ABSTRACT
From August 1996 through June 1998, 69 ventilated, intensive care unit patients at two Arizona hospitals had nosocomial respiratory tract cultures positive for Burkholderia cepacia. Intrinsically contaminated alcohol-free mouthwash was identified by pulsed-field gel electrophoresis as the source of the outbreak.
Subject(s)
Burkholderia Infections/epidemiology , Burkholderia cepacia/isolation & purification , Cross Infection/epidemiology , Disease Outbreaks , Mouthwashes , Aged , Arizona/epidemiology , Burkholderia Infections/mortality , Burkholderia Infections/transmission , Cross Infection/transmission , Drug Contamination , Electrophoresis, Gel, Pulsed-Field , Female , Hospital Mortality , Hospitals, Community , Humans , MaleABSTRACT
An unusual case of varicella-zoster hepatitis is reported which resulted in fatal massive hepatic necrosis in a 64-year old white female. The patient had had chickenpox 30 years prior to death but no cutaneous zoster at any time. The liver showed typical eosinophilic intranuclear inclusions and herpesvirus virions were demonstrated by electron microscopy. Indirect immunofluorescent serologic studies confirmed remote and recent infection by varicella-zoster virus. The potential significance of an incidental splenectomy performed 14 months before death and the general role of immunosuppression in the incidence and dissemination of varicella-zoster are discussed. The features of 13 reported cases of herpes simplex hepatitis are briefly reviewed.
Subject(s)
Hepatitis, Viral, Human/complications , Herpes Zoster/complications , Liver Cirrhosis/etiology , Female , Hepatitis, Viral, Human/pathology , Herpes Zoster/pathology , Humans , Liver Cirrhosis/pathology , Middle Aged , Splenectomy/adverse effectsABSTRACT
Acute cytomegalovirus (CMV) encephalitis developed in two immunologically normal adults. The diagnosis was confirmed by isolation of CMV from the CSF and urine in one case and from temporal lobe biopsy tissue, CSF, and urine in the second case. Both patients were treated with vidarabine and showed dramatic clinical improvement. Virus excretion, which had been chronic in one case, cleared after therapy. To our knowledge, these are the first persons with CMV encephalitis evidenced by isolation of the virus from the CNS. The response to vidarabine was impressive and warrants further evaluation.
Subject(s)
Cerebrospinal Fluid/microbiology , Cytomegalovirus Infections/complications , Cytomegalovirus/immunology , Encephalitis/etiology , Vidarabine/therapeutic use , Acute Disease , Adult , Antibodies, Viral/analysis , Cytomegalovirus/isolation & purification , Cytomegalovirus Infections/immunology , Encephalitis/drug therapy , Encephalitis/immunology , Female , Humans , Male , Middle Aged , Temporal Lobe/microbiology , Urine/microbiologyABSTRACT
This report documents the occurrence of an Osler node, subungual hemorrhages, and Janeway lesions peripheral to an infected arterial catheter. A brief review of these dermatological manifestations of infection is given and the importance of surgical removal of the involved artery after poor response to medical therapy is stressed.
Subject(s)
Iatrogenic Disease , Skin Diseases/etiology , Staphylococcal Infections/complications , Aged , Catheterization/adverse effects , Cloxacillin/therapeutic use , Female , Gentamicins/therapeutic use , Humans , Skin Manifestations , Staphylococcal Infections/drug therapyABSTRACT
We studied the incidence and type of side effects of minocycline in a double-blind study. A total of 45 volunteers (18 men and 27 women) were given minocycline, and 44 volunteers (23 men and 21 women) were given placebo. The men in both the minocycline and placebo groups were significantly (P < 0.0001) larger than the women in the comparable groups. Minocycline dosage was 100 mg every 12 h for 5 days, and placebo was administered in an identical manner. Minocycline serum concentrations were determined in 12 volunteers at 1, 2, 4, and 6 h after the morning doses on days 1, 3, and 5 of the study. Side effects were recorded by volunteers in diaries and also through daily interviews and were evaluated by examination and electronystagmography. Peak minocycline serum concentrations were seen by day 3 and correlated with the peak onset of side effects. These concentrations were significantly higher in women than in men. Vestibular side effects occurred in 70.4% of the women on minocycline and significantly (P < 0.0001) exceeded the rate of the women on placebo (9.5%). Only loss of balance was significantly (P < 0.05) increased in the men taking minocycline as contrasted with men on placebo. Electronystagmography generally revealed no abnormalities. Side effects were usually not severe: four volunteers in the minocycline group and two in the placebo group discontinued their capsules because of side effects. It is concluded that women experience an unacceptably high incidence of side effects from minocycline, and this may be related to their higher serum concentrations, which in turn may relate to their smaller size.
Subject(s)
Minocycline/adverse effects , Tetracyclines/adverse effects , Clinical Trials as Topic , Drug Evaluation , Female , Humans , Male , Placebos , Sex FactorsABSTRACT
A case of brain abscess following an apparently trival puncture wound to the eyelid is presented to emphasize the importance of meticulous examination of eye wounds in children to look for penetration into the cranial vault. Any suggestion of such penetrating injury either by history, examination, or X-ray should dictate neurosurgical consultation, and immediate local culture and debridement of the wound. If nonoperative management is elected, a careful watch must be kept for signs of infection, which dictate early exploration, and broad-spectrum antibiotic coverage of Gram-positive and Gram-negative organisms common to penetrating skull trauma.
Subject(s)
Brain Abscess/etiology , Eyelids/injuries , Wounds, Penetrating/complications , Brain Abscess/diagnosis , Child, Preschool , Female , Humans , Orbit/injuries , Skull Fractures/diagnosis , Skull Fractures/etiologyABSTRACT
The first reported case of bilateral endogenous endophthalmitis is presented and discussed with reference to pertinent literature. Diagnostic and therapeutic recommendations for suspected gram-negative endophthalmitis are presented and include: immediate paracentesis of the eye for gram stain and culture, systemic therapy with an antibiotic such as gentamicin and either subconjunctival, subtenon or intraocular injection of antibiotics. Despite these measures vision may be lost, and, as in this case, enucleation necessary.
Subject(s)
Endophthalmitis/microbiology , Escherichia coli Infections , Anti-Bacterial Agents/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Escherichia coli Infections/diagnosis , Escherichia coli Infections/drug therapy , Female , Gentamicins/therapeutic use , Humans , Middle AgedABSTRACT
Standardized rates of drug-attributed rises in blood urea nitrogen were 8.6%, 2.9%, and 9.3%, respectively, in patients receiving gentamicin alone, cephalothin alone, and both drugs together. These results provide evidence against a substantial synergism between the two drugs in the production of impaired renal function.
Subject(s)
Blood Urea Nitrogen , Cephalothin/adverse effects , Gentamicins/adverse effects , Adult , Drug Interactions , Female , Humans , Male , Middle AgedABSTRACT
Minocycline hydrochloride is a tetracycline derivative that has been advocated as the drug of choice in the treatment of meningococcal carriers. Recently, we studied a group of 30 patients who experienced a large number of side-effects after receiving minocycline for treatment of meningococcal meningitis. Twenty-seven of 30 (90%) suffered from dizziness, vertigo, ataxia, weakness, nausea, and vomiting. These symptoms appeared within the first 72 hours of taking minocycline, and disappeared within 48 hours of stopping the medication.
