Biomedical subjects
Publications and source records attributed to J C Pottage.
A patient with mediastinal histoplasmosis, alpha 1-antitrypsin deficiency, and panniculitis is presented. The patient showed dramatic response to treatment with ketoconazole. The associations of panniculitis with histoplasmosis and alpha 1-antitrypsin deficiency are discussed.
A pseudoepidemic due to Salmonella typhimurium occurred in the clinical microbiology laboratory of a university hospital and involved 10 patients. One patient received "unnecessary" antibiotics. Investigation of the events implicated a contaminated rubber pipette bulb. Such bulbs should be considered as a possible source of false-positive cultures.
Eighteen patients were evaluated after treatment with ceftazidime: these included nine nosocomial lower respiratory tract infections, four soft tissue infections, three bacteraemias and two bone infections. Thirty-five bacterial pathogens were isolated from these 18 patients. Two were resistant to ceftazidime and required alternative therapy. Sixteen of the 18 evaluable patients had a favourable response to ceftazidime. Seven of eight patients with Pseudomonas aeruginosa lower respiratory tract infections responded favourably. Fifteen possible complications were observed in ten of 23 patients who received ceftazidime. In three patients ceftazidime was discontinued due to possible complications of therapy. This trial provides preliminary support for the use of ceftazidime as an alternative to aminoglycosides in the treatment of serious infections caused by Gram-negative organisms, including Ps. aeruginosa.
Aeromonas hydrophila myonecrosis with gas gangrene and bacteremia developed in an elderly patient after minor trauma from a fishbone. Despite aggressive medical and surgical therapy, she experienced a rapidly fatal outcome. Literature on Aeromonas muscle infection is reviewed and implications for therapy are discussed.
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The results of treating chronic Pseudomonas aeruginosa osteomyelitis with cefsulodin at Rush-Presbyterian-St. Luke's Medical Center (RPSLMC) and eight other institutions are summarized. Eleven patients whose infections were proven by bone-biopsy culture were treated with cefsulodin at RPSLMC; one received two courses of treatment. Efficacy of therapy was evaluated for eight patients, all of whom had a polymicrobial infection. The average age of the patients was 52.3 years (range, 28-85). All had serious underlying illnesses or associated conditions. The mean inhibitory concentration of cefsulodin for the isolates of P. aeruginosa was 3.125 micrograms/ml (range, 0.78-6.25 micrograms/ml). Two patients received concomitant therapy with antibiotics not active against P. aeruginosa. Surgical debridement was performed in six of the eight patients. A favorable response was demonstrated in six of the eight patients. Follow-up for seven patients ranged from one week to 12 months, and in the eighth patient follow-up was 32 months. One patient relapsed twice. Seven possible complications of therapy were observed in five of the 11 patients who received cefsulodin; in three of these patients cefsulodin had to be discontinued. In studies of osteomyelitis conducted at other institutions, 10 of 14 patients for whom therapy could be evaluated had a favorable response to cefsulodin. Cefsulodin is a useful agent for the treatment of chronic osteomyelitis associated with P. aeruginosa.
Herpes simplex viral (HSV) hepatitis is uncommon in adults. Two new cases are reported herein; a literature review revealed an additional 33 patients. Ages ranged from 13 to 87 years; the mean age was 32.6 years, and the median was 28 years. HSV hepatitis usually occurs as part of disseminated HSV infection and is characterized by fulminant hepatic necrosis with serum transaminase levels frequently elevated 100- to 1,000-fold. Disseminated intravascular coagulation was present in 90% of the cases. Outcome was poor; 86% of the patients died. Eighty-six percent of the patients had an underlying condition associated with impaired host defenses. Renal transplantation (26%), steroid use other than in renal transplant patients (26%), and pregnancy (23%) were the most frequent underlying conditions. Early recognition and prompt initiation of antiviral therapy may offer a chance for improved survival rates.