form of coccidioidomycosis in endemic areas may be a problem for the flight surgeon, who may be faced with a poorly recognizable syndrome which first manifests itself weeks to months after the crewmember's return from deployment. We describe three cases of coccidioidomycosis in service members that highlight the difficulty in the diagnosis of this disease. These cases prompted an epidemiologic survey of recent cases of coccidioidomycosis among Air Force beneficiaries, presented here, to better define the impact of this disease on personnel assigned to endemic areas. A brief discussion of the epidemiologic and clinical features of the disease and of the aeromedical disposition of the aviator is presented.

Adult↗
PubMed1993

Psyllium worm.

Explore the source record for details and available documents.

Anal Canal↗
PubMed1992

A severe, unusual reaction to trimethoprim-sulfamethoxazole in patients infected with human immunodeficiency virus.

The clinical features of three patients with a life-threatening reaction to trimethoprim-sulfamethoxazole (TMP-SMZ) are presented along with seven other cases from the literature. All patients developed sudden fever and hypotension immediately after the administration of TMP-SMZ; usually this reaction occurred within approximately 2 weeks of completion of a previous course of the drug. All but one patient had a rash. Most patients were hypoxemic and developed diffuse pulmonary infiltrates. All patients responded rapidly to supportive care, while bacterial cultures remained negative. The presence, absence, or character of previous adverse reactions to TMP-SMZ did not predict subsequent severe reactions. Although its mechanism remains unclear, this reaction has features of both IgE-mediated anaphylaxis and cytokine (tumor necrosis factor)-mediated effects. We advise extreme caution, with close observation, when this drug is first readministered to patients who have experienced any TMP-SMZ-associated toxicity within the previous 6-8 weeks.

Adult↗
PubMed1992

Indolent orbital apex syndrome caused by occult mucormycosis.

The chronic or indolent presentation of rhino-orbital mucormycosis, as defined by the presence of symptoms for more than 1 month before diagnosis, is extremely unusual. A 45-year-old man with stable diabetes presented with a right orbital apex syndrome and minimal ethmoid and sphenoid sinusitis. Progression was indolent, and the diagnosis was not made until 7 weeks after admission, when a third biopsy was prompted by new cavernous sinus and carotid artery thromboses. Mucormycosis was found. The patient improved on amphotericin B (2 g) and strict blood glucose control. A remarkable aberrant regeneration of the right oculomotor nerve was seen following treatment. He remains free of active disease 4 years later. Orbital symptoms in well-controlled diabetics, which may even remain stable for weeks and lack direct signs of tissue invasion, should raise the suspicion of mucormycosis.

Carotid Artery Thrombosis↗
PubMed1991

Effect of a recombinant HIV gp160 vaccine on monokine production.

An investigation was undertaken to determine whether a recombinant gp160 envelope protein, which is currently being evaluated as a vaccine for AIDS, induces or modulates the production of tumour necrosis factor-alpha (TNF-alpha) or interleukin-1 beta (IL-1 beta). Incubation of monocytes from healthy, HIV-seronegative persons with 0.0001-1.0 micrograms of the recombinant vaccine did not result in the secretion of TNF-alpha or IL-1 beta, nor did the recombinant product augment or suppress monokine production by lipopolysaccharide (LPS) stimulated monocytes. The vaccine was also without a stimulatory or modulatory effect upon TNF-alpha or IL-1 beta secretion by monocytes from a patient with the AIDS-related complex (ARC) and from the monocytic THP-1 cell line. The lack of effect of gp160 on monokine production has important implications for its efficacy as a vaccine for AIDS.

Gene Products, env↗
PubMed1990

Rapidly progressing cervical cancer in a patient with human immunodeficiency virus infection.

Many malignancies occur in association with the acquired immunodeficiency syndrome (AIDS). The incidence of cervical intraepithelial neoplasia is increased in patients with human immunodeficiency virus (HIV) infection, although coexistent HIV infection and cervical cancer have not been described. We describe a patient with HIV infection and a stage IIB, poorly differentiated cervical carcinoma who initially responded well to standard radiation therapy. Relapse at an unusual periclitoral site as well as disseminated carcinomatosis appeared within 2 months. Despite chemotherapy with cisplatin, bleomycin, and mitomycin C, the patient died within 3 months of relapse. This pattern of aggressive tumor behavior may occur more frequently as HIV infection spreads into the heterosexual population. We recommend frequent pelvic and cytologic examinations of HIV-infected women and the consideration of an aggressive treatment approach should invasive carcinoma be detected.

Adult↗