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Biomedical subjects

R Longfield

Publications and source records attributed to R Longfield.

6 recordsLinked to original sources
PubMed1985

Cryptococcosis in the acquired immunodeficiency syndrome.

The clinical course and response to therapy of 27 patients with cryptococcosis and the acquired immunodeficiency syndrome were reviewed. Cryptococcosis was the initial manifestation of the syndrome in 7 patients, and the initial opportunistic infection in an additional 7. Meningitis was the commonest clinical feature (18 patients). Blood cultures and serum cryptococcal antigen were frequently positive. In patients with meningitis, leukocyte count, protein level, and glucose level in cerebrospinal fluid were frequently normal; cerebrospinal fluid India ink test (82%), culture (100%), and cryptococcal antigen (100%) were usually positive. Only 10 of 24 patients had no evidence of clinical activity of cryptococcal infection after completion of therapy; 6 of these 10 had relapses shown by clinical findings or at autopsy. Standard courses of amphotericin B alone or combined with flucytosine were ineffective. Cryptococcosis in patients with the syndrome is a debilitating disease that does not respond to conventional therapy; earlier diagnosis or long-term suppressive therapy may improve the prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Avoidance of false-negative blood culture results by rapid detection of pneumococcal antigen.

False-negative blood culture results may occur in children with pneumococcal bacteremia due to bacterial autolysis. We describe four patients with pneumococcal bacteremia whose aerobic blood cultures showed partial or complete autolysis of the pneumococci. Pneumococcal antigen, however, was rapidly detected in media from the blood culture bottles, using an agglutination assay. Processing of the media before analysis was necessary to prevent nonspecific agglutination and to allow the detection of a specific reaction. It is important that physicians and laboratory personnel be aware that pneumococci may rapidly autolyze during incubation, yielding false-negative culture results. Antigen detection methods may provide rapid and specific identification of the etiologic agent.

Agglutination Tests↗
PubMed1984

Multidose medication vial sterility: an in-use study and a review of the literature.

Contaminated multiple-dose medication vials (MDV) have been implicated in transmission of bacterial infections. It has been suggested that MDV be discarded after 24 hours or even after a single use. At our hospital, we cultured 1,223 weekly samples from 863 MDV in-use over a three-month period. Medications included xylocaine, insulin, heparin, immunizations, and miscellaneous agents. None of the samples was culture-positive. The duration of use was 9.5d (median), 18d (mean), and 1-402d (range) with 13% of vials in-use for more than 30 days. The mean duration of use was significantly shorter for medicine wards, emergency room, and outpatient clinics than for surgery and ob-gyn wards (p less than 0.05). Heparin and insulin MDV were in-use for significantly less time than xylocaine and miscellaneous agents (p less than 0.05), and insulin MDV were more regularly dated (p = 0.001). The percentage of undated MDV declined significantly by month during the study (p = 0.003). These results lend support to our current guideline that MDV should be dated upon opening and that, unless visible or suspected contamination occurs, vials are discarded either when empty or at the manufacturer's expiration date.

Antisepsis↗
PubMed1982

Pneumococcal sepsis with false-negative blood cultures.

Most physicians recognize the false-positive blood cultures (generally due to contamination) are common. Bacteria such as pneumococci, however, may rapidly die in broth cultures, and viable bacteria may not be identified. Several patients were observed with pneumococcal infections that had false-negative blood cultures 24 hours after inoculation. Hemolysis and methemoglobin formation in the bottle suggested bacterial growth within 12 hours after incubation, and blind subcultures at that time yielded pneumococci. Pneumococcal antigen could be detected in the blood culture bottles using counter-immunoelectrophoresis, even though subculture at 24 hours yielded no growth. Physicians and laboratory personnel should be aware that false-negative blood cultures may occur, particularly with certain bacteria such as Streptococcus pneumoniae, and that the blood culture bottles should be observed visually for the presence of brown sediment or hemolysis.

Adult↗
PubMed1979

Acute colitis and bacteremia due to Campylobacter fetus.

An acute febrile illness with dysentery and colitis developed in a 26-year-old man following a wilderness outing. Campylobacter fetus ssp. jejuni was subsequently grown on blood cultures drawn during the acute illness and 9 days later when the patient was asymptomatic. Proctosigmoidoscopic and histopathologic evidence of acute colitis was present on admission and resolved on follow-up examination. Campylobacter fetus spp. jejuni infection should be considered in the etiology of acute infectious colitis.

Adult↗