Search PubMed⌕ Search

Biomedical subjects

S J Antony

Publications and source records attributed to S J Antony.

At least 19 recordsLinked to original sources
PubMed2001

Vancomycin-resistant Enterococcus faecium osteomyelitis: successful treatment with quinupristin-dalfopristin.

Vancomycin-resistant enterococci (VRE) have recently emerged as an increasing concern in the management of severe infections. Treatment of these life-threatening infections has been limited to quinupristin-dalfopristin and, more recently, linezolid therapy. We report the first case, to our knowledge, of vancomycin-resistant Enterococcus faecium vertebral osteomyelitis treated successfully with quinupristin-dalfopristin. We review the recent epidemiology of VRE and briefly outline the pharmacology and pharmacokinetics of quinupristin-dalfopristin.

Aged↗
PubMed2001

Clinical experience with linezolid in the treatment of resistant gram-positive infections.

This study presents our clinical experience with linezolid in 19 patients with serious resistant gram-positive infections enrolled as part of the compassionate study. In this prospective, non-randomized, noncomparative study, 19 patients were enrolled as part of the National Compassionate Study Protocol conducted by Pharmacia-Upjohn. At the time of this writing, these patients had not been published in the literature. All of the patients had to have documented evidence of serious gram-positive infections in normally sterile sites and should have been unable to tolerate available antimicrobial therapy or be unresponsive to available drugs. Clinical characteristics, laboratory values, and pharmacokinetic and pharmacodynamic parameters were obtained. Patients were followed both short-term and long-term after completion of therapy. Nineteen patients were enrolled: 13 females and 6 males. The average age was 63 years. The average length of therapy with linezolid was 22 days. Methicillin-resistant Staphylococcus aureus (MRSA) was treated in eight patients, methicillin-resistant Staphylococcus epidermidis (MRSE) in two patients, vancomycin-resistant Enterococcus faecium (VREF) in eight patients, and coagulase-negative Staphylococcus in two patients. Co-infecting organisms include Enterococcus species colonization in six patients, Pseudomonas species in one patient, Serratia marcenens in one patient, and Candida albicans in one patient. Sterile sites that were infected included bone and joint (wounds and septic joints) in six patients, gastrointestinal system (hepatobiliary, liver abscess, Crohn's) in five patients, genitourinary (kidney and urine) in two patients, blood in five patients, respiratory in one patient, and aortic valve in 1 patient. Linezolid was given at 600 mg IV every 12 hours with a mean length of therapy of 22 days. Surgical drainage was used in combination with linezolid in 11 of the patients. Seventy nine percent of these patients achieved clinical and microbiologic cure, and none of the deaths reported in this series were related to the drug. Adverse events included skin rash in one patient, mild bone marrow suppression in two patients, and mild elevation in liver function tests in two patients. No life-threatening adverse events were noted. It appears that linezolid, along with surgical intervention (when necessary), appears to be an effective treatment option for resistant gram-positive infections. Long-term studies evaluating the possible resistance rates are necessary.

Acetamides↗
PubMed2000

Evolution of force distribution in three-dimensional granular media.

Based on the discrete element method, the nature of normal contact force distribution and the effect of microstructure (contact fabric) on stresses in granular media sheared under constant mean stress condition is analyzed. The particles are tested in a periodic cell, having a nearly monodispersed system of spherical particles ("hard" and "soft"). The granular systems were initially isotropically compressed to have different solid fractions in order to obtain "dense" and "loose" samples. To study the nature of the force distribution, the granular medium was considered as both (i) noncohesive and (ii) with low values of interface energy. For the granular systems considered here, the nature of force distribution is shown to be dependent on shear history. The amount of interface energy introduced in the granular system does not seem to change the nature of normal force distribution significantly. However, it improves the postpeak stability in agreement with previous research [C. Thornton, Geotechnique 50, 43 (2000)]. The simulation of systems subjected to quasistatic shearing, in general, reveals that in a hard system (both dense and loose), the normal contact force distribution (i) at "peak" shear strength is purely an exponential decay throughout the entire range of force scale that is used, and (ii) at "isotropic" and "steady" states, the contact normal force distribution is bimodal with forces greater than average decaying exponentially at both the states, while the forces less than average tend to be half-Gaussian at the "isotropic" state and a second-order polynomial function at the "steady" state. For the soft (dense) system, the normal contact force distribution at "peak" shear strength is bimodal with forces greater than average decaying exponentially while the forces less than average tend to be a second-order polynomial function. However, for the soft system at both "isotropic" and "steady" states, the contact normal force distribution is half-Gaussian throughout the entire range of force scale that is used. It has been pointed out that in a granular system undergoing slow shearing, the shear strength of the system seems to depend on the ability of the material to form strong fabric anisotropy of contacts carrying strong (greater than average) force.

Journal Article↗
PubMed2000

Lactobacillemia: an emerging cause of infection in both the immunocompromised and the immunocompetent host.

The bacterium, lactobacillus, is found in the mucosal surfaces of the mouth and the gastrointestinal and genitourinary tracts. There have been increasing reports of the micro-organism being a cause of serious infection in immunocompromised individuals. This article reviews the clinical presentation, laboratory characteristics and treatment of patients with lactobacillemia.

Anti-Bacterial Agents↗
PubMed1999

Actinomyces and nocardia infections in immunocompromised and nonimmunocompromised patients.

A retrospective survey of nocardia and actinomyces infections in five local hospitals was conducted over a 3-year period in El Paso, Texas, a border city, in the southwestern United States. The medical records of 42 patients with suspected nocardiosis or actinomycosis were reviewed. One patient was diagnosed with actinomyces and 12 patients with nocardia. Microbiological data included morphologic characteristics, biochemical profile, and susceptibility testing. Predisposing factors included leukemia, renal insufficiency, renal transplant, and lymphoma. No predisposing factors were found in 67% (n = 8) of patients (including the patient with actinomycosis). Twenty-three percent (n = 3) of patients had disseminated disease without evidence of underlying disease or immunosuppression. The mortality and morbidity of these infections appeared to be low.

Actinomycosis↗
PubMed1998

Multidrug-resistant enterococci: the dawn of a new era in resistant pathogens.

Resistant enterococci, especially vancomycin-resistant enterococci, have rapidly become an important nosocomial pathogen. They are increasingly prevalent among hospitalized patients, patients with serious chronic illnesses, and immunosuppressed patients. Risk factors identified include previous antibiotics, exposure to contaminated equipment, and close proximity to infected patients. Treatment of multidrug-resistant pathogens has become increasingly difficult, with increased morbidity and mortality in these patients. Strict infection control measures remain the mainstay in the management of these infections.

Anti-Bacterial Agents↗
PubMed1997

Isoniazid hepatotoxicity in renal transplant recipients.

Tuberculosis occurs at higher rates in renal transplant recipients than in the general population. It would be desirable to use isoniazid prophylaxis in renal transplant recipients at risk for reactivation of tuberculosis; yet many transplant centers do not routinely employ INH prophylaxis because they perceive transplant recipients to be an enhanced risk of hepatotoxicity from isoniazid. Data on the risk of isoniazid in renal transplant patients receiving cyclosporine-based immunosuppression are limited. We retrospectively studied 83 renal transplant recipients (mean age 39.1 +/- 11.7 yr) who had received INH prophylaxis between 1985 and 1994. Eight patients had laboratory evidence of chronic hepatitis B or chronic hepatitis C infection. The mean duration of INH therapy was 344 +/- 163 d. The mean serum glutamate oxalacetic transferase (SGOT) at the start of INH therapy was 24.1 +/- 10.9 I.U., and 10% of patients had mildly elevated SGOTs. Mean peak SGOT during therapy was 36.4 +/- 15.3 I.U. (p < 0.001 compared to start (SGOT). In follow up, 31% of patients had an abnormal SGOT (> 40 I.U.); however, the elevations were small (the highest SGOT was 88.I.U.) and never necessitated discontinuation of INH. No patient had jaundice or other evidence of clinical hepatotoxicity. The 95% confidence interval for the observed frequency of clinical hepatitis was 0% to 4.3%. At the end of INH therapy the mean SGOT was 22.7 +/- 6.2 I.U. (p > 0.2, compared with start SGOT) and only one patient had an abnormal SGOT. In conclusion, it appears that the risk of renal transplant recipients developing serious hepatotoxicity with the administration of INH is low and not different from normal individuals.

Adult↗
PubMed1997

Q fever pneumonia.

Pneumonia is one of the principal manifestations of Q fever, a disease caused by Coxiella burnetii. This bacterium can replicate only within cells, yet it is capable of surviving in the environment because it can withstand drying and substantial temperature variations. Livestock, especially sheep, goats and cattle, are a major reservoir of C burnetii. The organism is transmitted to humans by direct contact with animal products, especially during parturition. Aerosols have transmitted infection over considerable distances. The illness is characterized by an influenza-like syndrome with patchy pulmonary infiltrates. The pneumonia may be accompanied by biochemical evidence of mild hepatitis. The diagnosis is established serologically. Tetracycline or doxycycline provide effective therapy.

Animals↗
PubMed1997

Multidrug-resistant Pneumococcus causing vertebral osteomyelitis.

Primary vertebral osteomyelitis in a rare presentation of pneumococcal infection especially in an asymptomatic patient with no primary focus of infection. This report describes a patient who presented with lower back pain in which the magnetic resonance imaging showed little evidence of L1 and L2 vertebral body destruction. Cultures from these vertebral bodies grew penicillin and third-generation resistant pneumococcus. The patient was treated successfully with 6 weeks of vancomycin and rifampin.

Anti-Bacterial Agents↗
PubMed1997

Use of fluconazole in the treatment of non-AIDS cryptococcal meningitis.

The treatment of non-acquired immunodeficiency syndrome (AIDS) cryptococcal meningitis has not been well defined as yet. The current recommendation is amphotericin B with or without flucytosine. However, due to the many side effects of these drugs, fluconazole is becoming an attractive alternative in patients who cannot tolerate amphotericin B and flucytosine. This case study demonstrates the successful use of fluconazole in a patient with underlying diabetes mellitus and cryptococcal meningitis.

Aged↗
PubMed1996

Lactobacillus bacteremia: description of the clinical course in adult patients without endocarditis.

Lactobacillus bacteremia in the absence of endocarditis is a rare entity, and the clinical relevance of such bacteremia remains unclear. The clinical courses of lactobacillus bacteremia without endocarditis in 43 previously described patients and 12 new patients were reviewed. Bacteremia with Lactobacillus alone occurred in 34 (62%) of the patients, and 12 (22%) of the patients had bacteremia with other organisms, including Lactobacillus. Lactobacillus was isolated from another site in 18 (33%) of these patients. Intravenous catheter infections were not noted in these patients. Underlying conditions included cancer (6 patients), organ transplantation (9), diabetes mellitus (4), and recent surgery (12). Fever occurred in all patients, and eight (15%) of the patients experienced a sepsis syndrome. The mortality rate was 14%; however, only three deaths were attributed soley to lactobacillus sepsis. Lactobacillus bacteremia is an uncommon condition that usually occurs in patients with severe underlying illnesses and is frequently seen as a part of a polymicrobial infection. Blood cultures positive for Lactobacillus represent true infection and not contamination. Although resistance to commonly used antibiotics is common, the mortality rate associated with this bacteremia appears to be low.

Adult↗
PubMed1996

Nontropical pyomyositis in patients with AIDS.

Nontropical pyomyositis in persons with acquired immunodeficiency syndrome (AIDS) is an unusual entity with only a few cases having been described in the United States. Staphylococcus aureus is the most common organism implicated. The infection usually presents in a subacute indolent fashion with minimal inflammation. Fever and leukocytosis may be absent, and blood cultures are frequently negative. The diagnosis usually can be established by a combination of clinical features, computed tomography or ultrasound, and prompt examination of material obtained by aspiration or debridement. This article describes two cases of S aureus pyomyositis in patients with AIDS and reviews the literature relevant to this infection.

AIDS-Related Opportunistic Infections↗
PubMed1995

Leg cramps: differential diagnosis and management.

Leg cramps are a common problem, especially in the elderly. The differential diagnosis is extensive and includes the following conditions: true cramps, such as those related to heat, hemodialysis and electrolyte disturbances, as well as idiopathic cramps (the most common type); contractures occurring in conditions such as metabolic myopathies and thyroid disease; tetany, which is usually related to electrolyte disturbances, and dystonias, such as occupational cramps and those related to antipsychotic medications. Other leg problems that are not cramps, such as restless legs syndrome and periodic leg movements, also must be distinguished. The etiology of idiopathic leg cramps is not clear. Treatments for leg cramps include stretching exercises, quinine sulfate and vitamin E, but no treatment is conclusively effective. Nonetheless, in many patients relief of symptoms is achieved with one or more of these treatments.

Diagnosis, Differential↗