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Biomedical subjects

A A Harris

Publications and source records attributed to A A Harris.

At least 19 recordsLinked to original sources
PubMed1996

Acute bacterial meningitis.

Despite improvements in antibiotic therapy and the use of vaccines and chemoprophylaxis, acute bacterial meningitis remains a significant cause of morbidity and mortality in the United States. Early diagnosis and therapy are important once the condition has been considered and the appropriate available specimens collected. Changes in epidemiologic frequencies and antimicrobial susceptibilities suggest that therapy will become more uniform across all age groups. Rapid, specific diagnostic modalities for all etiologic agents and improved vaccines for Neisseria meningitidis type B and Streptococcus pneumoniae are urgently needed.

Acute Disease↗
PubMed1994

Prosthetic valve endocarditis: superiority of surgical valve replacement versus medical therapy only.

The objective of our study was to assess the long-term outcome of patients with prosthetic valve endocarditis. We used a multicenter, prospective, observational study design. Six university teaching hospitals with high volume cardiothoracic surgery participated. Seventy-four patients with prosthetic valve endocarditis as defined by explicit, objective criteria were selected for participation. All patients were followed up prospectively for 1 year. Thirty-one percent and 69% had development of endocarditis within 60 days of valve insertion ("early") and after 60 days ("late"), respectively. The most common causes were Staphylococcus epidermidis (40%), Staphylococcus aureus (20%), streptococcal species (18%), and aerobic gram-negative bacilli (11%). Physical signs of endocarditis (new or changing murmur, stigmata, emboli) were seen in 58%. At 6 months and 12 months, mortality was 46% and 47%, respectively. Surgical replacement of the infected valve led to significantly lower mortality (23%) as compared with medical therapy alone (56%), as assessed by both univariate and multivariate analyses (p < 0.05). Improved outcome was seen for the surgical group even when controlling for severity of illness at time of diagnosis. From these findings we conclude that accurate assessment of outcome in prosthetic valve endocarditis requires long-term follow-up of at least 6 months following diagnosis. Surgical therapy warrants greater scrutiny; evaluation in controlled clinical trials is appropriate.

Adult↗
PubMed1994

Magnetic resonance imaging in evaluation of a second-trimester ovarian twin pregnancy.

BACKGROUND: Ovarian pregnancy presents with abdominal pain and menstrual irregularities, and usually results in hemorrhage and hemoperitoneum in the first trimester. We describe the first case of a twin ovarian pregnancy diagnosed in the second trimester. Magnetic resonance imaging (MRI) was used in the preoperative evaluation of this patient. CASE: A woman presented at 19 weeks' gestation with abdominal pain and irregular bleeding. Her hemoglobin level was 5.9 g/dL, as compared to 10.8 g/dL in early pregnancy. Ultrasound showed a twin gestation with a mass anterior to the pregnancy, thought to be a placenta percreta or a hemorrhagic leiomyoma. An MRI was suspicious for an extrauterine pregnancy, showing the uterus displaced anteriorly by the pregnancy mass. Laparotomy revealed a hemoperitoneum and right twin ovarian pregnancy. A right salpingo-oophorectomy was performed. Pathology confirmed the diagnosis. CONCLUSION: Although ultrasound is the primary technique of imaging the pelvis during pregnancy, MRI should be considered when the ultrasound findings are limited or confusing.

Adult↗
PubMed1993

Prosthetic valve endocarditis resulting from nosocomial bacteremia. A prospective, multicenter study.

OBJECTIVE: To determine the incidence of endocarditis in bacteremic patients with prosthetic heart valves and the risk factors for and the effect of duration of antibiotic therapy on development of endocarditis in such patients. DESIGN: Multicenter, prospective observational study. SETTING: Six university teaching hospitals with high-volume cardiothoracic surgery. PARTICIPANTS: One hundred seventy-one consecutive patients with prosthetic heart valves who developed bacteremia during hospitalization. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated when they were identified as having bacteremia and 1, 2, 6, and 12 months after its occurrence. Of 171 patients, 74 (43%) developed endocarditis: Fifty-six (33%) had prosthetic valve endocarditis at the time bacteremia was discovered ("endocarditis at outset"), whereas 18 (11%) developed endocarditis a mean of 45 days after bacteremia was discovered ("new endocarditis"). Mitral valve location and staphylococcal bacteremia (Staphylococcus aureus or S. epidermidis) were significantly associated with the development of "new" endocarditis. All 18 cases of new endocarditis were nosocomial, and in 6 of these cases (33%) bacteremia was acquired via intravascular devices. Twenty-one patients without evidence of endocarditis at the time of bacteremia received short-term antibiotic therapy (< 14 days); 1 patient (5%) developed endocarditis. Eleven of 70 patients (16%) who received long-term antibiotic therapy (> 14 days) developed endocarditis (P > 0.2). CONCLUSIONS: Bacteremic patients with prosthetic heart valves were at notable risk for developing endocarditis, even when they received antibiotic therapy before endocarditis developed and regardless of the duration of such therapy. Intravascular devices were a common portal of entry.

Adult↗
PubMed1993

Evaluation of an outbreak of foodborne illness initiated in the emergency department.

STUDY OBJECTIVES: For many foodborne outbreaks, the pathogen and food vehicle never are identified. Delayed collection of epidemiologic and microbiologic information may contribute to this. We postulated that collection of this information from ill persons as they presented to the emergency department during a recent outbreak might contribute to earlier identification of the pathogen and vehicle. DESIGN: At least 690 of 1,900 conventioneers developed gastrointestinal symptoms after attending a banquet. A questionnaire was developed to collect information on specific food histories, incubation periods, symptoms, physical findings, and demographics. These results were compared with results of investigations by the city and state departments of public health. SETTING: The ED of Rush-Presbyterian-St Luke's Medical Center, a tertiary care university hospital in Chicago, Illinois. TYPE OF PARTICIPANTS: Adults (24 men and nine women) presenting to the ED with gastrointestinal symptoms after eating a common meal. MEASUREMENTS AND MAIN RESULTS: The clinical syndrome suggested an invasive pathogen. Based on this, clinical microbiology laboratory procedures were modified (isolation plates were reviewed during the evening shift). This led to early identification of the first isolates (Salmonella enteritidis) from the outbreak. The questionnaire also narrowed the vehicle to one of two foods served. Investigations by the departments of public health subsequently identified one of these, bread pudding with a raw egg based-sauce, as the vehicle. CONCLUSION: Outbreak evaluations can begin in the ED or any other patient care facility. This evaluation need not always add significantly to the expenditure of time, manpower, or laboratory studies. The evaluation of even a small percentage of ill persons from a large outbreak may provide useful epidemiologic information and be particularly important in settings with limited public health resources.

Adult↗
PubMed1991

Prevalence of measles antibodies in asymptomatic human immunodeficiency virus-infected adults.

One hundred five asymptomatic human immunodeficiency virus-seropositive adults were screened for measles antibody. Ages ranged from 21 to 59 years (mean, 35.7). CD4+ lymphocyte counts (range, 76-1137/mm3), percentage of CD4+ cells (6-42), CD4:CD8 ratio (0.08-1.3), measles antibody titers by EIA, and undocumented history of prior measles or immunization were obtained. Forty-six patients gave a history of measles but no immunization, 18 of immunization but no measles, 26 of immunization and measles, and 15 of neither measles nor vaccination. Only one patient (less than 1%) lacked levels of antibody considered protective. Neither the presence nor the level of antibody were predictable from patient age, history of measles or immunization, CD4+ lymphocyte count, percentage of CD4+ cells, or CD4:CD8 ratio. Nearly all subjects had antibody to measles, regardless of immunization or measles history. Whether these antibodies are truly protective is unknown.

Adult↗
PubMed1991

Pseudomembranous tracheobronchitis caused by Aspergillus.

Four immunosuppressed patients with a rapidly evolving, febrile, respiratory distress syndrome were found at autopsy to have Aspergillus pseudomembranes of their lower tracheobronchial tree. Steroids, neutropenia, broad spectrum antibiotic use, and alcoholism appear to be predisposing risk factors. Bronchoscopy may reveal the pathology but antemortem diagnosis is difficult because of the low yield of sputum cultures and fulminant nature of the disease.

Adult↗
PubMed1991

Vaccine choice and program participation rates when two hepatitis B vaccines are offered.

Participation rates of health care workers in voluntary free hepatitis B virus immunization programs are 35% to 40%. University teaching hospital employees at risk for hepatitis B virus and presenting for immunization were surveyed as to vaccine preference. Both plasma-derived and recombinant hepatitis B virus vaccines were available. During a 10-month period, 173 health care workers enrolled in the study. One hundred seventeen received recombinant vaccine, and 56 received plasma-derived vaccine; 66 were immunized postexposure. Concern of a relationship of human immunodeficiency virus to hepatitis B virus plasma-derived vaccine was acknowledged by a small number of health care workers as important in vaccine selection. Recombinant hepatitis B virus vaccine rapidly and substantially supplanted plasma-derived vaccine but did not increase program participation. We suspect that mandatory immunization or proof of immunity will be necessary if hepatitis B virus protection rates in health care workers are to improve.

Hepatitis B↗
PubMed1990

In vitro activity of tosufloxacin (A-61827; T-3262) against selected genital pathogens.

The in vitro activity of tosufloxacin (A-61827; T-3262) against 15 clinical isolates of Chlamydia trachomatis and 31 recent clinical isolates of Neisseria gonorrhoeae, including 15 spectinomycin-resistant N. gonorrhoeae and 16 penicillinase-producing N. gonorrhoeae, was determined. Tosufloxacin was compared with doxycycline, ciprofloxacin, and temafloxacin against C. trachomatis. Susceptibility testing was performed by using McCoy cell monolayers. The in vitro activity of tosufloxacin against N. gonorrhoeae was compared with that of ciprofloxacin, temafloxacin, doxycycline, ceftriaxone, and spectinomycin by using an agar dilution method. Tosufloxacin was as active as temafloxacin against C. trachomatis (MIC for 90% of strains tested [MIC90], 0.25 microgram/ml; MBC for 90% of strains tested [MBC90], 0.25 microgram/ml) and was almost as active as doxycycline (MIC90, 0.06 microgram/ml; MBC90, 0.125 microgram/ml). Ciprofloxacin, temafloxacin, and tosufloxacin were extremely active against N. gonorrhoeae, including spectinomycin-resistant N. gonorrhoeae and penicillinase-producing N. gonorrhoeae, with MIC90s of 0.004, 0.015, and 0.008 microgram/ml, respectively. Ceftriaxone was slightly less active (MIC90, 0.03 microgram/ml), and doxycycline was the least active drug tested (MIC90, 4.0 micrograms/ml). Tosufloxacin and temafloxacin had excellent activity against the C. trachomatis and N. gonorrhoeae strains tested.

4-Quinolones↗
PubMed1987

A pseudoepidemic due to atypical mycobacteria in a hospital water supply.

We describe a pseudoepidemic due to atypical mycobacteria contaminating the water used by a pathology laboratory and bronchoscopy suite on two floors of the same hospital building. Inspection of laboratory procedures revealed that contamination occurred during specimen processing in pathology and while obtaining the bronchoscopic specimens. Mycobacterium gordonae, Mycobacterium avium complex, and Mycobacterium scrofulaceum were identified. During an eight-month period, a total of 22 (31%) of 70 patients with positive acid-fast smears had either an illness inconsistent with tuberculosis or a known alternate diagnosis. Control was easily obtained by insertion of a 0.2-micron polymer filter into the outflow tubing of our pathology tap water-deionizing unit and the tap water source in the bronchoscopy suite. The pseudoepidemic led to additional diagnostic-therapeutic intervention, but no patient experienced delay in appropriate diagnosis. Pseudoepidemics due to atypical mycobacteria will likely be of increased importance in institutions providing care to patients with acquired immunodeficiency syndrome.

Disease Outbreaks↗
PubMed1987

Nosocomial Legionnaires' disease.

Members of the family Legionellaceae have emerged as important nosocomial pathogens. Bronchopneumonia is the typical illness and mimics other nosocomial pneumonias. On rare occasion, surgical wound infections may be due to legionellae. Legionella pneumophila is the species causing most human illness, but other species may predominate in individual institutions. Pneumonia is acquired by inhalation of environmental aerosols from water sources contaminated by Legionella sp. In the hospital setting contaminated water sources include potable water, heat-exchange systems, and cooling towers. Water temperature control and maintenance programs may prevent colonization of water systems. Should clinical cases and water colonization occur, aggressive suppression/eradication programs--by chlorination or heat/flush--must be instituted. Surveillance of pneumonias in high-risk patient groups is essential for early detection of a nosocomial outbreak. There has been no evidence of person-to-person transmission. Familiarity with diagnostic techniques and their pitfalls will permit institution of effective antimicrobial therapy.

Cross Infection↗
PubMed1986

Acute neurologic infections.

This article discusses acute bacterial, viral, toxin-mediated, and parasitic neurologic infections, emphasizing those infections that are potentially treatable, are rapidly fatal if untreated, or pose a significant risk of person-to-person transmission.

Bacterial Infections↗
PubMed1986

Haemophilus influenzae meningitis in the presence of a cerebrospinal fluid shunt.

Haemophilus influenzae meningitis in the presence of a cerebrospinal fluid shunt has been reported uncommonly. Staphylococcus aureus and Staphylococcus epidermidis, the most common etiological agents, are usually acquired by contiguous spread from an intraoperative or perioperative source. These infections usually occur within 2 months of shunt insertion and are rarely associated with bacteremia. Review of the literature shows that infection with H. influenzae typically occurs later than with the more common pathogens, is commonly associated with bacteremia, and frequently can be treated with antibiotics alone.

Adolescent↗