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PubMed1987

Salmon poisoning disease in juvenile coyotes: clinical evaluation and infectivity of metacercariae and rickettsiae.

Clinical salmon poisoning disease (SPD), and survival of Neorickettsia helminthoeca and metacercariae of Nanophyetus salmincola in fish were evaluated experimentally in 12-wk-old coyotes (Canis latrans) to determine the potential of SPD for biological control of coyotes. Coyotes readily ate fish that contained metacercariae and rickettsiae. They developed diarrhea, anorexia and lethargy within 7 days after feeding. Infected coyotes lost 58% of their body weight when compared to uninfected controls. They died or became moribund and were euthanatized within 17 days after feeding. Rickettsiae were present in the macrophages of lymph nodes of all affected coyotes. Clinical disease occurred in coyotes fed fresh fish, but not in coyotes fed fish stored at 4 C for greater than or equal to 30 days or at -20 C for 14 days. Metacercariae in fish were viable after 60 days at 4 C. These trematodes developed in coyotes, but clinical SPD did not occur. This indicated survival of metacercariae, but not rickettsiae. Metacercariae were not viable after 14 days at -20 C.

Animals↗
PubMed2005

Recognition of undiagnosed HIV infection: an evaluation of missed opportunities in a predominantly urban minority population.

The goals of this study were to quantify delays in diagnosing HIV infection in patients presenting for medical care prior to the identification of their HIV infection, and to determine characteristics of visits preceding the identification of HIV infection. This was a retrospective cohort study of consecutive newly diagnosed HIV infected patients in a large urban setting. Patients were predominantly minorities and identified from all inpatient and outpatient HIV tests performed between December 29, 1998 and December 27, 1999. Data were collected from all emergency department and clinic visits for each patient included in this study for a 3-year period preceding the first diagnosis of HIV infection. Two hundred seventy-eight patients tested positive for HIV during the study period. Of these, 76 (27%) met inclusion criteria. Twenty-three patients made a total of 53 health care visits preceding the diagnosis of their HIV infection. The median delay in diagnosis of HIV infection was 2 days (interquartile range [IQR], 1-22 days; range, 0-1093 days) for all subjects, although 19 (25%; 95% confidence interval [CI]: 16%-36%) patients had a delay in diagnosis of 30 days or more. Among those patients who had made prior health care visits, the median delay in diagnosis was 112 days (IQR, 33-690 days; range, 2-1093 days). No specific risk factor, historical clue, physical examination finding, or laboratory finding reliably identified patients with HIV infection. Documentation in the medical record of specific risk factors and clinical characteristics suggestive of HIV infection was poor. This study documented missed opportunities and delays in diagnosis of patients with unrecognized HIV infection. Clinicians must maintain a high index of suspicion for HIV infection in all patients.

AIDS Serodiagnosis↗
PubMed1979

Clinical course and diagnosis of genital herpes simplex virus infection and evaluation of topical surfactant therapy.

A prospective study of 37 men and 32 women with culture-proved genital herpes simplex virus (HSV) infection was undertaken to characterize the clinical manifestations of the disease and effects of topical therapy with Nonoxynol 9, a nonionic surfactant active in vitro against HSV. The duration of pain, lesions, and virus shedding was significantly longer in initial than in recurrent genital HSV infection. Cervical HSV shedding occurred in 11 of 13 initial infections versus two of 19 recurrences (p less than 0.001). Type 1 HSV caused seven of 29 initial and none of 40 recurrent infections (p less than 0.01). Clinical recurrences within six weeks were detected more often in men than in women and were unrelated to the menstrual cycle. The influence of coitus on recurrence is unclear. Papanicolaou smears were transiently abnormal (Class II) in four (12.5 per cent) of 32 female patients. Evidence of herpesvirus was detected cytologic smears from only 28 (41 per cent) of 69 culture-proved external lesions and three (23 per cent) of 13 culture-positive cervices. Serology was also of limited diagnostic value except in testing paired sera from initial infections. The topical therapy had no beneficial effect.

Adult↗
PubMed2001

Intracranial infective aneurysms: angiographic evaluation with treatment.

Infective intracranial aneurysms are relatively uncommon. They develop due to septic embolisation of the vasa vasorum or lumen of the artery, with resultant focal arteritis and necrosis, leading to aneurysm formation. They are an important cause for intracranial haemorrhage. Six cases of infective aneurysms are described. A focus of infection could be detected in all the patients. Surgery was done in three cases, out of which two patients made significant recovery, while one patient died in the immediate postoperative period. Out of the three cases, treated conservatively with antibiotic therapy, there was total resolution on follow up angiogram in two, while one patient was lost to follow up.

Adolescent↗
PubMed2004

Role of anti-granulocyte Fab' fragment antibody scintigraphy (LeukoScan) in evaluating bone infection: acquisition protocol, interpretation criteria and clinical results.

Scintigraphy using anti-granulocyte Fab' fragment (LeukoScan) was performed in a series of 220 consecutive patients with suspected bone infection referred to our centre between September 1999 and June 2002. Two protocols were compared for interpreting scans: (1) evaluation of early 4 h imaging alone (protocol A), and (2) evaluation both of early and delayed 24 h imaging (protocol B). Protocol A and protocol B showed equal values of sensitivity (91.9% in patients with diabetic foot and 84.2% in patients with joint prosthesis/peripheral bone implants). Conversely, specificity was higher adopting protocol B than protocol A: 87.5% vs 75.0% in patients with diabetic foot, and 85.7% vs 76.2% in patients with joint prosthesis/peripheral bone implants, respectively. In particular, an improvement in specificity using protocol B was found in those patients with infection and with only a mild LeukoScan uptake in the early 4 h imaging: in these patients an increasing uptake intensity pattern observed in the delayed 24 h imaging was indicative of infection while a decreasing pattern suggested a negative result. Instead, the evidence of a high uptake intensity in the early LeukoScan imaging was a strong indicator of infection and delayed imaging in these cases did not further improve specificity. In conclusion, in our experience, LeukoScan showed high sensitivity in diagnosing bone infection in patients with diabetic foot and joint prosthesis or other peripheral bone implants. Moreover, in patients with an early high LeukoScan uptake intensity further delayed images appears unnecessary for the purpose of diagnosing infection. In contrast in patients with an early mild LeukoScan uptake intensity only, delayed imaging appears to be recommendable for improving specificity.

Adult↗
PubMed1985

A controlled study of ticarcillin plus clavulanic acid versus piperacillin as empiric therapy for fever in the immunocompromised host.

Clavulanic acid, a potent beta-lactamase inhibitor, was studied in fixed combination with ticarcillin and used with tobramycin as empiric therapy for fever in the immunocompromised host. Fifty febrile episodes were evaluated in patients with hematologic malignancy and/or neutropenia. Eighty-one percent of evaluable infections treated with the study regimen of ticarcillin, clavulanic acid, and tobramycin responded. Seventy-four percent of evaluable infections treated with the control regimen of piperacillin, tobramycin, and vancomycin responded (p = 0.4). Resistance to piperacillin and ticarcillin were noted in 23.8 percent of 21 isolated organisms. Resistance to ticarcillin and clavulanic acid was noted in only one (4.7 percent) of the isolated organisms (p = 0.092). Untoward reactions, including rash, nephrotoxicity, and superinfection, were unusual and occurred with equal frequency in the study and control groups. Clavulanic acid in combination with ticarcillin was effective and safe in treating fever in the immunocompromised host.

Bacterial Infections↗
PubMed2005

Technetium-99m ciprofloxacin imaging in the diagnosis of postsurgical bony infection and evaluation of the response to antibiotic therapy: A case report.

The use of radiolabelled antibiotics is fast emerging as a promising diagnostic test for the detection of infective lesions, because of their specific binding to the bacterial component. Ciprofloxacin is a broad-spectrum antibiotic that has been used as a radiolabelled antibiotic in both the diagnosis of infections in rabbits and in clinical trials on humans. The diagnosis of skeletal microbial infections remains a challenge, especially in orthopaedic patients with implants. We present a case report of a patient with undiagnosed and unrelenting pain in the lower third of the left leg, which had persisted for 6 months. A novel scintigraphy, which was developed in-house using a 99mTC ciprofloxacin single vial kit, was used for diagnosing the active bacterial infection. A 99mTC methylene diphosphonate bone scan was also performed to locate precisely the site of the lesion. Gradually increasing concentrations of both the radiotracers confirmed the presence of active bacterial infection in the distal third of the left tibia. Follow-up scanning after antibiotic therapy showed the disappearance of the pooling of 99mTC ciprofloxacin, indicating a good response. Therefore, 99mTC ciprofloxacin has good diagnostic and prognostic applications in deep-seated covert skeletal microbial infections. However, the persistence of a focal concentration detected by the 99mTC methylene diphosphonate scan was attributed to the inflammatory and not the infective pathology.

Adult↗
PubMed1996

Evaluating the child with recurrent infections.

In evaluating recurrent childhood infections, the physician must keep in mind the rarity of true immunodeficiency and the frequency of atopy, day care, exposure to cigarette smoke and anatomic variations as predisposing factors in recurrent childhood illnesses. Determining true immunodeficiency involves exclusion of risk factors for human immunodeficiency virus infection, identification of a family history of immunodeficiency and recognition of specific physical and laboratory findings. In most cases, screening immunoglobulin studies will distinguish the normal child from the child with an abnormal immune system. Management of the patient with true immunodeficiency is carried out in collaboration with specialists in these uncommon disorders.

Child↗
PubMed1994

Diagnosis of human immunodeficiency virus (HIV) infection: multicenter evaluation of a newly developed anti-HIV 1 and 2 enzyme immunoassay.

A new anti-human immunodeficiency virus type 1 and 2 (anti-HIV 1 and 2) test is described. It uses recombinant p24 and peptides covering gp32, gp41, and gp120 to identify HIV-1 and HIV-2 infections. This test has been shown to be specific (99.5%) and sensitive (99.8%). In this respect, the assay was equal or superior to anti-HIV 1 and 2 tests run as references. The test was able to discriminate sera from patients with HIV infections from those from uninfected individuals with excellence; it also exerted high intra- and interassay precisions. The "modular" concept of the test allows the use of single components (gp32 or gp41) to separate between HIV-2 and HIV-1 infections, respectively.

Diagnosis, Differential↗
PubMed1993

Scintigraphic evaluation of pediatric urinary tract infection.

Scintigraphic evaluation of urinary tract infection, pyelonephritis, and renal scarring represents a significant portion of a clinical pediatric nuclear medicine practice. Renal scarring from recurring infection remains an important cause of end-stage renal disease and hypertension in the pediatric population. However, the clinical presentation in infants and young children is often elusive, and clinical diagnosis of upper tract involvement is frequently unreliable. As a result, diagnostic imaging has a critical role to play in the localization of infection to the lower or upper urinary tract. Radionuclide cystography and renal cortical imaging have become mainstays of this evaluation. Direct radionuclide cystography is the preferred cystographic screening technique, because it has lower radiation exposure and greater sensitivity for the detection of vesicoureteral reflux than either indirect radionuclide cystography or fluoroscopic contrast cystography. Renal cortical scintigraphy has become the standard for the detection of pyelonephritis and renal scarring. Correlation with histopathology has demonstrated a high degree of diagnostic accuracy. Acute pyelonephritis has been shown to be the necessary etiologic factor for the development of subsequent renal scarring, and the mechanism of renal injury in pyelonephritis has been extensively studied in experimental models. The ability of prompt and appropriate antibiotic therapy to dramatically reduce the incidence of subsequent scarring also has been conclusively demonstrated both clinically and in the experimental model. Vesicoureteral reflux was once thought to be a necessary prerequisite for the development of renal scarring. Although it is clear that the intrarenal reflux of infected urine will create pyelonephritis in the experimental model, the high incidence of pyelonephritis and subsequent scarring in the absence of demonstrable vesicoureteral reflux leaves the role of reflux in question. Although the role of vesicoureteral reflux is incompletely understood, its detection nevertheless remains a standard part of the patient's evaluation.

Child, Preschool↗