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Biomedical subjects

J F Fisher

Publications and source records attributed to J F Fisher.

At least 37 records · Page 2Linked to original sources
PubMed1988

Eosinophilia, respiratory symptoms and pulmonary infiltrates in rubber workers.

This report describes a spectrum of respiratory illnesses associated with eosinophilia which occurred in a group of workers exposed to fumes from a synthetic rubber-based curing operation. Respiratory syndromes induced by this exposure included an acute sensitizing illness with dyspnea and wheezing in some workers and pulmonary infiltrates with eosinophilia in others. Another worker developed chronic obstruction of the airways with recurrent bronchitic illnesses. Mild to marked peripheral eosinophilia, up to 3,000/cu mm, was usually present in the symptomatic workers and in 11 of 30 asymptomatic workers. These cases illustrate the diversity of respiratory illnesses which may result from a common workplace exposure and reinforce the importance of considering occupational exposures in the differential diagnosis of peripheral eosinophilia.

Acute Disease↗
PubMed1987

Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks.

One hundred ninety-four patients with cryptococcal meningitis were enrolled in a multicenter, prospective, randomized clinical trial to compare the efficacy and toxicity of four as compared with six weeks of combination amphotericin B and flucytosine therapy. Among 91 patients who met preestablished criteria for randomization, cure or improvement was noted in 75 percent of those treated for four weeks and in 85 percent of those treated for six weeks. The estimated relapse rate for the four-week regimen was higher--27 as compared with 16 percent--whereas the incidence of toxic effects for the two regimens was similar--44 as compared with 43 percent. Among 23 transplant recipients, 4 of 5 treated for four weeks relapsed, leading to the decision to treat the rest of the group for six weeks. Only 3 of the 18 treated for six weeks relapsed. In a third group of 80 patients, the protocol was not followed during the initial four weeks, and these patients were not randomized. Thirty-eight died or relapsed. Multifactorial analysis of pretreatment factors for all 194 patients identified three significant predictors (P less than 0.05) of a favorable response: headache as a symptom, normal mental status, and a cerebrospinal fluid white-cell count above 20 per cubic millimeter. These and other findings in this study are consistent with the view that the four-week regimen should be reserved for patients who have meningitis without neurologic complications, underlying disease, or immunosuppressive therapy; a pretreatment cerebrospinal fluid white-cell count above 20 per cubic millimeter and a serum cryptococcal antigen titer below 1:32; and at four weeks of therapy, a negative cerebrospinal fluid India ink preparation and serum and cerebrospinal fluid cryptococcal-antigen titers below 1:8. Patients who do not meet these criteria should receive at least six weeks of therapy.

Adolescent↗
PubMed1987

Synergism between Bacteroides fragilis and Staphylococcus aureus in experimental tibial osteomyelitis.

We explored the potential role of microbial synergy in an experimental rat osteomyelitis model. Osteomyelitis was assessed by gross pathologic conditions and quantitative cultivation of rat tibiae for the implanted organisms 21 days after challenge. When Staphylococcus aureus was used alone, the 50% infective dose (ID50) and the 100% infective dose (ID100) were 400 and 25,000 colony-forming units (CFU), respectively. When Bacteroides fragilis was inoculated alone, the ID50 was 150,000 organisms, and the ID100 was not confidently determined. Subinfectious numbers of B. fragilis added to the staphylococcal inocula yielded an ID100 as low as 20 staphylococci. Mixed inocula with 20 or 200 staphylococci and increasing numbers of B. fragilis yielded a dose-dependent increase in the number of staphylococci isolated from osteomyelitic tibiae. Multiple linear regression analysis confirmed the two inocula and their interaction to be significantly predictive of the 21-day quantitative assessment of staphylococci (r = 0.80). Synergy was most striking at low bacterial inocula. When even large numbers of S. aureus were added to B. fragilis, the B. fragilis inoculum required to initiate B. fragilis osteomyelitis was essentially unchanged. We conclude that small numbers of B. fragilis allow remarkably low numbers of S. aureus (20 or 200 CFU) to establish osteomyelitis in the rat.

Animals↗
PubMed1986

Peripheral eosinophilia and respiratory symptoms in rubber injection press operators: a case-control study.

To evaluate a suspected association between an outbreak of acute respiratory illness and eosinophilia and employment as a rubber worker, we performed a retrospective review of medical records of rubber workers employed from September 1983 to July 1984 in a plant housing a thermoinjection process. Twenty-five workers met the case definition of a respiratory illness requiring a physician visit. The predominant respiratory illness was acute in onset with cough, chest tightness, and dyspnea. Peripheral eosinophilia, up to 40% of white blood cells in a peripheral smear, was seen in 10 of 18 (56%) cases. Twenty-one of 25 white males with respiratory symptoms were employed in the thermoinjection process (odds ratio = 22, p less than .001). Smoking and employment in this process contributed independently to an increased risk of being a case as determined by a logistic regression analysis. Return to the plant building caused recurrence of symptoms in most cases, and these workers have been transferred or left the company. We conclude that a strong previously unrecognized association exists between employment in this neoprene rubber thermoinjection process and the development of an acute respiratory illness.

Adult↗
PubMed1986

Bread mold infection in diabetes. The life-threatening condition of rhinocerebral zygomycosis.

Rhinocerebral zygomycosis is a rare but dangerous fungal infection that affects primarily diabetic patients in ketoacidosis but other debilitated patients as well. A high index of suspicion among primary care physicians will lead to earlier diagnosis and help reduce the severe morbidity and mortality associated with the condition. Zygomycosis should be strongly suspected in diabetic patients presenting with unilateral headache, nasal congestion, or facial pain and swelling. If hyphae are not seen in nasal secretions on microscopy, biopsy of infected tissue must be done immediately to establish a diagnosis. Prompt treatment, including appropriate surgical intervention, amphotericin B therapy, and correction of metabolic derangements, is essential.

Antifungal Agents↗
PubMed1985

Disseminated candidiasis: a comparison of two immunologic techniques in the diagnosis.

Eighty-five subjects were tested for the presence of circulating candidal antigen (CAg) and anti-candidal antibody (CAb) using both an enzyme immunoassay (ELISA) and counterimmunoelectrophoresis (CIE). The 72 studied controls included laboratory volunteers; hospitalized patients without evidence of infection; febrile hospitalized patients without evidence of candidiasis; and patients with superficial candidiasis and candiduria. The control subjects were compared with 13 patients with proven disseminated candidal infection (disease prevalence = 15%). The ELISA CAb test was of greater individual sensitivity (92%) in separating patients with systemic candidiasis from all controls combined than the ELISA CAg, CIE CAg, or CIE CAb test (61%, 15%, 69%, respectively). The CIE CAg test, though specific (100%), was insensitive. Sensitivity, specificity, and predictive values were generally enhanced by employing combinations of tests. Sera from patients with disseminated candidiasis were much more likely to yield a positive result by two or more serologic tests than were control sera (p = less than 0.0004). The sensitivity of combinations ranged from 15% to 92%. The specificity of combinations ranged from 21% to 100%. The predictive value positive of combinations test ranged from 40% to 100%. Predictive value negative of combinations ranged from 69% to 98%. Patients with a variety of superficial and deep candidal infections apparently have detectable circulating CAb and/or CAg. The ELISA CAb test was superior to the other tests in identifying patients with disseminated candidiasis. Combinations of serologic tests may be superior to individual tests in the diagnosis or exclusion of serious disease due to Candida albicans.

Antibodies, Fungal↗
PubMed1983

Parkinsonism associated with intraventricular amphotericin B.

Little information is available regarding the in-vivo effects of amphotericin B on organs other than the kidney. The increasing use of intrathecal amphotericin B has resulted in several reports of neurotoxicity associated with the drug. Development of parkinsonism following intraventricular treatment with amphotericin B for cryptococcal meningitis in a young woman suggested a direct toxic effect on nervous tissue by amphotericin B. Although transient signs of parkinsonism have been described in a patient receiving intraventricular amphotericin B, persistent parkinsonism is an unprecedented occurrence.

Adult↗
PubMed1983

Osteomyelitis of the hand due to Torulopsis holmii.

Yeasts belonging to the genus Torulopsis, though generally considered saprophytes, are capable of causing serious illness in compromised patients. Torulopsis infections in patients with no apparent underlying disease are rare. We have described a previously healthy man who had osteomyelitis due to Torulopsis holmii as a complication of a penetrating hand injury. Despite in vitro susceptibility of the organism to amphotericin B and flucytosine and prolonged therapy with these agents, the infection relapsed after an apparent initial response.

Accidents↗
PubMed1983

Cryptococcal meningitis in pregnancy.

Cryptococcal meningitis was diagnosed in a pregnant woman at 21 weeks' gestation. The availability of fetal tissues, blood, and amniotic fluid in such a patient receiving therapy with amphotericin B plus flucytosine afforded the opportunity to study the effects of the disease and therapeutic agents on the developing fetus. The amphotericin B concentration in amniotic fluid was 0.25 micrograms/ml and that of flucytosine was 168 micrograms/ml. The concentrations in cord blood were 0.3 micrograms/ml and 64.7 micrograms/ml, respectively. No evidence was found of amphotericin B or flucytosine toxicity in fetal tissues, although exposure of the fetus to these compounds was of brief duration.

Adult↗
PubMed1982

Near-drowning complicated by brain abscess due to Petriellidium boydii.

Extracutaneous infection from Petriellidium boydii is an unusual occurrence despite the ubiquity of the organism in nature. Central nervous system infection by this organism is extremely rare, only seven previous reports having been found. The rarity of this manifestation prompted the report of a brain abscess occurring in a previously healthy youth after a near-drowning. The source of the infection was likely to have been the river water at the accident site, from which P boydii was isolated. Although previous in vitro susceptibility data and failure of amphotericin B therapy in a similar infection suggested miconazole treatment might be beneficial, the organism causing the brain abscess was resistant to miconazole and amphotericin B. This report emphasizes the urgent need for safer and more predictably effective alternatives to currently available antifungal agents.

Adult↗
PubMed1982

Discontinuous counterimmunoelectrophoresis in the diagnosis of antibiotic-associated colitis.

Discontinuous counterimmunoelectrophoresis (DCIE) was employed to detect the toxin of Clostridium difficile, etiologic antibiotic-associated colitis (AAC), in bacteria-free stool filtrates from 51 patients with diarrhea. Stool samples from 31 patients contained C. difficile toxin as determined by tissue-culture assay. A positive result was obtained by DCIE in 20 of the 31 patients (65%) and was influenced by the titer of toxin present. When toxin was present by tissue-culture assay in a dilution of less than or equal to 10(-2) (11 samples), DCIE was positive in only 2 (18%). However, DCIE yielded positive results in 18 of the 20 samples (90%) containing toxin titers greater than or equal to 10(-3). The combination of DCIE and sigmoidoscopy of colonoscopy was superior to either alone in the diagnosis of AAC irrespective of the toxin titer. Nine of 11 patients (82%) whose stool samples contained C. difficile toxin in a dilution of less than or equal to 10(-2) were recognized by DCIE, endoscopy, or both. In stool samples containing toxin in titers greater than or equal to 10(-3), no false-negative results were encountered (sensitivity equals 100%). Thus, 29 of 31 patients whose stool samples contained C. difficile toxin were identified when the results of DCIE and endoscopical examination were combined (sensitivity 93.5%). Neither endoscopical examination nor DCIE yielded positive results in the 20 patients whose stool samples lacked C. difficile toxin (specificity equals 100%). DCIE is a rapid, moderately sensitive, and specific method for detecting C. difficile toxin. When DCIE is combined with endoscopy, the vast majority of patients requiring specific therapy for AAC can be identified.

Anti-Bacterial Agents↗