Contaminated resuscitators: fatal threat to newborns.
Explore the source record for details and available documents.
Cross Infection↗
Biomedical subjects
J Fierer
Publications and source records attributed to J Fierer.
Pseudomonas aeruginosa epidemic traced to delivery-room resuscitators.
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
Immunologic competence of mouse placental cells in irradiated hosts.
Explore the source record for details and available documents.
Animals↗
Visceral leishmaniasis and other severe infections in an adult patient with p47-phox-deficient chronic granulomatous disease.
We report a rare case of a male patient without known immunodeficiency consecutively diagnosed with visceral leishmaniasis, brain abscess and cavitating pneumonia in the 3rd decade of life. Chronic granulomatous disease (CGD) was diagnosed by a nitroblue tetrazolium test. A p47-phox mutation of the NADPH oxidase of the leukocytes was suspected by immunoblotting and confirmed by DNA analysis. The patient was homozygous for this mutation while his mother and sister were heterozygous asymptomatic carriers. After the CGD diagnosis the patient started a chronic prophylactic regimen with subcutaneous interferon-gamma (0.05 mg/m2 of body surface/three times a week), and oral trimethoprim-sulfamethoxazole and itraconazole (both at 5 mg/kg/day) with no subsequent infections after 12 months of follow-up.
Adult↗
Polymorphonuclear leukocytes and innate immunity to Salmonella infections in mice.
Neutropenia makes normal mice more susceptible to infection with spv (+) but not spv (-) Salmonella dublin. This shows the important role of polymorphonuclear leukocytes in resistance to Salmonella that can grow in host macrophages. Polymorphonuclear leukocytes, part of the innate immune system, kill Salmonella in a complement-dependent manner, and work in concert with macrophages.
Animals↗
The fetid foot: lower-extremity infections in patients with diabetes mellitus.
Infections of the lower extremities in patients with diabetes mellitus have been attributed to Staphylococcus aureus and other facultatively anaerobic bacteria. However, a review of 30 consecutive diabetics who required surgery for lower-extremity infections revealed that 17 had mixed infections due to both obligate and facultative anaerobes; only six had infections due to S. aureus. Mixed infections often had characteristics of anaerobic suppuration and responded poorly to therapy. Patients with mixed infections required more operations than did those with staphylococcal infections, and their surgical wounds healed more slowly. Seven patients had infections with mixed enteric bacteria (neither anaerobes nor S. aureus), and their response to therapy was intermediate between that of the patients with mixed anaerobic infections and those with staphylococcal infections. Nine additional patients with mixed anaerobic infections were treated with cefoxitin; three required amputations at a level above the ankle, but six patients improved and required only limited surgery that preserved foot function. Bacteroides fragilis was the anaerobe isolated most often. Cefoxitin (less than or equal to 20 micrograms/ml) inhibited all of the anaerobes isolated from the nine patients and 97% of an additional 135 consecutive clinical isolates of B. fragilis; 98% of 54 strains of Bacteroides oralis and all of 34 strains of Bacteroides melaninogenicus were also inhibited. These in vitro results and the results of our clinical study show that cefoxitin is a promising antibiotic for therapy of foot infections due to a mixed flora of anaerobes in diabetics.
Aged↗
Chronic staphylococcal osteomyelitis: treatment with regimens containing rifampin.
Experience with rifampin as a component of combination antibiotic therapy for chronic staphylococcal osteomyelitis was reviewed. These data included the preliminary results of a randomized, prospective trial of parenteral nafcillin alone vs. parenteral nafcillin plus oral rifampin; the results of use of rifampin in combination with other oral antibiotics for the treatment of chronic staphylococcal osteomyelitis; and experience with rifampin regimens at the Oregon Health Sciences University. A total of 28 patients are described in this report; 70% of those who received regimens including rifampin experienced an apparent cure of infection. Most patients whose infections were not cured had inadequate surgical therapy or were also infected with other bacteria. Staphylococcus aureus was eradicated from the sinus drainage of all but one patient. Although these results are encouraging, a larger number of patients and a longer follow-up period are required for an adequate evaluation of the place of rifampin in therapy for chronic staphylococcal osteomyelitis.
Adult↗
Malassezia fungemia in neonates and adults: complication of hyperalimentation.
Until recently, Malassezia furfur was thought to be a pathogen only in tinea versicolor. More recently, this lipophilic yeast has been recovered from sick neonates with catheter-related infections. Malassezia fungemia was studied in seven patients, and the salient features of this infection in patients described in the literature were reviewed. Major risk factors include prolonged hospitalization, the presence of central venous catheters, and the use of intravenous fat emulsions. It is difficult to identify specific manifestations of fungemia in these complex cases occurring in patients with severe underlying disease; however, neonates often present with the signs and symptoms of sepsis and thrombocytopenia, whereas fever may be the only manifestation in adults. Some patients are asymptomatic. When symptoms are present, they resolve upon removal of the colonized catheter. The role of the lipophilic nature of Malassezia in the pathogenesis of infection is apparent from the ability of intravenous fat emulsions to support the growth of the fungus in vitro. A special solid medium that can be used to determine the true prevalence of malassezia fungemia has been devised. M. furfur must be considered in the differential diagnosis of opportunistic infections in patients receiving central hyperalimentation and should be sought by the culture of blood on appropriate medium.
Agar↗
Coccidioidomycosis of the extensor tenosynovium of the wrist. A case report.
A 59-year-old man had isolated coccidioidomycosis infestation of the tenosynovium of the wrist extensor tendons resistent to surgical and amphotericin chemotherapy. Some improvement has been noted on Miconazole chemothearapy, but neither the long term side effects nor clinical results are known.
Amphotericin B↗
Endotoxin-induced otitis media with effusion in the mouse. Immunohistochemical analysis.
A model of endotoxin-induced otitis media with effusion was developed in healthy BALB/c mice. Endotoxin extracted from Salmonella typhimurium (10 micrograms/ml) was injected into the middle ear bulla transtympanically and the resultant inflammatory response was analyzed using immunohistochemical methods. Serous effusions were observed otoscopically and mucosal edema and infiltrate were studied histologically, both peaking at 3 days and essentially resolving by 7 days. However, persistence of a small area of inflammation in the round window niche was consistently present at 2 weeks. The specific cellular responses to endotoxin were analysed by histologic and immunohistologic examination of the murine temporal bone. We used antibodies to identify T-lymphocytes (anti-Lyt-1, -Lyt-2), macrophages and neutrophils (anti-Mac-1), and immunoglobulins (anti-IgA, -IgG, -IgM). In the mucosal/submucosal infiltrate Mac-1+ and Lyt-1+ cells peaked from days 1 to 3. Within the luminal effusion Mac-1+ and Lyt-1+ cells as well as diffuse (not cell-associated) IgG, IgM, and IgA staining were most prevalent from days 1 to 3, while IgG-bearing plasma cells formed the majority of the luminal cells observed at 1 to 2 weeks. No significant influx of T-suppressor cells was observed at any time. The round window niche and anterior portion of the tympanic bulla mucosa were found to be the most reactive areas. These results suggest that endotoxin alone is capable of producing an inflammatory infiltrate in the mouse consistent with otitis media with effusion, and that the interaction of endotoxin with resident immunocytes of the middle ear, as well as serum derived immune cells, is consistent with the known phlogistic properties of endotoxin.
Animals↗
Coccidioidomycosis: a reemerging infectious disease.
Coccidioides immitis, the primary pathogenic fungus that causes coccidioidomycosis, is most commonly found in the deserts of the southwestern United States and Central and South America. During the early 1990s, the incidence of coccidioidomycosis in California increased dramatically. Even though most infections are subclinical or self-limited, the outbreak is estimated to have cost more than $66 million in direct medical expenses and time lost from work in Kern County, California, alone. In addition to the financial loss, this pathogen causes serious and life-threatening disseminated infections, especially among the immunosuppressed, including AIDS patients. This article discusses factors that may be responsible for the increased incidence of coccidioidomycosis (e.g., climatic and demographic changes and the clinical problems of coccidioidomycosis in the immunocompromised) and new approaches to therapy and prevention.
Antifungal Agents↗