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J A Shulman

Publications and source records attributed to J A Shulman.

11 recordsLinked to original sources
PubMed1986

Community-acquired bloodstream infection caused by Pseudomonas paucimobilis: case report and review of the literature.

Various sources of Pseudomonas paucimobilis bacterial infections have been documented. We report the third human case of bloodstream infection due to P. paucimobilis and review the literature in English regarding community-acquired and nosocomial infection due to this bacterium. Biochemical and genetic characteristics supporting the pathogenic potential of P. paucimobilis are presented, and the antibiotic susceptibility profile of the organism is summarized.

Aged↗
PubMed1985

Hepatocellular carcinoma simulating amebic liver abscess: report of a case and analysis of current diagnostic methods.

Radiological and serological tests are valuable tools commonly used in diagnosing amebic liver abscess. The limitations in sensitivity and specificity of the various imaging procedures should be recognized in order to avoid misinterpretation of test results. Serodiagnostic methods present potential pitfalls primarily because of their frequent inability to differentiate previous disease from active infection, and must therefore be interpreted carefully.

Adult↗
PubMed1977

Spinal epidural abscess.

This paper describes problems in the diagnosis and management of six patients with spinal epidural abscess. Since the clinical findings in this disease process are frequently misinterpreted, one must be careful to exclude this diagnosis in any patient with fever, leukocytosis, back pain and recent infection or back trauma. Alcoholic patients, in particular, seem at high risk for missed diagnosis since the clinical findings are frequently misinterpreted to be complications of alcoholism. Suspicion of spinal epidural abscess should lead to immediate lumbar puncture with manometrics as well as myelography. Once the diagnosis is established surgery should be immediate. Gram stains and cultures taken at the time of lumbar puncture or at operation will dictate appropriate antibiotic therapy. The cause of infection can be fairly well determined by the location of the abscess and a knowledge of the pathogenesis. Prognosis seems directly dependent on the preoperative neurologic status of the patient.

Abscess↗
PubMed1976

Recent survey of infectious meningitis in adults: review of laboratory findings in bacterial, tuberculous, and aseptic meningitis.

Infectious meningitis in adults was reviewed to establish the frequency of meningitis due to each causative agent and to reexamine the laboratory parameters that help to distinguish aseptic, bacterial, and mycobacterial meningitis. Aseptic meningitis occurred 2.2 times more often than bacterial and mycobacterial meningitis combined. The most common nonviral causative agent was the pneumococcus (23 cases) followed by the tubercle bacillus (11 cases) and the meningococcus (5 cases). Cerebrospinal fluid (CSF) Gram stain was the most useful study to rule in a bacterial cause: 89% of cases of bacterial meningitis had a positive initial Gram stain. Hyponatremia occurred in 73% of cases of tuberculous meningitis; hyponatremia combined with a negative Gram stain was highly suggestive of a tuberculous cause. One third of all patients with tuberculous and aseptic meningitis had a predominance of neutrophils in the CSF. No patient with aseptic meningitis had a CSF while count higher than 2,800 cells/cu mm or a CSF protein value higher than 250 mg/100 ml. Other reviews confirm this if cases due to lymphocytic choriomeningitis (LCM) are excluded. One patient with tuberculous meningitis in this series, and none of those cases reviewed, had a CSF white count higher than 1,200 cells/cu mm. Only 3.7% of the patients with aseptic meningitis had hypoglycorrhachia. Series reporting exclusively disease due to mumps and LCM have a higher frequency of hypoglycorrhachia.

Adult↗
PubMed1976

Immunization for the internist.

The emphasis of immunization programs and schedules has traditionally been directed to infants and children, since most of the vaccine-preventable diseases are seen predominantly in these age groups. Immunization procedures in adults are less well defined but still of importance. Diseases for which immunizations are given before disease exposure include tetanus, diphtheria, influenza, rubella, and mumps; travelers to foreign countries may need immunizations against typhoid, cholera, yellow fever, typhus, poliomyelitis, plague, and viral hepatitis; other vaccines are available before disease exposure in unusual epidemiologic situations. After exposure to disease but before onset of symptoms, immunizations are available for rabies, viral hepatitis, and measles. After the onset of clinical illness, passive immunization should be given for tetanus, diphtheria, and botulism. This paper summarizes current practices for active and passive immunization against these diseases in adults.

Adolescent↗
PubMed1976

Detection of pneumococcal polysaccharide in the sputum of patients with pneumococcal pneumonia by counterimmunoelectrophoresis.

Each of 41 patients with bacterial pneumonia was placed into 1 of 4 categories based on the relative clinical certainty of the diagnosis of pneumococcal pneumonia. The frequency of pneumococcal polysaccharide in the sputum by counterimmunoelectrophoresis (CIE) was then noted for each diagnostic category of patients. Detection of pneumococcal polysaccharide in sputum correlated with the diagnostic certainty of pneumococcal pneumonia, while results of culture of sputum were less indicative of pneumococcal infection. Saliva of 83 normal individuals failed to give positive tests for pneumococcal polysaccharide despite the presence of alpha-hemolytic streptococci on culture. Furthermore, the mere presence of pneumococci in cultures did not predict a positive test for polysaccharide by CIE nor did the absence of pneumococci mean that polysaccharide would not be detected. This study suggests that detection of pneumococcal polysaccharide appears more rapid, more sensitive, and more specific than sputum cultures in diagnosing pneumococcal infection of the lung.

Counterimmunoelectrophoresis↗
PubMed1975

Factors associated with mortality in brain abscess.

Coma on admission, multiple, deep, or ruptured abscess, inaccurate diagnosis, and inability to prove the diagnosis were factors contributing to mortality. In survivors, abscess generally followed cranial injury, surgery, or contiguous infection; in most fatal cases, brain abscess was secondary to a more remote primary infection. Ruptured or multiple abscesses or positive spinal fluid cultures were not found in survivors, and coma was present in only one. Fatal cases in patients admitted in coma usually did not exhibit focal signs, seizures, or symptoms of meningitis early in the illness; none of these patients had prior cranial injury or surgery. Absence of these delayed their seeking care and accurate diagnosis. Ruptured abscess was frequent in these patients. Most patients not in coma on admission had focal signs, seizures, symptoms or meningitis, or had prior cranial injury or surgery.

Adolescent↗
PubMedDate not supplied

Auxotypes and antibiotic susceptibility patterns of Neisseria gonorrhoeae from disseminated and local infections.

The arginine-hypoxanthine-uracil auxotype has been linked with the propensity of gonococci to cause disseminated infections. Gonococci recovered from 25 patients with disseminated gonococcal infections were compared with gonococci recovered from matched controls, patients with uncomplicated gonorrhea selected during the same month. Minimal inhibitory concentrations of penicillin, tetracycline, erythromycin, and ampicillin, and the nutritional requirements (auxotypes) for proline alone, arginine alone, arginine, hypoxanthine and uracil together, serine alone and cysteine-cystine (wild type) were analyzed by discriminant analysis. Significant susceptibility to penicillin characterized strains causing disseminated infection, and a proline requirement was the most common auxotype (48%) among strains isolated in Atlanta. Together the minimal inhibitory concentration of penicillin and the proline auxotype best separated the strains causing gonorrhea. The arginine-hypoxanthine-uracil auxotype was was found in only 24% of strains causing disseminated infections. A trait other than auxotype must determine the capacity of the organisms to disseminate.

Adult↗