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Biomedical subjects

J Bishara

Publications and source records attributed to J Bishara.

At least 19 recordsLinked to original sources
PubMed2005

Species distribution and antifungal susceptibility of Candida bloodstream isolates in a tertiary medical center in Israel.

To evaluate the species distribution and antifungal susceptibility of Candida isolates in a tertiary institution in Israel, all consecutive isolates of Candida spp. recovered from blood during the last 2 years were studied. The isolates were identified by the germ tube test and the API ID 32C test (bioMérieux, Marcy l'Etoile, France). MICs of antifungal agents were determined by the E test. Candida albicans was the most commonly isolated species, accounting for 44% (63/142) of the isolates, followed by Candida tropicalis (25%; 35/142), Candida parapsilosis (20%; 29/142), Candida glabrata (10%; 14/142), and Candida krusei (0.7%; 1/142). All isolates were sensitive to amphotericin B and voriconazole. Resistance to fluconazole (using a high MIC of >/=256 microg/ml) was found in 1.6% of C. albicans isolates, in 3.4% of C. parapsilosis isolates, and in 21.4% of C. glabrata isolates. Resistance to itraconazole was detected in 3.2% of C. albicans isolates, in 2.9% of C. tropicalis isolates, in 3.4% of C. parapsilosis isolates, and in 93% of C. glabrata isolates. Disparities in species distribution and antifungal susceptibility of Candida isolates from the institute studied versus Candida isolates from other centers and countries are described. The findings emphasize the need for continuous surveillance and further clinical investigational studies.

Academic Medical Centers↗
PubMed2003

Failure to detect Chlamydia pneumoniae by cell culture and polymerase chain reaction in major arteries of 93 patients with atherosclerosis.

To detect Chlamydia pneumoniae in punch specimens of the aortic wall of 61 patients undergoing coronary-aortic bypass graft, and carotid atheromas of 32 patients undergoing carotid endarterectomy, cell culture (HEp-2 cells) and two polymerase chain reaction assays in two different laboratories were used. All cultures and polymerase chain reaction tests for Chlamydia pneumoniae were negative. Further studies are required to explore the complex relationship between Chlamydia pneumoniae and atherosclerosis.

Aged↗
PubMed2002

Changing distribution of Candida species isolated from sterile and nonsterile sites in Israel.

To determine if the prevalence of non- albicans Candida spp. has increased at two institutions in Israel, the distribution of 6,954 Candida isolates obtained from sterile and nonsterile sites during the periods 1995-1996 and 1999-2000 were compared. In the latter period, a slight decrease was observed in the prevalence of non- albicans Candida spp. isolated from sterile sites (from 39% to 37%) and nonsterile sites (from 38% to 35%). Specifically, the prevalence of Candida glabrata increased significantly in sterile sites, from 26% to 35% (P=0.0095), and in nonsterile sites, from 18% to 27% (P<0.0001), and the prevalence of Candida krusei increased significantly in sterile sites, from 2% to 7% (P=0.0072). The prevalence of Candida parapsilosis decreased significantly in nonsterile sites, from 31% to 23% (P=0.0002). Continuous surveys of the distribution of Candida spp. and analysis of the clinical significance of changes are warranted.

Candida↗
PubMed2002

Epidemiological and clinical features of leptospirosis in Israel.

The epidemiology and clinical features of 46 cases of human leptospirosis diagnosed in Israel between 1986 and 1999 were analysed. The median patient age was 37.5 years (range, 16-85 years), and the male/female ratio was 43/3. The most common serogroup found was Leptospira icterohaemorrhagiae. The disease was associated with jaundice in 71% of cases, acute renal failure in 62%, rhabdomyolysis in 52%, pancytopenia in 28%, respiratory failure in 14% and disseminated intravascular coagulation in 5%. Leptospirosis occurs sporadically throughout the year, peaking during the summer months. A shift occurred from predominantly agriculture-related serogroups in the 1970s to urban-related serogroups during the study period reported, with Leptospira icterohaemorrhagiae being the dominant serogroup.

Adolescent↗
PubMed2001

Long-term outcome of infective endocarditis: the impact of early surgical intervention.

To determine the impact of early surgical intervention on long-term survival in patients with infective endocarditis (IE), charts of all patients who had IE from January 1987 through December 1996 were reviewed. A total of 252 patients with definite or possible IE were included. Forty-four patients (17.5%) had early surgery on median hospital day 2 (range, 0-30 days), and 208 patients (82.5%) received medical treatment alone. On multivariate analysis, several variables, including early surgical intervention, improved long-term survival rates (hazard ratio, 1.5; P=.03), mainly in patients with Staphylococcus aureus etiology (P=.04). When patients with prosthetic devices were excluded, the median duration of survival for patients who had early surgery was >150 months, compared with 61.5 months for patients in the medical group (P=.1). Early surgical intervention compared with medical therapy alone is associated with increased short- and long-term survival rates in patients with IE, primarily when IE is caused by S. aureus.

Adolescent↗
PubMed2001

Sporotrichoid lymphangitis due to group A Streptococcus.

We describe what is, to our knowledge, the first case of sporotrichoid lymphangitis caused solely by group A Streptococcus in an otherwise healthy patient. Infection with pyogenic pathogens, such as streptococci and staphylococci, as well as with the most common causes of sporotrichoid lymphangitis (i.e., Sporothrix schenkii, Nocardia brasiliensis, Mycobacterium marinum, and Leishmania species) should be considered in differential diagnosis for some patients.

Humans↗
PubMed2001

Tricuspid valve endocarditis in adult patients without known predisposing factors.

Four patients with no known predisposing conditions developed tricuspid valve endocarditis. All patients had community-acquired infection with a rapidly progressive course that was complicated by right heart failure and respiratory insufficiency. Pulmonary involvement was prominent in all cases. The infectious process was due to Staphylococcus aureus in three patients and to Streptococcus intermedius in one patient. Three patients underwent early surgical intervention; the outcome was favourable in all cases. It is clear that tricuspid valve endocarditis can occur in the absence of known predisposing factors, and when Staphylococcus aureus is involved, the course of the disease may be acute and rapidly progressive.

Adult↗
PubMed2001

Amphotericin B--not so terrible.

OBJECTIVE: To describe a patient who developed adverse reactions to two different lipid formulations of amphotericin B: liposomal amphotericin B (AmBisome) and amphotericin B colloidal dispersion (ABCD, Amphocil), yet tolerated amphotericin B deoxycholate (Fungizone) despite renal toxicity. CASE SUMMARY: A 72-year-old woman with acute myelomonocytic leukemia was treated with amphotericin B deoxycholate for suspected pulmonary aspergillosis; the drug was well tolerated but resulted in renal failure. Antifungal therapy was then changed to liposomal amphotericin B. Within 10 minutes of liposomal amphotericin B infusion, the patient developed severe dyspnea, chest pain, and a feeling of imminent death. On the following day, liposomal amphotericin B was switched to amphotericin B colloidal dispersion. Again, within 10 minutes of this infusion, the patient developed fever, chills, hypotension, severe chest pain, dsypnea, and a feeling of imminent death. The patient refused any further treatment with these drugs and insisted on switching back to amphotericin B deoxycholate, which was then administered for 10 days and was well tolerated. DISCUSSION: Severe adverse reactions, such as anaphylaxis, cardiac toxicity, and respiratory failure, following administration of all three lipid formulations of amphotericin B have been reported. In most reported cases, switching to a different lipid formulation of amphotericin B was well tolerated. This is in contrast to our case, where a severe reaction was repeated when another lipid preparation was given, necessitating switching back to amphotericin B deoxycholate despite its nephrotoxicity. CONCLUSIONS: In some patients, paradoxically, lipid formulations of amphotericin B may be less tolerable than conventional amphotericin B.

Acute Kidney Injury↗
PubMed2001

Antibiotic use in patients with erysipelas: a retrospective study.

BACKGROUND: Erysipelas is a skin infection generally caused by group A streptococci. Although penicillin is the drug of choice, some physicians tend to treat erysipelas with antibiotics other than penicillin. OBJECTIVES: To define the pattern of antibiotic use, factors affecting antibiotic selection, and outcome of patients treated with penicillin versus those treated with other antimicrobial agents. METHODS: A retrospective review of charts of adult patients with discharge diagnosis of erysipelas was conducted for the years 1993-1996. RESULTS: The study group comprised 365 patients (median age 67 years). In 76% of the cases infection involved the leg/s. Predisposing condition/s were present in 82% of cases. Microorganisms were isolated from blood cultures in only 6 of 176 cases (3%), and Streptococcus spp. was recovered in four of these six patients. Cultures from skin specimens were positive in 3 of 23 cases. Penicillin alone was given to 164 patients (45%). Other antibiotics were more commonly used in the second half of the study period (P < 0.0001) in patients with underlying conditions (P = 0.06) and in those hospitalized in the dermatology ward (P < 0.0001). Hospitalization was significantly shorter in the penicillin group (P = 0.004). There were no in-hospital deaths. CONCLUSIONS: We found no advantage in using antibiotics other than penicillin for treating erysipelas. The low yield of skin and blood cultures and their marginal impact on management, as well as the excellent outcome suggest that this infection can probably be treated empirically on an outpatient basis.

Adult↗
PubMed2000

Seven-year study of bacteraemic pneumonia in a single institution.

In order to enhance current knowledge of nosocomial and community-acquired bacteraemic pneumonia in a single tertiary hospital in Israel, a 7-year study was conducted. Using a computerised database, all patients who had bacteraemic pneumonia from March 1988 to August 1995 were studied. During the study period, pneumonia was the source of bacteraemia in 319 of 4,548 (7%) episodes, occurring in 295 patients; 211 (66%) episodes were community-acquired and 108 (34%) were nosocomial. The microoroganisms isolated most frequently from patients with community-acquired bacteraemic pneumonia were Streptococcus pneumoniae (46%), Staphylococcus aureus (10%) and Haemophilus influenzae (8%); while Pseudomonas spp. (17%), Klebsiella spp. (11%) and Staphylococcus aureus (10%) were isolated most often from the patients with nosocomial bacteraemic pneumonia. The median age of patients was 68 years (range, 0.003-100). The overall mortality was 34%. No significant difference was found between the mortality rates of patients with community-acquired (31%) and nosocomial (40%) bacteraemic pneumonia (P=0.1). Multivariate analysis showed that hypothermia, respiratory failure, impaired consciousness, tracheal intubation, Staphylococcus aureus aetiology, septic shock, inappropriate empiric antibiotic treatment and age significantly increased mortality.

Aged↗
PubMed2000

Osteomyelitis of the ribs in the antibiotic era.

A total of 106 cases of rib osteomyelitis were reviewed, including 2 cases described in detail. Mycobacterial and bacterial infections accounted for 47 cases each. Fungal rib osteomyelitis occurred in 11 cases and 1 case was caused by Entamoeba histolytica. Most cases occurred in children and young adults. The mean duration of symptoms before diagnosis was 16, 26 and 32 weeks for bacterial, mycobacterial and fungal rib osteomyelitis, respectively. Common clinical signs were fever (73%), soft tissue mass (64%) and chest pain (60%). Route of infection was defined in 85 cases: 62% from contiguous spread and 38% via haematogenous route of infection. Eighty-nine percent had a favourable outcome after antimicrobial therapy with or without surgery. In conclusion, rib osteomyelitis is a rare infection of various aetiologies. The majority of cases occur in children and young adults and its diagnosis is usually delayed for several weeks.

Adult↗
PubMed2000

Temperature-sensitive suppressor mutations of the Escherichia coli DNA gyrase B protein.

Escherichia coli strain LE316 contains a mutation in gyrB that results in the substitution of Val164 to Gly and confers both chlorobiocin resistance and temperature sensitivity. Selection for suppressors of the ts phenotype yielded second-site mutations in GyrB at His38 and Thr157. The properties of proteins bearing these mutations have been characterized, and a mechanism of suppression is proposed based upon structural considerations.

Antibiotics, Antineoplastic↗
PubMed1999

Home intravenous antibiotic therapy for patients with infective endocarditis.

Although home intravenous antibiotic therapy (HIAT) is increasingly being used for various infectious diseases, outpatient treatment of infective endocarditis (IE) is still uncommon. Recently, the American Heart Association recommended outpatient treatment of endocarditis only for infections with streptococci that are highly susceptible to penicillin. Herein, the experience with HIAT in patients with IE due to a diversity of pathogens is presented. During a 3-year period, 37 patients with IE who were in a stable condition and were cooperative were enrolled in a service for HIAT after completion of diagnostic procedures. Of the 37 patients, 21 were male; mean age was 64.3 years (range 20-87 years); in most cases (26/37), IE involved a native valve. Causative organisms were Streptococcus spp. (20), Staphylococcus spp. (10), Enterococcus spp. (2), Enterobacter spp. (1), and Erysipelothrix rhusiopathiae (1), while three were unknown. The most common antibiotics used were ceftriaxone and vancomycin. Almost three-quarters of the intravenous lines were peripheral. The mean duration of HIAT was 26.2 +/- 8.5 days, with 92% of the patients cured by it. Most complications were minor. Six patients were rehospitalised and two of them required valve replacement. In half of the rehospitalised patients, the complication was unrelated to HIAT. Surprisingly, almost all of the complications necessitating rehospitalisation occurred in patients with streptococcal IE and most involved native valves. HIAT may be suitable for IE due to a diversity of pathogens and involving prosthetic as well as native heart valves, provided there are proper patient and antibiotic selections, good follow-up, and vigilant monitoring of complications.

Adult↗
PubMed1999

Infective endocarditis in renal transplant recipients.

Because of the increasing number of renal transplantations performed and the rarity of reported cases of infective endocarditis in these patients, we studied the clinical characteristics of this infection in this population. We report on two cases from our experience and review reported cases of infective endocarditis in renal transplant recipients retrieved from the MEDLINE system. In addition, we reviewed a large series of infective endocarditis looking for patients with renal transplants. In addition to our 2 cases, 12 previously reported cases were found. The mean time from transplantation to diagnosis of infective endocarditis was 3.5 years (range 2 months to 15 years). Causative organisms included fungi, Staphylococcus aureus (3 cases each), Corynebacterium sp. (2 cases), Streptococcus viridans, VRE, Brucella sp., Clostridium sp., Nocardia sp. and Erysipelothrix sp. (one case each). Skin manifestations of endocarditis and/or splenomegaly were not reported in these patients. Septic emboli and mycotic aneurysms were relatively common. The overall mortality rate was 50% (7 of 14 patients died). Infective endocarditis seems to be rare in renal transplant recipients. The few reported cases are characterized by unusual causative micro-organisms and atypical clinical presentation. Further studies are needed to delineate the magnitude and scope of this association.

Adult↗