Rapid-onset reversible ocular toxicity from ethambutol therapy.
Explore the source record for details and available documents.
Cytomegalovirus Infections↗
Biomedical subjects
B C Fox
Publications and source records attributed to B C Fox.
A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora, and the cost-benefit of prophylaxis.
PURPOSE: To determine the efficacy of long-term prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) for prevention of bacterial infection following renal transplantation, the absorption of TMP-SMZ in transplant patients, the effects of prophylaxis on the microflora, and the cost-benefit of prophylaxis. PATIENTS AND METHODS: One hundred thirty-two adult patients selected to undergo renal transplantation participated in a randomized, double-blind, placebo-controlled trial. RESULTS: Patients randomized to receive TMP-SMZ experienced fewer hospital days with fever (3.3% versus 7.7%, p less than 0.001) and significantly fewer bacterial infections during the transplant hospitalization after removal of a urethral catheter (0.76 versus 1.88 per 100 days, p less than 0.005) and following discharge from the hospital (0.08 versus 0.30 per 100 days, p less than 0.001). During the transplant hospitalization, a daily dose of 320/1,600 mg was highly effective for prophylaxis whereas 160/800 mg daily gave unexpectedly low blood levels and was effective only for prevention of urinary tract infections after catheter removal. Prophylaxis was most effective in prevention of infections of the urinary tract (24 versus 54, p less than 0.005) and bloodstream (one versus nine, p less than 0.01) and infections caused by enteric gram-negative bacilli (four versus 46, p less than 0.001), enterococci (six versus 22, p = 0.006), or Staphylococcus aureus (one versus nine, p = 0.01). Prophylaxis did not prevent urinary tract infection associated with urethral catheters in the early posttransplant period, but after catheter removal, reduced the risk of urinary tract infection threefold (p less than 0.001). No significant differences in colonization by TMP-SMZ-resistant gram-negative bacilli were identified between the two groups; patients given TMP-SMZ were, paradoxically, less likely to become colonized by candida, probably because of less exposure to antibiotics for treatment of infection. Recipients of prophylaxis did not have a higher rate of infection caused by TMP-SMZ-resistant bacteria or Candida; however, their infections were more likely to be caused by resistant bacteria than infections in patients in the placebo group (62% versus 18%, p less than 0.001). CONCLUSIONS: Prophylaxis with TMP-SMZ, which is well tolerated, significantly reduces the incidence of bacterial infection following renal transplantation, especially infection of the urinary tract and bloodstream, can provide protection against Pneumocystis carinii pneumonia, and is cost-beneficial. Subnormal absorption of TMP-SMZ in the early posttransplant period mandates 320/1,600 mg daily for optimal benefit. Prophylaxis has little discernible effect on the microflora.
Absorption↗
Heavy contamination of operating room air by Penicillium species: identification of the source and attempts at decontamination.
Increased rates of nosocomial infection caused by filamentous fungi in immunocompromised patients prompted microbiologic surveillance of the central air handling systems in our hospital. During a 4-year period, Penicillium species were isolated from 47 patients, including two with surgical wound infections caused by Penicillium. Counts of Penicillium in operating room air were much higher (195 colony-forming units [CFU]/m3) than in 95% filtered corridor air (14.6 CFU/m3; p less than 0.01). Ventilation ducts and terminal units lined with fiberglass in the operating room air handling system were heavily contaminated by Penicillium; the fiberglass was also contaminated with Aspergillus species. Corrective measures included filter replacement and decontamination of the ventilation system with aerosolized chlorine solution. Although operating room air remained free of filamentous fungi during the next 7 months, contamination eventually recurred and required repeated decontamination. We believe that certification guidelines are highly desirable for hospital ventilation systems, especially if the system serves immunocompromised patients.
Air Microbiology↗
Mycobacterial disease associated with aplastic anaemia.
Haematological changes associated with infectious disease are relatively common but true aplastic anaemia secondary to infection is rare. We describe a patient wit disseminated Mycobacterium avium-intracellulare infection and who had a histologically proven remission of his aplastic anemia accompanying antimycobacterial therapy. We also review the literature on the haematological changes associated with mycobacterial infections and other infectious causes of aplastic anaemia.
Aged↗
The use of a DNA probe for epidemiological studies of candidiasis in immunocompromised hosts.
Reproducible typing procedures to differentiate isolates of Candida albicans are limited. C. albicans isolates were obtained from immunocompromised patients by using DNA restriction enzyme fragment analysis and hybridization with both a radiolabeled mitochondrial DNA probe and a nonradioactive (biotinylated) DNA probe. There were 110 pathogenic and nonpathogenic C. albicans isolates from 63 immunocompromised patients. EcoRI restriction fragment analysis with the biotinylated probe revealed different "fingerprint" patterns for 60 of 63 patients. Analysis of 57 isolates from 20 patients showed no intrapatient variation regardless of the isolation site. DNA probe "fingerprint" patterns were analyzed for eight patients on serially recovered (range, 2-18 mo) C. albicans isolates. The unique patient profiles persisted over time. The application of this biotinylated C. albicans DNA probe provides a more sensitive means than simple gel restriction fragment analysis to define the epidemiology of C. albicans infection. The use of this biotin-labeled nonradioactive probe has potential application in clinical evaluations of outbreaks of nosocomial candidiasis.
Biotin↗
Increased infections associated with the use of OKT3 for treatment of steroid-resistant rejection in renal transplantation.
We compared the infections encountered in 23 renal transplant patients given the monoclonal anti-T-cell antibody, Orthoclone OKT3 (OKT3), for treatment of steroid-resistant rejection in 1986 and in 23 control patients from 1984 to 1985 with resistant rejection matched demographically, for severity of rejection and for risk factors predisposing to infection, who did not receive OKT3; recipients of OKT3 received substantially less prednisone, cyclosporine, and antilymphocyte globulin (ALG) than control patients for treatment of the rejection episode. Fourteen (61%) patients given OKT3 developed one or more infections in the 3-month period following treatment as compared with 9 control patients (39%) given conventional antirejection therapy with high-dose steroids and, usually, ALG. Patients given OKT3 were significantly more likely to develop serious infections (pneumonia, bacteremia, meningitis, or severe viral infection; 16 episodes vs. 4, P = .02). Six recipients of OKT3 (26%) acquired infections typically encountered in states associated with depressed cell-mediated immunity (CMI)--Listeria sepsis (2), disseminated nocardiosis and Mycobacterium tuberculosis infection (1), cytomegalovirus (CMV) pneumonia (1), Yersinia infection with severe dermatophytosis (1), and Epstein-Barr virus-associated lymphoproliferative syndrome (1)--as compared with 1 case of mild CMV infection in the control group (P = .08). Trimethoprim-sulfamethoxazole (TMP-SMZ) was given to 19 patients in each group; all 4 recipients of OKT3 who did not receive TMP-SMZ prophylaxis developed life-threatening infection, 3, bacteremia (2 with Listeria) and 1, disseminated nocardiosis and M tuberculosis infection. These data suggest that OKT3 given for treatment of resistant rejection in renal transplantation predisposes the patient to serious infection, particularly with opportunistic pathogens characteristically associated with depressed cell-mediated immunity. Prophylaxis with TMP-SMZ, which is safe, well tolerated, and effective for reducing the incidence of infection in renal transplantation, may be especially important during OKT3 therapy.
Anti-Bacterial Agents↗