Biomedical subjects
Publications and source records attributed to E D Everett.
The in vitro susceptibility of 96 isolates of Propionibacterium acnes to 17 antibiotics was determined by utilizing an agar dilution technique. With the exception of the aminoglycosides, these organisms are susceptible to virtually all of the commonly used antimicrobial agents.
Transient, usually asymptomatic bacteremia occurs in a wide variety of procedures and manipulations, particularly those associated with mucous membrane trauma. It may also occur with such daily functions as tooth brushing and bowel movements. These brief bacteremias are especially common in tooth extraction and other dental procedures. Although numerical risk is uncertain, these bacteremias can occasionally give rise to infective endocarditis in the susceptible patient. While no proof exists that antibiotics given prior to procedures causing bacteremia prevent endocarditis in humans, experimental evidence in rabbits supports their use. Therefore, in situations where bacteremia is highly predictable, it would seem wise to administer prophylactic antimicrobials. Procedures in the susceptible host where prophylactic antibiotics seem prudent include dental manipulations and urinary tract instrumentation. Whether patients with acquired valvular or congenital heart disease who are to undergo abdominal surgical procedures should routinely receive prophylactic antibiotics is unclear. However, until the incidence of transient bacteremia associated with various abdominal procedures is further defined, endocarditis-prone patients should probably receive prophylaxis. Furthermore, patients with prosthetic valves who are subjected to upper gastrointestinal endoscopy, sigmoidoscopy, liver biopsy, or barium enema should also probably have antibiotic pretreatment. For dental procedures and for upper gastrointestinal endoscopy in patients with prosthetic valves, a combination of penicillin and streptomycin or vancomycin alone is recommended. For urinary tract instrumentation in all patients and for sigmoidoscopy, liver biopsy, or barium enema in patients with prosthetic valves, prophylaxis should be with ampicillin and gentamicin or vancomycin and gentamicin.
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The clinical and laboratory findings in six cases of anaerobic diphtheroid infection of cerebrospinal fluid shunts are described. These organisms have been infrequently reported as a cause of shunt infections but our data indicate that such infections may be more common than currently appreciated. Propionibacterium species are common contaminants of cerebrospinal fluid specimens, but when isolated from the spinal fluid of a patient with a shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. Fever was a constant finding frequently accompanied by signs of central nervous system dysfunction. Spinal fluid pleocytosis was usually limited to 1 to 200 cells and protein and sugar values were variable. The organisms grow slowly, therefore spinal fluid cultures should be held for at least 14 days before they are reported as negative.
A prospective study of the risk of bacteremia in 84 women having insertion and in 16 women having removal of intrauterine devices was performed. Bacteremia was not found in any of these 100 women at 1 to 3, 15, or 30 minutes after the procedure or in any of 57 women studied again 1.5 hours later. Because of the remote risk of bacteremia, the presence of congenital or valvular heart disease need not be an absolute contraindication to the use of an intrauterine device for contraception in an otherwise healthy young woman. Prophylactic antimicrobial therapy during insertion or removal of an intrauterine device appears to be unnecessary in the absence of evident pelvic infections. The risk of bacteremia during removal of an intrauterine device from an infected uterus cannot be determined from this study.
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A study of immunofluorescence of yeast in the urine was carried out in 18 patients with funguria in an effort to correlate gamma globulin coating with evidence of tissue invasion or as an indicator for institution of therapy. Positive immunofluorescence of yeast in urine is common but is neither indicative of upper urinary tract yeast invasion nor a useful guideline for beginning treatment.
During the 6-year period from 1965 through 1970, 39 patients with pulmonary melioidosis were treated at Fitzsimons Army Medical Center. Although this is a disease with a well-defined endemic area that does not include the United States, cases will no doubt continue to be seen in this country. These cases may result from acute infection in the endemic area, with subsequent travel to this country, or from delayed reactivation of a latent infection acquired months or years earlier. Given the potential for occurrence of this disease in the United States, continued awareness by the medical profession is important. The typical patient with subacute or chronic pulmonary melioidosis presents with fever, productive cough, weight loss, and a history of visiting an endemic area sometime in the past. Chest radiographs disclose upper lobe infiltrates and/or cavitation, suggesting granulomatous disease. With careful bacteriologic examination, sputum cultures are positive for Pseudomonas pseudomallei, which is susceptible to tetracycline, chloramphenicol, sulfonamides, and kanamycin. The titer of the indirect hemagglutinating antibodies will almost always be greater than 1:40. Most patients respond to therapy with tetracycline alone of in combination with chloramphenicol. Occasionally, a patient may require surgical intervention; if so, ideally the sputum should be negative, and a lobectomy, rather than segmentectomy, should be performed.
The effect of normal serum and serum for seven patients with disseminated candidiasis (DC) on candidacidal activity of normal human neutrophils (PMNL) was studied. PMNL incubated in DC serum had depressed candiacidal activity when compared to studies with normal serum. The candidacidal defect was not related to differences in particle uptake since phagocytic indices were similar with either normal or DC serum. DC serum did not affect PMNL bactericidal activity against Staphylococcus aureus. When Candida albicans (CA) was incubated in either normal or DC sera, washed, and added to PMNL in normal serum, pronounced inhibition of candidacidal activity was seen in all studies with CA previously incubated in DC serum. Dilution of DC serum or absorption of DC serum with heat-killed CA reversed the candidacidal defect. Ultrastructural studies of phagocytized CA demonstrated small ("tight") phagolysosomes and a delay in breakdown of an electron-dense coating on CA previously incubated in DC serum when compared to controls. Inhibition of leukocyte candidacidal activity appeared to be related to high titers of IgG antibodies against CA present in DC serum.
Twenty-six healthy controls and 45 patients with clinically suspected candidiasis were studied utilizing precipitin determination by double immunodiffusion, agglutinin titers, and presence of clumping factor by microscopy. The data are used to evaluate the specificity, reproducibility, and ease of performance of the procedures. Our results indicate that there is considerable overlap in agglutinin titers in patients with or without visceral candidiasis and that determination of clumping factor by microscopy only is inadequate for diagnosis. Precipitin tests were positive in 80% of patients with visceral candidiasis (exceptions were highly immunosuppressed hosts). This test is easily performed, reproducible, and can be applied in any general hospital laboratory. Neither agglutinin nor precipitin determination appears to be applicable to determining duration of therapy.
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