A case of interstitial pneumonitis during amiodarone therapy.
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Alveolitis, Extrinsic Allergic↗
Biomedical subjects
F Schlaeffer
Publications and source records attributed to F Schlaeffer.
Ciprofloxacin in the treatment of nosocomial multiply resistant Acinetobacter calcoaceticus bacteremia.
Twelve cases of multiply resistant Acinetobacter calcoaceticus bacteremia occurred in three intensive care units in three different outbreaks. All patients were mechanically ventilated, on broad spectrum antibiotics and had central lines when bacteremia occurred. The sites of primary infection were: abdominal (n = 3); respiratory (n = 4); central lines (n = 4); CNS (n = 1). In eight cases the acinetobacter strains were susceptible to ciprofloxacin only. Four other strains were sensitive to amikacin as well. All 11 patients treated with ciprofloxacin alone (seven) or in combination with amikacin (four) fully recovered from the infection. The 12th patient died before antibiotic susceptibility was available. Ciprofloxacin seems to be an excellent therapeutic agent for A. calcoaceticus infections.
Acinetobacter Infections↗
Parenteral fluoroquinolones in children with life-threatening infections.
The new fluoroquinolones have not been tested in children despite their wide spectrum of in vitro activity and efficacy, because of an observed damage to cartilage in young animals. However, in some cases they may be life-saving. We present three pediatric patients with life threatening infections in whom the fluoroquinolones were used when other antibiotics failed: A seven-year-old boy with meningitis due to multiresistant Acinetobacter calcoaceticus, a three-year-old boy with Job's syndrome with line sepsis due to Staphylococcus epidermidis and a four month-old boy with agammaglobulinemia with mixed infection due to Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. All three children were cured of their infections.
Body Temperature↗
Chlamydia pneumoniae community-acquired pneumonia: a review of 62 hospitalized adult patients.
In a prospective study, Chlamydia pneumoniae was identified as the etiological agent in 62 (17.9%) of 346 adult patients hospitalized over the course of one year for community-acquired pneumonia at the Soroka Medical Center in Beer-Sheva, Israel. The diagnosis of C. pneumoniae infection was based on serological testing of antibodies by the MIF technique. In 43 of these patients (69.4%), at least one other etiological agent, in addition to C. pneumoniae for community-acquired pneumonia was identified. Streptococcus pneumoniae was identified in 34 patients with C. pneumoniae (54.8%), as an additional causative factor in infection. Community-acquired pneumonia patients with C. pneumoniae were significantly older than non-C. pneumoniae patients (p = 0.03), had a higher APACHE II score on admission (p < 0.05), a higher rate of positive blood cultures (p = 0.02), and longer periods of hospitalization (p = 0.022). Seven patients with pure C. pneumoniae infection recovered, despite treatment which is not considered to be specific for C. pneumoniae. It was concluded that C. pneumoniae is a common etiological agent for community-acquired pneumonia in our region, particularly in the elderly, and is characterized by a high rate of concomitant infections with other pulmonary pathogens. No specific clinical or radiological pattern was discerned that could distinguish between C. pneumoniae community-acquired pneumonia and non-C. pneumoniae community-acquired pneumonia.
Adolescent↗
IL-1beta and IL-6 in community-acquired pneumonia: bacteremic pneumococcal pneumonia versus Mycoplasma pneumoniae pneumonia.
Interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) levels in 20 patients with bacteremic Streptococcus pneumoniae community-acquired pneumonia (CAP) were compared with these cytokine levels in 20 patients with Mycoplasma pneumoniae CAP. All 40 patients survived hospitalization and underwent a follow-up examination one month later. Serum IL-1beta and IL-6 levels were determined by the enzyme immunoassay (EIA) method using commercial kits. In the acute phase of CAP, IL-6 levels were significantly higher in the S. pneumoniae group (p = 0.014), while IL-1beta levels were higher in the M. pneumoniae group (p = 0.046). In the convalescence phase, the two cytokines were detected in a considerable number of patients in both groups. In this phase, only the level of IL-1beta was significantly higher in the M. pneumoniae group than in the S. pneumoniae group (p = 0.03). We conclude that the levels of IL-1beta and IL-6 are different between patients with S. pneumoniae-CAP and M. pneumoniae-CAP during the acute phase. In the convalescence phase, cytokine levels remain high in some of the CAP patients, but a significant difference between the groups exists only for IL-1beta. Further studies are required.
Adult↗
Adult respiratory distress syndrome as a complication of acute pyelonephritis during pregnancy.
Two cases of ARDS as a complication of acute pyelonephritis during pregnancy are presented. The severity of the clinical condition necessitated treating both patients by mechanical ventilation with high positive-end expiratory pressure. The review of the only six other similar cases already reported (only one needing vigorous respiratory treatment) as well as the two cases presented in this report show that the pyelonephritic aetiology of ARDS in pregnancy is very rare. Nevertheless, any septic condition could be complicated by respiratory failure in pregnancy. ARDS must be suspected in those patients suffering from urinary tract infection in which signs of hypoxia appeared during the third trimester of pregnancy. Early recognition of the syndrome, closed monitoring and vigorous treatment can prevent maternal complications and/or fetal distress.
Acute Disease↗
Zoonotic infections as causes of hospitalization among febrile Bedouin patients in southern Israel.
A prospective 12-month study was conducted throughout 1998 to determine the frequency of selected bacterial zoonoses as causes of fever among hospitalized Bedouins in southern Israel. One or more zoonoses were diagnosed in 30 (27%) of 110 patients admitted with fever. Brucellosis was diagnosed in 9 (8%), rickettsial infections in 20 (18%), and ehrlichiosis in 2 (2%), one of whom had also evidence of rickettsial spotted fever infection. None of the patients was diagnosed with Q fever. Compared with patients without zoonoses, patients with zoonoses were younger (P = 0.01), fewer of them had underlying conditions (P < 0.02), they had a longer febrile period prior to hospitalization (P = 0.04), a significantly higher proportion had arthralgia (P = 0.02), rash (P = 0.03), and splenomegaly (P = 0.04) and a lower proportion had pathological findings on chest auscultation (P < 0.01). Patients with zoonoses were found to have more commonly anaemia (P = 0.03) and leucopenia (P = 0.02) compared to the rest of the study population. Of the 30 patients with zoonoses 60% were misdiagnosed and only 57% received adequate antibiotic treatment. Zoonotic infections are a common cause of fever in adult Bedouins living in southern Israel. Because of the non-specific features of these diseases they are often misdiagnosed. Blood cultures and multiple serological tests should be used in the investigation of fever in such patients and tetracycline should be considered for initial empirical treatment.
Adult↗
Extrapulmonary tuberculosis in an immigrant society: clinical and demographic aspects of 92 cases.
Extrapulmonary tuberculosis accounted for 33% of all new cases of tuberculosis identified at the Soroka Medical Center in Beer Sheva, Israel, during a 10-year period. The most common types of extrapulmonary infection diagnosed were genitourinary tuberculosis (54% of patients), lymphadenitis (13%), pleural tuberculosis (9%), and tuberculosis of bones and joints (8%). Of 92 patients, 51% were Jews of Ethiopian origin, 29% were Jews of non-Ethiopian origin, and 20% were Bedouins. Thus, extrapulmonary tuberculosis remains a significant problem for Israel's heterogeneous population.
Ethiopia↗
Ceftriaxone plus once daily aminoglycoside with filgrastim for treatment of febrile neutropenia: early hospital discharge vs. Standard In-patient care.
BACKGROUND: In febrile neutropenic patients, ceftriaxone plus an aminoglycoside is effective for the treatment of infection, while filgrastim reduces the extent and duration of neutropenia. Because the once daily dosing regimen of this combination permits ambulatory treatment, there is a need to test criteria for early hospital discharge. METHODS: Hospitalized adult patients with febrile neutropenia (following chemotherapy) considered to be potentially treatable on a follow-up out-patient basis were entered into this open-label, multinational study. Patients received a once daily combination of ceftriaxone for > or =5 days, aminoglycoside for > or =2 days, and filgrastim until the absolute neutrophil count was > or =1.0x10(9)/l for 2 days. Those initially responding to therapy (reduction of fever by > or =1 degrees C within 72 h, and clinical improvement) were randomized into standard in-patient or follow-up out-patient treatment groups, the latter patients being discharged from hospital early, after meeting defined criteria. RESULTS: 105 patients were enrolled, of whom 21 initial non-responders were not randomized. Efficacy was evaluable in 80 patients. Success (resolution of fever and symptoms, maintained for 7 days after cessation of therapy, and eradication of infecting pathogens) was similar among in-patients (40/42, 95%) and out-patients (34/38, 89%). The duration of hospitalization was shorter for out-patients than in-patients (median of 4 vs. 6 days, respectively). No hospital readmissions were necessary in out-patients. All other efficacy parameters assessed were comparable in both groups, as was tolerability/safety. One potentially drug-related death was reported. CONCLUSIONS: Patients who satisfy prospectively defined criteria for early discharge can be treated safely on an out-patient basis with a regimen of once daily ceftriaxone plus an aminoglycoside with filgrastim. In addition to reducing healthcare costs, it may improve patients' quality of life.
Adult↗