The diagnostic utility of bone marrow aspiration and biopsy in patients with acquired immunodeficiency syndrome.

Diagnostic bone marrow aspiration, biopsy, and culture are useful procedures in the evaluation of patients with suspected or proven acquired immunodeficiency syndrome (AIDS) who are febrile. In as many as one fourth of these patients, the information provided by the bone marrow examination may establish a diagnosis of a disseminated opportunistic infection when other studies are not informative. We have also discovered a previously unreported association between thrombocytopenia and the presence of bone marrow granulomas in our patients with AIDS and suggest that thrombocytopenia may be a clue to enable the clinician to predict a positive bone marrow result more accurately. The explanation for this apparent association remains to be elucidated.

Controlled, comparative study of ciprofloxacin versus ampicillin in treatment of bacterial respiratory tract infections.

The efficacy and safety of ciprofloxacin in bacterial bronchitis were compared with those of ampicillin in a double-blind, prospective clinical trial. Eighty-seven patients received either oral ciprofloxacin (750 mg twice daily) or oral ampicillin (500 mg four times daily). Ciprofloxacin was as effective as ampicillin and produced a 98 percent clinical cure rate. Significantly more pretreatment bacterial isolates were susceptible to ciprofloxacin (p less than 0.05), and ciprofloxacin had a significantly higher rate of sputum sterilization than did ampicillin (p less than 0.05). Ciprofloxacin showed broad in vitro antibacterial activity with particularly low minimal inhibitory concentrations for gram-negative organisms. Ciprofloxacin was well tolerated; there were few adverse effects, and patients had a significantly lower incidence of diarrhea with ciprofloxacin than with ampicillin (p less than 0.05). Ciprofloxacin was an effective and well-tolerated treatment for bacterial bronchitis that had the advantages of broad in vitro antibacterial activity and twice-daily dosing.

Soft tissue infections in parenteral drug abusers.

Thirty-four parenteral drug abusers admitted with soft tissue infections underwent bacteriologic and immunologic evaluation. Staphylococcus aureus and beta hemolytic streptococci were the most common organisms recovered. Enteric gram negative aerobes and oral flora were common and enteric anaerobes rare. Absolute lymphopenia and elevations in the IgA, IgG and IgM fractions of the immunoglobulins were common as were false positive VDRL examinations. Cutaneous anergy was found in 83% of the group and 70% of a simultaneously noninfected addict group. Staphylococcal carriage was frequent. Because of variation in the flora between this and other reported groups, ongoing bacteriologic surveillance could be a useful guide to initial antibiotic therapy. Differences in the pattern of immune reaction in this group when compared to different addict groups suggest a difference in antigenic stimulation, possibly as a result of differences in bacteriologic exposure.

Infections in parenteral drug abusers. Further immunologic studies.

In our previous study of soft tissue infections in parenteral drug abusers, two thirds of the infections were polymicrobial. Oral and enteric organisms were frequently recovered. These patients and a group of uninfected addicts showed frequent cutaneous anergy, lymphopenia, and hypergammaglobulinemia. An additional group of uninfected addicts was studied. The mean levels of IgA, IgG, and IgM were higher in the uninfected addicts. In the addict and control groups, elevations in IgA (17 percent of total), IgG (65 percent), and IgM (19 percent) levels were found. Zinc levels were within normal limits. T-cell populations below 70 percent were seen in five of the seven addicts and two of the four control subjects. Reversed helper to suppressor cell ratios were found in three of the seven addicts and control subjects. No consistent pattern of immunologic abnormalities emerged. The interrelationship of the abnormalities in the addict and their relationship to AIDS is unclear.

Use of the automicrobic and enteric-tek systems for identification of Enterobacteriaceae.

Studies were performed to evaluate the use of the Enteric-Tek (ET) and the AutoMicrobic system (AMS) for the identification of 201 Enterobacteriaceae freshly isolated from clinical specimens. All test systems were inoculated simultaneously from the same MacConkey agar plate. Organisms were also identified with conventional media. Identifications with the ET and AMS agreed with those made with conventional biochemicals 97% of the time. At a 95% confidence level, the ET was able to identify 75% of the isolates within 18 h without the aid of additional biochemical tests; the AMS identified 92% in 8 h. Technologist time needed for identifications made with the AMS was reduced approximately 57% compared with the ET. In all instances in which the AMS identification disagreed with the conventional, the ET identified the organism correctly. Similarly, organisms misidentified by the ET were correctly identified by the AMS. The data suggest that the AMS and ET identify clinical isolates with comparable accuracy; however, the AMS offers a significant savings in time.

Influence of acute exposure to cigarette smoke on the alveolar macrophage system.

The influence of cigarette smoke on the numbers and viability of alveolar macrophages in the lungs of mice was determined by utilizing techniques for quantitating lung deposition of bacteria and alveolar macrophage harvest. Alveolar macrophages were obtained by pulmonary lavage. The studies were performed under basal conditions, after the inhalation of cigarette smoke and after exposure to bacterial aerosols and cigarette smoke in sequence. Macrophage yields were increased 1.1, 1.2, and 1.5 times basal levels by exposure to cigarette smoke alone for 1, 2, and 4 hours, repectively. The inhalation of Staphylococcus aureus for 30 minutes induced a 2.4-fold increase in macrophage numbers. Within 15 minutes after bacterial deposition, macrophage yields dropped 33 percent, but elevated levels were restored at 30 minutes and then maintained for the remainder of the 4 hour test period. Cigarette smoke introduced immediately after bacterial challenge and maintained for up to 4 hours did not alter the macrophage response provoked by pulmonary deposition of staphylococci. In addition, smoke inhalation had no effect on the cellular characteristics of lung harvests and the viability of alveolar macrophages. These data demonstrate that cigarette smoke provoked an increase in alveolar macrophage numbers and did not have a deleterious effect on the mobilization of alveolar macrophages; namely, the maintenance of a macrophage response in relation to an airborne bacterial challenge.

Primary pulmonary sporotrichosis complicated by perirectal abscess.

A 48-year old, retired mounted policeman was followed for 4 years through 4 hospitalizations for progression of his bilateral, cavitary lung disease. His sputum was always negative for acid-fast bacilli and fungi. Subsequently, a painful perianal swelling appeared that was incised and drained of purulent material. Five years after first seen, sputum and rectal drainage revealed Sporothrichum schenckii in many cultures. Serologic evidence of sporotrichosis was also present. With amphotericin B therapy, the patient showed marked clinical improvement. Unfortunately, he died from an episode of acute respiratory failure. Although most patients with primary cutaneous or primary pulmonary sporotrichosis are horticulturists, the writers believe that this disease should be considered in any undiagnosed, chronic, cavitary lung disease, even in the absence of this occupational history.