Cryptococcus laurentii infection complicating peritoneal dialysis.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
J T Sinnott
Publications and source records attributed to J T Sinnott.
Yersinia enterocolitica causing spinal osteomyelitis and empyema in a nonimmunocompromised host.
We have reported a case of spinal osteomyelitis and empyema caused by Yersinia enterocolitica. Because this patient was in otherwise good health without evidence of liver disease, the extent of her illness was remarkable. This unique report of Y enterocolitica infection of the spine not only illustrates the organism's capacity for hematogenous spread in nonimmunocompromised patient, but documents survival in the face of widely disseminated multisystemic disease. Furthermore, the management of this patient was unusual in that operation was required. The astute clinician should consider the possibility of spinal involvement in a patient with Yersinia colitis and neck pain and should also recognize the possibility of serious and widespread infection in an otherwise low-risk patient. In a patient with widespread disease, focal collections of fluid may necessitate surgical management.
Cervical Vertebrae↗
Cryptococcal pyarthrosis complicating gouty arthritis.
Cryptococcal arthritis remains a rare entity. Crystalline arthropathy has been described in association with bacterial infection, but no similar association has been described for crystalline joint disease and fungal infection. We have described a renal transplant patient with concurrent gout and cryptococcal arthritis that responded favorably to treatment. Joints with crystalline arthropathy should be cultured for both bacteria and fungi.
Acute Disease↗
Using OKT3 to reverse cardiac allograft rejection.
Acute rejection is the major impediment to long-term patient survival after organ transplantation. Historically, the treatment of cardiac allograft rejection has been use of cytotoxic agents combined with high-dose steroids, resulting in an increased incidence of undesirable side effects. A new agent, OKT3, appears to be capable of reversing acute rejection episodes without significant morbidity. We report 10 cardiac transplant recipients in whom acute rejection was dramatically reversed and clinical symptoms resolved after treatment with OKT3. Side effects were minimal, including febrile episodes, innocuous diarrheal syndromes, mild opportunistic infections, and one hypotensive episode. Critical care nurses administering OKT3 must be cognizant of the risks and benefits of therapy in addition to recognizing potential drug side effects. A nursing care plan was devised to identify nursing diagnoses and intervention related to patient and family education as well as recognition and treatment of the reported adverse effects.
Acute Disease↗
The 'swimming-pool granuloma' that wouldn't heal.
Explore the source record for details and available documents.
Adult↗
The treatment of advanced cardiac allograft rejection.
Severe cardiac allograft rejection remains a serious problem despite the advances of cyclosporine-based immunosuppression. This study analyzes our experience with 202 recipients of cardiac allografts who were treated primarily with cyclosporine and prednisone. Failure of such therapy in 86 patients (43%) resulted in 105 episodes of advanced cardiac allograft rejection as diagnosed by endomyocardial biopsy. Of 101 rejection episodes that were initially treated with intravenous pulse therapy, 48 (48%) were successfully resolved, yet 60% of these successes were associated with major infections. Patients in whom steroid therapy failed or was contra-indicated received intravenous antithymocyte globulin (ATG) or intravenous monoclonal antibody (OKT3). ATG and OKT3 successfully reversed severe rejection in 26 (81%) of 32 and in 13 (93%) of 14 episodes, respectively. Infectious complication rates were 54% and 21%, respectively. Because the majority (87%) of these rejection episodes occurred within the first 30 days after treatment, many of them may have resulted from inadequate immunosuppressive induction therapy. Based on our results, we believe that advanced cardiac allograft rejection may be managed best by individualizing immunosuppressive therapy, thus enhancing prevention, and by adding OKT3 to the regimen when rejection occurs.
Adolescent↗
Respiratory syncytial virus.
RSV is now understood to be the most significant viral respiratory pathogen of infants and is capable of causing both bronchiolitis and pneumonia. It is a particular risk to hospitalized infants as the virus is easily spread through close contact. The most vulnerable infants are those who suffer with either congenital heart disease or bronchopulmonary dysplasia who easily fall prey to pulmonary complications of infection. Strict environmental control and the use of protective clothing and eyewear should be implemented to decrease the nosocomial spread of RSV. Available diagnostic studies include viral isolation, fluorescent antibody stains, and enzyme immunoassays. Treatment of the disease is usually supportive but hospitalized patients frequently benefit from aerosolized ribavirin therapy. Hopefully, current vaccine trials will be successful and this pathogen will not only be treatable but will also be preventable.
Child, Preschool↗
Capnocytophaga.
Capnocytophaga has been found to cause disease in the normal and the immunocompromised patient. Most often this organism is an opportunist that is difficult to isolate but easy to identify and a unique reminder that uncommon infection may respond to common antibiotics.
Anti-Bacterial Agents↗
Respiratory syncytial virus pneumonia in a cardiac transplant recipient.
Explore the source record for details and available documents.
Adult↗
Infections in patients receiving OKT3 monoclonal antibody for cardiac rejection: results of a small clinical trial.
Orthoclone OKT3 (muromonab-CD3), a murine monoclonal antibody that virtually eliminates circulating T cells and inhibits medullary lymphocyte function, has recently been found effective in reversing stubborn severe allograft rejection after heart transplantation. To determine the influence of OKT3 therapy on the development of infections in cardiac allograft recipients, we compared the frequency and severity of infection in 16 patients who underwent treatment for cardiac allograft rejection at our institution from July 1985 through November 1986. these included 11 patients on OKT3 therapy and 5 patients on a conventional immuno-suppressive regimen. With 2 exceptions late in the trial, OKT3 was used only as a rescue therapy, for patients who did not respond to standard adjunctive therapy consisting of high doses of corticosteroids or antithymocyte globulin, or both. The 5 patients who did not receive OKT3 responded to adjunctive therapy and were in general not as ill as the OKT3 recipients. Our protocol specified that patients in both groups be studied during the 6 weeks (42 days) immediately following transplantation. During this period of study, 6 patients in our 11 member OKT3 group experienced 25 infectious processes, 22 of which occurred in only 3 patients and 14 of which were considered life-threatening (2 of the 3 very ill patients died during the study period). These infections were found most often in the gastrointestinal and genitourinary tracts, involved both bacterial and nonbacterial pathogens, and developed about 2 weeks after the initiation of therapy. By comparison, 2 patients in our 5-member non-OKT3 group experienced 3 infectious processes during the study period, and these were not life-threatening. Because of the occurrence in the OKT3 group of 22 of the 25 infections in only 3 patients, these early results were skewed, but a trend was noted towards a higher incidence of bacterial infection in the OKT3 group. A larger and longer-term trial is under way to evaluate the trend.
Journal Article↗
Candida (Torulopsis) glabrata.
Candida (Torulopsis) glabrata is usually a nonpathogenic fungus living saprophytically with normal flora. However, under special circumstances, the organism can become locally invasive and potentially disseminate. Laboratory identification is based on colonial appearance, absence of hyphae, and characteristic biochemical reactions. Treatment usually consists of amphotericin B with occasional reports of 5-fluorocytosine usefulness. It is apparent that Torulopsis represents yet another "evolving" disease with which the clinician must be familiar because successful treatment rests on successful diagnosis.
Candida↗
Rotavirus.
The consequences of rotavirus infection cannot be over-estimated. It kills millions of children and accounts for occasional illness in adults. The agent is a complex reovirus with a unique capsid that invades columnar epithelial cells disrupting ion transport and producing dehydration. There is no specific therapy, making the need for prevention paramount. Cases must be identified and enterically isolated with some authorities even encouraging respiratory isolation.
Child, Preschool↗
Smoking and medical videotapes sold in pharmacies.
Explore the source record for details and available documents.
Florida↗
Treatment of cytomegalovirus gastrointestinal ulceration in a heart transplant patient.
A 62-year-old man developed cytomegalovirus gastrointestinal infection associated with moderate cardiac rejection. The patient was successfully treated with a new therapeutic agent 9-(1,3-dihydroxy-2-proproxymethyl) guanine during maximal immunosuppression. The medication was well-tolerated, and the patient had an excellent response to therapy. We believe this has significant implications for cytomegalovirus-induced gastrointestinal disease in the heart transplant patient.
Acyclovir↗
The use of OKT3 for stubborn heart allograft rejection: an advance in clinical immunotherapy?
The suppression of heart allograft rejection in heart transplantation commonly employs cyclosporine, steroids, and azathioprine, or some combination thereof as baseline therapies. When severe or stubborn rejection is unaltered by these drugs, adjunctive immunotherapy is required. This article details our experience in treating difficult allograft rejections with a purified murine monoclonal antibody directed against the murine antihuman mature T cell (OKT3) lymphocyte. The inclusion criteria for use of OKT3 included severe histologically confirmed rejection (7 on a 0 to 10 scale), rejection refractory to other immunosuppressive agents (methylprednisolone, antithymocyte globulin), or contraindications toward the use of other immunosuppressive agents. From July 1985 through September 1986, 11 patients with severe rejection that was documented by histologic, biochemical, and clinical criteria were treated with intravenous OKT3. Of these patients, 10 had received orthotopic heart transplantations and one had undergone heterotopic transplantation. The mean duration of therapy was 14.4 days, with a single, average dose of 5 mg/day. Intended duration of therapy was 14 days per our protocol. Occasionally this was extended because of evidence of ongoing rejection or because of the potential toxicity of other immunosuppressive agents (i.e., cyclosporine nephrotoxicity in a patient with kidney failure). One patient demonstrated an equivocal response to the drug but experienced no side effects. In the remaining 10 patients a full course of treatment with OKT3 dramatically reversed the rejection and resulted in improved graft performance. On a standardized scale for histologic grading of rejection the average score decreased from 8.4 to 4.1 and stayed in the "mild" rejection range (0 to 4) thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)
Adjuvants, Immunologic↗
Haemophilus parainfluenzae endocarditis in a patient with mitral valve prolapse.
Haemophilus parainfluenzae is a frequent cause of "culture-negative" endocarditis (i.e., endocarditis owing to a fastidious organism which may require longer incubation periods and/or enrichment media for detection compared to traditional pathogens). More cases will probably be identified with improvements in growth and isolation techniques. A case of H. parainfluenzae endocarditis is presented in a patient with mitral valve prolapse, which illustrates the difficulty in diagnosing endocarditis when initial blood cultures are negative. Particularly, it emphasizes the difficulty in selecting appropriate antibiotic therapy since beta-lactamase producing organisms are being isolated with increased frequency. This report is unique in that it documents successful treatment with a cephalosporin and what is, to our knowledge, the third reported case of a beta-lactamase producing H. parainfluenzae causing endocarditis. The authors believe that beta-lactamase stable second or third generation cephalosporins should constitute initial treatment of H. parainfluenzae endocarditis until sensitivity studies become available, since beta-lactamase production by this organism would nullify the effect of the previous agent of choice, ampicillin.
Adult↗