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Biomedical subjects

L B Guze

Publications and source records attributed to L B Guze.

At least 73 records · Page 4Linked to original sources
PubMed1978

Non-group D streptococcal meningitis misidentified as enterococcal meningitis. Diagnostic and therapeutic implications of misdiagnosis by screening microbiology.

Two patients had nonhemolytic Gram-positive coccal meningitis. Both pathogens were initially misidentified as a group D enterococcus by growth in "selective" media, which led to the use of inappropriate and potentially toxic systemic and intrathecal aminoglycosides. Careful evaluation of the antibiotic sensitivity data and additional microbiological studies allowed correct identification of the organism. The important diagnostic and therapeutic considerations in differentiating true enterococcal infections, especially meningitis, from those caused by other alpha-hemolytic or nonhemolytic streptococci are emphasized. A simple laboratory schema for rapid recognition of such pathogens is reviewed.

Adult↗
PubMed1978

Adult Haemophilus influenzae type B vertebral osteomyelitis: a case report and review of the literature.

Osteomyelitis in adults due to Haemophilus influenzae is exceedingly rare. We report a case of H. influenzae type b vertebral osteomyelitis in an adult. Review of the English literature reveals one other adult patient with H. influenzae osteomyelitis, and sporadic pediatric cases. Although a variety of predisposing host resistance factors have been postulated to account for this infection, the deficiency responsible for adult infection remains undelineated. Bone biopsy is mandatory for diagnosis when blood cultures are negative. The isolation and identification of H. influenzae may be delayed because of its fastidious growth requirements. Treatment with ampicillin or chloramphenicol appear to be most efficacious considering the antibiotic sensitivities of the organism.

Ampicillin↗
PubMed1978

An intercity outbreak of meningococcal meningitis in adults.

An intercity outbreak of meningococcal meningitis occurred in five adults, with the acute onset of symptoms developing in two of the patients after they returned to Los Angeles from the San Francisco Bay area. The secondary attack rate was 36.4 percent in this entirely adult household. The authors review reports of secondary cases in civilian epidemics, as well as recommendations for chemoprophylaxis in household contacts.

Adolescent↗
PubMed1977

Thrombotic thrombocytopenic purpura-like syndrome associated with infective endocarditis. A possible immune complex disorder.

A thrombotic thrombocytopenic purpura (TTP)-like syndrome was the chief presenting feature in two patients with infective endocarditis. Clinical and laboratory aberrations of the syndrome were rapidly reversed by specific antimicrobial therapy. Hypocomplementemia and high levels of circulating immune complexes were detected initially in both patients. Because these returned to normal as the TTP syndrome abated, an immunopathologic mechanism may have been operative.

Adult↗
PubMed1977

Role of anaerobic bacteria in spontaneous peritonitis of cirrhosis: report of two cases and review of the literature.

The role of anaerobic or microaerophillic bacteria in spontaneous peritonitis of cirrhosis has not been clearly defined. Among 126 cases recorded in the literature, in only eight (6 per cent), including the two reported here, was bacterascites associated with anaerobic or microaerophilic bacteria. Clinical features in these cases were indistinguishable from those associated with aerobic bacteria. However, polymicrobial bacterascites occurred in four of eight cases associated with anaerobes, as contrasted with only 10 of 118 cases (8 per cent) associated with aerobes alone. On the other hand, concurrent bacteremia occurred in only one of eight cases associated with anaerobes as contrasted with 52 of 118 cases (44 per cent) of aerobic spontaneous peritonitis. Experimental evidence is cited in an attempt to explain this relatively low incidence of spontaneous peritonitis associated with anaerobic or microaerophilic bacteria, despite the high density of these organisms in the normal bowel flora.

Adult↗
PubMed1977

Cytomegalovirus mononucleosis in a healthy adult: association with hepatitis, secondary Epstein-Barr Virus antibody response and immunosuppression.

A 35 year old previously healthy physician had clinical manifestations of a mononucleosis illness complicated by arthralgia, vesicular pharyngitis and hepatitis. Initially, the patient had cytomegalovirus (CMV) viremia (predominantly in polymorphonuclear leukocytes) followed by the presence of CMV in the urine, throat and semen. He also had an antibody response to the Epstein-Barr virus which appeared to be a secondary type. During the acute phase of illness, only 7 per cent of the patient's lymphocytes formed spontaneous T cell rosettes as compared to a normal value of 65 to 70 per cent. Concurrently, evidence of abnormal delayed hypersensitivity was manifested by the loss of reactivity to mumps skin test antigen. All clinical and laboratory abnormalities except for the persistence of CMV in the pharynx, urine and semen returned to normal after resolution of the clinical illness.

Adult↗
PubMed1977

Cytomegalovirus retinitis secondary to chronic viremia in phagocytic leukocytes.

We studied the relationship between the duration and intensity of cytomegalovirus viremia, cytomegalovirus complement fixing antibody, and cytomegalovirus retinitis in 61 renal transplant recipients. Five (8%) patients had chronic viremia which lasted more than six months. Two of the five developed typical cytomegalovirus retinitis and a severe fungal infection after intensive viremia of more than 11 months' duration. Retinitis did not develop in 22 patients with short-term viremia. Infectious cytomegalovirus was largely associated with polymorphonuclear leukocytes, but the virus was associated with monocytes during the immature granulocytic response accompanying one patient's terminal illness.

Adult↗
PubMed1977

Chemotactic activity of L-forms and mycoplasma.

L-forms of Streptococcus faecalis, Escherichia coli and Proteus mirabilis showed significantly less chemotactic activity for normal human leucocytes than did parent bacterial forms which were strongly chemotactic. Mycoplasma pneumoniae and Mycoplasma hominis did not demonstrate chemotactic activity.

Chemotaxis↗
PubMed1977

Experimental hematogenous endophthalmitis due to Candida: species variation in ocular pathogenicity.

The ocular pathogenicity of species of Candida other than albicans was studied in the rabbit model of hematogenous candida endophthalmitis by injection of 10(5)-10(8) colony-forming units of Candida krusei, Candida parapsilosis, Candida guilliermondii, Candida tropicalis, Candida stellateoidea, and Candida albicans (control). At one and three weeks after infection, rabbits were examined by indirect ophthalmoscopy and were sacrificed for culture of eyes and kidneys. With an inoculum of 10(8) organisms, C. tropicalis and C. stellatoidea infected the kidneys but only occasionally infected the chorioretina and never infected the vitreous. Organisms were cultured only rarely from the kidneys of rabbits infected with C. krusei, C. guilliermondii, and C. parapsilosis; these species were never isolated from eyes. The C. albicans control consistently infected the kidney, chorioretina, and vitreous; approximately equal numbers of C. albicans were isolated from these organs. These data suggest a relative resistance of ocular tissues to hematogenous candida infections with species other than C. albicans.

Animals↗
PubMed1977

Quantitation of amphotericin B with use of high-pressure liquid chromatography.

A chemical method for determination of concentrations of amphotericin B in serum and cerebrospinal fluid (CSF) is described. After extraction with methanol, the antibiotic was separated by reverse-phase, high-pressure liquid chromatography and quantitated by absorption at 405 nm. The lower limit of detection of this assay was 0.02 microng/ml. Relative standard deviations of less than 3.6% were noted for multiple determinations of sera containing 0.20 and 1.00 microng of amphotericin B/ml. No interfering peaks were found in extracts of serum or CSF from normal humans or in extracts of serum from patients treated with other drugs and antimicrobial agents, including 5-fluorocytosine. Comparison of the method with microbiological assays showed correlation coefficients of 0.90 and 0.83 for serum and CSF determinations, respectively. This chemical assay is very rapid (less than 30 min), sensitive, accurate, and specific and appears to be suitable for routine clinical use.

Amphotericin B↗
PubMed1977

A double-blind comparison of clindamycin with penicillin plus chloramphenicol in treatment of septic abortion.

The responses to therapy with either clindamycin alone or penicillin plus chloramphenicol in 77 patients with septic abortions were compared in a randomized, double-blind study. Although fever index and duration of hospitalization were similar for both groups of patients, significantly more patients in the group that received clindamycin developed major complications (P less than 0.05). This is believed to result from clindamycin's lack of activity against aerobic gram-negative bacilli. Aggressive management that included early uterine evacuation and broad-spectrum antibiotics effective against both aerobic and anaerobic bacteria was the key to reduced morbidity and mortality rates in treatment of septic abortion. For patients treated with clindamycin, early uterine evacuation appeared more important than antibiotic therapy (P less than 0.005). Bacteremia was documented in a total of 29 patients (38%). Bacteremia was polymicrobial in eight patients (28%) and involved anaerobes exclusively in 18 (62%), aerobes exclusively in nine (31%), and both aerobes and anaerobes in two (7%). The organisms most frequently isolated were Bacteroides (other than Bacteroides fragilis), Peptostreptococcus, and Escherichia coli.

Abortion, Septic↗
PubMed1977

Clindamycin for treatment of sepsis caused by decubitus ulcers.

Bacteremia was documented in 19 (76%) of 24 patients with sepsis caused solely by decubitus ulcers, persisted in all but two, and was polymicrobial in 10 (42%). Obligate anaerobes were isolated from 12 patients (63%) and included Bacteroides fragilis in 11 (58%). Aerobes, primarily Proteus (21%) and Staphylococcus (16%), were isolated in nine patients (47%). Therapy was judged appropriate when the microbial isolates were susceptible in vitro to the antibiotic used. Nineteen patients received clindamycin plus gentamicin, which was considered appropriate for all but one patient. Four patients received cephalothin plus kanamycin, which was inappropriate for three patients. One patient received appropriate treatment with methicillin, gentamicin, and chloramphenicol. Patients who received appropriate antibiotics and had surgical intervention had the lowest mortality rate (14%); in those treated with appropriate antibiotics but without surgical intervention, the incidence of death was 67% (P less than 0.05). Patients who received inappropriate antibiotics, whether or not there was surgical intervention, had a 75% mortality rate (P less than 0.05). Surgical debridement and antibiotic therapy effective against aerobic as well as anaerobic bacteria are important factors in the treatment of sepsis caused by decubitus ulcers.

Aerobiosis↗
PubMed1977

Comparative susceptibility of anaerobic bacteria to ticarcillin, cefoxitin, metronidazole, and related antimicrobial agents.

The in vitro antimicrobial activity of two newer agents, ticarcillin and cefoxitin, against 204 recent clinical isolates of anaerobic bacteria was determined by an agar dilution technique, and compared to their related compounds carbenicillin, cephalothin, and penicillin, as well as metronidazole, clindamycin, and chloramphenicol. Ticarcillin was similar to carbenicillin, and cefoxitin was more active than cephalothin. At readily achievable blood concentrations of each antimicrobial agent, ticarcillin was slightly less active than clindamycin against Bacteroides fragilis. Cefoxitin was superior to cephalothin and penicillin against B. fragilis. Penicillin remained highly active against all obligate anaerobes other than B. fragilis. Metronidazole, while highly effective against B. fragilis and Clostridium perfringens, was only intermediately effective against anaerobic gram-positive cocci and relatively inactive against nonsporulating anaerobic gram-positive bacilli. Further evaluation of the clinical efficacy of ticarcillin, carbenicillin, and cefoxitin against anaerobic infections is indicated.

Anaerobiosis↗
PubMed1977

Campylobacter fetus associated with pulmonary abscess and empyema.

An unusual case of community-acquired necrotizing aspiration pneumonia with pulmonary abscess and empyema associated with Campylobacter fetus (formerly Vibrio fetus) in mixed culture is reported. This microaerophilic gram-negative curved bacillus has been increasingly associated with human disease. Unlike most pathogens associated with community-acquired aspiration pneumonia, this organism is usually resistant to penicillin. Infection associated with this organism is characteristically relapsing in nature and requires protracted antimicrobial therapy.

Adult↗
PubMed1977

Endocarditis due to Pseudomonas aeruginosa in a heroin addict. Successful treatment with trimethoprim-Sulfamethoxazole mixture plus colistin.

Endocarditis of the tricuspid valve due to Pseudomonas aeruginosa in a heroin addict failed to respond to therapy with gentamicin, carbenicillin, and amikacin. Clinical and bacteriologic cure was achieved with oral administration of a trimethoprim-sulfamethoxazole mixture plus parenteral therapy with colistin. In vitro synergism was demonstrated for the three drugs at concentrations achievable in the serum. Therapy for endocarditis due to Pseudomonas continues to be a major problem; however, the successful treatment of this patient warrants consideration for instituting therapy with a trimethoprim-sulfamethoxazole misture plus colistin in individuals with this infection who fail to respond to standard therapeutic regimens for severe infections with Pseudomonas.

Adult↗