Search PubMed⌕ Search

Biomedical subjects

J D Semel

Publications and source records attributed to J D Semel.

16 recordsLinked to original sources
PubMed1996

Association of athlete's foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples.

We performed a study to determine how often patients with cellulitis of the lower extremities in the absence of trauma, peripheral vascular disease, or chronic open ulcers have ipsilateral interdigital athlete's foot and whether cultures of samples from the involved interdigital spaces would yield potentially pathogenic bacteria. Athlete's foot was present in 20 (83%) of 24 episodes of cellulitis that were studied. Cultures of samples from interdigital spaces yielded Beta-hemolytic streptococci in 17 (85%) of 20 cases, Staphylococcus aureus in 9 (45%) of 20 cases, and gram-negative rods in 7 (35%) of 20 cases. Only Beta-hemolytic streptococci were recovered significantly more often from patients than from a group of controls with athlete's foot who did not have cellulitis (P < .01). Athlete's foot may be a common predisposing condition for cellulitis of the lower extremities. In comparison with attempts at microbiological diagnosis such as aspiration and/or biopsy of the area of cellulitis, cultures of samples from the interdigital spaces combined with serial determinations of antistreptolysin titers may offer a simpler noninvasive method of microbiological diagnosis.

Bacteria↗
PubMed1995

Severe vaginal infection with Entamoeba histolytica in a woman who recently returned from Mexico: case report and review.

Genital amebiasis is a rare complication of infection with Entamoeba histolytica, even in areas where the pathogen is endemic. We describe a patient who apparently contracted intestinal amebiasis on a trip to Mexico and who presented with ulcerative vulvovaginitis 2 months later. Her condition rapidly progressed to severe necrotizing vulvovaginitis that required a radical vulvectomy. Histopathologic examination of the surgical specimen revealed the presence of E. histolytica trophozoites. The patient recovered after surgery and antiamebic therapy. We review the epidemiology and pathogenesis of genital amebiasis as well as therapy for this rare infection.

Aged↗
PubMed1991

Seizures in patients simultaneously receiving theophylline and imipenem or ciprofloxacin or metronidazole.

Five patients had apparently drug-induced seizures while simultaneously receiving theophylline and either imipenem (three patients), ciprofloxacin (one patient), or ciprofloxacin and metronidazole (one patient). Seizures ceased upon reduction in dosage or discontinuation of the suspected offending agents. Imaging studies failed to reveal new structural lesions in the central nervous system in any patient, and only one had a history of neurologic disease. Although the exact mechanism for seizure induction cannot be determined from these cases, potential drug interactions exist, because theophylline, imipenem, and ciprofloxacin are all believed to increase excitation of the central nervous system by inhibition of gamma-aminobutyric acid binding to receptors. In addition, ciprofloxacin decreases the clearance of theophylline from the body, predisposing the patient to elevated theophylline levels. Physicians prescribing theophylline with imipenem, ciprofloxacin, or metronidazole should carefully monitor patients for indications for drug therapy, drug dosage, organ impairment affecting drug metabolism, and signs of toxicity. Seizures may accompany oral theophylline therapy, even at "therapeutic" serum theophylline concentrations.

Aged↗
PubMed1990

Aeromonas hydrophila water-associated traumatic wound infections: a review.

The bacterium Aeromonas hydrophila is commonly found in natural bodies of water, and is a potential invasive pathogen for those who suffer trauma while submerged in water. Five patients treated by the authors and 18 previously reported patients were reviewed to further define the characteristics of A. hydrophila wound infections. Although Aeromonas has been isolated from salt and brackish water, all 23 cases occurred following contact with fresh water. Signs of infection usually appeared 8-48 hours following puncture or laceration injury. The foot or leg were most commonly involved. Infection was frequently rapidly progressive; fascia, tendon, muscle, bone, or joint involvement occurred in 39% of cases. In addition to A. hydrophila, other aerobic and anaerobic bacteria were found in 48% of cases. Aeromonas infection should be suspected in cases of early and rapidly progressive wound infection following trauma in fresh water. Broad-spectrum antimicrobial therapy and appropriate surgical care should be promptly instituted.

Aeromonas↗
PubMed1987

Complex partial status epilepticus presenting as fever of unknown origin.

A woman experienced multiple attacks of fever, each lasting 24 to 72 hours, over 1 1/2 years. The patient herself could not relate details of most episodes; her husband reported observing extreme prostration and incoherence during some of the episodes. A thorough investigation at three medical centers failed to reveal any of the usual causes of fever of unknown origin. Finally, another family member observed a sudden loss of responsiveness without loss of consciousness, blank staring, and repetitive arm movements. A diagnosis of complex partial status epilepticus was made, and fever was documented in association with repetitive complex partial seizures on two occasions in the hospital. Both the fever and the seizures were controlled by anticonvulsant medication, and both recurred under observation when the medication was discontinued. A review of the charts of adult patients admitted to the hospital for a primary neurologic disorder showed that those with epilepsy were more likely to experience fever within the first 24 hours than those without epilepsy (13 of 29 vs five of 29) especially if multiple seizures occurred. Fever may occur in association with seizures; occasionally it may be a presenting manifestation.

Carbamazepine↗
PubMed1986

SIADH during disseminated Herpes varicella-zoster infections: relationship to vidarabine therapy.

Three patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) during the course of disseminated Herpes Varicella-Zoster (HVZ) virus infections are reported. In one patient and two previously reported patients, SIADH occurred at or shortly after admission, prior to antiviral drug therapy. In two patients and one previously reported patient, SIADH began or hyponatremia worsened after vidarabine therapy was begun. Therefore, SIADH may occur during the course of untreated, disseminated HVZ infection. However, the relatively high fluid volume required to dilute vidarabine may play a role in the development of the clinical and laboratory manifestations of SIADH, in patients receiving the drug. Physicians should avoid excess fluid intake and monitor serum sodium carefully when caring for patients with disseminated HVZ infections. Doses of vidarabine greater than 10 mg/kg/day may increase the likelihood of SIADH. Acyclovir therapy was not associated with worsening of hypotonic hyponatremia in our patients.

Acyclovir↗
PubMed1984

Fever on drug-free day of alternate-day steroid therapy.

A patient is described who had high spiking fever following a changeover from daily to alternate-day prednisone therapy. No infectious cause was found, and antibiotic therapy did not affect the temperature graph. Previously, the patient, who had dermatomyositis, experienced minimal or no temperature elevation during observation in the hospital, first while receiving no therapy, and later while receiving daily prednisone therapy. Fever disappeared promptly when daily prednisone therapy was resumed. It is postulated that the 12- to 24-hour "drugless" period experienced by a patient during alternate-day prednisone therapy could lead to a withdrawal syndrome characterized by a tertian malaria-like temperature pattern. The importance of recognizing such a phenomenon and distinguishing it from infection is emphasized.

Aged↗
PubMed1984

Cutaneous findings in a case of psittacosis.

A patient had severe pneumonia, respiratory failure, and disseminated intravascular coagulation caused by Chlamydia psittaci. Cutaneous findings included a maculopapular blanching rash, acrocyanosis, superficial venous thromboses, and splinter hemorrhages under the fingernails. The history of exposure to potential vectors of psittacosis and the presence of some or all the cutaneous findings described herein may lead to the early recognition of psittacosis.

Chlamydophila psittaci↗
PubMed1983

Elevated creatine phosphokinase levels associated with influenza A/Texas/1/77 infection.

24 patients admitted to hospital between December 1, 1977 and March 3, 1978 with cultural or serological evidence of influenza A infection were retrospectively analyzed for evidence of elevated creatine phosphokinase (CPK) levels. 14 patients had elevated CPK levels not attributable to usual causes. Muscle biopsies from 2 patients showed focal necrosis and myopathic changes. Influenza A/Texas/1/77 was isolated from the biopsy specimen of 1 patient. Patients with elevated CPK levels tended to have greater per day hospital costs and more complications than patients with normal CPK levels. Elevated CPK levels are relatively common in hospitalized patients with influenza and may be due to influenza virus involvement of skeletal muscle.

Biopsy↗
PubMed1978

Pseudomonas maltophilia pseudosepticemia.

During a 17 month period, 25 hospitalized adult patients had blood cultures reported as positive for Pseudomonas maltophila. Review of the hospital records suggested that these were contaminants and that blood for coagulation studies and for cultures that were subsequently positive had been drawn simultaneously. The source of contamination appeared to be black-top evacuated collection tubes used for coagulation studies in adults. Cultures of the liquid anticoagulant tubes yielded a pure growth of greater than 10(5) colony forming units (CFU)/cc of Ps. maltophilia on blood agar. Mock trials demonstrated that following venipuncture by syringe, inoculation of contaminated black-top tubes prior to inoculation of blood culture bottles would yield false-positive blood cultures (pseudosepticemia). One patient being treated for streptococcal prosthetic valve endocarditis and having frequent coagulation studies with blood obtained via direct venipuncture into evacuated collection tubes was found to have superinfection of his prosthetic valve with Ps. maltophilia at autopsy. Prosthetic valve infection may have occurred after reflux of contaminated anticoagulant from an evacuated collection tube directly into the vein. Contaminated evacuated collection tubes are a potential source of confusion in the diagnosis of infection as well as a potential source of true infection.

Adult↗
PubMedDate not supplied

Fever associated with repeated intramuscular injections of analgesics.

Five patients who developed a fever of undetermined origin during hospitalization are discussed. No infection was found in any of these patients. Occurrence of fever was temporally related to intramuscular (im) analgesic injections. In four cases damage of subcutaneous tissue was evident, and in two cases gallium scans showed uptake of gallium at injection sites. All five patients had received hydroxyzine either alone or in combination with other im analgesics. In addition, a retrospective chart survey of patients hospitalized for back pain who had received more than 30 im analgesic injections was carried out. Ten of 29 patients had fever lasting one to 15 days that could not be explained by the presence of obvious infection or inflammation or by the use of a nonanalgesic drug. In the chart survey it was found that febrile patients had been hospitalized significantly longer and had received more injections of all types and more injections of combinations of analgesics per patient than had afebrile patients. Thus, repeated im injections of analgesics may be associated with fever, with or without signs of tissue injury. Particular care should be taken in deciding whether im administration of hydroxyzine is necessary. Injection sites should be carefully monitored.

Analgesics↗
PubMedDate not supplied

Gentamicin- and clindamycin-resistant Staphylococcus aureus.

From 1975 through 1978 isolates from 21 of 230 (9%) Staphylococcus aureus bacteremias were resistant to gentamicin and clindamycin. Gentamicin- and clindamycin-resistant S aureus (GCRS) accounted for 23% of all S aureus isolates from 1977 compared with 2 to 6% in the two years immediately preceding, and the year following 1977. When compared with patients with gentamicin- and clindamycin-sensitive S aureus (GCSS) from 1977, GCRS were more often isolated from patients who acquired their infections in the hospital, particularly in the intensive care unit. A significant association existed between prior or concurrent therapy with gentamicin and/or clindamycin and the isolation of GCRS. Infection with GCRS was associated with a 73% mortality rate versus 28% with GCSS. GCRS were susceptible to oxacillin, cephalothin, tetracycline, and vancomycin. GCRS were resistant to kanamycin and tobramycin but were susceptible to amikacin (median MIC of GCRS, 4.0 microgram/ml). Multiple bacteriophage types of S aureus were involved, and resistance appeared to be plasmid-mediated. A survey of antibiotic usage showed that in comparison to January 1977, a mikacin usage increased and gentamicin usage decreased in March 1979. Because of the popularity of the combination of clindamycin and gentamicin for therapy of life-threatening infections, clinicians should be aware of potential gentamicin- and clindamycin-resistance in S aureus.

Clindamycin↗