Biomedical subjects
Publications and source records attributed to D Schlossberg.
Leisure-time activities expose us to a variety of infections. The traveler confronts new pathogens and vectors. Camping, hiking and gardening have attendant risks, as does exposure to fresh and salt water. Adventuresome eating poses gastronomic threats, and pets, sexual exposure and organized sports each contribute distinctive infectious risks to participants.
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A 68 year old diabetic man developed septicaemia and multiple liver abscesses due to Streptococcus intermedius. Liver biopsy revealed streptococcal botryomycosis which showed the Splendore-Hoeppli phenomenon. Diabetes mellitus is an example of the immunosuppressed states that have been associated with botryomycosis.
We reviewed 71 consecutive patients with Streptococcus pneumoniae bacteremia. The patients were analyzed by age, sex, ethnic background, and clinical presentation. Laboratory data reviewed included a CBC count, electrolyte levels, liver function studies, chest radiograph, HIV status, a sputum culture and Gram's stain, and sensitivities for the S pneumoniae isolated. Modalities of therapy, response to treatment, and ultimate outcome were examined. Many of the patients with pneumococcal bacteremia did not have cough, fever, or chills. HIV positivity was a risk factor for pneumococcal infection although it was not associated with increased mortality. Mortality correlated with elderly status, leukopenia, and lack of fever. Many patients had symptoms suggestive of atypical pneumonia including myalgia and mental status change. Hyponatremia and hyperbilirubinemia were commonly noted.
Patients with defective immune systems are susceptible to Legionella infection, especially when the defect involves cell-mediated immunity. Thus, acquired immune deficiency syndrome (AIDS), corticosteroid administration, and hairy cell leukemia are risk factors for Legionellosis. Patients who have AIDS may be at risk for relapsing infections. Corticosteroid administration appears to predispose patients to simultaneous infection with multiple strains of Legionellae and development of lung abscess. Legionellosis also is found in patients who have humoral immune defects, but to a lesser extent. Thus, multiple myeloma, chronic lymphocytic leukemia, and chronic granulomatous disease have all been complicated by Legionella infection, although the risk seems to be minimal.
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The combination of fever and rash comprises an extensive differential diagnosis. Many of the causes of this presentation are life-threatening. In this article, rashes are categorized as petechial, maculopapular, vesicular, erythematous, and urticarial. Each type of rash is then divided into infectious etiologies, both treatable and nontreatable, and noninfectious etiologies. It is usually possible to arrive at a workable differential diagnosis when clinical, historical, and epidemiologic factors are considered.
HISTORY AND FINDINGS: A 32-year-old man, known to have been HIV-positive for 6 years, was admitted to hospital because of dyspnoea and dry cough. For 8 months he had an HIV illness in stage C3 (Center for Disease Control and Prevention, Atlanta) with fever, weight loss and obviously reduced general and nutritional state. There was almost total auscultatory dullness over the right hemithorax and the chest radiogram showed massive right pleural effusion, as well as broad pleural deposits which were suspicious of tumours. The first pleural aspiration recovered 1000 ml exudate. An infectious cause could not be identified. As the effusion was refractory to treatment (301 of effusion were drained over several days), thoracoscopy was performed despite the patient's poor general condition. It revealed extensive tumour masses over the right pleura. COURSE: After the endoscopy the patient's condition deteriorated rapidly and he died 3 weeks after admission, only 1 1/2 months after onset of the first symptoms. Histological examination of the endoscopically obtained biopsy revealed large-cell carcinoma. The form of growth indicated that it was a pseudomesotheliomatous carcinoma. CONCLUSION: No previous case of this type of tumour in an HIV-positive patient has been reported. This patient's course was less favourable than is expected in those without HIV infection.
Azithromycin and clarithromycin are alternatives to conventional macrolides in the routine treatment of many dermatologic, upper respiratory, and lower respiratory tract infections. In this role as alternative therapy, they are better tolerated, less toxic, and more convenient to take, although at a greater cost to the patient. This dosing convenience is an important consideration for the clinician; as shown by Nelson, patient compliance ranges from 95% with once-daily dosing to 58% with four-times-a-day dosing. Thus, less frequent dosing with both drugs as well as the shorter course of therapy possible with azithromycin may be therapeutically advantageous. In addition to their role as alternatives to conventional macrolide therapy, azithromycin and clarithromycin extend the spectrum of macrolides and offer new therapeutic options for H. influenzae, MAC in AIDS, MOTT, and leprosy. Finally, experimental therapy may extend their use for additional opportunistic infections, such as toxoplasmosis and cryptosporidiosis.
Psittacosis may occur in epidemic or sporadic form. We report an outbreak of avian and human psittacosis associated with an aviary in Philadelphia, Pa. The epidemic spread among birds in the aviary and then to men and women who were in contact with the birds. Chlamydia psittaci was cultured from infected birds, and the human patients were evaluated clinically and serologically. After proper treatment of the birds, cleaning of their cages, and institution of appropriate bird-handling techniques, the outbreak among the birds resolved. The human patients were treated, and no subsequent cases have been seen.
Endophthalmitis usually results from surgical trauma, and it rarely complicates intravenous drug abuse. A case is reported of an intravenous drug abuser who had staphylococcal endophthalmitis.
Aortic valve replacement was complicated by sternal wound infection with Mycobacterium fortuitum. The wound was treated with débridement and antibiotic therapy. Five months later the patient developed fever, and blood cultures yielded M fortuitum. At surgery, aortitis with pseudo-aneurysm formation was encountered. Mycobacterium fortuitum grew from the aortic lesion. This is the first report of M fortuitum causing aortitis, although this organism is known to infect sternal wounds and mediastinum. Mediastinal infection can progress despite a normal wound appearance. Its manifestations may be delayed and may include infections of the aorta as well as of the sternum and mediastinum.
A male homosexual (positive for the human immunodeficiency virus) with a recent cat scratch developed fever, epitrochlear and axillary lymphadenopathy, and retinitis. Subsequently, he developed skin (epitheloid hemangioma) and mucosal lesions (Kaposi's sarcoma), multiple liver abscesses, and pleural effusion. Warthin-Starry stains and/or electron micrographs of lymph nodes and skin lesions demonstrated bacilli characteristic of those associated with cat-scratch disease. Cultures of lymph node, pleural fluid, and liver abscess specimens yielded organisms believed to be the causative agent of cat-scratch disease. We believe that disseminated cat-scratch disease may become an indicator of opportunistic infection signaling acquired immunodeficiency syndrome in a patient who is positive for the human immunodeficiency virus.
We describe a sibship affected by subsequent periampullary, colorectal and gastric carcinoma. Three of 4 siblings (2 males, 1 female) developed a periampullary carcinoma at the age of 20, and the 2 brothers subsequently had colorectal and gastric carcinoma. One of them also had familial adenomatous polyposis. There is suggestive evidence of vertical transmission of a gene predisposing to a hereditary colorectal carcinoma syndrome.
Six normal adults with varicella pneumonia were treated successfully with acyclovir sodium. All patients showed resolution of roentgenographic and arterial blood gas abnormalities. In addition, five of the six patients demonstrated thrombocytopenia that resolved with therapy. Intravenous acyclovir therapy should be instituted as early as possible in patients who may have varicella pneumonia.
Forty-four patients with histologically confirmed esophageal cancer were irradiated with 60 Gy, checked endoscopically and by biopsy, and then followed clinically or radiologically until their death. The findings confirm the local destructibility of esophageal cancer with loosely ionized radiation and a favorable effect on quality of life. Three quarters of the patients were able to take normal food at the end of the radiotherapy, while the remainder were at least able to swallow soft foods. Radiotherapy can be offered as an effective alternative to patients, especially when operation is associated with a high risk. This is also demonstrated by the fact that 23 of 32 patients who had endoscopy and biopsy again at the end of the radiotherapy had no histologically demonstrable tumor.