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Biomedical subjects

T J Marrie

Publications and source records attributed to T J Marrie.

At least 91 records · Page 5Linked to original sources
PubMed1994

Measuring the functional impact of fatigue: initial validation of the fatigue impact scale.

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients' perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning. This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group's reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared. This initial validation study indicates that the FIS has considerable merit as a measure of patient's attribution of functional limitations to symptoms of fatigue.

Adult↗
PubMed1994

The value of open lung biopsy in immunocompetent patients with community-acquired pneumonia requiring hospitalization.

OBJECTIVE: To determine the role of open lung biopsy in immunocompetent patients with community-acquired pneumonia who require hospitalization. DESIGN: A group of 1,118 patients with severe community-acquired pneumonia that required hospitalization were enrolled in the study. Of the patients, 26 underwent open lung biopsy. Another 18 of these patients were immunocompromised and were excluded from this segment of the study. SETTING: Tertiary care 800-bed hospital from November 1981 to May 1989. RESULTS: Progressive diffuse pulmonary infiltrates and negative conventional cultures were the indications for biopsy in most of these patients. Eighteen (69 percent) were immunocompromised. The eight immunocompetent patients underwent a retrospective review of their course in hospital. Three patients died. The diagnostic yield from open lung biopsy was 25 percent. A specific histologic diagnosis was made in one patient--lipoid pneumonia. The pulmonary histologic finding were nonspecific in the remaining patients, but in four, in combination with the clinical data, gave useful information and resulted in therapy change. Culture of a pulmonary tissue yielded cytomegalovirus in one other patient. Serologic testing had a low yield in this group with three patients having a positive result. CONCLUSIONS: Open lung biopsy is rarely necessary in immunocompetent patients with community-acquired pneumonia. In a small group of patients where it is necessary, however, both positive and negative results are important in directing therapy.

Adult↗
PubMed1994

Pneumonia caused by Nocardia species.

There are nine species of Nocardia. Nocardia asteroides accounts for 80% of infections caused by this organism in man. N brasiliensis causes 3% to 9% of these infections, and N farcinica is being recognized with increasing frequency. We present three cases of Nocardia pneumonia two of which were caused by N asteroides and one was caused by N farcinica. These cases illustrate the diverse nature of nocardiosis and show that sometimes it is difficult to determine whether the Nocardia was community- or nosocomially-acquired.

Aged↗
PubMed1993

Mycoplasma pneumoniae pneumonia requiring hospitalization, with emphasis on infection in the elderly.

PURPOSE: To determine the frequency and the clinical characteristics of Mycoplasma pneumoniae pneumonia in the elderly. METHODS: Analysis of cases of M pneumoniae pneumonia accumulated as part of a prospective study of community-acquired pneumonia. RESULTS: Sixty-four (4.9%) of 1300 patients had pneumonia due to M pneumoniae. Six (9.3%) of the 64 were 65 years of age or older. None of the elderly patients had a discharge diagnosis of M pneumoniae compared with 21 of those 64 years of age or younger (36%). Sixty-four percent of the patients with M pneumoniae received erythromycin therapy compared with 45% of 1118 of the patients with community-acquired pneumonia. The clinical features of the six elderly patients with M pneumoniae did not allow distinction from other causes of pneumonia. One patient presented with normal pressure pulmonary edema due to infection with both M pneumoniae and respiratory syncytial virus; a second patient had his Salmonella carrier state converted to bacteremia during his episode of M pneumoniae. Three presented as nonspecific pneumonia in the elderly, while one patient had a slowly resolving infection due to a narrowed bronchus. The 58 patients who were 64 years of age or younger demonstrated four previously unrecognized or underemphasized features of M pneumoniae infection--prolonged thrombocytopenia, one patient; recurrent pulmonary hemorrhage, one patient; thrombocytosis, 45% of the patients; and prolonged hospital stay, eight (13.7%) of the 58 patients. Only one patient died (1.5%) and this was a result of Shy-Drager syndrome. CONCLUSIONS: Mycoplasma pneumoniae accounts for 4.9% of community-acquired pneumonia requiring hospitalization, and 9% of these patients were 65 years of age or older. There are no clinical features that distinguish this form of pneumonia from that due to other agents. The mortality rate from this infection is low even in the elderly.

Adult↗
PubMed1993

Thrombotic microangiopathy associated with Streptococcus pneumoniae bacteremia: case report and review.

Thrombotic microangiopathy, a disease within the clinical spectrum of thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome, was recognized in a previously healthy 50-year-old woman who presented with pneumococcal bacteremia complicated by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and disorientation. After treatment with plasma exchange and antibiotics, the patient's clinical condition improved. Discontinuation of plasma exchange resulted in a relapse of thrombocytopenia and microangiopathic hemolytic anemia that responded to reinitiation of this intervention. The production of the enzyme neuraminidase by Streptococcus pneumoniae is thought to contribute to the pathogenesis of the thrombotic process. Although pneumococcal infection has been associated with hemolytic-uremic syndrome in children, review of the literature on adults revealed only one such case (in a patient who had undergone splenectomy in the remote past). This report therefore documents an unusual complication of pneumococcal bacteremia in an immunocompetent adult.

Anemia, Hemolytic↗
PubMed1993

Seroepidemiology of Coxiella burnetii among wildlife in Nova Scotia.

We used an indirect immunofluorescence assay to determine antibody titers to phase I and phase II Coxiella burnetii antigens in serum samples from a variety of wild animals in Nova Scotia. Forty-nine percent of the hares, 16.5% of the moose, 7.1% of the raccoons, and 1.5% of the white-tailed deer tested had antibodies to phase I antigen. We conclude that there is extensive infection of the hare population by C. burnetii, with lesser degrees of infection of the moose, raccoon, and deer population.

Animals↗
PubMed1993

Gallium-67-citrate and bone scintigraphy in disseminated North American blastomycosis.

We present a patient with North American blastomycosis involving lung and bone. Chest radiographs and CT scan showed a mass in the lung. Bone scintigraphy detected a photon-deficient area in the sternum and 67Ga SPECT showed uptake in the right upper lung and in the sternum. A diagnostic thoracotomy and needle biopsy from the sternal lesion revealed granulomatous infection due to Blastomyces dermatitidis. After 3 mo of antifungal therapy, the follow-up 67Ga study showed no evidence of the original lesions but demonstrated a new, asymptomatic, unsuspected lesion in the left infraspinatous muscle. This case illustrates that North American blastomycosis should be included in the differential diagnosis in cases of atypical pulmonary disease with bone involvement, even in geographic regions that are not considered endemic for this microorganism. Gallium-67 and bone scintigraphy may be useful in determining the extent of dissemination, in detecting occult lesions and in the follow-up of response to therapy.

Adult↗
PubMed1993

Bacteremic community-acquired pneumonia due to viridans group streptococci.

We studied 1118 patients with community-acquired pneumonia who were admitted to our hospital over an 8-y period. Seventy-six of the 1118 patients were bacteremic and 7 (9.2%) of these had blood cultures positive for various viridans streptococci. Four had polymicrobial bacteremia (S. mitis, S. sanguis 1, S. sanguis II; S. mitis, S. sanguis II; S. MG; S. sanguis II, Neisseria sp; S. intermedius, S. aureus). For 3 of the 7, viridans streptococci were the only agents implicated in the etiology of the pneumonia. These patients were classified as definite viridans streptococcal pneumonia; the remaining 2 were probably and 2 were possibly due to these micro-organisms. The 5 males and 2 females had a mean age of 61.8 y. The mortality rate was 28%. All were febrile and had elevated white blood cell counts. The 5 who had arterial blood gas measurements performed were hypoxemic pO2 34-68 torr. The chest radiographs were not distinctive--a segmental alveolar opacity was the most common abnormality. We conclude that viridans streptococci rarely cause bacteremic community-acquired pneumonia. There are no distinctive clinical or radiographic features of this type of pneumonia.

Adult↗
PubMed1992

Reactivation of Q fever following cardiac surgery.

To determine whether reactivation of Q fever occurs following cardiac surgery 43 patients who had antibodies to Coxiella burnetii were identified pre-operatively. Serum samples were collected 1, 4 to 6, and 24 weeks post-operatively. One patient had active Q fever endocarditis. Seven of the remaining 42 (17%) had a > or = fourfold rise in titres for antibodies to Coxiella burnetii post-operatively. Only two of these seven had an increase in antibody titres for other agents suggesting that the fourfold titre rise for Coxiella burnetii was not part of a polyclonal response. It is concluded that self-limited reactivation of infection may occur among Coxiella burnetii seropositive patients undergoing open heart surgery.

Aged↗
PubMed1992

Colonisation of the respiratory tract with Legionella pneumophila for 63 days before the onset of pneumonia.

We report the case of a 70-year-old man who was admitted to hospital A 66 days before developing Legionella pneumophila pneumonia 6 days after open heart surgery at hospital C. The strain of L. pneumophila recovered from the patient's sputum was of the same subtype (monoclonal antibody type, enzyme type, plasmid profile, and restriction endonuclease pattern) as a strain of L. pneumophila in the potable water supplied to the room where he stayed in hospital A. We conclude that the patient's respiratory tract became colonised by L. pneumophila while he was in hospital A and persisted for at least 63 days until he developed pneumonia requiring antibiotic treatment while in hospital C.

Aged↗
PubMed1992

Bacteraemic pneumococcal pneumonia: a continuously evolving disease.

During an 8 year prospective study of community-acquired pneumonia (CAP) requiring hospitalisation we found that 47 of 1118 (4.2%) patients had Streptococcus pneumoniae bacteraemia. Females outnumbered males 27:20. The mean age was 63.4 years and 25% of our patients were admitted from a nursing home. A comparison with the 1071 other patients with CAP showed that patients with bacteraemic pneumococcal pneumonia (BPP) were more likely to be female and to have alcoholism, diabetes mellitus, and chronic obstructive pulmonary disease as co-morbidities. The mortality rate of 19% in BPP was not significantly lower than the 22% rate for the remaining patients with CAP. Four of the nine (44%) patients with BPP who died, did so within 24 h of admission, compared with 29 of 236 (12.3%) (P less than 0.02) who died of CAP. A notable clinical feature was the absence of cough in 19% while overall in only 66% was the cough productive. Most of the patients had a non-specific clinical presentation. Fifty-three per cent had an uncomplicated stay in hospital. We conclude that bacteraemic pneumococcal pneumonia is a continuously evolving disease and for the first time may now be more common in women.

Bacteremia↗
PubMed1992

Each water outlet is a unique ecological niche for Legionella pneumophila.

We determined the natural history of the colonization of our hospital's potable water by culturing water approximately biweekly from 20 sites throughout the hospital for 4 years. Overall, 545 (24.7%) of the 2200 samples grew Legionella pneumophila. During hyperchlorination, 11.7% of the samples were positive while 41.6% were positive in the absence of chlorination. There was no seasonal trend towards positivity, but there was marked inter-site variation in the semi-quantitative culture results. However, a single strain of legionella (as defined by plasmid profiling) tended to persist at a site. Such a site was a unique ecological niche in that different sites in the same wing were populated by distinct strains. The two wings of our hospital had a significantly different distribution of strains of legionella-plasmid profile type III predominated in the Victoria Wing while types II and VI predominated in Centennial Wing. Twenty-four of our 28 cases of nosocomial Legionnaires' disease occurred in the Centennial Wing. Three of the four cases in the Victoria Wing were caused by plasmid profile type III while 18 of the 24 isolates from patients who acquired their infection in the Centennial Wing were type II. We conclude that each water outlet serves as its own ecological niche of L. pneumophila.

Cross Infection↗