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C C Kibbler

Publications and source records attributed to C C Kibbler.

At least 55 records · Page 3Linked to original sources
PubMed1997

Disseminated infection due to Cylindrocarpon lichenicola in a patient with acute myeloid leukaemia.

We describe what is to our knowledge the first reported case of disseminated infection due to Cylindrocarpon. The presumed source was athlete's foot, a condition with which this fungus has previously been associated. Diagnosis was made by needle aspiration of a cutaneous lesion. Radiographic evidence of pulmonary involvement was present. The infection resolved following marrow regeneration and treatment with amphotericin B. Correct identification of Cylindrocarpon may be useful in guiding antifungal therapy.

Aged↗
PubMed1997

Empirical antifungal therapy in febrile neutropenic patients: current status.

Empirical antifungal therapy has become established as standard practice in hematology and oncology units over the past decade and its use is increasing. A number of agents have been evaluated and intravenous amphotericin B has emerged as the drug of choice. Evidence of its benefit is limited and only clearly demonstrated in patients not receiving prior antifungal prophylaxis. However, although there have been improvements in the diagnosis of invasive fungal infections, it has been well shown that many patients who die during periods of neutropenia succumb to undiagnosed fungal infection, and also, if treatment is to be effective, it should be started as soon as possible after the onset of infection. Better targeting of antifungal prophylaxis (or preemptive therapy) and empirical therapy may now be possible and standard empirical therapy needs to be reevaluated in the light of changes in the underlying immune status of neutropenic patients and the development of new antifungal agents for prophylaxis and treatment.

Antifungal Agents↗
PubMed1996

Fungal infections: a survey of laboratory services for diagnosis and treatment.

A questionnaire on the services provided and the methods used for the diagnosis of fungal infections and for the support of antifungal chemotherapy was sent to members of the British Society for Medical Mycology (BSMM) and the British Society for Antimicrobial Chemotherapy (BSAC). Ninety-five responses from general microbiology laboratories in the United Kingdom were analysed, and we compared services provided by laboratories that serve a transplant unit with those offered by other laboratories. We estimate that about 150 cases of cryptococcosis, 500 to 600 of candidaemia, and 300 to 400 of invasive aspergillosis are identified by laboratories in the United Kingdom (UK) each year. The clinical laboratories are aware of the importance of fungal infection, but rely heavily on reference services. In some laboratories, however, the degree of investigation of specimens and the procedures in use are inadequate for diagnosing systemic mycoses and determining the susceptibility of isolates to antifungal agents. The balance between reference and local services requires attention and external quality assurance needs to be applied effectively. In addition, effective methods for the diagnosis of systemic mycoses, and reliable and practicable methods for determining the susceptibility of isolates to antifungal agents, are needed urgently.

Antifungal Agents↗
PubMed1996

Chaetomium pneumonia in patient with acute myeloid leukaemia.

A patient with relapsed refractory acute myeloid leukaemia developed typical fungal lung lesions despite intravenous amphotericin B prophylaxis. Chaetomium globosum was cultured from the resected right lower lobe. Histology showed branching hyphae negative for common Aspergillus species by immunohistochemical staining. Previous reports of invasive disease caused by Chaetomium and some applications of immunohistochemical staining for Aspergillus are discussed.

Adult↗
PubMed1995

Infections in liver transplantation: risk factors and strategies for prevention.

Infection affects up to 70% of liver transplant recipients and is the second most common complication after rejection and graft dysfunction. Identified risk factors for infection include: previous transplantation; type of biliary anastomosis; transfusion requirements at surgery; surgical complications; duration of operation; duration of postoperative ventilation; serological status of donor and recipient; steroid use and serotherapy for rejection; and pre- and post-transplant antibiotic usage. The majority of symptomatic infections are bacterial and relate to surgery (intra-abdominal, biliary and wound infections), ventilation and intravenous cannulae. Cytomegalovirus infections occur in 45-100% of recipients but are asymptomatic in the majority. Fungal infections are mostly due to Candida albicans but infections due to Aspergillus spp. occur in approximately 6% and carry a high mortality. There are very few prospective comparative trials of antimicrobial prophylaxis in this patient population. The management of these patients needs to be based on such studies.

Anti-Bacterial Agents↗
PubMed1995

Meningitis due to oral streptococci following percutaneous glycerol rhizotomy of the trigeminal ganglion.

Percutaneous rhizotomy of the trigeminal ganglion is an established technique in the management of trigeminal neuralgia. Meningitis has been reported as a complication of radiofrequency rhizotomy. We report two cases in which percutaneous glycerol injection of the trigeminal ganglion was followed by meningitis due to oral streptococci. While initial laboratory features might be considered consistent with meningitis due to Streptococcus pneumoniae, optimal therapy is likely to differ as a consequence of current antimicrobial susceptibility patterns.

Glycerol↗
PubMed1995

Neutropenic infections: strategies for empirical therapy.

There remains a consensus for early empirical therapy in febrile neutropenic patients. Many trials over the past decade have demonstrated the efficacy of broad spectrum, single agent therapy. With the shift in bacteria causing infections from Gram-negative to Gram-positive in these patients, the provision of specific therapy for these latter organisms has been examined in a variety of studies with differing results. The strategy of giving empirical amphotericin B to patients with persistent fever has become established over the past 10 years, but there is concern that this is no longer valid in many patients receiving systemic prophylaxis with azole antifungal agents. This review examines the various strategies for therapy and choice of agents and makes recommendations for initial therapy and modification.

Anti-Bacterial Agents↗
PubMed1994

A nosocomial outbreak due to non-encapsulated Haemophilus influenzae: analysis of plasmids coding for antibiotic resistance.

An outbreak of infections with non-encapsulated Haemophilus influenzae, resistant to ampicillin, chloramphenicol, sulphonamide and tetracycline involved 13 elderly patients and three nurses on acute admission and care of the elderly wards. Thirty-two isolates were found to be indistinguishable on analysis of biotype, antibiogram, serotype and major outer membrane proteins (MOMP). Plasmids could not be identified in the original isolates but after mating with a Rec A H. influenzae recipient, the resultant transconjugates were found to harbour either a 72 kilobase pair (kB) plasmid coding for resistance to chloramphenicol, ampicillin, sulphonamide and tetracycline or a 65 kB plasmid coding for resistance to chloramphenicol, ampicillin and sulphonamide. Both plasmids yielded virtually indistinguishable restriction digest patterns. This suggests that the tetracycline resistance gene (Tc gene) is a non-essential component of one basic plasmid responsible for the multiple antibiotic resistances seen in the strains recovered during the outbreak. This illustrates the value of plasmid profiles to compare strains of non-encapsulated H. influenzae, and suggests that plasmid restriction enzyme analysis is critical.

Aged↗
PubMed1993

Progress in the diagnosis and management of aspergillosis in bone marrow transplantation: 13 years' experience.

Over 13 years, we have seen 16 cases of proven invasive aspergillosis in 446 bone marrow transplant recipients, an incidence of 3.6%. The incidence of infection is low in patients with uncomplicated allogeneic or autologous bone-marrow transplants (< 2% and 0, respectively). Of the 16 episodes following transplantation, 10 occurred in patients with late transplant complications who were no longer in protective isolation. In patients who had focal pulmonary lesions (as diagnosed by computed tomographic scanning), culture of bronchoalveolar lavage (BAL) fluid was not an effective diagnostic procedure. In diffuse pulmonary disease due to Aspergillus, culture of BAL fluid had a sensitivity of 100%. Aspergillus species were isolated from an additional six patients who had no evidence of invasive aspergillosis. Graft rejection was a significant predisposing factor for the development of invasive aspergillosis (P < .001, log-rank test), and in our hospital, these patients now receive intravenous amphotericin B as prophylaxis. None of the six patients whose chest roentgenograms showed abnormalities before transplantation and who underwent surgical resection as part of the treatment for invasive aspergillosis developed recurrent infection.

Adolescent↗
PubMed1993

Activities of potential therapeutic and prophylactic antibiotics against blood culture isolates of viridans group streptococci from neutropenic patients receiving ciprofloxacin.

All 47 sequential blood culture isolates of viridans group streptococci obtained from febrile neutropenic patients receiving quinolone prophylaxis were susceptible to vancomycin, teicoplanin, and imipenem. Resistance to benzylpenicillin (MIC for 50% of isolates [MIC50], 0.125 microgram/ml) and ceftazidime (MIC50, 4 micrograms/ml) was common. Most isolates were susceptible to amoxicillin, co-amoxiclav (amoxicillin-clavulanic acid at a 2:1 ratio by weight), azlocillin, clarithromycin, and erythromycin, with azithromycin showing comparable activity. The MIC90 of sparfloxacin was 1 microgram/ml; those for ciprofloxacin and ofloxacin were > 16 and 16 micrograms/ml, respectively.

Anti-Bacterial Agents↗
PubMed1993

Bacteriological evaluation of a down-draught necropsy table ventilation system.

AIMS: To evaluate the microbiological efficacy of a down-draught necropsy table ventilation system (which surrounds the cadaver with a "curtain" of air under continuous extraction) during post mortem procedures. METHODS: Air sampling was carried out both in the presence and absence of staff and cadaver and during a full post mortem procedure, with functioning and non-functioning table air extraction. The penetration of the air "curtain" was also examined during the use of an oscillating bone saw by means of a tracer organism, Bacillus subtilis var niger, painted on to the skull. RESULTS: There was little difference between bacterial counts obtained in the presence of staff only, staff plus cadaver, or during a post mortem examination. With all counts obtained, however, there was a two to three-fold reduction when the ventilation was in operation compared with when the extract duct was occluded. Using the tracer organism, a two to three log reduction in counts was shown when the "curtain" was in operation during the use of the oscillating bone saw. CONCLUSIONS: These results suggest that the system provides potential protection for post mortem room staff against airborne infections.

Air Conditioning↗
PubMed1992

Parvovirus B19 outbreak in a children's ward.

Parvovirus B19 infection can cause severe complications in pregnant women, individuals with haemolytic anaemia, and those who are immunocompromised. In a hospital outbreak of this infection, a balance should be struck between protection of these individuals and the maintenance of medical services. The index case of an outbreak of parvovirus B19 infection among staff and patients of a paediatric ward was not identified. 58 members of staff were screened for B19 markers and 4 of the 6 susceptible men and 6 of the 24 susceptible women became infected (p = 0.05) as defined by serum IgM and viraemia. 1 of the 11 adults (10 members of staff and 1 parent) infected remained symptom-free. 12 immunocompromised patients were also assessed, and symptom-free infection developed in 2 of these. During the outbreak staff with symptoms were put on sick leave, immunocompromised patients (there were none with haemolytic anaemia) were given normal human immunoglobulin and nursed in single rooms by B19 IgG-positive, IgM-negative staff, and the ward was closed to B19 IgG-negative pregnant women. However, the limitation of spread of infection cannot be attributed with certainty to the measures taken.

Adult↗
PubMed1992

Stomatococcus mucilaginosus: an emerging pathogen in neutropenic patients.

Stomatococcus mucilaginosus was isolated from eight neutropenic patients during nine febrile episodes over a 13-month period. Five of these isolates were from definite infections, including one case of fatal meningitis. This slime-producing, catalase-variable, gram-positive coccus is a component of the normal oral flora of humans. Its biochemical profile may result in misidentification; however, unlike most micrococci, it characteristically fails to grow on media containing 5% NaCl. All but one of our isolates were sensitive to benzylpenicillin, and all were sensitive to vancomycin. S. mucilaginosus may prove to be an important pathogen in severely immunocompromised patients.

Adult↗
PubMed1992

Infection caused by Mycobacterium chelonae: a diagnostic and therapeutic problem in the neutropenic patient.

Mycobacterium chelonae, a rapidly growing species, is a significant cause of fever in neutropenic patients. We describe three febrile neutropenic patients at the Royal Free Hospital from whom this organism was isolated on several occasions. The condition of the first patient improved as the neutrophil count recovered. The second patient developed pulmonary disease and required surgical resection of a pulmonary lesion. The third patient, who had rapidly progressive, diffuse pulmonary disease, responded to an antibiotic regimen including erythromycin and ciprofloxacin. Both our findings and reports in the literature suggest that neutropenia may be a major risk factor for disseminated infection due to M. chelonae and that treatment is effective only after the recovery of the neutrophil count.

Adult↗