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C J Fichtenbaum

Publications and source records attributed to C J Fichtenbaum.

25 records · Page 2Linked to original sources
PubMed1994

Serious Pseudomonas aeruginosa infections in patients infected with human immunodeficiency virus: a case-control study.

We conducted a case-control study to determine the incidence and clinical features of and risk factors for Pseudomonas aeruginosa infections in patients infected with human immunodeficiency virus (HIV). Twenty-five patients who had 37 episodes of P. aeruginosa infection from 1990 through 1992 were identified. Most of the patients (92%) were homosexual men with low CD4+ lymphocyte counts and a history of AIDS. The annual incidence rates of P. aeruginosa infection were 3.5% (1990), 6.3% (1991), and 8.7% (1992). Most infections were community-acquired (68%) and involved the respiratory tract (73%). Patients were more likely than HIV-infected controls to have AIDS and had more AIDS-defining opportunistic illnesses. The overall mortality was 36%. Recurrent episodes were common (39%). We conclude that P. aeruginosa infections may be an increasing problem in patients with extremely advanced HIV infection. Clinicians should consider including antibiotics with activity against P. aeruginosa in the empirical treatment for suspected bacterial infection in patients with advanced HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1993

Ehrlichiosis presenting as a life-threatening illness with features of the toxic shock syndrome.

OBJECTIVE: To describe clinical and laboratory features of patients with severe ehrlichiosis, some of whom presented with toxic shock syndrome (TSS)-like illnesses, and to report, to our knowledge, the first documented fatal case of ehrlichiosis in a child. DESIGN: Case series. SETTING: Tertiary-care medical center. PATIENTS: All patients with documented ehrlichiosis during a 3-year period, August 1, 1989, to July 31, 1992. RESULTS: Eight patients (age range: 2 to 46 years) met clinical and serologic diagnostic criteria for ehrlichiosis. The mean interval from first contact with a physician to initiation of appropriate antibiotic therapy was 4.6 days (range: 1 to 11 days). All eight patients with ehrlichiosis had fever, chills, thrombocytopenia, and abnormal liver function test results. Most patients also had rash (seven), conjunctival hemorrhage or erythema (six), and leukopenia (six). Four cases met diagnostic criteria for TSS with fever, hypotension, rash, and multiorgan dysfunction. Two patients required mechanical ventilation, and one of these, a 6 1/2-year-old boy, died of complications of the infection. A ninth patient with probable ehrlichiosis also met diagnostic criteria for TSS. CONCLUSIONS: Human ehrlichiosis can present as a severe, life-threatening illness that may resemble TSS. The diagnosis of ehrlichiosis was not considered by the physicians who first cared for these patients. Greater awareness of the potential severity of ehrlichiosis is needed to ensure that proper treatment is initiated early in the course of the disease.

Adolescent↗
PubMed1993

Use of paromomycin for treatment of cryptosporidiosis in patients with AIDS.

Cryptosporidiosis in patients with AIDS often leads to a severe wasting illness that is difficult to treat. Recent reports suggest that paromomycin may be useful in the treatment of intestinal cryptosporidiosis. We reviewed our experience using paromomycin for the treatment of cryptosporidiosis in seven patients with AIDS. All patients received paromomycin (500 mg orally every 6 hours) for an average of 11.7 days. The mean follow-up period was 3.2 months. All patients had an initial response to paromomycin that was characterized by a decrease in frequency of diarrheal episodes, stabilization of body weight, and/or eradication of cryptosporidia from the stool. The mean number of diarrheal episodes decreased from 10.9 to 1.7 daily. Stabilization or increase in body weight was noted for five of seven patients, and eradication of oocysts was documented for three patients. Relapses or recurrences were noted for three patients. Treatment with paromomycin was well tolerated by all patients with the exception of two, who experienced nausea and abdominal discomfort. Thus, paromomycin appears to be a promising agent for treatment of acute cryptosporidiosis.

AIDS-Related Opportunistic Infections↗
PubMed1992

Treatment of endocarditis due to Pseudomonas aeruginosa with imipenem.

Therapy for endocarditis due to Pseudomonas aeruginosa is complicated by the emergence of resistance during therapy, lack of universally available synergistic antimicrobial agents, and unacceptably high morbidity and mortality rates. The authors report a case of aortic valve endocarditis due to P. aeruginosa in which resistance to piperacillin developed during combined therapy with tobramycin. Bacteriologic cure was obtained with a combination of imipenem/cilastatin and tobramycin. The authors review six other cases of P. aeruginosa endovascular infections treated with imipenem.

Adult↗
PubMed1991

Review of duodenal diverticula.

Duodenal diverticula occur in 2-5% of patients undergoing barium studies of the upper intestinal tract. Duodenal diverticula are classified into two types: extraluminal or intraluminal. Usually of little clinical significance, they can cause obstruction, cholelithiasis, ascending cholangitis, ulcers, and hemorrhage, and may perforate. Associated intestinal tract malformations have been reported in 40% of patients with intraluminal duodenal diverticula. Diagnosis is made by endoscopy or upper gastrointestinal series. In symptomatic cases, extraluminal diverticula are amenable to surgery, whereas intraluminal diverticula may be either surgically or endoscopically resected. Imaging of the biliary tree should be performed prior to any intervention.

Diverticulum↗