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Biomedical subjects

J R Perfect

Publications and source records attributed to J R Perfect.

150 records · Page 9Linked to original sources
PubMedDate not supplied

Adverse drug reactions to systemic antifungals. Prevention and management.

Systemic administration of antifungal agents for invasive mycoses has dramatically increased over the past 10 years in many fields of medicine. The increase has been due both to an increasing immune compromised population and to potent antibacterial agents which allow these fungi to invade tissue. It is apparent that our understanding of the use of both the old and new antifungal agents has significantly increased in the last few years. In this review, we attempt to document our extensive knowledge of the adverse effects of the polyenes, flucytosine, griseofulvin and azoles when given systemically for treatment. Interwoven in this documentation of the adverse reactions to these agents is the attempt to help clinicians potentially avoid some of these adverse effects and if they do occur, to be able to identify and successfully manage them.

Antifungal Agents↗
PubMedDate not supplied

Treatment of vancomycin-resistant enterococci, with a focus on quinupristin-dalfopristin.

Enterococci are the second most common cause of hospital-acquired infections, and drug resistance among these organisms is a growing problem. Vancomycin-resistant enterococci (VRE) now account for 7.9% of the nosocomial enterococcal infections. There is no standard therapy for VRE. Although some agents have shown in vitro activity alone or in combination, including ciprofloxacin, doxycycline, novobiocin, teicoplanin, chloramphenicol, and rifampin, treatment options are limited to combinations of drugs with marginal efficacy against the pathogens. Quinupristin-dalfopristin is a new investigational agent with activity against gram-positive cocci, including VRE.

Anti-Bacterial Agents↗
PubMedDate not supplied

Dominant selection system for use in Cryptococcus neoformans.

Present transformation systems for Cryptococcus neoformans depend on complementation of auxotrophic mutants. We have developed a dominant selection system for transformation of wild-type strains of cryptococci in which resistance to the antibiotic hygromycin B is used as the selectable marker. A heterologous fusion gene construct was created by attaching the putative promoter sequence and start site from a cryptococcal actin gene to a truncated hygromycin B phosphotransferase gene from E. coli. Biolistic transformation with this construct resulted in cryptococci resistant to hygromycin B, and transformation efficiencies approached approximately 500 transformants per microgram DNA. The construct was found to exist in transformants as both extrachromosomal and integrative forms. The transformants with integrated constructs were stable both in vitro and in vivo, and constructs were recoverable from most transformed cells using a plasmid rescue technique. This is the first dominant selection system for use in C. neoformans, and it should prove useful for molecular studies with this important pathogenic yeast.

Actins↗
PubMedDate not supplied

Study of Cryptococcus neoformans actin gene regulation with a beta-galactosidase-actin fusion.

An expression plasmid carrying a heterologous gene fusion between the Cryptococcus neoformans actin promoter and the Escherichia coli reporter gene, LACZ, was constructed to study actin regulation in C. neoformans. Two randomly stable transformants, designated 20.6 and 20.9, were selected for further examination. Both ectopic and homologous recombination with vector insertion in tandem repeats occurred in these transformants. Transformant 20.9 carried more copies of ACTp::LACZ in its genome than 20.6 and this was reflected in expressing higher levels of beta-galactosidase activity. In vitro, these transformants showed higher levels of beta-galactosidase activity expressed when the transformants were propagated at higher temperatures (37 degrees C vs 30 degrees C). However, beta-galactosidase expression in the transformants was variable during logarithmic and stationary growth phases and this differential expression was temperature dependent. This report shows that the constitutive actin gene in C. neoformans is regulated by temperature and growth and this fact should be taken into consideration when actin expression is used as a standard to compare the expression of other regulated genes. Also, a more sensitive reporter construct will be needed for in vivo gene analysis of regulation.

Actins↗
PubMedDate not supplied

Chest discomfort associated with liposomal amphotericin B: report of three cases and review of the literature.

Liposomal formulations of amphotericin B are designed to maintain therapeutic efficacy of amphotericin B deoxycholate while reducing its associated toxicities. In three patients chest discomfort occurred during planned 1-hour infusions of liposomal amphotericin B (AmBisome) 3 mg/kg/day during an open-label trial. The first patient experienced chest tightness and difficulty breathing and the second had dyspnea and acute hypoxia, both within 10 minutes of the start of the infusion. The third patient complained of chest pain 5 minutes after the start of two infusions. All symptoms resolved on terminating therapy. Two patients were later rechallenged with slower infusions and tolerated the drug well. A review of the English-language literature revealed only two other case reports of infusion-related chest or pulmonary reactions with the drug, although similar reactions were noted in several reports of clinical trials. Further review of the literature revealed reports of chest and pulmonary adverse events with other liposomal formulations of amphotericin B, liposomal daunorubicin, liposomal doxorubicin, and liposomes. The pathophysiology of such reactions remains unclear, and premedication with diphenhydramine did not completely prevent this reaction in one of our patients. We recommend infusing liposomal amphotericin B over at least 2 hours with careful monitoring for adverse reactions.

Adolescent↗