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Biomedical subjects

E Anaissie

Publications and source records attributed to E Anaissie.

At least 73 records · Page 4Linked to original sources
PubMed1992

Bacteremia due to Achromobacter xylosoxidans in patients with cancer.

Bacteremia due to Achromobacter xylosoxidans is rare, and little information on treatment is available. Between 1983 and 1988, A. xylosoxidans was recovered from 26 cultures of blood from 10 patients with cancer and clinical signs of infection, including one patient with septic shock and two with pneumonia. Neutropenia did not seem to be a predisposing factor. The infection may have been catheter related in four patients and associated with gastrointestinal pathology in four others. Probable cause was not determined in the remaining two. In vitro studies of susceptibility showed that the isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ), the antipseudomonal penicillins, ceftazidime, cefoperazone, and imipenem; moderately susceptible to ciprofloxacin; and resistant to ceftriaxone, cefotaxime, cefoxitin, ceftizoxime, aztreonam, and amikacin. All patients receiving therapy recovered, including those six who received TMP-SMZ or a beta-lactam antibiotic as a single agent. A. xylosoxidans bacteremia is a significant infection and may be catheter related or associated with gastrointestinal pathology. The infection usually responds to therapy with TMP-SMZ or an appropriate beta-lactam antibiotic.

Adolescent↗
PubMed1992

Opportunistic mycoses in the immunocompromised host: experience at a cancer center and review.

The field of opportunistic mycoses in the patient with cancer is rapidly changing. Not only are fungal infections increasing in frequency in this patient population, but these infections are occurring earlier during the course of cytotoxic chemotherapy, and newer fungi are increasingly recognized as potentially lethal pathogens. Candidiasis remains the most commonly encountered infection. The spectrum of disease includes candidemia and acute and chronic disseminated candidiasis. Pulmonary aspergillosis and disseminated aspergillosis are common and remain relatively resistant to therapy. Disseminated fusariosis and trichosporosis are almost always fatal in the setting of persistent profound neutropenia. Therapy for these mycoses relies on the use of amphotericin B and 5-fluorocytosine. Newer antifungal agents, such as fluconazole and itraconazole, appear to exhibit good activity against a variety of fungi. Newer approaches need to be tested for the treatment of the more-resistant mycoses and may include the use of maximally tolerated doses of antifungal agents, colony-stimulating factors, and combination therapy.

Humans↗
PubMed1992

A novel murine model of disseminated trichosporonosis.

Serious infections caused by Trichosporon beigelii have been noted with increasing frequency in immuno-compromised patients. Progress in understanding the pathogenesis of this emerging infection has been limited by the lack of an animal model. We developed a CF1 mouse intravenous inoculation model of disseminated trichosporonosis to evaluate the pathogenicity of T. beigelii in transiently immunosuppressed mice. Four inocula (1 x 10(6), 1 x 10(7), 2 x 10(7), and 4 x 10(7) CFU per animal) of one clinical strain of T. beigelii 3001 were tested. Mice in groups of 10 were each injected with a single intravenous dose of one inoculum. Mortality correlated with inoculum size, as survival time was significantly shorter in mice injected with 4 x 10(7) or 2 x 10(7) CFU than in mice that received 1 x 10(7) or 1 x 10(6) CFU (P less than 0.01). Necrotizing abscesses with conidial and hyphal elements and neutrophil and macrophage infiltration were observed in all major organs examined. Resistance to infection was markedly lowered by immunosuppression with either cyclophosphamide or cortisone acetate, with a significantly shorter survival time and a greater fungal burden per organ in immunosuppressed animals than in normal animals (P less than 0.01). Nine additional strains were inoculated intravenously with around 5 x 10(6) CFU. Injection of each of these strains caused 100% mortality, in a pattern similar to that observed with strain 3001.

Animals↗
PubMed1992

Collaborative investigation of broth microdilution and semisolid agar dilution for in vitro susceptibility testing of Candida albicans.

A study was performed in two laboratories to evaluate the effect of growth medium and test methodology on inter- and intralaboratory variations in the MICs of amphotericin B (AMB), flucytosine (5FC), fluconazole (FLU), itraconazole (ITRA), and the triazole Sch 39304 (SCH) against 14 isolates of Candida albicans. Testing was performed by broth microdilution and semisolid agar dilution with the following media, buffered to pH 7.0 with morpholinepropanesulfonic acid (MOPS): buffered yeast nitrogen base (BYNB), Eagle's minimal essential medium (EMEM), RPMI 1640 medium (RPMI), and synthetic amino acid medium for fungi (SAAMF). Inocula were standardized spectrophotometrically, and endpoints were defined by the complete absence of growth for AMB and by no more than 25% of the growth in the drug-free control for all other agents. Comparative analyses of median MICs, as determined by each test method, were made for all drug-medium combinations. Both methods yielded similar (+/- 1 twofold dilution) median MICs for AMB in EMEM and RPMI, 5FC in all media, and FLU in EMEM, RPMI, and SAAMF. In contrast, substantial between-method variations in median MICs were seen for AMB in BYNB and SAAMF, FLU In BYNB, and ITRA and SCH in all media. Interlaboratory concordance of median MICs was good for AMB, 5FC, and FLU but poor for ITRA and SCH in all media. Endpoint determinations were analyzed by use of kappa statistical analyses for evaluating the strength of observer agreement. Moderate to almost perfect interlaboratory agreement occurred with AMB and 5FC in all media and with FLU in EMEM, RPMI, and SAAMF, irrespective of the test method. Slight to almost perfect interlaboratory agreement occurred with ITRA and SCH in EMEM, RPMI, and SAAMF when tested by semisolid agar dilution but not broth microdilution. Kappa values assessing intralaboratory agreement between methods were high for 5FC in all media, for AMB in BYNB, ENEM, and RPMI, and for FLU in EMEM, RPMI, and SAAMF. One laboratory, but not the other, reported substantial to almost perfect agreement between methods for ITRA, and SCH in EMEM, RPMI, and SAAMF. Both laboratories reported poor agreement between methods for the azoles in BYNB. Discrepancies noted in azole-BYNB combinations were largely due to the greater inhibitory effect of these agents in BYNB than in other media. These results indicate that the semisolid agar dilution and broth microdilution methods with EMEM or RPMI yield equivalent and reproducible MICs for AMB, 5FC, and FLU but not ITRA and SCH.

Agar↗
PubMed1991

Review of Citrobacter bacteremia in cancer patients over a sixteen-year period.

A review was conducted of 65 episodes of Citrobacter bacteremia in cancer patients during a 16-year period. Cases of polymicrobial bacteremia were excluded from this analysis. The infection occurred most commonly in patients with acute leukemia. Most patients acquired the infection in the hospital, and 57% had received antibiotic therapy during the preceding ten days. Fever occurred in 98% of cases and shock in 17%. Thirty-eight percent of patients had concomitant pneumonia. Patients with shock, pneumonia or hemorrhage had a substantially poorer prognosis. The response rate was 72% for patients who received appropriate antibiotics. Patients who continued to have positive blood culture results while receiving appropriate antibiotic therapy had a poor prognosis. Beta-lactam antibiotics were more effective than aminoglycosides.

Adolescent↗
PubMed1991

Comparison of the in vitro antifungal activity of free and liposome-encapsulated amphotericin B.

One hundred and four pathogenic yeast isolates (32 Candida albicans, 20 Candida tropicalis, 20 Candida parapsilosis and 32 Cryptococcus neoformans) and 21 mould isolates (13 Aspergillus spp. and eight Fusarium spp.), most of which were isolated from patients with cancer, were tested for susceptibility to free amphotericin B and a small unilamellar liposomal formulation of amphotericin B using a microbroth dilution method. Minimal fungicidal concentrations were also determined for Candida spp. and Cryptococcus neoformans. The minimal inhibitory concentrations of liposomal amphotericin B were comparable with those of the free drug; furthermore, the fungicidal activity of these two drugs did not differ significantly.

Amphotericin B↗
PubMed1991

Fluconazole therapy for chronic disseminated candidiasis in patients with leukemia and prior amphotericin B therapy.

OBJECTIVE: To study the efficacy of fluconazole against chronic disseminated candidiasis (hepatosplenic candidiasis) in patients with leukemia in whom amphotericin B treatment had failed. DESIGN: Retrospective analysis of patients with chronic disseminated candidiasis treated with fluconazole on a compassionate investigational new drug protocol. SETTING: Multi-institutional. PATIENTS AND METHODS: Twenty consecutive patients received 100 to 400 mg of fluconazole per day for a median of 30 weeks. All had either failed to respond to treatment with more than 2 g of amphotericin B or had serious amphotericin B-related toxicities. RESULTS: Fourteen of 16 evaluable patients (88%) responded. Responses were observed in seven of nine patients in whom adequate doses of amphotericin B had failed and in all seven patients who had amphotericin B-related toxicities. In 12 patients, cytotoxic chemotherapy was continued without flare of the infection. Fluconazole was well tolerated with rare side effects. Aspergillus superinfection developed in three patients and contributed to the death of two of them. CONCLUSION: Fluconazole is a safe and effective agent with significant activity against chronic disseminated candidiasis.

Adult↗
PubMed1991

Experimental fusarial hyalohyphomycosis in a murine model.

The pathogenicity of two clinical strains of Fusarium solani was studied in normal and transiently neutropenic outbred CF1 and CD1 male mice. Three inocula (5 x 10(5), 1 x 10(6), and 5 x 10(6) spores/animal) were tested. Groups of 10 mice each were injected with a single intravenous dose of one inoculum. Mortality correlated with the dose of inoculum, as survival was significantly shorter in mice injected with 5 x 10(6) cfu/mouse than in mice that received 1 x 10(6) or 5 x 10(5) cfu/mouse (P less than .001). Necrotizing abscesses with acute branching septate hyphae, neutrophil and macrophage infiltration, and hemorrhage were observed. The median survival of neutropenic mice was shorter than that of normal mice (P less than .001). Neutropenic mice did not show evidence of an inflammatory cellular reaction and exhibited significantly higher numbers of fungi per gram of infected tissue (P less than .001). Intact host defenses in normal mice were able to confine the infection to the kidneys after initial dissemination. In contrast, disseminated infection persisted in most organs in immunosuppressed animals.

Animals↗
PubMed1991

Fluconazole susceptibility testing of Candida albicans: microtiter method that is independent of inoculum size, temperature, and time of reading.

In vitro antifungal susceptibility testing generally remains unstandardized and unreliable for directing therapy. When azoles are tested, this problem is further compounded by the lack of definite reading end points. We determined the in vitro susceptibility of 50 Candida albicans isolates (including 10 reference strains) to fluconazole by using a microbroth dilution method in which microtiter plates were agitated immediately before reading. Six fungal inoculum sizes (ranging from 2 x 10(2) to 4 x 10(5) CFU/ml), three different times of reading (24, 48, and 72 h), and two temperatures (30 and 35 degrees C) were tested. We also compared visual and spectrophotometric determinations of MIC end points. This agitation method resulted in clear-cut visual end points that were reproducible for different observers within the same laboratory, that were independent of inoculum size, temperature of incubation, and time of reading, and that correlated well with the degree of fungal inhibition as determined by spectrophotometry. Median MICs also correlated with usually achievable levels of fluconazole in serum and tissue of humans and experimental animals.

Candida albicans↗
PubMed1990

Beta-lactam regimens for the febrile neutropenic patient.

A total of 535 evaluable febrile episodes in neutropenic patients were randomly assigned to treatment with ticarcillin-clavulanate plus vancomycin (TV), ceftazidime plus vancomycin (CV), or all three antibiotics (TCV). The TCV regimen was significantly more effective than TV, considering all evaluable episodes, documented infections, gram-negative infections, and infections in patients with persistent severe neutropenia (less than 100 neutrophils/mm3). The results with CV were intermediate between TV and TCV. The toxicities were similar with all three regimens and consisted primarily of skin rashes. The TCV regimen is effective for empiric therapy of fever in neutropenic patients and probably should be utilized in preference to CV or TV, although its superiority over CV in this study was inconclusive.

Adolescent↗
PubMed1989

Antifungal susceptibility of 44 clinical isolates of Fusarium species determined by using a broth microdilution method.

The MICs and minimum fungicidal concentrations of amphotericin B, natamycin, miconazole, itraconazole, and flucytosine against 17 isolates of Fusarium solani, 14 isolates of Fusarium moniliforme, 10 isolates of Fusarium oxysporum, and 3 isolates of Fusarium semitectum were determined by a broth microdilution method. Amphotericin B and natamycin were the most active agents tested and failed to show any inoculum size effect. In contrast, miconazole and itraconazole showed poor inhibitory and fungicidal activities, and the inoculum size had a major effect on the results. Flucytosine had no activity against any of the isolates tested.

Antifungal Agents↗
PubMed1989

Nosocomial fungal infections. Old problems and new challenges.

The frequency of nosocomial mycoses has substantially increased in recent years, primarily because of the use of intensive therapeutic regimens in patients with cancer and organ transplantation. Furthermore, newer fungi previously considered as contaminants or harmless colonizers have now emerged as significant human pathogens, particularly in the immunocompromised host. Only through the collaboration between clinicians, pathologists, microbiologists, and infection control officers can these fungal infections be recognized and treated early. It is hoped that the proper implementation of infection control policies, the advent of newer antifungals and biological response modifiers, and the advances in immunosuppressive regimens for organ transplant recipients will result in a significant improvement in the prevention and treatment of these life-threatening opportunistic mycoses.

Aspergillosis↗
PubMed1988

Central nervous system histoplasmosis. An unappreciated complication of the acquired immunodeficiency syndrome.

Involvement of the central nervous system (CNS) by Histoplasma capsulatum is a rare event. It is usually not included in the differential diagnosis of CNS lesions in patients with acquired immunodeficiency syndrome (AIDS). Herein are described four patients with AIDS and progressive disseminated histoplasmosis who had CNS involvement. Histoplasmosis in the CNS may produce meningitis, single or multiple brain abscesses, and may present with either a clinical picture of obtundation or a deteriorating space-occupying CNS lesion. Three of the four patients were treated with amphotericin B and had initial clinical response, but ultimately, all experienced a relapse and died from their infection.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The emerging role of Fusarium infections in patients with cancer.

Infection due to Fusarium species is an increasing cause of serious potentially fatal disease in patients with cancer. We described 9 patients with infection caused by Fusarium species during a 4-year period at the M. D. Anderson Hospital. The spectrum of infections included disseminated disease in 4 patients, skin or soft-tissue infections in 3, pneumonia in 1, and fungemia in 1. All 4 patients with disseminated infection had culture- and biopsy-proven skin lesions caused by Fusarium species and the blood cultures yielded the organism in 3 of these 4 patients. Maxillary sinusitis was the presenting manifestation of Fusarium infection in 2 of these 4 patients, suggesting that paranasal sinuses are potential portals of entry for the infection. Eight patients had a hematological malignancy and 7 were neutropenic at the onset of their infection. Patients with deep-seated infections remained neutropenic and died from infection despite treatment with amphotericin B. All 5 isolates tested in vitro showed resistance to ketoconazole and miconazole, whereas 3 were susceptible to amphotericin B. Fusarium species could play a role in producing myelosuppression and fungal cultures are required to differentiate it from the more commonly encountered Aspergillus species. Fusarium species are emerging as a serious, potentially fatal, pathogen in patients with cancer.

Adolescent↗
PubMed1987

Primary small intestinal lymphoma in adults. A comparative study of IPSID versus non-IPSID in the Middle East.

Seventy-five cases of primary small intestinal lymphoma (PSIL) were diagnosed in adults at the American University of Beirut Medical Center (AUBMC) during the period from 1961 to 1980. Two additional cases of immunoproliferative small intestinal disease (IPSID) in the premalignant phase also were studied. Thirty-two patients had IPSID; 27 non-IPSID; and in 18 patients it was difficult to distinguish IPSID from non-IPSID. While the former was shown to be a distinct disease entity with characteristic clinical, pathologic, and immunologic features, the latter was found to have no particular features in this part of the world. In addition to alpha heavy chain protein (AHCP) which is the biological marker of IPSID, the most important finding that distinguished the two diseases was that IPSID was always associated with a dense, compact mucosal cellular infiltrate (MCI) that was continuous and uninterrupted all along the length of the small intestine. In non-IPSID, MCI was lacking and the pathology was confined to sites of gross abnormalities. Sites distant to the primary lesion were free of disease. It was reported previously that the MCI in IPSID is characteristically diffuse plasmacytic or lymphoplasmacytic (DLP). Our study indicates that in addition to this infiltrate, the disease may be associated with another type of infiltrate which is follicular lymphoid (FL). Sixteen patients had DLP; ten, FL; and three, mixed infiltrate. The relationship of AHC disease and IPSID is discussed. AHCP may be found in intestinal fluid, serum, within the abnormal cell, or at its surface. Immunofluorescence and immunoperoxidase studies must be done on all intestinal and nodal tissue specimens in all patients with PSIL for the detection of AHCP, particularly in those where serum and intestinal fluid are negative for this protein. The hypothesis that the DLP infiltrate represents the secretory form of IPSID, while the FL the nonsecretory form, is introduced. IPSID is an ideal model for the study of the etiology and pathogenesis of lymphoma in man.

Adolescent↗
PubMed1987

Pseudomonas putida. Newly recognized pathogen in patients with cancer.

Pseudomonas putida was recovered from blood culture specimens between 1980 and 1985 in 15 patients with cancer. No isolates were found in specimens obtained before 1980. Eight patients were considered to have septicemia (more than one positive blood culture result plus clinical signs of infection). Septicemia was monomicrobial in three of those eight patients and polymicrobial in five. Of these eight patients, one had pneumonia and three had phlebitis, cellulitis, or both at the site of the venous catheter. The infection appeared to be catheter-related in these three patients, with response to catheter removal in one patient, response to catheter removal and antibiotics in one patient, and response to antibiotics alone in one patient. P. putida was isolated from the site of insertion and the tip of the catheter in one of these three patients. Following therapy, all patients had a rapid recovery from their infection. In vitro susceptibility testing revealed that 90 percent of the isolates were susceptible to piperacillin, ceftazidime, imipenem, and ciprofloxacin.

Catheterization↗