Biomedical subjects
Publications and source records attributed to G E Mathisen.
We report a case of aquarium-borne Mycobacterium marinum infection in a patient who presented simultaneously with cryptosporidiosis and the acquired immunodeficiency syndrome.
The diagnosis of Branhamella catarrhalis pneumonia in five cases was established by culture of pulmonary secretions obtained by transtracheal aspiration. B catarrhalis caused an acute lobar pneumonia which usually responded promptly to appropriate antimicrobial therapy. Recognition that this organism may cause pneumonia in a nonimmunocompromised person should alert clinicians to consider it as a possible pathogen when Gramnegative diplococci are seen on smears of specimens from the lower respiratory tract.
Moxalactam was administered intravenously or intramuscularly or both in doses of 1 to 12 g/day to 45 patients with clinically significant infections (17 soft tissue or bone, 9 pleuropulmonary, 9 septicemic, 6 urinary tract, and 4 intraabdominal infections). Mean 0.5-h postinfusion levels were 105 micrograms/ml for a 4.0-g dose, 44.7 micrograms/ml for a 2.0-g dose, and 18 micrograms/ml for a 1.0-g dose. We identified 28 isolates of Enterobacteriaceae, 10 Pseudomonas aeruginosa isolates, 9 Staphylococcus aureus isolates, and 15 anaerobic bacterial isolates. A total of 15 patients were clinically cured, 8 patients improved, 13 patients improved initially but suffered subsequent relapses or superinfections, and 10 patients failed therapy. Toxicity was generally minimal (reversible eosinophilia, and mild liver function abnormalities, and elevated prothrombin time). The selection or emergence of resistant organisms in 17 patients during treatment (particularly Pseudomonas, enterococci, and Candida) was a disturbing feature of therapy. Our results were generally favorable, considering the complicated underlying medical problems of this group of patients.
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Eighteen consecutive cases of brain abscess or cerebritis seen at the Veterans Administration Wadsworth Medical Center (Los Angeles, Calif.) during 1970-1982 were analyzed. Fifteen occurred after the computerized axial tomographic (CT) scanner for diagnosis and follow-up became available in 1976. The patient population included 14 individuals with significant underlying medical problems and with a clearly identifiable contiguous or distant source. Four patients had multiple brain abscesses; the most common site of involvement in the remaining 14 patients was the parietal lobe. Microorganisms were isolated from 14 patients and included a variety of aerobic and anaerobic bacteria. Of the 27 isolates, 12 were microaerophilic species or strictly anaerobic bacteria. Therapy was most often a combination of surgical drainage and antimicrobial agents. Usually the drug regimen included penicillin and chloramphenicol and, more recently, the combination of penicillin and metronidazole. One of the two patients with brain abscess treated with antimicrobial agents alone died. Two patients with presumed bacterial cerebritis improved with chemotherapy alone. This study reaffirms the important role of anaerobes in brain abscess. The advent of the CT scanner appears to have been a valuable development in both diagnosis and monitoring of therapy, but mortality (22%) still remains relatively high. Although metronidazole will likely prove to represent a significant advance in antimicrobial therapy, surgical drainage still appears to be the mainstay of therapy for treatment of established abscesses.
Plesiomonas shigelloides is being recognized with increasing frequency as a human pathogen. The organism is ubiquitous in fresh and brackish water, and clinical illness has been associated with foreign travel and ingestion of inadequately cooked seafood. We describe a 64-year-old Filipino woman who presented 2 weeks after elective cholecystectomy and pancreatic biopsy with left upper quadrant pain, abdominal distention, and fever. Computerized tomography of the abdomen revealed an abscess in the tail of the pancreas with fluid accumulation in the lesser omental sac. Percutaneous aspiration yielded purulent material, and P. shigelloides was recovered in pure culture. To our knowledge, this is the first reported case of pancreatic abscess due to P. shigelloides.