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Biomedical subjects

B A Lipsky

Publications and source records attributed to B A Lipsky.

69 records · Page 4Linked to original sources
PubMed1984

Hemophilus influenzae as a cause of urinary tract infections in men.

Hemophilus influenzae has rarely been reported to cause urinary tract infections, but media supportive of its growth are not routinely used for urine cultures. At two Veterans Administration medical centers, H influenzae was isolated from the urine of eight men in the past four years. All had anatomic or functional genitourinary abnormalities, and half had had chronic pyelonephritis or recurrent urinary tract infections. Three patients had acute cystitis, two patients had pyelonephritis, two patients had prostatitis, and one patient had asymptomatic bacteriuria with pyuria. Cases were discovered by primary isolation on chocolate agar or sheep's blood agar, by "satelliting" around staphylococci, or by positive urine Gram's stains. Urine Gram's stains disclosed organisms in all six nonprostatitis cases. Organisms were all nonserotypable, were of biotypes 2, 3, or 4, and were beta-lactamase negative. Hemophilus influenzae may be a more common uropathogen in adults than previously recognized.

Adult↗
PubMed1983

"The best laid plans . . .": an evaluation of a patient education program.

Graphic instructions for the collection of clean-voided urine specimens were posted in outpatient clinic bathrooms. These signs were intended to supplant clinic staff verbal instructions and to improve patients' ability to perform this procedure correctly. To assess the impact of the signs, the contamination rates were determined for urine culture specimens for the 6-month periods immediately preceding and following their introduction. The contamination rate for 306 consecutive specimens submitted before the signs were hung (12 per cent) was significantly lower (p = 0.004) than for the 360 specimens submitted afterward (20.6 per cent). Further, the incidence of true bacteriuria was significantly higher before the signs were posted (21.8 per cent) than afterward (15.2 per cent) (p = 0.02). There was no reported change in the provision of verbal instructions by clinic personnel, and the signs provoked some negative reactions from patients and visitors. This unexpected adverse outcome of a well-intended patient education effort is reported so that others may profit from the authors' mistakes.

Evaluation Studies as Topic↗
PubMed1981

Pneumococcal vaccine in the United States. A critical analysis.

The capsular polysaccharide pneumococcal vaccine approved by the Food and Drug Administration in November 1977 has been recommended for persons older than 2 years believed to be at high risk for pneumococcal disease, including those aged 50 years and older, those with chronic systemic illnesses, and those living in certain institutions. A critical review of the available evidence shows little documentation of an increased incidence of, or mortality from, pneumococcal disease for many of these suggested categories. Moreover, except for children with sickle cell disease, there is no convincing evidence that the vaccine is effective for the chronically ill, and unpublished controlled studies have demonstrated no benefit for ambulatory, elderly, or institutionalized patients. Thus, there is currently no information to support widespread pneumococcal vaccination in this country, and further investigations are needed to determine in what situations this vaccine is worthwhile.

Age Factors↗
PubMed1981

Drug fever.

Most medications can cause fever, with or without concomitant clinical manifestations. The fever may arise from the drug's pharmacologic action, its effects on thermoregulation, a local complication following parenteral administration, or an idiosyncratic response. The most common mechanism is probably an immunologic reaction mediated by drug-induced antibodies. Drug fever may have any pattern; it typically occurs after seven to ten days of treatment and usually resolves within 48 hours of discontinuing the administration. Failure to diagnose drug fever may lead to inappropriate and potentially harmful diagnostic and therapeutic interventions. In suspected cases, it is necessary to discontinue administration of all potentially causative medicines, together or sequentially. Rechallenge with the offending agent will usually cause recurrence of fever within a few hours, confirming the diagnosis.

Body Temperature Regulation↗
PubMed1981

Suppurative granulomatous lymphadenitis caused by corynebacterium ovis (pseudotuberculosis).

A 30-year-old previously healthy man developed cervical adenopathy associated with mild constitutional symptoms. Corynebacterium ovis was isolated in pure culture from lymph node tissue on two separate occasions, and small gram positive organisms were identified in both lymph nodes with tissue gram stain. Histopathologically, the nodes displayed suppurative and necrotizing granulomas. Of eight previously reported cases of C. ovis lymphadenitis in man, all but one have involved inhabitants of rural Australia, most of whom had contact with sheep, an animal reservoir of C. ovis. Necrotizing granulomas were usually observed. The patient described was an American urban dweller with a history of raw milk ingestion. We believe this to be the first reported case of C. ovis lymphadenitis from the United States. C. ovis infection should be considered n the differential diagnosis of localized lymphadenitis with necrotizing and/or suppurative granulomas. In evaluation of granulomatous lymphadenitis tissue gram stain should be performed and culture of a diphtheroid organism not readily dismissed.

Adult↗
PubMed1978

Bacterial culture specimens. Categories, collection, and interpretation.

An approach to the collection and interpretation of bacterial cultures based on specimen category is presented. The sensitivity and specificity of cultures of material taken from deep closed body areas (category 1), deep communicating body areas (category 2), and superficial body surfaces (category 3) are considered.

Anaerobiosis↗
PubMed1975

Central nervous system disease in systemic lupus erythematosus. Therapy and prognosis.

The effect of corticosteroid therapy in 28 patients with 52 episodes of neuropyciatric disease in systemic lupus erythematosus (SLE) was elevated. Categories of organic central nervous system disease were seizures (eight patients), organic brain syndromes (nine patients), aseptic meningitis (four patients) and a variety of focal neurologic findings (seven patinets). Fourteen pateints had 15 episodes of functional psychosis without other evidence of neurologic disease. Although there was a general correlation between clinical and serologic evidnce of active SLE and the development of organic neurolgic disease, there was no evidence that therapy with very large doses of corticosteroids was beneficial. Of the deaths in this series, two were due to probable active SLE involving the central nervous system wheras five were attributable to complications of therapy. The long-term morbidity, likewise, was high in the patients who recieved large doses of corticosteroids. In all, 12 patients had major complications of corticosteroid therapy. Functional psychosis was usually preciptated by corticsoteroid therapy and respond to a reduction in steroid dosage and administration of psychotropic drugs.

Adolescent↗
PubMedDate not supplied

Principles and practice of antibiotic therapy of diabetic foot infections.

Foot infections are a common and serious problem in diabetic patients. They usually occur as a consequence of a skin ulceration, which initially is colonized with normal flora, and later infected with pathogens. Infection is defined clinically by evidence of inflammation, and appropriate cultures can determine the microbial etiology. Aerobic gram-positive cocci are the most important pathogens; in chronic, complex or previously treated wounds, gram-negative bacilli and anaerobes may join in a polymicrobial infection. In all diabetic foot infections a primary consideration is whether or not surgical intervention is required, e.g. for undrained pus, wound debridement or revascularization. Antibiotic regimens are usually selected empirically initially, then modified if needed based on results of culture and sensitivity tests and the patient's clinical response. Initial therapy, especially in serious infections, may need to be broad-spectrum, but definitive therapy can often be more targeted. Severe infections usually require intravenous therapy initially, but milder cases can be treated with oral agents. Treatment duration ranges from 1-2 weeks (for mild soft tissue infection) to more than 6 weeks (for osteomyelitis). The choice of a specific agent should be based on the usual microbiology of these infections, data from published clinical trials, the severity of the patient's infection, and the culture results. Extension of infection into underlying bone can be difficult to diagnose and may require imaging tests, e.g. magnetic resonance scans. Cure of osteomyelitis usually requires resection of infected bone, but can be accomplished with prolonged antibiotic therapy. Various non-antimicrobial adjunct therapies may sometimes be helpful. Published in 2000 by John Wiley & Sons, Ltd.

Anti-Bacterial Agents↗
PubMedDate not supplied

Four-year prospective evaluation of community-acquired bacteremia: epidemiology, microbiology, and patient outcome.

The objectives of this study were to (1) describe the epidemiology and microbiology of community-acquired bacteremia; (2) determine the crude mortality associated with such infections; and (3) identify independent predictors of mortality. All patients with clinically significant community-acquired bacteremia admitted to a university-affiliated Veterans Affairs medical center from January 1994 through December 1997 were evaluated. During the study period, 387 bacteremic episodes occurred in 334 patients. Staphylococcus aureus, Escherichia coli, and coagulase-negative staphylococci were the most commonly isolated organisms; the most frequent sources were the urinary tract and intravascular catheters. Approximately 14% of patients died. Patient characteristics independently associated with increased mortality included shock (OR 3.7, p = 0.02) and renal failure (OR 4.0, p = 0.003). The risk of death was also higher in those whose source was pneumonia (OR 6.3, p = 0.03) or an intra-abdominal site (OR 10.7, p = 0.02), or if multiple sources were identified (OR 13.4, p = 0.003). Community-acquired bacteremia is often device-related and may be preventable. Strategies that have been successful in preventing nosocomial device-related bacteremia should be adapted to the outpatient setting.

Adult↗
PubMedDate not supplied

Citrobacter infections in humans: experience at the Seattle Veterans Administration Medical Center and a review of the literature.

The genus Citrobacter is a distinct group of human pathogens comprising three species: Citrobacter freundii (biotypes a and b), Citrobacter amalonaticus, and Citrobacter diversus. In this review the clinical and microbiologic experience during 1972-1978 at the Seattle Veterans Administration Medical Center (Seattle, Wash.) with 298 isolates of Citrobacter is analyzed in relation to a survey of the literature. The most common sources of citrobacter isolates were urine, sputum, and soft tissue exudates. Members of this genus can cause neonatal meningitis and, perhaps, gastroenteritis in both children and adults. Although deep tissue infections due to Citrobacter have been reported only occasionally, in this study a large number of cultures of peritoneal fluid and bone contained Citrobacter. Most isolates of Citrobacter were from elderly, debilitated patients and either represented secondary infections or were of indeterminate clinical significance.

Adult↗
PubMedDate not supplied

Infections caused by nondiphtheria corynebacteria.

After decades of confusion about their microbiologic classification and clinical significance, the nondiphtheria corynebacteria have emerged as important pathogens. Although isolation of these organisms may represent contamination with skin flora, several species, including Corynebacterium ulcerans, Corynebacterium pseudotuberculosis (Corynebacterium ovis), Corynebacterium haemolyticum, Corynebacterium pseudodiptheriticum, Corynebacterium equi, Corynebacterium bovis, Corynebacterium xerosis, and corynebacteria of group JK, clearly cause disease in humans. Most of these organisms infect animals, which are the source of human infection with some species. Some nondiptheria species of Corynebacterium produce recognizable clinical syndromes such as granulomatous lymphadenitis, pneumonitis, pharyngitis, cutaneous infections, and, most commonly, endocarditis. Certain species infect healthy hosts, while others predominantly attack immunocompromised individuals. Several species produce toxins, including a diphtheria-like toxin, a dermonecrotic toxin, and a soluble hemolysin. A microbiologic scheme of identification of the genus Corynebacterium and its major defined species is presented.

Animals↗
PubMedDate not supplied

Factors affecting the clinical value of microscopy for acid-fast bacilli.

In order to assess the clinical value of microscopy for acid-fast bacilli (AFB), the results of 3,207 clinical specimens submitted for mycobacterial smear and culture were analyzed. Mycobacteria grew from 176 (5.5%) of the specimens, 95 (54%) of which were Mycobacterium tuberculosis. Although the overall sensitivity of the smear was low (33%), 65% of respiratory specimens yielding M. tuberculosis had positive AFB smears. Furthermore, 96% of patients with pulmonary tuberculosis from whom more than one specimen was processed had at least a single positive AFB smear. Smear sensitivity correlated well with quantitative growth; 89% of specimens yielding greater than or equal to 50 colonies per slant were smear positive. Specificity of the AFB smear was high; 89% of smear-positive specimens had positive cultures. After the results from culture-negative patients known to have active tuberculosis were eliminated from the analysis, the specificity of a positive smear rose to 98.3%. When the results of all specimens from each patient were considered in toto, the AFB smear had a predictive value of greater than or equal to 96%.

Aniline Compounds↗
PubMedDate not supplied

Factors affecting staphylococcal colonization among NIDDM outpatients.

Because colonization with Staphylococcus aureus probably predisposes to staphylococcal infections, we examined several factors that may be associated with staphylococcal carriage in outpatients with non-insulin-dependent diabetes mellitus and in nondiabetic controls. Nose and skin carrier rates for 59 diabetic patients were significantly greater (30.5%) than for 44 controls (11.4%) (P = .02), but rates did not differ significantly between diabetic patients who injected insulin (31.0%) and those who did not (30.0%). Among the diabetic patients, staphylococcal colonization was not significantly correlated (P greater than .05) with recent antibiotic treatment, age, race, or clinical duration of diabetes but was inversely correlated (P less than .03) with glycemic control, as measured by fasting plasma glucose and glycosylated hemoglobin levels. Hospitalization in the previous year was also associated with staphylococcal colonization, and it was significantly more common among the diabetic patients than the controls; however, this did not account for the increased colonization rates observed. Our results in a well-characterized population confirm an increased rate of staphylococcal colonization among diabetic as compared with nondiabetic outpatients but demonstrate that neither injections of insulin nor various pertinent demographic factors explain this finding.

Adolescent↗
PubMedDate not supplied

Comparative clinical reliability of fasting plasma glucose and glycosylated hemoglobin in non-insulin-dependent diabetes mellitus.

Because accurate determination of glycosylated hemoglobin (GHb) is difficult and relatively expensive in comparison with the modest cost and ready availability for tests of fasting plasma glucose (FPG), we examined the reliability of repeated measurements of FPG and GHb in typical diabetic outpatients taken in the usual clinical setting. We determined FPG and GHb concurrently on three separate occasions spanning 4 wk in 41 patients with non-insulin-dependent diabetes mellitus (NIDDM) and, for contrast, 5 with insulin-dependent diabetes mellitus (IDDM). Most of the NIDDM subjects were obese, with initial FPG levels ranging from 93 to 355 mg/dl. The reliability of each test was estimated by calculating two measures: the intraclass correlation coefficient (rho I) and the coefficient of variation (CV) for the repeated test values. For NIDDM patients treated with diet or oral hypoglycemic agents (OHA), rho I for FPG, log(FPG), and GHb were very similar. For insulin-treated NIDDM patients, rho I for FPG was somewhat lower than the coefficient in other treatment groups, and the reliability of FPG by this measure did not match the reliability of GHb within the limits of statistical significance. By analyzing the CV of test values repeated within subject, the reliability of FPG did not differ from GHb in any of the NIDDM treatment groups. Although patients were recruited sequentially to minimize sample selection bias, caution must be exercised in the interpretation of the statistical analyses of reliability with either rho I or CV due to limitations imposed by small sample size.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗