Successful treatment of focal hepatic candidiasis with liposomal amphotericin B.
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Adult↗
Biomedical subjects
M T Cafferkey
Publications and source records attributed to M T Cafferkey.
Post-tonsillectomy bacteraemia.
Post-tonsillectomy bacteraemia is a well recognized aetiological factor in streptococcal endocarditis. Prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy. Recent studies have shown a change in the microflora and an increase in the number of penicillin resistant organisms in the tonsils of patients undergoing tonsillectomy. The aim of this study has been to assess the incidence of post-tonsillectomy bacteraemia, identify the organisms associated with it and review the suitability of penicillin in prophylactic regimens. Of the 32 patients included in the study, 11 (34.4%) had positive post-tonsillectomy blood cultures. We were surprised at this low incidence of bacteraemia and have postulated a possible reason. Haemophilus influenzae was isolated from 4 (36.4%) of the positive cultures and Streptococcus viridans in only 1 (9%). Rather than using penicillin for prophylaxis a beta-lactamase stable antibiotic would be more appropriate.
Bacteremia↗
Fine-needle aspiration in recurrent tonsillitis.
The incidence of tonsillitis that is unresponsive to penicillin therapy is leading to concern. This phenomenon has been linked to a change in the core tonsil bacteria, in particular beta-lactamase production. To date, the only way to identify the presence of these resistant microbes is at tonsillectomy. In this prospective study, we performed fine-needle tonsil aspiration in 34 patients (mean age, 7.6 years) before tonsillectomy. The bacteriologic nature of the aspirate was compared with that obtained from culturing the tonsillar surface (in situ) and core of the resected tonsils. The bacteriologic findings of the aspirate corresponded closely with those of the tonsil core (qualitative and quantitative comparison), while the superficial swab was of limited value in predicting the core bacteria. Based on this study, tonsil fine-needle aspiration may have a place in the treatment of recurrent tonsillitis.
Adolescent↗
Methicillin-resistant Staphylococcus aureus--a reappraisal.
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Anti-Bacterial Agents↗
Differences in tonsil core bacteriology in adults and children: a prospective study of 262 patients.
The tonsillar microflora of 262 patients with recurrent acute tonsillitis studied in 1989-1990 is presented. The patient population was divided into three age groups to determine any age-related features. One-hundred and forty-nine patients (57%) were in the 2-7-year-old group, 72 (28%) the 8-14-year-old age group, and the remaining 41 (15%) were over 15 years of age. H. influenzae was the single most common bacterium isolated from the centre of the tonsil (referred to as 'tonsil core'), and this was more prevalent in the 2-7-year-old age group. Staph aureus was the next most commonly isolated bacterium and was most frequently seen in the 8-14-year-old age group (29%). Anaerobic bacteriology was performed in 120 patients. Strict anaerobic species were isolated in significant numbers from the tonsil core in 5% but were present in the superficial culture in all. Anaerobes were present in moderate to heavy numbers in 32% of superficial swabs overall and this was more frequently seen in the older age groups. Mixed pathogens were found throughout all age groups and were most prevalent in the 8-14-year-old age group at 46%. The commonest mixture was H. influenzae and Staph aureus. Normal flora only was commonly found in the superficial swab and rarely in the tonsil core. The number of specimens containing a beta-lactamase producer was assessed for each group; this was similar in all of the groups ranging from 43% in the 2-7-year-old group and 53% in the 8-14-year-old group to 39% in the greater than 15-year-old group.
Adolescent↗
Importation of methicillin-resistant Staphylococcus aureus from Baghdad to Dublin and subsequent nosocomial spread.
We report the spread of a methicillin- and gentamicin-resistant Staphylococcus aureus strain (MGRSA) from the Middle East and its subsequent dissemination within two hospitals in Dublin. The index case, a 30-year-old male with serious blast injuries was transferred from a Baghdad hospital to a Dublin hospital in May 1985. He was heavily infected with two MGRSA strains, one of which spread and was responsible for numerous episodes of nosocomial infection. This strain was very similar to MGRSA isolates recovered in a Baghdad hospital during 1984. This imported strain has now spread to two hospitals in our group causing sepsis. This report emphasizes the difficulty of detecting an imported strain in an endemic area, but above all points to the potential for spread when there is considerable movement of patients and personnel.
Adult↗
Changes in tonsillar bacteriology of recurrent acute tonsillitis: 1980 vs. 1989.
Recurrent acute tonsillitis is a common problem. Despite this, there still remain many controversies regarding aetiology and correct management. The tonsillar microflora of 33 children with recurrent acute tonsillitis studied in 1980 and 58 patients studied in 1989 is presented. A comparison of the microbiology in the two periods studied a decade apart suggests that the pathogenic profile is changing. Haemophilus influenzae increased from 39 to 62% in the deep tonsillar tissue in the decade. There was a concomitant increase in incidence of Staphylococcus aureus from 6 to 40% of cases. In the same interval, mixed microflora increased from 18 to 52%. Anaerobic organisms were isolated in insignificant numbers. Unique to this study, 44% of H. influenzae isolates in 1989 were beta lactamase producers, increasing from only 2% in 1980. All of the S. aureus were beta lactamase producers. In the majority, the throat swabs grew only organisms commensal to the upper respiratory tract however, the deep tonsillar tissue excised at tonsillectomy carried significant growths of pathogenic organisms confirming the inadequacy of the superficial tonsillar swab as an indicator of treatment.
Acute Disease↗
Nebulized amphotericin B as prophylaxis against invasive aspergillosis in granulocytopenic patients.
The efficacy of inhaled amphotericin B in prevention of invasive aspergillosis in patients with granulocytopenia (granulocytes less than 0.5 X 10(9)/l for greater than 10 days) was investigated over a 12-month period. Amphotericin B prophylaxis was administered twice daily for the period of granulocytopenia to 34 patients who were at risk during 144 episodes of granulocytopenia. The cohort at risk was compared with historical controls. In the 2 years prior to institution of prophylaxis, 14 patients (11.4% of those at risk) developed invasive aspergillosis. All cases occurred whilst the patients were nursed on the open wards. Aspergillosis did not develop in 25 granulocytopenic patients nursed in single rooms with HEPA filtration. Since institution of prophylaxis, there have been no cases of invasive aspergillosis. These data suggest that nebulized amphotericin B may be useful in preventing invasive pulmonary aspergillosis in granulocytopenic patients, especially those nursed on the open wards, and warrants further investigation.
Agranulocytosis↗
Management of tonsillitis by the general practitioner.
Seventy-eight of 107 general practitioners completed a questionnaire to assess the management of recurrent acute tonsillitis by the primary care physician. Penicillin was the antibiotic of choice in acute tonsillitis, used by 74 (95%) respondents. Of these, 45% recommended ampicillin/amoxycillin. In the case of penicillin allergy, 67 (86%) chose erythromycin. For the treatment of tonsillitis unresponsive to initial therapy, a wide variety of agents were quoted; the most common being erythromycin (27 cases, 35%) and co-trimoxazole (16 cases, 20%). There were 17 separate indications for surgical referral given, the most common being recurrent tonsillitis (68 cases, 87%). Two or more reasons for surgical referral were stated by 55 (71%) GPs. These findings are discussed with particular reference to recent reports of penicillinase producing bacteria in association with recurrent acute tonsillitis.
Erythromycin↗
Superior mesenteric vein thrombosis caused by Yersinia pseudotuberculosis.
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Adult↗
Yersinia infections in surgical practice.
This article reviews the clinical manifestations of Yersinia bacteria emphasizing their recent rise in incidence and describing how Yersinia infection presents to the general surgeon. Geographical variations, patterns of disease, pathogenicity and the problems in diagnosis and management are discussed. This common but often unrecognized infection is usually self-limiting but the very young, the very old and the immunocompromised are at greater risk and prompt treatment is required to save lives.
Gastroenteritis↗
Study of appropriate antibiotic therapy in transurethral prostatectomy.
Septicaemia is the commonest cause of morbidity and mortality following transurethral prostatectomy. Routine blind antibiotic prophylaxis is not always effective and there is a tendency to over-use potent new and expensive antimicrobials. Attempts to "sterilise" the urine preoperatively are also expensive and disruptive. However, appropriate treatment/prophylaxis can be administered economically using rapidly obtained laboratory results. We describe here a technique of routine direct antibiotic sensitivity testing (DST) of the patient's urine pre-operatively and before catheter removal. Such testing can be performed by junior medical staff in a ward side-room. An appropriate antibiotic may then be administered parenterally 1 h before surgery or catheter removal. A total of 102 consecutive patients underwent TURP and only 1 of those with infected urine became septicaemic. In this instance, an appropriate antibiotic had been incorrectly given orally before removal of the catheter. If the antibiotic sensitivities of a patient's urine are known, and an appropriate antibiotic is given parenterally 1 h pre-operatively or before catheter removal, the incidence of septicaemia following transurethral surgery may be significantly reduced.
Anti-Bacterial Agents↗
Production of bacteriocin-like antagonism by clinical isolates of Yersinia enterocolitica.
Fourteen clinical isolates of Yersinia enterocolitica serotype O:3 and four well-documented virulent strains of serotypes O:3, O:8, and O:9 were biotyped and examined for plasmid-associated autoagglutination and calcium dependency and for epithelial cell adherence. These strains were tested for the production of bacteriocin-like antagonism by using tryptone soya blood agar at room temperature and at 37 degrees C. By using the cross-streaking method, three clinical isolates produced inhibitory substances at room temperature. These substances were active against a variety of clinical isolates and their plasmid-cured derivatives at both room temperature and 37 degrees C. The inhibition was easier to read after incubation of the cross-streaked plate at 37 degrees C. The inhibition patterns indicate that two of the three producer strains appear to recognize potentially virulent O:3 strains, with or without the virulence plasmid.
Antibiosis↗
Sources and outcome for methicillin-resistant Staphylococcus aureus bacteraemia.
Eighty-eight episodes of MRSA septicaemia occurring in 82 patients were studied prospectively. In 15 episodes bacteraemia was transient, in 36 non-fatal, in 33 fatal, while in four septicaemia was a major contributory factor in the patient's death. There were more patients aged over 60 years in the septicaemia groups compared to the transient bacteraemia group (P = 0.01), and patients with septicaemia were usually recently postoperative and/or suffering from severe underlying disease. Circulation access sites were the commonest source of the bacteraemic organisms with non-surgical wounds including burns, varicose ulcers and bed sores as the next most common. In four of the 16 burns patients, fatal septicaemia followed surgical debridement of infected burns. In only eight episodes was there no apparent source of bacteraemia.
Adolescent↗
Yersinia-induced uveitis in Ireland.
A prospective study was undertaken on 54 patients with an apparently idiopathic first attack of acute anterior uveitis. Blood samples were assayed for antibodies to Yersinia enterocolitica and Yersinia pseudotuberculosis, and tested for HLA type. Thirteen patients were found to have serological evidence of recent yersinia infection, eight with Y. enterocolitica and five with Y. pseudotuberculosis. The clinical course of uveitis did not differ from that typically found in HLA-B27 positive patients. Five patients were observed to develop non-ocular inflammation at a variable interval. The means by which eye inflammation follows yersinia infection is discussed in the light of recent theories on pathogenesis of HLA-B27 associated diseases.
Adult↗
Pulmonary infection due to methicillin-resistant Staphylococcus aureus.
Methicillin-resistant Staphylococcus aureus (MRSA) are now causing severe clinical infection on a worldwide basis. Pulmonary infection due to MRSA although widely reported is poorly documented. We report the predisposing factors, underlying diseases, treatment and outcome in 4 patients with pneumonia, 3 patients with empyema thoracis, 1 patient with pneumonia and empyema thoracis, 1 patient with pneumonia plus lobectomy wound infection and 2 patients with lung abscess. Vancomycin was highly effective in treatment, a finding compatible with experience treating other severe MRSA infections.
Adolescent↗
Association of reactive arthropathy and Morganella morganii cross reacting with Yersinia enterocolitica.
Two patients exhibited reactive arthropathy in association with chronic diarrhoea and abdominal pain. Rising titres of agglutinating antibody to Yersinia enterocolitica O3 were observed in association with arthropathy. Morganella morganii was isolated from faeces of one patient in heavy growth. In both patients, absorption of the sera with morganella antigen abolished yersinia reactivity. Morganella titres were more than 8 times the yersinia titres and were unaffected by absorption with Yersinia. Neither patient had detectable antibody to the predominant enterobacterial species present in faeces. One patient developed acute cystitis with Proteus mirabilis and had no serological response to the proteus isolate. We conclude that the elevated morganella titres were specific. The role of M. morganii in intestinal disorders remains to be established, but from our findings, it should be added to the list of organisms associated with reactive arthropathy.
Adult↗
Yersinia infection and acute abdominal pain.
In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320 control subjects (2%). Yersiniosis occurred in 31% of patients with acute appendicitis. Acute-phase serum samples only, obtained in a further 307 patients, yielded a falsely low frequency of yersiniosis (4%). Y pseudotuberculosis was five times more common than Y enterocolitica, and Y pseudotuberculosis type IV was the most common serotype, accounting for 43% of Yersinia infections. Yersinia may play a more important part in the aetiology of acute abdominal pain, and particularly acute appendicitis, than has been previously appreciated. Antibody titres to both Y enterocolitica and Y pseudotuberculosis frequently rise late in infections causing abdominal pain. Consequently analysis of acute-phase serum samples alone leads to underdiagnosis of yersiniosis.
Abdomen↗