From effect size into number needed to treat.
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Humans↗
Biomedical subjects
C T Fang
Publications and source records attributed to C T Fang.
Successful treatment of disseminated Mycobacterium szulgai infection with ciprofloxacin, rifampicin, and ethambutol.
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Adolescent↗
In vitro activity of quinupristin/dalfopristin against clinical isolates of common gram-positive bacteria in Taiwan.
The MICs of quinupristin/dalfopristin against common Gram-positive bacteria isolated from various clinical specimens at a university hospital in Taiwan were determined by the agar dilution method. The tested bacteria included methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus (MSSA), methicillin-resistant Staphylococcus epidermidis (MRSE), methicillin-susceptible S. epidermidis (MSSE), Streptococcus pyogenes, Streptococcus pneumoniae, and Enterococcus faecalis. With the exception of E. faecalis all bacteria were susceptible to quinupristin/dalfopristin. The MIC50 and MIC90 were, respectively, 0.25 microgram/mL and 0.5 microgram/mL for both MRSA and MSSA; 0.25 microgram/mL and 0.5 microgram/mL for MRSE; 0.25 microgram/mL and 0.25 microgram/mL for MSSE; 0.125 microgram/mL and 0.125 microgram/mL for S. pyogenes; and < or = 0.03 microgram/mL and 0.25 microgram/mL for S. pneumoniae. Eighty-two percent of the tested E. faecalis isolates were intermediately resistant or resistant to quinupristin/dalfopristin, with an MIC50 of 2 micrograms/mL and an MIC90 of 4 micrograms/mL. Quinupristin/dalfopristin seems to be a promising antimicrobial agent against common Gram-positive bacteria other than E. faecalis in Taiwan.
Anti-Bacterial Agents↗
Antithyroid-drug-induced agranulocytosis complicated by life-threatening infections.
Agranulocytosis is a rare complication of antithyroid drugs, and the aetiologies of community-acquired, life-threatening infections in patients taking these drugs have not previously been systematically described. Of 5653 hyperthyroid patients treated with antithyroid drugs at National Taiwan University Hospital between January 1987 and December 1997, 13 (0.23%) developed agranulocytosis with life-threatening infections. The most common presentations were fever (92%) and sore throat (85%). Initial clinical diagnoses were acute pharyngitis (46%), acute tonsillitis (38%), pneumonia (15%) and urinary tract infection (8%). Positive blood cultures from six patients yielded Pseudomonas aeruginosa (3), Escherichia coli (1), Staphylococcus aureus (1), Capnocytophaga species (1). Two patients died of uncontrolled infection, thyroid storm and multiple organ failure. Cases of antithyroid-drug-induced agranulocytosis in the English language literature are reviewed; Gram-negative bacilli, including Klebsiella pneumoniae (4 patients) and P. aeruginosa (3), were the most common pathogens in clinical isolates. Our observation and review suggest that broad-spectrum antibiotics with anti-pseudomonal activity should be given to patients with antithyroid drug-induced agranulocytosis who present with severe infection.
Adolescent↗
Imported malaria: successful treatment of 31 patients in the era of chloroquine resistance.
The diagnosis and management of imported malaria presents a continuing challenge in developed countries, including Taiwan. We retrospectively analyzed the records of all 31 patients with imported malaria treated at National Taiwan University Hospital from January 1984 through December 1998. Plasmodium falciparum was identified as the causative malarial parasite in 18 patients, P. vivax in 12, and P. ovale in one. All 31 patients had fever, but only 13 presented with the characteristic fever pattern. The most common initial laboratory abnormalities were thrombocytopenia (20/31), mild hyperbilirubinemia (20/31), and leukopenia (7/31). The median time from the onset of fever to the correct diagnosis was 4 days for P. falciparum and 5 days for P. vivax. In 28 cases, the clue that led to early diagnosis was the patient's travel history. Quinine, but not chloroquine, was effective in 17 out of 18 cases of falciparum malaria. Three patients treated with intravenous quinine required a change of regimen because of life-threatening quinine toxicity; artesunate served as a safe and effective alternative in this situation. While most patients with tertian malaria were cured with the standard chloroquine and primaquine regimen, a higher dosage was required for one case acquired in Papua New Guinea. All patients, including two with severe malaria, survived. We conclude that, the mortality of imported malaria in the chloroquine resistance era can be minimized with early recognition by obtaining a thorough travel history, and instituting appropriate antimalarial chemotherapy based on precise identification of species. Quinine toxicity should be closely monitoried, especially when this drug is given intravenously.
Adolescent↗
Necrotizing fasciitis caused by Serratia marcescens in two patients receiving corticosteroid therapy.
Necrotizing fasciitis (NF), a devastating soft tissue infection, is rarely attributed to Serratia marcescens. We here report two patients with S. marcescens NF, both of whom had underlying renal disease and had been receiving corticosteroid therapy. The first patient, a 40-year-old man with systemic lupus erythematosus and uremia on prednisolone therapy, developed fulminant cellulitis and septic shock 1 month after a skin biopsy for cutaneous vasculitis of the left foot. The cellulitis evolved to NF, and blood and necrotic tissue cultures both grew S. marcescens. The patient completely recovered after debridement and ceftazidime therapy. The second patient, a 73-year-old man receiving prednisolone therapy for nephrotic syndrome, developed right leg cellulitis that evolved to NF. Blood and necrotic tissue cultures both grew S. marcescens. After aggressive debridement and ciprofloaxcin therapy, the NF improved. However, the patient died of aspiration pneumonia and massive gastrointestinal bleeding 1 month later. These findings illustrate that S. marcescens should be considered as a potential pathogen causing NF in susceptible hosts.
Adult↗
In vitro activity of meropenem against common pathogenic bacteria isolated in Taiwan.
The in vitro antimicrobial activity of meropenem, in comparison with nine other antimicrobial agents, against 12 different common pathogenic bacteria were evaluated to know the susceptibility of common bacteria to meropenem in Taiwan. Meropenem was active against most Gram-positive, Gram-negative, and anaerobic bacteria, including methicillin-sensitive Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Burkholderia cepacia, Acinetobacter baumannii, Haemophilus influenzae, and Bacteroides fragilis. For many of them, meropenem was the most active one in comparison with other broad-spectrum cephalosporins, aztreonam, imipenem, and ciprofloxacin. It is concluded that meropenem is a very active agent against most common pathogenic bacteria. It is uncommon for these common bacteria, except MRSA and Stenotrophomonas maltophilia, to be resistant to meropenem in Taiwan, where a high prevalence of resistance to other antimicrobial agents was found in many of the common bacteria.
Anti-Bacterial Agents↗
Efficacy and safety of cefepime treatment in Chinese patients with severe bacterial infections: in comparison with ceftazidime treatment.
An open label, randomized comparative study was conducted to evaluate the safety and efficacy of cefepime, in comparison with ceftazidime, in the treatment of adult hospitalized Chinese patients with severe bacterial infections. Forty patients with severe infections including septicemia, urinary tract infection and bacterial pneumonia were randomly assigned to receive treatment with cefepime (2 g intravenously every 12 h) or ceftazidime (2 g intravenously every 8 h). The cefepime group (20 evaluable patients) and ceftazidime group (16 evaluable patients) were comparable with respect to age, sex, underlying diseases and distribution of infection type. In both groups urinary tract infection was the most common type of infection and Escherichia coli was the most common etiologic microorganism. The rates of satisfactory clinical response were similar in the cefepime and ceftazidime groups (95 versus 93.7%; 95% confidence interval: -0.14 - 0.17, P = 0.87). The bacteriological response rates of the cefepime and ceftazidime groups did not differ significantly (88.9 versus 85.7%; 95% confidence interval: -0.30 - 0.36, P = 0.85). Both cefepime and ceftazidime were well tolerated, with similar incidence of side effects. The results of this study suggest that cefepime is as safe and effective as ceftazidime for the treatment of serious infections in adult hospitalized Chinese patients.
Asian People↗
Haemophilus aphrophilus bacteraemia complicated with vertebral osteomyelitis and spinal epidural abscess in a patient with liver cirrhosis.
Haemophilus aphrophilus is rarely implicated as an aetiology of spinal epidural abscess. A 73-year-old woman with liver cirrhosis who developed H. aphrophilus bacteraemia complicated with vertebral osteomyelitis and spinal epidural abscess is presented. Without surgical decompression, she was successfully treated with cefotaxime for 3 weeks, followed by maintenance with ciprofloxacin for another 10 weeks. The clinical features of eight previously reported cases of vertebral osteomyelitis without epidural abscess due to H. aphrophilus are reviewed.
Abscess↗
Fusarium solani fungemia in a bone marrow transplant recipient.
Disseminated Fusarium solani infection, with its distinctive skin lesions, is an emerging cause of mortality in bone marrow transplant recipients worldwide. However, it has never been reported before in Taiwan. We report a 21-year-old man with disseminated fusariosis who developed fever, myalgia and generalized erythematous papules on day 8 after undergoing allogeneic bone marrow transplantation for severe aplastic anemia. Histopathology of the skin lesion revealed mycotic emboli. Cultures of both blood and tissue from skin biopsy grew Fusarium solani. Despite amphotericin B therapy, fever persisted and graft failure developed. A second transplantation, using mobilized peripheral blood stem cells from the same donor, was tried but the patient died of progressive multiple organ failure before any evidence of engraftment.
Adult↗
Life-threatening scrub typhus with meningoencephalitis and acute respiratory distress syndrome.
A 21-year-old man presented with fever, rash, seizure, stiff neck and rapidly progressive bilateral pulmonary infiltrates. Cerebrospinal fluid (CSF) study revealed pleocytosis with predominant polymorphonuclear cells, and hypo-glycorrhachia. Status epilepticus occurred, followed by acute respiratory distress syndrome with respiratory failure. Blood and CSF cultures for bacteria were negative, but an indirect immunofluorescence assay revealed a fourfold rise in antibody to Rickettsia tsutsugamushi in paired serum and a 1:2560 (+) IgM antibody titer. Severe scrub typhus with meningoencephalitis and extensive pneumonitis was diagnosed. The patient survived after intravenous minocycline therapy and intensive care, including aggressive seizure control, supportive mechanical ventilation and avoidance of fluid overloading. He had a nearly complete recovery. Practicing physicians in Taiwan should be aware of this reportable disease and its potentially serious complications if not promptly diagnosed and treated.
Adult↗
Streptococcus adjacens endocarditis in a patient with nephrotic syndrome.
Streptococcus adjacens has never previously been reported as an etiologic organism of infective endocarditis in Taiwan. We describe a case of severe native valve endocarditis caused by S. adjacens, involving the mitral valve, the aortic valve, and the left atrium, in a 29-year-old woman with nephrotic syndrome on steroid therapy. Blood cultures yielded gram-positive cocci that grew poorly on blood agar but strongly on chocolate agar. Despite aggressive antibiotic treatment, the patients continued to have high fever and progressive congestive heart failure, which necessitated surgical intervention. Symptoms were alleviated after surgery; teicoplanin was continued for 4 weeks and the patient remained symptom-free at the 6 month follow up. To our knowledge, this is the first reported case of bacterial endocarditis involving the left atrium without preexisting myxoma.
Adult↗
Clinical manifestations, microbiology and prognosis of 42 patients with necrotizing fasciitis.
Forty-two cases of necrotizing fasciitis (NF) surgically confirmed between January 1991 and October 1995 were retrospectively reviewed. This was done in order to describe the underlying diseases, clinical presentations, etiology and outcome of NF and to assess the prognostic value of a simplified severity scoring system. The system scores changes in consciousness status, body temperature, blood pressure and ventilation to determine the likely outcome of NF. Twenty-five men and 17 women with a median age of 51 years (range, 17-87 yr) were included. Diabetes mellitus (57.1%) was the most common underlying disease. The mean duration of symptoms before admission was 8 days (median, 7 d; range, 1-30 d). The extremities (66.7%) were most commonly involved. Initial clinical presentations within 48 hours of admission included skin erythema and swelling at the affected site (97.6%), pyrexia (61.9%), hypotension (33.3%), altered consciousness (28.6%), bullous lesions (26.2%) and crepitus (9.5%). The mean number of isolated pathogens was 1.8 (range, 0-6). Eight patients had mixed aerobic and anaerobic infections. The attributable case fatality rate was 23.8%. Higher severity score (> or = 4 points), hypotension, altered consciousness, respiratory failure requiring ventilator support, elevation of alanine aminotransferase levels > twofold, serum creatinine > 177 mumol/L, thrombocytopenia (< 100 x 10(9)/L), and worsening symptoms and signs within 48 hours of admission were associated with higher fatality rates (p < 0.05).
Adolescent↗
Study of HIV antibody screening for blood donors by a pooling-serum method.
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Blood Donors↗
Diagnosis of chronic hepatitis C: comparison of immunoassays and the polymerase chain reaction.
We evaluated a series of first- and second-generation enzyme-linked immunoassays for anti-HCV and compared the findings to those with two confirmatory assays, the recombinant immunoblot assay and serum HCV RNA, in patients with chronic hepatitis C, primary biliary cirrhosis, and chronic hepatitis B. All second-generation immunoassays had good sensitivities (98-100%). Interestingly, detection of HCV RNA had a sensitivity of only 93%, although it was 100% specific. The recombinant immunoblot assay and a peptide-based immunoassay also had good specificity (97% and 100%, respectively), whereas the second-generation immunoassay based on recombinant proteins had a high rate of false positivity, particularly among patients with primary biliary cirrhosis and hyperglobulinemia (specificity 68%). Thus, the diagnosis of HCV infection appears to require the use of more than one test. Whereas a second-generation enzyme-linked immunoassay can be used as an initial test, a confirmatory test (such as recombinant immunoblot assay or determination of hepatitis C viral RNA) may be required if the diagnosis remains uncertain.
Cohort Studies↗
Human T-lymphotropic virus (HTLV) types I and II infection in sexual contacts and family members of blood donors who are seropositive for HTLV type I or II. American Red Cross HTLV-I/II Collaborative Study Group.
Interviews and laboratory testing were conducted for 168 contacts referred by former blood donors identified as seropositive for antibody to human T-lymphotropic virus type I (HTLV-I) or type II (HTLV-II). Thirty-two (28%) of 114 heterosexual contacts of seropositive donors, including 12 women and 20 men, were found to be antibody positive. None of 40 offspring (except one adult man who reported sexual contact in Puerto Rico) or 14 other (nonspousal) family members were seropositive. Thirty-one of the seropositive contacts were typeable as having either HTLV-I (52%) or HTLV-II (48%). Assessment of couples found that the median duration of the sexual relationship was significantly longer (p = 0.03) for those in which both partners were infected than in discordant pairs. Analysis of risk history data for 22 infected couples revealed that, in three cases, risk factors (Japanese ancestry or sexual contact with an injecting drug user) could be identified in the women, but not in their male partners. Among couples in which the male had the greater risk history, the risk factor was either a history of transfusion, birth or sexual exposure in an endemic area, or injected drug use. Counseling strategies for individuals with HTLV-I or HTLV-II infection should take into account the relatively high seroprevalence in their partners and should address the potential for sexual transmission in both directions.
Adolescent↗
Unaltered lymphocyte subsets in hepatitis C virus-seropositive blood donors.
Lymphocyte subsets were evaluated by dual-color flow cytometry in whole blood specimens from 35 blood donors who were seropositive on enzyme-linked immunosorbent assay (ELISA) for hepatitis C virus (HCV) and whose sera reacted in a four-antigen recombinant immunoblot assay (RIBA) (referred to as the HCV+R group), 15 donors who were seropositive on ELISA for HCV with indeterminate or negative RIBA results (the HCV+I/N group), and 25 HCV-seronegative controls (HCV-group). The cell subsets assessed included natural killer cells, B cells, T cells, CD4 and CD8 subsets of T cells, and T-cell subsets defined by the coexpression of markers that appear (HLA-DR, CD25, CD38) or disappear (CD45RA) after activation. A one-way analysis of variance revealed no significant differences among the three study groups. These findings show that, unlike cytomegalovirus- and human immunodeficiency virus-positive individuals, HCV-positive individuals do not exhibit lymphocyte alterations indicative of the immune activation caused by chronic viral infection.
Antigens, CD↗
Evaluation of an indirect immunofluorescence assay for confirmation of human immunodeficiency virus type 1 antibody in U.S. blood donor sera.
An indirect immunofluorescence assay (IFA) was evaluated as a confirmatory test for antibody to human immunodeficiency virus type 1 in U.S. blood donor sera previously found to be repeatedly reactive by enzyme immunoassay. IFA results were 100% concordant with a licensed Western blot (immunoblot) for 53 negative and 49 positive samples. Four samples which exhibited antibody to viral proteins from more than one gene, yet were indeterminate by Western blot by the manufacturer's criteria, were also reactive by IFA, whereas 49 additional indeterminate samples were IFA negative.
AIDS Serodiagnosis↗