Biomedical subjects
Publications and source records attributed to E D Everett.
The antimicrobial therapy of systemic salmonella infections is presently limited to ampicillin, chloramphenicol, and sulfamethoxazole and trimethoprim. Infrequently, alternative therapy may be necessary. We report the successful treatment of a case of Salmonella vertebral osteomyelitis with cefotaxime sodium.
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A 60-year-old man had pyogenic meningitis due to Francisella tularensis acquired by tick bite. His disease initially improved but later relapsed after a standard course of streptomycin. Complete resolution resulted from prolonged combined therapy with streptomycin and tetracycline. Successful treatment of acute tularemic meningitis has not previously been reported. Our experience suggests that therapy should include agents that reliably penetrate the CSF, that is, tetracycline or chloramphenicol, for optimal treatment of this rare form of tularemia.
The usual tissue form of Histoplasma capsulatum is a small intracellular yeast, though extracellular organisms of unusually large size have also been described. The production of hyphae in tissue has been regarded as rare and we believe not generally appreciated. We report a case of probable Histoplasma endocarditis from which an embolus demonstrated abundant mycelial forms on histologic examination. Of previously reported cases of H capsulatum endocarditis with detailed pathologic description, nine of 27 cases are found to demonstrate hyphal forms. Hyphal structures should be considered a common morphologic variant of H capsulatum in intravascular lesions.
Patients infected with Histoplasma capsulatum exhibit protean clinical manifestations and similarly express variable humoral immune responses. Therefore, the specific goals of this study were to more clearly define host immune responses by determining the concentrations of total and H. capsulatum-specific immunoglobulins in sera from patients with acute or chronic pulmonary and disseminated histoplasmosis. H. capsulatum-specific (AS) IgG, IgA and IgM, and total IgE were determined by radioimmunoassays while total IgG, IgA, and IgM were quantitated by laser nephelometry. In general, total IgG and IgA were elevated, while IgM and IgE were either decreased or normal for the three clinical forms of histoplasmosis studies. Antigen-specific IgG and IgA were markedly elevated in all classes of disease, whereas AS-IgM was only slightly increased. Total and AS-IgG were elevated in the sera of chronic patients directly proportional to the number of demonstrable precipitin bands.
A patient with renal failure secondary to amyloidosis and undergoing continuous ambulatory peritoneal dialysis had fungal peritonitis due to Trichoderma viride, an organism ubiquitous in the soil. Tissue invasion by this species has not previously been reported. In vitro susceptibility of the organism suggests that such infections may respond to amphotericin B or ketoconazole although our patient died before a response to therapy could be evaluated.
The in vitro bactericidal activity of certain antimicrobials, especially aminoglycosides, is markedly diminished at an acid pH. In an attempt to correlate this factor with the poor response of gram-negative bacillary pneumonia to aminoglycoside therapy, the endobronchial pH of selected groups of subjects was measured via a bronchoscopically directed pH electrode. The average peripheral, i.e., subsegmental, endobronchial pH of normal persons, patients with chronic lung disease, and patients with pneumonia was 6.58 +/- 0.06, 6.62 +/- 0.10, and 6.61 +/- 0.06, respectively. The average central airway, i.e., major bronchi or tracheal, pH at 6.64 +/- 0.07 did not vary significantly from that of peripheral airways. The presence of pneumonia in individual bronchi was associated with a significantly lower pH than that in noninfected bronchi: 6.48 +/- 0.12 versus 6.69 +/- 0.13 (p less than 0.05). This relatively acid environment appears exaggerated within pneumonic airways and may contribute toward decreasing the effectiveness of aminoglycosides and certain other antimicrobials used in treating lung infection.
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Despite technical advances, Foley catheter associated urinary tract infections continue to be the leading cause of nosocomial infections. PVP-I2 has been shown to be nonirritating to abraded tissue and we have shown that dilute solutions are bactericidal for organisms causing Foley catheter associated urinary tract infections. The purpose of this study was to ascertain the toxicity of PVP-I2 on the catheterized rat bladder and to measure the systemic absorption of I2. Bladder catheters were surgically placed into each of 3 groups of rats: group 1, catheters only; group 2, irrigation with PBS q.8h; and group 3, irrigation with a 1:3 dilution of a 10 per cent PVP-1 per cent I2 solution q-8h. One-half of each group was sacrificed at 1 and 2 weeks respectively. Photographs of mounted bladders and histologic sections were then graded by 3 independent observers. Blood for protein bound iodine (PBI), T3 and T4 levels was obtained before the study and at sacrifice. No difference in ulcerations, erythema or inflammation was noted. PBI was higher in group 3 rats at conclusion than group 1 and 2 (6.88 mg./dl. versus 3.42 mg./dl.) (p less than 0.05). There was no difference in T3 or T4 levels. In this study, PVP-I2 was no more toxic to the bladder than catheterization alone or irrigation with PBS.
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In five patients, peritonitis caused by uncommon agents was acquired during continuous ambulatory peritoneal dialysis. Three patients had yeast (two Candida albicans, one C parapsilosis), one Aspergillus fumigatus, and one Nocardia asteroides infections. A review of the literature indicates that yeasts are the most common cause of peritoneal dialysis-associated fungal peritonitis; only one other possible case of Aspergillus sp and no Nocardia infections have been proved, to our knowledge. Observations are recorded in reference to diagnosis and suggested methods of treatment.
We have described a case of Cryptococcus neoformans endophthalmitis, especially rare in the absence of simultaneous CNS involvement. The key to management appears to lie in early diagnosis, which is difficult because there are multiple causes of uveitis; clinical examination will not establish the specific cause. If clinical improvement is not apparent after several days of nonspecific therapy and other studies have failed to yield a diagnosis, appropriate stains and cultures of vitreal aspirate should be done for fungi and other organisms. Amphotericin B plus 5-fluorocytosine is the treatment of choice, possibly with intravitreal instillation of amphotericin B and vitrectomy.
A radioimmunoassay for determination of human immunoglobulin G, A, and M class antibodies to Histoplasma capsulatum is reported. Yeast-phase antigen from H. capsulatum was adsorbed onto polyvinyl chloride microtiter plates as the solid phase. Human antibodies were allowed to react with this antigen, followed by addition of rabbit anti-human alpha- or mu-heavy chain sera. 125I-labeled staphylococcal protein A was then added and allowed to bind the human and rabbit immunoglobulin G. With this technique, it is possible to evaluate individual human serum samples for antigen-specific classes of antibodies. This assay may be useful for monitoring the immune response in histoplasma infections.
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