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PubMed1993

Plants used in Guatemala for the treatment of dermatophytic infections. 2. Evaluation of antifungal activity of seven American plants.

From 52 plants screened for antifungal activity, 26 (50%) were active against dermatophytes. This paper reports further evaluation of seven American plants against four pathogenic fungi (Aspergillus flavus, Epidermophyton floccosum, Microsporum gypseum and Trichophyton rubrum), the part showing most activity, the best solvent and, in three cases, the minimal inhibitory concentration (MIC) against the fungus in pure culture. Antifungal activity was confirmed in all of the plants, but not all parts; the most active parts were the bark and leaves. The most active species were Byrsonima crassifolia, Cassia grandis, Gliricidia sepium and Malpighia glabra. Diphysa robinioides, Rhizophora mangle and Cassia occidentalis were less active. The most susceptible fungi were E. floccosum and T. rubrum; A. flavus was not susceptible. Ethanol was usually the best solvent and the MIC of C. grandis, C. occidentalis and D. robinioides was 50 micrograms/ml.

Antifungal Agents↗
PubMed2005

Evaluation of infections in non-small cell lung cancer patients treated with radiotherapy.

PURPOSE: We aim to determine infections occurring in patients with non-small cell lung cancer during radiotherapy (RT). METHODS AND MATERIALS: A total of 181 patients had been treated with thoracic radiotherapy between October 1995 and December 1999. Radiotherapy was given using 1.8-3Gray (Gy) fraction daily, five fractions a week for a total dose of 59.4Gy (30-70.2Gy). A complete history was collected retrospectively for each patient. All microbiological examinations were performed according to the routine procedures of the hospital laboratory. Numeric and categoric variables were employed such as sex, age, performance status, histology, stage, chemotherapy, usage of corticosteroids, neutropenia, surgery, hospitalization, associated diseases, smoking during treatment, package per year of cigarette smoking, dose of radiotherapy, and response rates. RESULTS: Infections developed in 84 patients (46%, 84/181) during thoracic radiotherapy. A 101 episodes of infections developed in these patients. Most patients suffered from sputum production (65%), cough (59%), auscultation findings (31%) and fever (31%). Gram-negative bacteria were the most frequently isolated pathogens in the cultures of specimens (70%, 16/23 samples). Neoadjuvant chemotherapy (OR=4.81; 95% CI, 1.57-9.12; p=0.003) and neutropenia (OR=4.25; 95% CI, 1.44-6.89; p=0.009) were found as risk factors for influencing infection based on logistic regression analyses. Package per year of cigarette smoking was found statistically significantly higher in patients with infections than patients without infections (p=0.001). A slight increase in infections, which was of borderline statistical significance (p=0.07), was observed in patients age over 70. Ciprofloxacin and clarithromycin were the most frequently used agents in treatment. Median survival was 9 months in the patients with infection and 13 months in the 97 patients without infection. Overall survival seemed to be statistically significantly better in patients without infection than patients with infection (p=0.042) calculated using Kaplan-Meier method. Based on Cox regression analyses; overall survival was not correlated to presence of infection but associated with poor performance status (</=80) (OR=2.35; 95% CI, 0.85-8.93; p=0.03), and usage of corticosteroids (OR=2.68; 95% CI, 0.98-6.72; p=0.01). The dose of radiation therapy >5940 cGy (OR=2.06; 95% CI, 0.72-7.18; p=0.007) and the absence of response to treatment (OR=2.45; 95% CI, 0.89-14.23; p<0.001) were also found to be risk factors for survival. CONCLUSIONS: Infections are important causes of morbidity and mortality in lung cancer patients. The control of infection in these patients may improve the survival. Predisposing factors and treatment management approaches in non-small cell lung cancer should be defined carefully.

Adult↗
PubMed1998

Evaluation of infection control parameters according to the 1994 Centers for Disease Control and Prevention Tuberculosis guidelines: a 2-year experience.

BACKGROUND: Because of classification as a high-risk institution for potential Mycobacterium tuberculosis exposure and an employee purified protein derivative conversion rate of 2.7%, a large university-affiliated county hospital enhanced administrative and engineering controls, as recommended by its tuberculosis task force in early 1994. METHODS: For 1994 and 1995 the medical records of all patients with culture-confirmed M. tuberculosis were reviewed according to the 1994 Centers for Disease Control and Prevention guidelines for case surveillance and risk assessment (infection control parameters). The chi 2-test was used to compare 1994 and 1995 infection control parameters for statistical significance (p < or = 0.05). RESULTS: In 1994 and 1995 there were 253 patients with tuberculosis, 85% of whom (214/253) had pulmonary-site tuberculosis. The "representative" patient with pulmonary tuberculosis was profiled, along with institution-specific surveillance data on diagnostics, medication regimens, and airborne isolation practices. Between 1994 and 1995 there was a trend toward increased numbers of homeless patients with tuberculosis, from 8.2% to 17% (p = 0.07). Decreases in the numbers of HIV seropositive patients with tuberculosis from 35% in 1994 to 24% in 1995 (p = 0.2) and of jailed patients with tuberculosis from 9.8% to 5% (p = 0.5) were not significant. Drug-resistance patterns increased from 13% to 24%, with borderline significance (p = 0.06). The employee purified protein derivative testing compliance rate increased from 49% in 1994 to 74% in 1995, with the purified protein derivative conversion rate also increasing from 2.7% to 3.5%. CONCLUSION: The infection control parameter data were beneficial in identification of institution-specific risk factors for our population with tuberculosis. Although labor-intensive, the annual tuberculosis reports supported requests for administrative and engineering controls; however, efficacy of the 1994 tuberculosis control plan was difficult to assess from purified protein derivative conversion rates alone, because the testing compliance rate also increased.

Adult↗
PubMed2000

Transesophageal echocardiography (TEE) in the evaluation of infective endocarditis.

Echocardiography is an essential tool for the modern diagnosis and management of infective endocarditis and its complications. The negative predictive value of surface imaging is inadequate to rule out endocarditis in most instances; diagnostic sensitivity is improved by way of the transesophageal approach. The clinical scenario and pretest probability of disease should guide the use of transesophageal versus transthoracic imaging. Those at high risk for endocarditis or its complications in particular should undergo early TEE. Serial studies may be required to guide management. In the setting of an initially negative echocardiographic study, a repeat examination is indicated if the clinical suspicion of endocarditis persists or if the clinical picture changes. Combined transthoracic echocardiography and TEE may supply complementary information useful in management and follow-up. As most published research predates recent advances in imaging, the impact of changing technology, such as harmonic and three-dimensional imaging, in the management of endocarditis is yet to be determined.

Aortic Valve↗
PubMed2002

Diagnostic methods current best practices and guidelines for histologic evaluation in infective endocarditis.

Infective endocarditis (IE) often presents diagnostic and therapeutic challenges and continues to cause high morbidity and mortality. Confirmation of the diagnosis of IE is important for the purposes of epidemiologic and clinical studies and is crucial for patient management. Despite recent advances in diagnostic techniques, about 10% of IE cases remain culture-negative. Because pathological examination of cardiac valves to demonstrate vegetations and valvular inflammation remains the gold standard for the diagnosis of IE, the role of the pathologist is often decisive, especially when bacteriologists fail to isolate a microorganism or when a microorganism that has been isolated may be a contaminant. Furthermore, the pathologist may play an important role in identification of previously unknown infectious agents.

Aged↗
PubMed2006

Optimized scintigraphic evaluation of infection and inflammation: role of single-photon emission computed tomography/computed tomography fusion imaging.

Gallium-67 citrate and radiolabeled white blood cells have become standard inflammation/infection-seeking agents whereas other agents, such as (99m)Tc diphosphonates, commonly are used to infer an infectious process. These radiopharmaceuticals reflect physiologic and pathologic function rather than anatomical abnormality. In the clinical setting, it is often necessary to correlate these functional studies with anatomical imaging. The advent of single-photon emission computed tomography, as well as positron emission tomography, provides tomographic images for direct correlation to anatomic modalities such as computed tomography and magnetic resonance imaging. The methods by which these functional and anatomic imaging modalities are correlated include side-by-side, software, and hardware fusion. Clinically, fusion imaging has been applied primarily to oncologic and neurologic applications. The literature supports the premise that multimodality fusion would increase the specificity of the physiologic modality and increase the sensitivity of the anatomic modality. Our institution uses software fusion to aid in the diagnosis of infection and inflammation. Through case vignettes, we illustrate applications for single-photon emission computed tomography/computed tomography fusion for the diagnosis of infection and inflammation in multiple organ systems.

Equipment Design↗
PubMed2000

Prospective evaluation of infection with hepatitis G virus in relation to hepatocellular carcinoma in Shanghai, China.

The health consequences of hepatitis G virus (HGV) infection in humans remain to be determined. Inconsistent results of HGV and the risk of hepatocellular carcinoma (HCC) have been found in retrospective case-control studies. No prospective studies have addressed this issue. A prospective study including 18,244 men in Shanghai, China, was conducted to assess the role of HGV infection in HCC development. Serum HGV RNA and hepatitis B surface antigen (HBsAg) were assessed in 127 HCC case patients and 660 matched control subjects drawn from the cohort. Four patients with HCC (3.1%) and 21 control subjects (3.2%) were positive for serum HGV RNA. The presence of HGV RNA in prediagnostic serum was not associated with the risk of HCC (odds ratio, 1.0; 95% confidence interval, 0.3-2.9). No association between HGV RNA positivity and HCC risk was observed in either HBsAg-positive carriers or noncarriers. It is concluded that HGV infection plays no role in HCC development in this high-risk population.

Aged↗
PubMed2001

Pretransplant evaluation for infections in donors and recipients of solid organs.

The risk of infectious disease reactivation in recipients of and transmission by solid-organ transplants remains, and thorough screening and testing of recipient and donor is especially important. In conceiving screening strategies, it is crucial to consider the sensitivity and specificity of individual diagnostic tests in the context of their use. Furthermore, recognition of special risks for infectious complications of transplantation will help to guide preventive, diagnostic, and therapeutic steps in the control of infectious complications in individual patients. The acceptability of risks for infectious complications after transplantation depends also on the urgency of transplantation of a vital organ as well as the availability of organs. Although these principals are well accepted, standards for the extent of screening and criteria for inappropriate donors and exclusion of unfit recipients remain controversial to some extent.

Communicable Diseases↗
PubMed1980

Evaluation of infection in neutropenic patients with indium-111-labeled donor granulocytes.

Donor granulocytes, obtained by filtration leukophoresis, were labeled with In-111-oxine and injected into seven severely neutropenic patients. All patients were febrile, and presumed to have infection, although infection was eventually proved in only five. Excellent demonstration of infection was achieved in two patients, and fair localization in one. One negative scan became positive when repeated with sedimentation-derived cells from a different donor. This method may be useful in detecting infections in neutropenic patients.

Abscess↗
PubMed1999

Identifying and evaluating wound infection.

Wound infection is a serious problem in the home care patient. Early detection of infection, prompt treatment, and continuous surveillance are pivotal to elimination of the infection and prevention of complications. This article addresses identification of wound infection in postsurgical and chronic wounds based on data obtained from the patient's history, physical examination, and diagnostic tests. Appreciating the overt and subtle signs and symptoms of wound infection and acting on them is critical to timely diagnosis and treatment.

Acute Disease↗
PubMed1985

Echocardiographic evaluation of infective endocarditis in children.

To determine the incidence and prognostic importance of the echocardiographic abnormalities associated with infective endocarditis, we reviewed these findings in 45 episodes occurring in 41 children and young adults. Thirty-three patients had congenital cardiac abnormalities, and eight patients had no previously known heart disease. Echocardiographic abnormalities were detected in 16 of the 45 episodes of endocarditis (36%). M-mode echocardiography revealed abnormalities in seven of the 35 episodes (20%) in which it was performed, and two-dimensional echocardiography revealed abnormalities in 16 of the 28 episodes (59%) in which it was used. The presence of echocardiographic abnormalities was unrelated to the causative organism and to the need for early operation.

Adolescent↗
PubMed2003

Prognosis and clinical evaluation of infection caused by Rhodococcus equi in HIV-infected patients: a multicenter study of 67 cases.

OBJECTIVE: To assess the clinical characteristics and the factors that influenced the prognosis of patients with HIV and infection caused by Rhodococcus equi. DESIGN: Observational, multicenter study in 29 Spanish general hospitals. SETTING: These hospitals comprised a total of 20,250 beds for acute patients and served a population of 9,716,880 inhabitants. PATIENTS: All patients with HIV and diagnosed R equi infection until September 1998. RESULTS: During the study period, 19,374 cases of AIDS were diagnosed. Sixty-seven patients were included (55 male patients; mean +/- SD age, 31.7 +/- 5.8 years). At the time of diagnosis of R equi infection, the mean CD4+ lymphocyte count was 35/ micro L (range, 1 to 183/ micro L) and the stage of HIV infection was A3 in 10.4% of patients, B3 in 31.3%, C3 in 56.7%, and unknown in 1.5%. R equi was most commonly isolated in sputum (52.2%), blood cultures (50.7%), and samples from bronchoscopy (31.3%). Chest radiographic findings were abnormal in 65 patients (97%). Infiltrates were observed in all of them, with cavitations in 45 patients. The most active antibiotics against the strains isolated were vancomycin, amikacin, rifampicin, imipenem, ciprofloxacin, and erythromycin. After a mean follow-up of 10.7 +/- 12.8 months, 23 patients (34.3%) died due to causes related to R equi infection and 6 other patients showed evidence of progression of the infection. The absence of highly active antiretroviral therapy (HAART) was independently associated with mortality related to R equi infection (relative risk, 53.4; 95% confidence interval, 1.7 to 1,699). Survival of patients treated with HAART was much higher than that of patients who did not receive this therapy. CONCLUSIONS: Infection by R equi is an infrequent, opportunistic complication of HIV infection and occurs during advanced stages of immunodepression. In these patients, it leads to a severe illness that usually causes a bacteremic, cavitary pneumonia, although HAART can improve the prognosis.

Actinomycetales Infections↗
PubMed2001

Immunologic evaluation in infective endocarditis.

OBJECTIVE: To analyze the immune response in peripheral blood of patients with infective endocarditis. METHODS: We studied 10 patients with infective endocarditis, age range from 20 to 50 years-old, males and females, and 20 healthy subjects in the same age range. The diagnosis of the disease was based on the clinical picture, echocardiogram, and hemoculture based upon samples drawn and tested before the treatment started. The were no history of atopy or malnutrition, no autoimmune disease, and they were not using any immunosuppressant or antibiotic medication. RESULTS: The patients with endocarditis had significantly higher T and B lymphocyte, CD4+ and CD8+ cell counts, IgM and IgG serum levels, and C4 component of the complement than the control group; no significant difference concerning serum IgA and neutrophil oxidative metabolism; a significant decrease in C3, chemotaxis, and monocyte phagocytosis;cryoglobulins were detected in 66.6% of patients and they were formed by IgG, IgM, IgA, C3, and C4. CONCLUSION: The patients with infective endocarditis were immunocompetent in most sectors of immune response and, at a certain moment, an autoimmune component may be present.

Adult↗
PubMed1978

Hygiene in the prevention of udder infections. IV. Evaluation of teat dips with excised cows' teats.

Suspensions of Staphylococcus aureus, Streptococcus agalactiae, Escherichia coli, and Pseudomonas aeruginosa were used to contaminate teats excised from cows. Commercially available teat dips were applied for evaluation of comparative germicidal activity. Iodophors, sodium hypochlorite, and sodium dichloro-s-triazenetrione were highly effective against all four test organisms. Quarternary ammonium, chlorhexidine, and cetylpyridinium chloride were effective against Staphylococcus aureus, and Streptococcus agalactiae but not Escherichia coli and Pseudomonas aeruginosa. Bronopol and 8-hydroxyquinoline sulfate were marginally effective on the two Gram positive organisms and ineffective on the two Gram negatives. Three of the dips were ineffective against all four pathogens; two were in nonaqueous bases, and the other was a blend of pine oil and antibodies with udder origin. In other trials, iodophor at .3% titratable iodine was highly effective against Staphylococcus aureus and Streptococcus agalactiae. Products containing .5 and 1% iodophor maintained effectiveness after each was used to dip 140 teats under conditions of commercial dairying. Logarithmic reduction in the geometric mean number of organisms recovered from teats was more meaningful for evaluating data than percent reduction.

Animals↗