Biomedical subjects
Publications and source records attributed to W A Agger.
Nitrofurantoin has been described as a cause of both hepatocellular cholestatic hepatic injury. A case report of a patient in whom granulomatous hepatitis developed attributed to nitrofurantoin is given.
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Lethal nosocomial mucormycosis developed in three previously well individuals while they were receiving intensive care for acute hemorrhagic pancreatitis, for cardiogenic shock, and for a ruptured intra-abdominal aortic aneurysm. In two cases, the condition was first seen as progressive cavitary pneumonia refractory to antibacterial therapy; Mucoraceae was identified in all three patients only at autopsy. Each patient had received large doses of corticosteroids and broad-spectrum antibiotics, and all had suffered from respiratory failure, acute renal failure with acidosis, and severe hyperglycemia in association with total parenteral nutrition. Mucoraceae should be regarded as an additional nosocomial pathogen in the setting of advanced life-support care.
Carbenicillin has been advocated for treatment of infections caused by Bacteroides fragilis and other anaerobic bacteria. Wide-scale use of the drug in this setting could result in a substantial increase in carbenicillin-resistant Pseudomonas aeruginosa, an effect that would have serious implications. Thirty-four strains of B. fragilis, one-half from bacteremic infections, were tested in vitro, and penicillin G was found to be twice as active as carbenicillin on an equal weight basis; 94% of the strains were inhibited by 32 microgram of penicillin/ml, a level easily achieved therapeutically. Penicillin killed B. fragilis organisms as rapidly as carbenicillin. In two subjects given equivalent doses (100 mg/kg intravenously) of carbenicillin and aqueous penicillin G, the bactericidal activity of serum against B. fragilis after administration of each drug was the same. Controlled clinical trials of treatment of anaerobic bacterial infections with penicillin G in high dosage, carbenicillin (or closely related ticarcillin), clindamycin, and chloramphenicol should be undertaken. Carbenicillin (and ticarcillin) for the present would seem better reserved for P. aeruginosa infections.
A preponderance of clusters seen on direct Gram stain of blood cultures positive for gram-positive cocci was 98% sensitive and 100% specific for identification of staphylococcal species or of Peptococcus. A preponderance of chains, pairs, or both was 100% sensitive and 98% specific for identifying streptococci. Further presumptive identification of either staphylococci or streptococci based on microscopic morphology was unreliable. The direct Gram stain is highly reliable for differentiating staphylococci from streptococci and should be of considerable value to clinicians selecting initial antimicrobial therapy.
Primary sporotrichosis of the eye is very rare; most infections are limited to the conjunctiva or adnexa. We report a case of Sporothrix endophthalmitis associated with necrotizing ethmoid sinusitis developing in a young diabetic man with ketoacidosis. The infection clinically resembled rhino-ophthalmic mycormycosis. Cure followed evisceration and an abbreviated course (215 mg) of amphotericin B. Sporothrix must now be regarded as another fungal agent capable of causing primary rhino-ophthalmic infection similar to Mucor.
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The purpose of this study was to determine the source of organisms responsible for biliary infection associated with T-tube placement. Two groups of patients who had had T-tubes placed following common bile duct exploration were studied. In one group of 34 patients, bacterial cultures were taken daily from the drainage bag and the lumen of the T-tube. In the second group of patients, paired daily bacterial cultures were taken from the T-tube lumen and the skin tract surrounding the T-tube. Results of the first group showed the drainage bag to be the initial site of infection in seven cases, with "descending" infection from the patient's skin occurring in 27 cases, 14 in whom the organism was initially present in the bile while in the other 13 the organism appeared later. In the second group, of 32 isolates only five were found extraluminally before they appeared within the lumen, these five being all Staphylococcus epidermidis. Thus the majority of bile infections occurring after T-tube placement were found to originate from the patient's own biliary tree or skin.
The infectious complications in 23 patients with mutilating wounds due to trauma during corn harvesting were compared with those in 41 patients with factory-related hand injuries of similar severity. Initial cultures revealed bacterial growth in 89% of the agricultural wounds and in 63% of the factory wounds. A mean of 3.8 initial bacterial species were isolated per corn-harvesting wound vs. 0.9 species per factory wound. Gram-negative rods were recovered from 81% of the agricultural wounds; the commonest of these organisms were Enterobacter species and Xanthomonas maltophilia. Only 7% of factory-wound cultures grew gram-negative rods. Osteomyelitis, all with gram-negative rods, developed in five (22%) of the patients with farm injuries but did not occur in patients with factory wounds. More gram-negative rods were recovered from environmental cultures of corn-harvesting machines and corn plants than from those of factory machinery.
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