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Biomedical subjects

D Rimland

Publications and source records attributed to D Rimland.

70 records · Page 4Linked to original sources
PubMed1983

Cerebrospinal fluid pleocytosis after seizures.

Cerebrospinal fluid (CSF) pleocytosis after seizure activity has been anecdotally reported for many years, but it has not been well documented. We reviewed the records of all adult patients admitted to Grady Memorial Hospital from November 1979 through October 1980 with the diagnosis of seizure. Of 102 patients whose CSF was examined, 35 (34%) had pleocytosis; in 31 (30%) there was no explanation for the pleocytosis despite laboratory and radiologic tests to rule out established causes. For those patients without an identifiable cause of pleocytosis the mean number of white cells was 72/cu mm with a median of 10 and a range from 3 to 464. A predominance of polymorphonuclear leukocytes (PMNs) was found in 57% of the initial CSF examinations. Eighty-six percent of patients with seizures due to ethanol withdrawal had a PMN predominance in their CSF, and 88% of patients with seizures due to a recent or remote cerebrovascular accident had a mononuclear cell predominance. The pleocytosis was usually transient; normalization of the CSF was associated with the rapid recovery of the patient. We conclude that an abnormal CSF leukocyte count may be entirely attributable to seizure activity, although the mechanism is unknown. Before assigning this cause, however, a thorough search is imperative to rule out treatable disorders that may cause CSF pleocytosis.

Adult↗
PubMed1983

Acquired immune deficiency syndrome.

Acquired immune deficiency syndrome, or AIDS, is an unexplained severe disturbance of the cell-mediated immune system that renders victims susceptible to a group of otherwise-rare diseases and infections, chiefly Kaposi's sarcoma and Pneumocystis carinii pneumonia. AIDS has been the object of intensive research since mid-1981 when the syndrome was first described by the Centers for Disease Control (CDC). The victims fall into four main group: homosexually-active males, IV drug users, Haitians, and hemophiliacs. The CDC has noted a doubling of AIDS cases every six months, with the current count--as of June 27, 1983--being 1,676, and the overall mortality rate 39%. The outbreak is most severe in New York City, with the remainder concentrated primarily in other major American cities. Cases have also been reported in 38 states, Washington, D.C., and Puerto Rico. At present there are no specific diagnostic tests (diagnosis is primarily clinical), and there is still no specific treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Infectious complications of the peritoneovenous shunt.

The peritoneovenous shunt has been recently advocated to relieve massive ascites refractory to medical therapy. Several complications of the shunt have been described but the incidence of infection has not been elucidated. We reviewed the records of all patients undergoing peritoneovenous shunt at the Emory University Affiliated Hospitals from 1975 to 1980. Eighty-five peritoneovenous shunts were done in 56 patients. Eighteen of the shunt insertions (21%) were followed by a major infection--eight bacteremias, eight peritonitis, and nine wound infections. Most infections were caused by aerobic gram-negative bacilli or Staphylococcus aureus. Fever was common (62%) in the immediate postoperative period but was not clearly related to infection, or the administration of antibiotics or antipyretics. Shunt removal appeared to be necessary in treating bacteremic patients but not in patients with only peritonitis or wound infections. Infection is a common complication of the peritoneovenous shunt and may limit its usefulness.

Anti-Bacterial Agents↗
PubMed1982

Disseminated coccidioidomycosis in a heart transplant recipient.

A cardiac transplant patient developed disseminated coccidioidomycosis shortly after transplantation and institution of immunosuppressive therapy. The patient was maintained on intravenous and intrathecal amphotericin B for 19 months, but when therapy was discontinued, the disease relapsed and he died. At autopsy the cardiac allograft was without signs of rejection, but the patient had coccidioidomycotic lesions in multiple organs. There is an increasing number of reports of disseminated coccidioidomycosis in immunocompromised patients, especially those who receive steroids or immunosuppressive therapy. Coccidioidomycosis may represent a severe complication in the transplant patient.

Azathioprine↗
PubMed1981

Asymptomatic cryptococcal meningitis.

Two cases of asymptomatic cryptococcal meningitis are described. The disease was diagnosed only after Cryptococcus neoformans was cultured from lung tissue and urine. These cases represent 2 of 11 meningitis cases seen in a 10-yr period at this hospital. Of 11 cases of extraneural cryptococcosis, 6 had lumbar punctures and these 2 had positive culture results. Asymptomatic cryptococcal meningitis is not rare. Our experience suggested that lumbar punctures should be performed routinely in patients with cultures yielding Cryptococcus neoformans from extraneural sites.

Cryptococcosis↗
PubMed1980

The effect of ethanol on adherence and phagocytosis by rabbit alveolar macrophages.

Several defects in host defense mechanisms of chronic alcoholics have been described, but the effect of ethanol on the alveolar macrophage has not been defined. Monolayers of rabbit alveolar macrophages established on plastic culture dishes were exposed to various agents to evaluate the maintenance of adherence. Ethanol produces a rapid onset loss of adherence in this system. The loss of adherence is (1) dose-dependent, (2) transient despite the continued presence of ethanol, and (3) due to a change in the macrophage. Similar rapid-onset, transient loss of adherence is produced by osmolar agents, inducers of cAMP, and colchicine. Phagocytosis of latex particles by rabbit alveolar macrophages in suspension is also transiently decreased by ethanol. These results suggest that inhibition of alveolar macrophage adherence and phagocytosis may be mediated by one or a combination of three mechanisms: osmolar forces altering the cell membrane, changes in cyctic nucleotide concentrations, or disruption of microtubules. Ethanol may act through some combination of these mechanisms to produce functional abnormalities of alveolar macrophages.

Animals↗
PubMed1979

Gonococcal endocarditis in the antibiotic era.

Since the introduction of penicillin in 1942, there have been only 11 culture-proven cases of gonococcal endocarditis in the English literature. Most patients are under 30 years of age and have no history of heart disease. The aortic valve is often involved and aortic regurgitation is common. The bacteriologic diagnosis can be difficult and may require more than six blood cultures and a long incubation period. Circulating immune complexes appear to be the cause of many of the extracardiac manifestations. The three new cases reported herein and review of the literature emphasize the distinctive features of gonococcal endocarditis.

Adult↗
PubMed1977

Hepatitis B outbreak traced to an oral surgeon.

Over a four-year period in a five-county area, 71 patients with clinical hepatitis B had dental work performed in the two to six months before their illness. Fifty-five cases were traced to a single oral surgeon. Seventy-nine per cent of these patients were positive for hepatitis B surface antigen (HBsAg) and most had no other recognized source of hepatitis. An investigation of the implicated dentist uncovered no gross inadequacies in instrument sterilization or general dental procedures; however, the dentist was found to be an asymptomatic carrier of HBsAg of the same subtype (ay) as nine of 11 of his patients who had hepatitis and whose serums were available for testing. Since no HBSAg was found in the dentist's saliva, urine or feces, and since he admitted to having frequent cuts on his fingers, it is possible that a "hemoral" transmission of HBs Ag produced hepatitis in his patients.

Adolescent↗
PubMed1976

Immunization for the internist.

The emphasis of immunization programs and schedules has traditionally been directed to infants and children, since most of the vaccine-preventable diseases are seen predominantly in these age groups. Immunization procedures in adults are less well defined but still of importance. Diseases for which immunizations are given before disease exposure include tetanus, diphtheria, influenza, rubella, and mumps; travelers to foreign countries may need immunizations against typhoid, cholera, yellow fever, typhus, poliomyelitis, plague, and viral hepatitis; other vaccines are available before disease exposure in unusual epidemiologic situations. After exposure to disease but before onset of symptoms, immunizations are available for rabies, viral hepatitis, and measles. After the onset of clinical illness, passive immunization should be given for tetanus, diphtheria, and botulism. This paper summarizes current practices for active and passive immunization against these diseases in adults.

Adolescent↗
PubMedDate not supplied

Absence of factors associated with significant urinary tract infections caused by coagulase-negative staphylococci.

Coagulase-negative staphylococci, excluding Staphylococcus saprophyticus, have recently been implicated as pathogens in urinary tract infections, especially in catheterized patients. In order to evaluate any laboratory markers for significant isolates of coagulase-negative staphylococci, we prospectively studied 72 patients with significant, indeterminant, or contaminant urine isolates of coagulase-negative staphylococci. Patients in the three categories did not differ by age, sex, presence of a urinary catheter, or other instrumentation or likelihood of nosocomial acquisition. The isolates from these three groups of patients were similar in antibiotic susceptibility and ability to produce slime. Overall, slime-producing coagulase-negative staphylococci were more likely to be S. epidermidis than any other species, but slime production was not associated with presence of pyuria, symptomatic urinary tract infection, instrumentation, nosocomial acquisition, or multiple antibiotic resistance. In this prospective study, no demographic characteristics or laboratory markers of coagulase-negative staphylococci were associated with clinical significance, as defined by symptoms or the presence of pyuria.

Bacteriuria↗
PubMedDate not supplied

Cladophialophora bantiana isolated from an AIDS patient with pulmonary infiltrates.

Cladophialophora bantiana causes a rare phaeohyphomycosis, usually manifested by brain abscesses but rarely by skin or pulmonary lesions. It has not been reported as a common colonizer or as a cause of pulmonary symptoms in patients with AIDS. We present a case in which C. bantiana was repeatedly isolated from the sputum of a patient with AIDS having pulmonary infiltrates.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Infections caused by Mycobacterium szulgai in humans.

Mycobacterium szulgai is a scotochromogenic species that has recently been recognized as a human pathogen. Twenty-four cases of disease caused by M. szulgai in humans have been reported in the English-language literature. The clinical features of these cases were reviewed, and three additional cases (two pulmonary, one extrapulmonary) were studied. Pulmonary disease indistinguishable from that caused by Mycobacterium tuberculosis was the commonest type of infection caused by M. szulgai (18 of 27 cases). Olecranon bursitis was reported in three cases, and disseminated infection was noted in three cases occurring in immunocompromised patients. M. szulgai is more susceptible to standard antimycobacterial agents than are other nontuberculous mycobacteria, notably the Mycobacterium avium complex. Clinical improvement and cure of pulmonary disease can be anticipated when treatment includes at least three drugs effective in in vitro susceptibility tests. Surgical excision appears unnecessary in pulmonary disease but may be indicated in olecranon bursitis.

Anti-Bacterial Agents↗
PubMedDate not supplied

Genetic variation in Pneumocystis carinii isolates from different geographic regions: implications for transmission.

To study transmission patterns of Pneumocystis carinii pneumonia (PCP) in persons with AIDS, we evaluated P. carinii isolates from patients in five U.S. cities for variation at two independent genetic loci, the mitochondrial large subunit rRNA and dihydropteroate synthase. Fourteen unique multilocus genotypes were observed in 191 isolates that were examined at both loci. Mixed infections, accounting for 17.8% of cases, were associated with primary PCP. Genotype frequency distribution patterns varied by patients' place of diagnosis but not by place of birth. Genetic variation at the two loci suggests three probable characteristics of transmission: that most cases of PCP do not result from infections acquired early in life, that infections are actively acquired from a relatively common source (humans or the environment), and that humans, while not necessarily involved in direct infection of other humans, are nevertheless important in the transmission cycle of P. carinii f. sp. hominis.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Mechanisms of ethanol-induced defects of alveolar macrophage function.

Several defects in host defense mechanisms of alcoholics have been described, but their role in the development of infections, especially pneumonia, is uncertain. Ethanol, in concentrations of 400 mg/100 ml, inhibits phagocytosis of radiolabeled bacteria by rabbit alveolar macrophages from 73 to 80% of control. Intracellular survival of Staphylococcus aureus is increased to 131% of control by exposure to ethanol. To evaluate the mechanisms of these ethanol-induced defects, the effect of ethanol on microtubular function and changes in levels of cAMP were evaluated. Colchicine (10(-6) M), a disrupter of microtubules, produces 49% capped cells (migration of fluorescein isothiocyanate-labeled concanavalin A (FITC-ConA) to one end of the cell), but ethanol produces no capping, even at concentrations of 2000 mg/100 ml. This suggests that the ethanol effect is not mediated by disruption of microtubules. cAMP levels, measured by radioimmunoassay, increased two-fold over control values after 10 min incubation with ethanol. The increase is dose dependent with a rapid onset. The effect of ethanol on alveolar macrophages is probably complex, but changes in osmolarity and increases in cAMP levels, perhaps interrelated by some pertubation in the cell membrane, may explain the defect.

Animals↗
PubMedDate not supplied

Comparison of trimethoprim-sulfamethoxazole, dapsone, and pentamidine in the prophylaxis of Pneumocystis carinii pneumonia.

STUDY OBJECTIVE: To compare the incidence of Pneumocystis carinii pneumonia (PCP) in patients infected with the human immunodeficiency virus (HIV) receiving one of three prophylactic agents. DESIGN: Retrospective chart review. SETTING: A university-affiliated Department of Veterans' Affairs medical center HIV clinic. PATIENTS: All 200 HIV-infected patients enrolled in the clinic who were prescribed a PCP prophylactic drug during 18 months. INTERVENTIONS: Patients were administered oral trimethoprim-sulfamethoxazole (TMP-SMX) DS, oral dapsone, or aerosolized pentamidine in a heirarchic fashion. A subset of 110 patients received only one of the prophylaxis regimens for at least 6 months; they were examined separately for the purpose of statistical analysis. MEASUREMENTS AND MAIN RESULTS: One case of PCP was diagnosed in 1110 patient-months of oral TMP-SMX DS therapy, 6 in 418 patient-months of oral dapsone therapy, and 3 in 164 patient-months of aerosolized pentamidine therapy. In the subset population, the documented incidence of PCP was 0% among 71 TMP-SMX DS-treated patients, 16% among 25 dapsone-treated patients (p < 0.004), and 14% among 14 aerosolized pentamidine-treated patients (p < 0.03). For patients receiving primary prophylaxis, the incidence of PCP was 0% for 58 receiving TMP-SMX, 15% for 20 receiving dapsone (p = 0.015), and 17% for 6 receiving pentamidine (p = 0.094). CONCLUSION: We believe TMP-SMX DS was more effective than oral dapsone or aerosolized pentamidine in preventing PCP in these HIV-infected patients.

AIDS-Related Opportunistic Infections↗