Fever, lymphadenopathy, eosinophilia, lymphocytosis, hepatitis, and dermatitis: a severe adverse reaction to minocycline.

A 17-year-old female patient who had been taking oral minocycline (50 mg twice daily) for 3 weeks for acne developed an eruption that progressed to an exfoliative dermatitis. This illness was also characterized by fever, lymphadenopathy, pharyngitis, a leukemoid reaction, lymphocytosis, eosinophilia, hepatitis, and noncardiogenic pulmonary edema. Dramatic improvement followed institution of corticosteroid therapy. Studies for infectious and collagen vascular diseases were negative. This severe illness was likely caused by minocycline, and we speculate that minocycline may have acted as a superantigen, causing lymphocyte over-activation and massive cytokine release.

Seroprevalence of HIV infection in childbearing women in Nova Scotia.

OBJECTIVE: To determine the prevalence of HIV-1 infection in childbearing women in Nova Scotia. DESIGN: An anonymous, unlinked seroprevalence study using "leftover" cord bloods. The study was done in 2 stages: I-Halifax Co. women delivering between February 1, 1992 and December 31, 1993; II-non-Halifax Co. women delivering between November 15, 1993 and December 15, 1994. RESULTS: Of 9,115 deliveries during stage I and 5,515 during stage II, specimens were tested from 8,864 (97.2%) and 5,219 (95%) respectively. Halifax Co. women were older, more often married and more often reported a STD than the non-Halifax Co. participants with 20% under age 20 reporting a history of STD. There was one EIA and WB positive result among Halifax Co. women (seroprevalence 1/10,000; 95% CI 0.03-6.29) and one EIA positive, WB indeterminant result among non-Halifax Co. women (seroprevalence 0/10,000; 95% CI 0-5.7). CONCLUSION: There is a low prevalence of HIV infection among Nova Scotia childbearing women. However, a substantial number, especially those < age 20, reported a history of STD.

Neuroendocrine assessment of serotonin (5-HT) function in chronic fatigue syndrome.

Prolactin and cortisol responses to dl-fenfluramine challenge were examined in 11 patients with chronic fatigue syndrome and in 11 healthy controls who were age and gender matched. After obtaining two baseline samples, each subject was given 60 mg of dl-fenfluramine orally and further blood samples were drawn hourly during the following five hours in order to measure prolactin and cortisol levels. There was no difference in either baseline or fenfluramine-induced hormonal responses between patients with chronic fatigue syndrome and controls. There was also no correlation between depression scores on HAM-D and hormonal responses in patients with chronic fatigue syndrome. The findings of this study do not support a role for 5-HT in chronic fatigue syndrome.

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.

Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea.

An unlinked seroprevalence survey of human immunodeficiency virus (HIV) antibody was conducted using stored sera from all patients who attended the sexually transmitted disease (STD) clinic in Halifax, Nova Scotia between 1980 and 1986. None of the sera collected from 584 patients during 1980 were HIV positive. Of the 2867 patients who visited the clinic between 1981 and 1986, 27 (0.9%; 95% CI 0.6% to 1.2%) had the antibody. None of the 784 female patients were HIV seropositive. Of the 1,884 heterosexual men in the study, 5 (0.3%; 95% CI 0.1% to 0.5%) were HIV seropositive, and 22 (11.1%; 95% CI 6.7% to 15.5%) of the 199 homosexual men were HIV seropositive. There was a strong association between a history of syphilis and HIV antibody among heterosexual men (OR = 76.8; 95% CI 12.0 to 491.3; P = 0.001). Among homosexual men younger than 30 years of age, HIV infection was associated with a history of syphilis (OR = 18.2; 95% CI 5.1 to 64.7; P = 0.035) and a history of gonorrhea (OR = 8.2; 95% CI 4.2 to 16.0; P = 0.001). The association between a history of gonorrhea and HIV infection was strongest among homosexual men who had three or more sexual partners in the last month. These findings supplement existing evidence that STDs increase the likelihood of HIV transmission.

Cytomegalovirus infection among women attending a sexually transmitted disease clinic: association with clinical symptoms and other sexually transmitted diseases.

The prevalence rates of cytomegalovirus, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and herpes simplex virus infection were determined for 247 women attending a sexually transmitted disease clinic in Halifax, Nova Scotia between July 1983 and December 1985. Isolation rates were 8.5%, 32.8%, 27.1%, 7.3%, and 6.5% for the five infectious agents, respectively. With multiple logistic regression analysis, the presence of cervical cytomegalovirus infection was independently associated with age less than 23 years and with gonococcal infection. Factors predictive of C. trachomatis infection included age less than 23 years, gonococcal infection, oral contraceptive use, and purulent discharge. Number of lifetime sexual partners was statistically associated only with herpes simplex virus infection. N. gonorrhoeae, C. trachomatis, and T. vaginalis were all independently associated with purulent discharge. Cytomegalovirus, N. gonorrhoeae, and C. trachomatis were statistically more likely to be present concurrently with other organisms than to be present as a single infection. Women with another genital infection were 6.5 times more likely to have cytomegalovirus than were women with no other genital infection. Of the 21 women with cytomegalovirus, only two had no other sexually transmitted disease. These findings suggest that N. gonorrhoeae and other sexually transmitted diseases may play a role in either the sexual transmission of or the reactivation of cervical cytomegalovirus infection.

Double-blind, randomized comparison of 24 weeks of norfloxacin and 12 weeks of norfloxacin followed by 12 weeks of placebo in the therapy of complicated urinary tract infection.

We evaluated the benefits of prolonging norfloxacin therapy from 12 to 24 weeks for complicated urinary tract infection in a double-blind, randomized, placebo-controlled study. During the second 12 weeks, norfloxacin was superior to placebo (P less than 0.05) in suppressing bacteriuria. Adverse effects were common but mostly confined to the initial 12 weeks.

Clinical evaluation of rosoxacin for the treatment of chancroid.

One hundred seven men with Haemophilus ducreyi-positive chancroid were assigned to receive 300 mg of rosoxacin as a single dose or 150 mg twice daily for 3 days. Ulcers and buboes were followed clinically and bacteriologically for 1 month. Of 40 evaluable males on the 3-day regimen, 38 (95%) were cured, while only 14 of 23 (61%) males on the single-dose regimen were cured; this regimen was discontinued. There was one ulcer relapse at day 21 in both groups; the one relapse in the single-dose group had a persistent culture-positive bubo. Eight of nine (89%) buboes followed to the endpoint on the 3-day rosoxacin regimen were cured, versus three of six (50%) on the single-dose regimen. Adverse effects were mainly related to the central nervous system but were minor and did not require intervention. None of the treatment failures was due to organisms resistant to rosoxacin, and failure of the single-dose regimen presumably was related to duration of tissue levels rather than to drug resistance. Administration of 150 mg of rosoxacin twice daily for 3 days is an effective regimen for the therapy of chancroid and is a reasonable alternative to other short-course regimens.

Single-dose ceftriaxone therapy of gonococcal ophthalmia neonatorum.

Ceftriaxone (125 mg) given as a single intramuscular dose without topical therapy was evaluated in seven infants with smear-positive gonococcal ophthalmia neonatorum. Neisseria gonorrhoeae was isolated from the eyes of six infants, and four of these isolates were penicillinase-producing N. gonorrhoeae. Two infants had concomitant ocular infection with Chlamydia trachomatis. All seven infants, when seen at follow-up, showed marked clinical improvement. Conjunctivitis resolved completely in four infants. One infant was lost to subsequent follow-up, while two infants had persistent ophthalmia due to C. trachomatis. Follow-up eye cultures for N. gonorrhoeae were all negative.

Comparative trial of norfloxacin and trimethoprim-sulfamethoxazole in the treatment of women with localized, acute, symptomatic urinary tract infections and antimicrobial effect on periurethral and fecal microflora.

Forty-three women with acute, symptomatic urinary tract infections were randomized to receive either norfloxacin (400 mg) twice daily or trimethoprim-sulfamethoxazole (160-800 mg) twice daily for 10 days. Of the 43 patients, 7 (16%) had low-count bacteriuria and pyuria and were included in the evaluation. Escherichia coli was isolated in 72% of the infections, whereas coagulase-negative staphylococci were isolated in 14%. All isolates were susceptible to the assigned study drug. The MICs for 90% of the strains susceptible to norfloxacin and trimethoprim-sulfamethoxazole were less than or equal to 2 and less than or equal to 0.8-16 micrograms/ml, respectively. The cure rates for norfloxacin and trimethoprim-sulfamethoxazole were 95 and 90%, respectively. There were 17 patients with presumptive upper tract infections; only 1 of these relapsed after therapy. The effects on the periurethral flora were similar in both groups, but the infecting organism was eradicated from the fecal flora in 93% of the patients treated with norfloxacin and in 57% of the patients treated with trimethoprim-sulfamethoxazole. More early reinfections occurred in the trimethoprim-sulfamethoxazole group, with resistant organisms appearing in urine and in the periurethral and fecal flora in all cases. Three patients in each group experienced adverse clinical effects, but these were more severe in the trimethoprim-sulfamethoxazole group. No adverse hematological or biochemical changes were noted. From these results, we concluded that norfloxacin is at least as effective as trimethoprim-sulfamethoxazole in the therapy of acute, symptomatic urinary tract infections in women.

Prospective, randomized, comparative trials in the therapy for intraabdominal and female genital tract infections.

The results of four prospective, randomized comparative trials, in which the authors' two university teaching hospitals participated, that compared selected antimicrobial regimens with the combination of clindamycin and an aminoglycoside in the therapy for intraabdominal and female genital tract infections are reviewed. In the first trial, the rates of cure for patients with intraabdominal infections were 33 (79%) of 42 treated with clindamycin and gentamicin, 43 (81%) of 53 treated with chloramphenicol and gentamicin, and 35 (90%) of 39 treated with ticarcillin and gentamicin. The rates of cure for females with genital tract infections were 16 (94%) of 17, 11 (100%) of 11, and 12 (92%) of 13 treated with the three respective combinations. The rates of cure in the second study were 22 (88%) of 25 treated with metronidazole and gentamicin and 23 (88%) of 26 treated with clindamycin and gentamicin. In the third study, the rates of cure were 23 (82%) of 28 treated with cefoxitin and tobramycin as compared with 24 (89%) of 27 treated with clindamycin and tobramycin. In the fourth study, 21 (87%) of 24 patients treated with ceftizoxime alone are cured as compared with 13 (87%) of 15 treated with clindamycin and tobramycin. These prospective, randomized trials suggest that chloramphenicol and gentamicin, ticarcillin and gentamicin, metronidazole and gentamicin, cefoxitin and tobramycin, or ceftizoxime alone are as effective as clindamycin and gentamicin or tobramycin in therapy for mixed aerobic/anaerobic infections.

Chronic cystitis: a non-diagnosis.

Sequential clinical and bacteriological information is needed for all patients with recurrent urinary infections to determine if infections are recurring due to failure to eradicate organisms from the urine during therapy (persistence), failure to eradicate organisms from renal parenchyma (relapse), or re-entry of organisms into the urinary tract from the fecal perineal reservoir (reinfection). If properly applied, these diagnostic definitions facilitate appropriate management of women with recurring urinary infection. Treatment may include single dose therapy and longterm low dose prophylaxis.