Biomedical subjects
Publications and source records attributed to H D Rose.
Diarrhea and pseudomembranous colitis appeared in a patient receiving antibiotic therapy with cephalosporin derivatives only. There was a prompt remission following treatment with cholestyramine resin.
A prospective study of 15 patients with pulmonary aspergilloma was undertaken over an 11 year period. Serious underlying diseases, particularly chronic obstructive pulmonary disease and alcoholic cirrhosis, were present in 12 of them. Eight of 15 patients whose clinical and roentgenographic course was followed for an average of 50 months, received no specific therapy. There were four deaths in this group, none attributable to aspergilloma. The aspergilloma had lysed spontaneously in two, decreased in size in one and was unchanged in one. In the four surviving patients who had no treatment, the aspergilloma lysed spontaneously in one, remained unchanged in two and increased in size in one. Of the seven patients who were treated medically or surgically, three died. Among the seven deaths (untreated and treated patients combined), six were clearly related to underlying disease. The prognosis of aspergilloma is related primarily to the nature and severity of the underlying disease(s). Contrary to the conclusions of previous reports, the experience in our series of patients suggests that routine surgical excision of aspergilloma is not indicated.
A 54-year-old diabetic patient had unexplained fever and embolic occlusion of the splenic, right renal, right hypogastric, right superficial femoral, and left popliteal arteries. Aspergillus fumigatus was recovered from a femoral clot. An aortogram revealed a mycotic aneurysm of the thoracic aorta to be the source of the infected emboli. Surgical excision of the aneurysm and therapy with amphotericin B were unsuccessful.
A prospective study of 64 patients admitted to a medical intensive care unit and 86 patients admitted to a surgical intensive care unit was done to determine the frequency of pharyngeal, intestinal, and tube site colonization with Gram-negative bacilli. Studies were carried out over a 13-week period. The pharyngeal carrier rate among the surgical patients increased by a total of 34 strains compared to 14 strains among medical patients. Similarly, the intestinal carrier rate increased by 35 strains compared to 12 strains. The increased carriage in surgical patients was related more to the presence of indwelling tubes and colonization of multiple sites in the same patient than to the use of antimicrobial drugs. Pharyngeal and rectal colonization in medical patients was related to antibiotic therapy. Indwelling tubes were used predominately in surgical patients and were a significant reservoir of these organisms.
A prospective study of patients hospitalized in a large Veterans Administration Hospital between November 1963 and November 1973 revealed 123 patients with deep mycotic infections. The incidence of these infections almost doubled during the last 5 years. Candida (55 patients) and Aspergillus (26 patients) were the major causative agents. Nine other fungal caused infection in the remaining patients. Candidemia was rare prior to the introduction of commerical percutaneously-inserted venous catheters in 1965. The incidence increased further following the introduction of parenteral hyperalimentation in 1969, and Torulopsis fungemia (5 patients) appeared for the first time. Invasive pneumonia caused by spore-forming Aspergillus decreased when patients were moved from an old, naturally-ventilated hospital to a new, mechanically-ventilated one. The air in both hospitals was sampled on one occasion for the presence of fungal spores, and spores of Aspergillus fumigatus were detected only in the old hospital. Our experience suggests that hospital-acquired Aspergillus infection of the lung might be eliminated if all incoming hospital air is filtered, properly vented, and not recirculated. Efforts to decrease hospital-acquired fungal infections include vigorous infection control procedures for intravenous therapy, judicious use of any therapy that predisposes to infection, and further evaluation of improved mechanical control of hospital ventilation.
Disseminated Mycobacterium kansasii infection associated with pancytopenia was diagnosed in a 40-year-old man found to have granulomata in kidney and liver biopsy specimens. The M. kansasii was isolated from the urine and tissue obtained by renal biopsy. Serial renal biopsies and renal tissue obtained at autopsy showed severe interstitial fibrosis which was thought to represent a tissue response to the M. kansasii infection. The periportal and parenchymal fibrosis found in the liver at autopsy were consistent with a similar response in the liver.
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