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Biomedical subjects

R Kapila

Publications and source records attributed to R Kapila.

At least 37 records · Page 2Linked to original sources
PubMed1986

Cryptococcal infections in patients with acquired immune deficiency syndrome.

Cryptococcus neoformans is a major pathogen in patients with acquired immune deficiency syndrome and was found to infect 13.3 percent of such patients seen at two medical centers. Serum cryptococcal antigen levels were as high as 1:2,000,000 and, despite therapy, often remained elevated. Antigen titers in the cerebrospinal fluid generally declined at an expected rate in the survivors. The significance of high antigen titers in the blood after a prolonged course of therapy with amphotericin B and 5-flucytosine is unknown.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Bacteremia and fungemia in patients with acquired immune deficiency syndrome.

Patients with acquired immune deficiency syndrome (AIDS) are known to have identifiable host defense deficiencies, especially deficiencies in cell-mediated immunity. They are at increased risk for developing infections of the bloodstream caused by Cryptococcus neoformans and Salmonella species. However, bacteremias caused by other enteric gram-negative rods and Pseudomonas aeruginosa are found less frequently in patients with AIDS than in patients without AIDS (P less than 0.001 and P less than 0.01, respectively). The findings of specific organisms in blood is consistent with the known types of host defense deficiencies in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Yield of bone marrow culture in the diagnosis of infectious diseases in patients with acquired immunodeficiency syndrome.

The yield in cultures of bone marrow aspirations or biopsies was determined in 50 patients with acquired immunodeficiency syndrome. Most patients were febrile and had no identifiable source of infection. Concurrent stool, urine, and blood samples were also cultured. The bone marrow aspiration and biopsy procedures produced no complications and enabled a microbiological diagnosis to be made in 42% of the cases. Granuloma formation was not seen in any of the infected bone marrow specimens despite the fact that mycobacteria were seen in abundance in some. Bone marrow culture is a valuable low-morbidity invasive procedure in the evaluation of febrile patients with acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex.

Central nervous system tuberculosis occurred in three patients with the acquired immunodeficiency syndrome (AIDS) and seven patients with AIDS-related complex who were evaluated for 48 months. Nine patients were intravenous drug abusers and one was Haitian. Five patients had cerebral-ring-enhancing lesions and three had hypodense areas. The clinical spectrum included meningitis in two patients, multiple cerebral abscesses in one, and tuberculomas in four. All Mycobacterium tuberculosis isolates were sensitive to standard antituberculous drugs. All patients received treatment with isoniazid, rifampin, and pyrazinamide; six patients also received streptomycin. Three patients with AIDS died of opportunistic infection preceded by central nervous system tuberculosis. Among the patients with the AIDS-related complex, three improved with treatment, three were lost to follow-up, and one died. Tuberculosis should be considered in the differential diagnosis of central nervous system mass lesions in intravenous drug abusers with AIDS or AIDS-related complex. Because patients with tuberculosis can be cured, biopsy of accessible brain mass lesions should be mandatory. Preventive therapy may be indicated in drug abusers without disease.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Neuropathologic observations in acquired immunodeficiency syndrome (AIDS).

Neuropathologic changes are described in eight fatal cases of the acquired immunodeficiency syndrome (AIDS), including four subjects who were i.v. drug abusers (two women, two men), two Haitian men, one bisexual man, and one women who had no known risk factors for AIDS. All cases had significant infections of the brain, with examples of bacterial, fungal, protozoal, and viral disease in the group. Combined infections were observed in three cases, including one case of previously unreported central nervous system (CNS) abscess due to Nocardia (combined with Salmonella). The most frequent CNS pathogen was Toxoplasma gondii, which in both Haitian subjects co-existed with systemic tuberculosis, leading to diagnostic difficulty. Only one case of "subacute encephalitis" was represented, although in other cases microglial nodules were associated with Toxoplasma and Cryptococcus organisms, as well as probable cytomegalovirus. Non-infectious complications included a cerebral infarct (one case), central pontine myelinolysis (one case), and diffuse microcystic change of the white matter (one case).

Acquired Immunodeficiency Syndrome↗
PubMed1985

Actinomycetales infection in the acquired immunodeficiency syndrome.

Four parenteral drug abusers with the acquired immunodeficiency syndrome had nonmycobacterial actinomycetales infections. Three patients had nocardiosis and one developed a streptomyces lymphadenitis. There was pericardial involvement in two patients, and two patients died. Presumptive diagnoses were often incorrect, highlighting the risks of empiric therapy in these patients. Four of the nine patients with the acquired immunodeficiency syndrome and nocardia or streptomyces infections whose cases were reported to the Centers for Disease Control also had mycobacterial disease. A common susceptibility to these agents may exist in these immunosuppressed patients.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Anterior thigh pain or tenderness. A diagnostically useful manifestation of bacteremia.

In four patients with putative infectious process, anterior, bilateral proximal thigh pain and tenderness unaccompanied by generalized myalgias developed. This unusual manifestation, observed in these and other patients, was associated with demonstrable bacteremia. Aside from tenderness, no local abnormalities were found and the pain and tenderness disappeared after appropriate therapy. Creatine kinase levels, measured in three of the four patients, were elevated in only one. This manifestation is useful clinically as it strongly suggests bacteremia; attention to this finding can be lifesaving.

Abdomen↗
PubMed1982

Superinfection: another look.

Superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections. Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.

Adult↗
PubMed1982

Fatal Streptococcus MG-intermedius (Streptococcus milleri) meningitis in an adult.

A case of purulent meningitis in an adult caused by Streptococcus MG-intermedius, also known as Streptococcus milleri, is described. The intriguing taxonomical history of this organism and its association with mycoplasma pneumoniae pulmonary infections is reviewed. The incidence of central nervous system infections due to this organism is also discussed.

Cross Reactions↗
PubMed1980

Prospective evaluation of combinations of antimicrobial agents for endometritis after cesarean section.

Two hundred and thirty-six women were studied for the development of endometritis following cesarean section. Cultures were taken of the amniotic fluid and endocervix through the internal os during the operative procedure. Of the 236 patients, clinical evidence of endometritis developed in 105. Positive cultures of the amniotic fluid or the endocervix, or both, were not helpful in predicting significant clinical infection. The patients with endometritis were treated with a combination of either clindamycin and gentamicin or cefazolin and gentamicin. All of the 54 patients, receiving clindamycin and gentamicin improved, but eight of the 51 patients in the cefazolin group failed to respond but, subsequently, improved after the administration of clindamycin. No serious toxicity was observed in either group.

Amniotic Fluid↗
PubMed1979

Pseudomonas putrefaciens as a cause of septicemia in humans.

Septicemia due to Pseudomonas putrefaciens was found in an elderly man with chronic leg ulcers. This organism is rarely cultured from human material and has been reported to cause skin and ear infections in only a few patients. Its potential for invasiveness is documented in this case for the fourth time.

Humans↗
PubMed1978

Infective endocarditis in heroin addicts: epidemiological observations and some unusual cases.

The total number of cases of heroin-induced endocarditis occurring over a four-year period were reviewed in order to explain an increase in the number of cases in the last year studied (1975). Brown heroin was noted to be used more frequently by addicts during the period of increased incidence. Cultures of "street samples" of brown and white heroin as well as cocaine were obtained in order to elucidate a possible relationship between the increased use of brown heroin and the increased number of endocarditis cases. Despite frequent contamination of both white and brown heroin, none of the common endocarditis-causing pathogens were isolated from the samples. Staphylococcus aureus, the most common etiological agent, frequently resulted in tricuspid endocarditis. That the accepted criteria for tricuspid endocarditis may be present without actual cardiac valve involvement is demonstrated by a most unusual case of hepatic vasculature infection.

Adolescent↗
PubMed1977

Evaluation of clindamycin and other antibiotics in the treatment of anaerobic bacterial infections of the lung.

Fifty patients who had pneumonia, lung abscess, or empyema, and whose specimens had a fetid odor, were presumed to be suffering from anerobic lung infection and were treated with clindamycin either orally (33 patients) or parenterally (17). Forty-six patients showed marked improvement or recovered; two also underwent lung resection, and thoracotomy was performed in 10. There were three outright treatment failures, and superinfection occurred in one patient. A review of the literature suggests that clindamycin and penicillin (in substantial dosage) are equally effective in treatment of anaerobic lung infection. Transtracheal aspiration is not deemed necessary if the patient is expectorating fetid sputum.

Adolescent↗
PubMed1977

A nosocomial outbreak of influenza A.

During the first week of March 1974, a hospitalized patient being evaluated for hyperproteinemia and hypertension experienced fever, chills, and myalgia and showed pulmonary signs consistent with diffuse pneumonia. Subsequently, the findings from serologic tests confirmed that the patient had viral influenza. Seven other compromised hosts on the same ward developed symptoms of pneumonic influenza, and serologic data on three of the seven confirmed influenza A2. Additionally, a previously healthy young adult admitted with acute respiratory distress died of nonbacterial complications and was shown to have community-acquired influenza. The unusual features of the epidemic were the intrahospital localization of the epidemic in compromised hosts, the high rate of pneumonic complications, the low rate of secondary bacterial infection, and the severity of the viral pneumonia in the community-acquired case.

Adult↗
PubMed1977

Death-producing hemoptysis in tuberculosis.

Massive hemoptysis in patients with tuberculosis is reported infrequently and then virtually always in association with cavitary disease or aspergilloma. In contrast, we describe herein five cases characterized by hemoptysis on admission, bilateral pulmonary disease, samples of sputum positive for acid-fast bacilli by Ziehl-Neelsen stain, and no obvious cavitary disease. In each, hemoptysis subsided and then suddenly recurred in prodigious amounts, leading to death, probably from asyphyxiation. In patients hospitalized with tuberculous hemoptysis of any amount, with or without an obvious cavity, aggressive diagnostic evaluation, including bronchoscopic examination, may define the site of bleeding, thus permitting rapid surgical intervention if the hemoptysis increases.

Adult↗
PubMed1976

Study on the usefulness of hypertonic culture media.

Specimens from 300 patients were studied using five to nine aerobic and anaerobic culture media, including five that were hypertonic, Groups studied included fever of unknown origin, suspected endocarditis, endocarditis during therapy, bacteremia during therapy, abscess and cellulitis, presumed infectious arthritis, renal transplantation during rejection, collagen disease, sarcoidosis, lymphoma, and colitis. Isolates in hypertonic media were reverted to parent form by agar passage. In only 5% of these selected cases were organisms found in hypertonic, but not conventional, media that appeared on the basis of repeated isolation and/or serological studies to come from the patient. Nine of the 16 appeared to be of major significance. The two groups in which use of highly enriched, hypertonic media seemed most helpful were suspected endocarditis and undefined meningitis with negative cultures using standard media. The most effective of the hypertonic media used was 0.3 M sucrose in brain heart infusion with 20% horse serum. In most instances, the organism grew only in the hypertonic sucrose, and in most cases it appeared in conventional rather than aberrant form. Hypertonic media, especially 0.3 M sucrose, are of substantial helpin a small number of carefully selected cases.

Adolescent↗