ABSTRACT
Cocaine, used intravenously, increases the risk of infections, but its effects on neutrophil phagocytosis have not been examined in vitro. Human neutrophils were suspended in cocaine hydrochloride 0, 1, 10, 50, 100 or 200 microg/ml in Hank's balanced salt solution to which was added a phagocytic meal of killed Saccharomyces cerevisiae stained with the pH indicator dye bromcresol purple. Yeast per phagocytosing neutrophil and the percent neutrophils phagocytosing yeast were reduced in neutrophils treated with cocaine 100 and 200 microg/ml (P < 0.05). When examined for percent of yeast phagocytosed after 10 minutes, neutrophils treated with cocaine 1-200 microg/ml demonstrated a decrease (P < 0.05). However, at 60 minutes only neutrophils treated with cocaine 50 and 100 microg/ml still showed a decrease in percent of yeast phagocytosed. Phagolysosomal acidification was impaired in neutrophils treated with 50, 100 and 200 microg/ml cocaine. Thus, cocaine inhibits neutrophil phagocytosis and phagolysosomal acidification in vitro, offering a reason for cocaine users/abusers to have impaired host defense and to be potentially at higher risk for infections.
Subject(s)
Cocaine/toxicity , Neutrophils/drug effects , Neutrophils/physiology , Phagocytosis/drug effects , Phagosomes/drug effects , Phagosomes/metabolism , Cocaine/administration & dosage , Cocaine-Related Disorders/immunology , Dose-Response Relationship, Drug , Humans , Hydrogen-Ion Concentration , Immune Tolerance/drug effects , In Vitro Techniques , Neutrophils/immunology , Saccharomyces cerevisiae/immunologyABSTRACT
BACKGROUND: Metabolic acidosis from accumulation of lactic acid is a relatively common condition, whereas its causation by thiamine deficiency is not. METHODS: We studied a pregnant alcoholic patient who presented with hyperemesis and a high anion gap acidosis. RESULTS: Lactic acidosis and thiamine deficiency were confirmed. The patient's symptoms and acidosis resolved with thiamine administration. CONCLUSIONS: Lactic acidosis caused by thiamine deficiency must be suspected when pregnant patients at risk for thiamine deficiency present with a high anion gap acidosis. A large dose of thiamine must be administered immediately.
Subject(s)
Acidosis, Lactic/etiology , Alcoholism/complications , Pregnancy Complications/blood , Thiamine Deficiency/complications , Acidosis, Lactic/blood , Acidosis, Lactic/diagnosis , Adult , Alcoholism/blood , Diagnosis, Differential , Female , Humans , Pregnancy , Thiamine/therapeutic use , Thiamine Deficiency/blood , Thiamine Deficiency/diagnosis , Thiamine Deficiency/etiologyABSTRACT
BACKGROUND: Doxycycline has a high degree of activity against many common respiratory pathogens and has been used in the outpatient management of lower respiratory tract infections, including pneumonia. OBJECTIVE: To evaluate the efficacy of intravenous doxycycline as empirical treatment in hospitalized patients with mild to moderately severe community-acquired pneumonia. PATIENTS AND METHODS: We conducted a randomized prospective trial to compare the efficacy of intravenous doxycycline with other routinely used antibiotic regimens in 87 patients admitted with the diagnosis of community-acquired pneumonia. Forty-three patients were randomized to receive 100 mg of doxycycline intravenously every 12 hours while 44 patients received other antibiotic(s) (control group). The 2 patient groups were comparable in their clinical and laboratory profiles. RESULTS: The mean+/-SD interval between starting an antibiotic and the clinical response was 2.21+/-2.61 days in the doxycycline group compared with 3.84+/-6.39 days in the control group (P = .001). The mean+/-SD length of hospitalization was 4.14+/-3.08 days in the doxycycline group compared with 6.14+/-6.65 days in the control group (P = .04). The median cost of hospitalization was $5126 in the doxycycline group compared with $6528 in the control group (P = .04). The median cost of antibiotic therapy in the doxycycline-treated patients ($33) was significantly lower than in the control group ($170.90) (P<.001). Doxycycline was as efficacious as the other regimens chosen for the treatment of community-acquired pneumonia. CONCLUSION: Doxycycline is an effective and inexpensive therapy for the empirical treatment of hospitalized patients with mild to moderately severe community-acquired pneumonia.
Subject(s)
Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/drug therapy , Doxycycline/economics , Doxycycline/therapeutic use , Pneumonia/drug therapy , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Community-Acquired Infections/economics , Community-Acquired Infections/microbiology , Doxycycline/administration & dosage , Female , Hospitalization , Humans , Infusions, Intravenous , Male , Middle Aged , Pneumonia/economics , Pneumonia/microbiology , Severity of Illness Index , Treatment OutcomeABSTRACT
Nocardial spinal cord abscesses are extremely rare. Only three have been reported, one each from Austria, Thailand, and the United States. All three patients also had extraneurologic nocardiosis. We present the first case of an intramedullary abscess caused by Nocardia asteroides and without concomitant extraneurologic nocardiosis. It is also the first such abscess in a living human being to be diagnosed by both magnetic resonance imaging and tissue culture. Resolution was complete after treatment.
