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Biomedical subjects

M J Chusid

Publications and source records attributed to M J Chusid.

At least 37 records · Page 2Linked to original sources
PubMed1989

Chronic, recurrent multifocal osteomyelitis. Case report and review of the literature.

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual inflammatory process involving multiple osseous sites, often recurrently. The authors recently diagnosed CRMO in an 8-year-old girl who had complained of toe pain for several weeks. A number of other involved, asymptomatic areas were discovered by bone scan. Biopsy of the lesions did not reveal any pathogens. Antibiotics and inflammatory agents were not used, and the patient recovered. A review of previously reported cases of CRMO showed 1) that this entity affects children almost exclusively, 2) that from two to 18 sites, usually in the extremities, can be affected at one time, and 3) that about 20 percent of the patients develop a pustular rash on their palms and soles. Other than an elevated erythrocyte sedimentation rate, there are no consistent laboratory abnormalities, and cultures of affected bone are negative. Histopathology typically shows a chronic inflammatory response, sometimes with granulomas. Antiinflammatory agents and antibiotics offer little consistent beneficial effect. The disease is self-limited, and patients usually recover fully, although exacerbations may occur. In the proper clinical setting, CRMO should be considered, since recognition of this entity avoids costly and potentially harmful diagnostic and therapeutic interventions.

Child↗
PubMed1989

Brucellosis: an unusual cause of a child's fever of unknown origin.

A 3-year-old Wisconsin native with the symptoms of chronic fever, hepatosplenomegaly, and inability to walk, was found to have an elevated anti-Brucella titer. Blood and bone marrow cultures grew Brucella melitensis, biotype 3. This infection was likely acquired during a trip to Mexico several months earlier during which the child had ingested raw milk. The patient's father was also discovered to have brucellosis. Both were successfully treated with antibiotic therapy. Although brucellosis has been almost totally eradicated in the United States, in the appropriate setting it should be considered as a possible cause of fever of unknown origin in a child.

Brucellosis↗
PubMed1989

Fatal rhabdomyolysis following influenza infection in a girl with familial carnitine palmityl transferase deficiency.

Severe rhabdomyolysis following an influenza B infection developed in a previously well 13-year-old girl. There was no history of trauma. Her course was complicated by episodes of severe hyperkalemia, hypocalcemia, hyperphosphatemia, and myoglobinuria. Renal failure, hypertension, and life-threatening arrhythmias developed; she died. Muscle biopsy revealed that this girl had carnitine palmityl transferase deficiency. An asymptomatic sister was demonstrated to have the same disorder. Although carnitine palmityl transferase deficiency is usually associated with mild bouts of rhabdomyolysis that become apparent only in adulthood, severe forms of this disorder may be seen in children. Life-threatening rhabdomyolysis and myoglobinuria may follow any infection associated with decreased intake. If carnitine palmityl transferase deficiency is diagnosed in a proband, other siblings should be evaluated so that proper preventative measures can be undertaken to help prevent the development of symptoms in susceptible individuals who have not been recognized to have the disease.

Acute Kidney Injury↗
PubMed1988

Pulmonary aspergillosis appearing as chronic nodular disease in chronic granulomatous disease.

Chronic nodular pneumonia is unusual in children. Three children are described who presented with diffuse nodular pulmonary disease and in whom lung biopsy demonstrated Aspergillus infection. One child was known to have chronic granulomatous disease of childhood (CGD) and further investigation demonstrated CGD in the other two patients as well. These cases indicate that Aspergillus infection and CGD should be considered in the differential diagnosis in children who present with chronic diffuse nodular pneumonia.

Aspergillosis↗
PubMed1988

Lyme disease presenting as heart block.

Lyme disease is now recognized as an infectious process capable of involving multiple organs including the cardiovascular system. We recently treated a boy whose complaints on admission related only to symptomatic heart block that was severe enough to require transvenous pacing. This boy was subsequently determined to have had Lyme Disease after his medical testing was reevaluated for possible tick exposure. In rare instances symptomatic heart block may be the sole presenting complaint of Lyme Disease in children.

Child↗
PubMed1987

Mixed morphotype susceptibility testing of Pseudomonas aeruginosa from patients with cystic fibrosis.

Disk diffusion antibiograms were determined for mixtures of Pseudomonas aeruginosa morphotypes isolated from the sputum of patients with cystic fibrosis (CF). The results were compared with the predicted susceptibility patterns derived from the antibiograms of individual morphotypes within the mixture. Fifty separate cultures, each yielding two, three, or four distinct morphotypes of Pseudomonas aeruginosa were evaluated. Overall, the correlation between observed and predicted results was 92.2% with only 2.9% of all observations leading to major disagreements in susceptibility. These data suggest that mixed morphotype susceptibility is potentially a useful method to monitor the collective resistance of colonizing strains of Pseudomonas aeruginosa from the respiratory tract of patients with CF.

Anti-Bacterial Agents↗
PubMed1987

Epidemiologic markers of pediatric infections caused by coagulase-negative staphylococci.

Several epidemiologic markers (species, slime production and antimicrobial susceptibility) were examined for 256 isolates of coagulase-negative staphylococci (C-S) obtained from clinical specimens in a 1-year period. The medical records of the 169 pediatric patients from whom the C-S were obtained were reviewed and divided into infected (N = 11) and uninfected (N = 158) groups. The phenotypic traits of strains associated with infection included: (1) slime production (P = 0.014); (2) slime-positive Staphylococcus epidermidis (P = 0.002); and (3) resistance to penicillin (P = 0.03), oxacillin (P less than 0.001), clindamycin (P = 0.003), chloramphenicol (P less than 0.001) and trimethoprim/sulfamethoxazole (P less than 0.001). Infected patients were significantly older (P = 0.006) than uninfected patients. Simultaneous isolation of the same strain of C-S from the aerobic and anaerobic bottles of a single blood culture increased the probability of sepsis (P = 0.004). The combination of these patient and laboratory data may be useful in determining the clinical significance of C-S recovered from pediatric patients.

Child↗
PubMed1986

Quantitation of corneal inflammation by chemiluminescense.

Various inflammatory agents, including Pseudomonas aeruginosa, bacterial filtrates, endotoxin, and phorbol myristate acetate were found to induce significant increases in corneal chemiluminescense (CLM). Disruption of polymorphonuclear leukocytes within corneas by sonication, freeze-thawing or cryotherapy, or reduction of corneal infiltration by induction of neutropenia resulted in marked decreases of CLM. Increased corneal CLM was associated with significant increases in corneal thickness and water content. Oxygen-free radical scavengers significantly inhibited CLM of experimentally infected corneas in vitro, as did the anti-inflammatory agents prednisolone acetate, indomethacin, and salicylic acid. In vivo therapy of infected corneas with prednisolone resulted in significant reductions in corneal CLM, thickness, and water content compared with saline-treated eyes. The CLM assay is a simple technique that allows quantitation of corneal inflammation and evaluation of the effect of therapeutic agents on corneal inflammation.

Animals↗
PubMed1986

Cyclic neutropenia in identical twins.

Cyclic neutropenia developed in identical twin girls. The onset of neutropenia in these children occurred three years apart. Neutrophil cycling diminished, and symptoms decreased in the initially affected twin during a five-year follow-up. Some cases of cyclic neutropenia may be genetically determined; however, the onset and clinical manifestations may be modified by other internal and external factors. There may also be a prodromal period during which neutrophils cycle, but the patient is neither neutropenic nor symptomatic.

Adolescent↗
PubMed1986

Cerebral toxoplasmosis in an immunocompromised host. A precise and rapid diagnosis by electron microscopy.

In immunocompromised patients with cerebral toxoplasmosis, the tachyzoite forms rather than cystic and bradyzoite forms of the protozoon are commonly seen. These tachyzoites are minute, scattered among cellular debris, sometimes lodged inside macrophages and neutrophils, and difficult to visualize by light microscopy, even with special stains. Immunodiagnostic tests may be falsely negative due to inability of the host to produce appropriate antibodies. Isolation of the organism is dangerous because Toxoplasma gondii is highly infective. In this situation, transmission electron microscopy (EM) may be a diagnostic tool of choice. It demonstrates the fine definitive features of the protozoon and can be expedited to give results in five hours. Further evaluation of EM for diagnosing possible toxoplasmosis in immunocompromised patients is indicated.

Adolescent↗
PubMed1986

Cerebral infarction in Hemophilus influenzae type B meningitis.

Over a 5-year period, 8 (4.7%) of the 170 children diagnosed at Milwaukee Children's Hospital as having Hemophilus influenzae type b (HITB) meningitis developed cerebral infarction. Compared with children who did not develop infarcts or with children who developed other neurologic complications, such as subdural effusion, empyema, or meningoencephalitis, these children had significantly higher cerebrospinal fluid (CSF) leukocyte counts on initial lumbar puncture and had a greater likelihood of seizure activity. In seven of eight patients with cerebral infarction, a focal or generalized seizure heralded neurologic findings associated with abnormal radiographic studies. Two of the eight patients died, and two were permanently severely damaged. In the other four patients, there was eventual recovery from gross neurologic deficits. The mortality in patients with HITB meningitis complicated by cerebral infarction (25%) was significantly greater than that in other patients with HITB meningitis (0.6%). The pathophysiology of infarction in patients with bacterial meningitis is uncertain but may in part relate to arteriospasm. Cerebral infarction is a serious, and in the present experience, not uncommon complication of H. influenzae meningitis.

Cerebral Infarction↗
PubMed1986

The role of the polymorphonuclear leukocyte in the induction of corneal edema.

Corneal inflammation is frequently associated with the development of corneal edema. It has been suggested the development of corneal edema might in some way be related to the presence of polymorphonuclear leukocytes (PMNLs) within inflamed corneas. In the present studies, it was found that corneal thickness markedly increased after experimental infection with Pseudomonas aeruginosa, but in guinea pigs made neutropenic by whole body irradiation, significantly less of an increase in corneal thickness occurred. Furthermore, corneas from non-neutropenic animals experimentally infected with P. aeruginosa consistently showed a greater increase in water content than did infected corneas from neutropenic animals. Over the first 48 hr of infection, the increase in corneal water was directly proportional to the corneal ingress of radiolabelled PMNLs. Corneal inflammation induced by intracorneal injection of the PMNL chemotactic agents phorbol myristate acetate (PMA) or endotoxin was also associated with a significant increase in corneal water compared with neutropenic animals. These data strongly suggest that activated PMNLs in the cornea are responsible for the induction of corneal edema in infected corneas.

Animals↗
PubMed1985

Polymorphonuclear leukocyte kinetics in experimentally induced keratitis.

The movement of polymorphonuclear leukocytes (PMNLs) into inflamed corneas was studied using a quantitative technique to measure PMNL chemotaxis in vivo. Our studies suggested that, in this model, most PMNLs enter the cornea through limbal vessels. A variety of bacterial agents, including viable bacteria, killed bacteria, culture filtrates, and endotoxin, were found to induce a significant corneal inflammatory response. Of the agents tested, viable Pseudomonas aeruginosa produced greatest inflammation. Host factors (serum, PMNLs) also induced movement of PMNLs into corneas, but only after preincubation with activating agents. Normal serum, resting PMNLs, and PMNL lysates derived from resting cells did not promote PMNL corneal ingress. These studies provide further insight into the movement of PMNLs into the inflamed cornea and information that may be of use in developing techniques to inhibit the corneal inflammatory response.

Animals↗