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Biomedical subjects

D H Spach

Publications and source records attributed to D H Spach.

At least 37 records · Page 2Linked to original sources
PubMed1994

Campylobacter jejuni bacteremia and Guillain-Barré syndrome in a patient with GVHD after allogeneic BMT.

Guillain-Barré syndrome is a rare neurologic complication after allogeneic BMT. In the non-transplant setting, Guillain-Barré syndrome has typically been associated with antecedent acute infections and numerous reports have suggested an association between Campylobacter jejuni infection and the subsequent development of Guillain-Barré syndrome. Thus far, however, reports of C. jejuni-associated Guillain-Barré syndrome have been limited to gastrointestinal C. jejuni infections and none has been reported in BMT transplant patients. We report a case of C. jejuni bacteremia associated with Guillain-Barré syndrome that developed in a patient with chronic GVHD approximately 1 year after allogeneic BMT. The patient was treated with intravenous immunoglobulin and intravenous ciprofloxacin and had partial recovery. Our report illustrates that Guillain-Barré syndrome can occur in association with C. jejuni bacteremia and is a rare cause of polyneuropathy after BMT.

Bacteremia↗
PubMed1993

Babesiosis in Washington State: a new species of Babesia?

OBJECTIVE: To characterize the etiologic agent (WA1) of the first reported case of babesiosis acquired in Washington State. DESIGN: Case report, and serologic, molecular, and epizootiologic studies. SETTING: South-central Washington State. PATIENT: A 41-year-old immunocompetent man with an intact spleen who developed a moderately severe case of babesiosis. MEASUREMENTS: Serum specimens from the patient were assayed by indirect immunofluorescent antibody (IFA) testing for reactivity with seven Babesia species and with WA1, which was propagated in hamsters inoculated with his blood. A Babesia-specific, ribosomal-DNA (rDNA) probe was hybridized to Southern blots of restriction-endonuclease-digested preparations of DNA from WA1, Babesia microti, and Babesia gibsoni. Serum specimens from 83 family members and neighbors were assayed for IFA reactivity with WA1 and B. microti. Small mammals and ticks were examined for Babesia infection. RESULTS: The patient's serum had very strong IFA reactivity with WA1, strong reactivity with B. gibsoni (which infects dogs), but only weak reactivity with B. microti. DNA hybridization patterns with the rDNA probe clearly differentiated WA1 from B. gibsoni and B. microti. Four of the patient's neighbors had IFA titers to WA1 of 256. The tick vector and animal reservoir of WA1 have not yet been identified, despite trapping 83 mammals and collecting 235 ticks. CONCLUSIONS: WA1 is morphologically indistinguishable but antigenically and genotypically distinct from B. microti. Some patients elsewhere who were assumed to have been infected with B. microti may have been infected with WA1. Improved serodiagnostic and molecular techniques are needed for characterizing Babesia species and elucidating the epidemiology of babesiosis, an emergent zoonosis.

Adolescent↗
PubMed1993

Transmission of infection by gastrointestinal endoscopy and bronchoscopy.

OBJECTIVE: To review reports on the transmission of infections by flexible gastrointestinal endoscopy and bronchoscopy in order to determine common infecting microorganisms, circumstances of transmission, and methods of risk reduction. DATA SOURCES: Relevant English-language articles were identified through prominent review articles and a MEDLINE search (1966 to July 1992); additional references were selected from the bibliographies of identified articles. STUDY SELECTION: All selected articles related to transmission of infection by gastrointestinal endoscopy or bronchoscopy; 265 articles were reviewed in detail. DATA SYNTHESIS: Two hundred and eighty-one infections were transmitted by gastrointestinal endoscopy, and 96 were transmitted by gastrointestinal endoscopy, spectrum of these infections ranged from asymptomatic colonization to death. Salmonella species and Pseudomonas aeruginosa were repeatedly identified as the causative agents of infections transmitted by gastrointestinal endoscopy, and Mycobacterium tuberculosis, atypical mycobacteria, and P. aeruginosa were the most common causes of infections transmitted by bronchoscopy. One case of hepatitis B virus transmission via gastrointestinal endoscopy was documented. Major reasons for transmission were improper cleaning and disinfection procedures; the contamination of endoscopes by automatic washers; and an inability to decontaminate endoscopes, despite the use of standard disinfection techniques, because of their complex channel and valve systems. CONCLUSIONS: The most common agents of infection transmitted by endoscopy are Salmonella, Pseudomonas, and Mycobacterium species. To prevent endoscopic transmission of infections, recommended disinfection guidelines must be followed, the effectiveness of automatic washers must be carefully monitored, and improvements in endoscope design are needed to facilitate effective cleaning and disinfection.

Bronchoscopes↗
PubMed1993

Septic arthritis of the temporomandibular joint: review of the literature and report of two cases in children.

Septic arthritis of the temporomandibular joint (TMJ) has a high morbidity, is infrequently reported, and has been described almost exclusively in adults. We present two cases of septic arthritis of the TMJ that occurred in children after minor blunt trauma. Literature related to septic arthritis of the TMJ was reviewed, and a composite list of cases was constructed. The most common causes were various infections of the head and neck, rheumatic joint disease, and iatrogenesis. Pathogens may gain access to the TMJ by several routes. Patients typically present with an acute, tender, monarticular arthritis with associated swelling and erythema. Malaise, nausea, and vomiting may also be present. Traumatic effusions, fractures, and neoplasms may present in a similar fashion, and mimic TMJ septic arthritis. Staphylococcus aureus is the most commonly reported pathogen and often causes permanent joint damage. Aspiration and analysis of joint fluid, as well as blood chemistry, imaging studies, and clinical impression, may assist in the diagnosis. Timely diagnosis and treatment are essential for a successful outcome; therapy should include antimicrobial agents, adequate drainage, and resting of the joint. Complications include spread of infection, postinfectious bony changes, and fibrous (or bony) ankylosis of the temporomandibular joint.

Arthritis, Infectious↗
PubMed1993

Cytomegalovirus-induced hemorrhagic cystitis following bone marrow transplantation.

Cytomegalovirus (CMV) is a common cause of morbidity and mortality following bone marrow transplantation but has not been demonstrated to cause hemorrhagic cystitis in this setting. We describe a patient who developed gross hematuria and lower abdominal pain 47 days after bone marrow transplantation was performed. Subsequently, CMV was detected in bladder endothelial cells with use of monoclonal antibody staining that was specific for the virus. No other cause for the patient's hemorrhagic cystitis was discovered. The gross hematuria and pain persisted until the patient received intravenous ganciclovir. This case demonstrates that CMV-induced hemorrhagic cystitis can occur following bone marrow transplantation and may respond to antiviral therapy.

Adolescent↗
PubMed1993

Endocarditis caused by Rochalimaea quintana in a patient infected with human immunodeficiency virus.

Rochalimaea quintana and Rochalimaea henselae are closely related, fastidious, gram-negative rickettsiae. Thus far, the spectrum of human Rochalimaea sp. infections has not included endocarditis. We describe a 50-year-old human immunodeficiency virus-positive man who developed endocarditis caused by R. quintana. DNA relatedness studies, which compared our patient's blood culture isolate with known Rochalimaea species, identified the organism as R. quintana. Our report expands the spectrum of Rochalimaea sp. infections and identifies a new infectious cause of endocarditis.

DNA, Bacterial↗
PubMed1993

HIV infection in older patients: when to suspect the unexpected.

The number of AIDS patients over age 60 has risen steadily in the past decade. The number of transfusion-acquired AIDS cases probably has peaked--or will soon peak. Homosexual (or bisexual) behavior remains the predominant risk factor for AIDS until the seventh decade. Disease progression appears to be more rapid in the elderly, although the observed shorter survival time may result from a delay in diagnosis. Symptoms of HIV infection are often nonspecific, such as fatigue, anorexia, weight loss, and decreased physical and cognitive function. The five most common opportunistic infections in older HIV-infected patients are Pneumocystis carinii pneumonia, tuberculosis, Mycobacterium avium complex, herpes zoster, and cytomegalovirus. A number of features of HIV-related dementia may help to distinguish it from Alzheimer's disease.

AIDS Dementia Complex↗
PubMed1992

Lack of circumcision increases the risk of urinary tract infection in young men.

OBJECTIVE: To determine whether lack of circumcision increases the risk of urinary tract infection (UTI) in adult men. DESIGN AND SETTING: Retrospective case-control study (1987-1990) at a sexually transmitted disease clinic in Seattle, Wash. PATIENTS: Twenty-six men (median age, 30 years) who had microbiologically confirmed symptomatic UTIs (cases) compared with 52 men (median age, 32 years) who had urinary symptoms but negative urine cultures (controls). MAIN OUTCOME MEASURE: Circumcision status among bacteriuric and nonbacteriuric men. RESULTS: The bacteriuric and nonbacteriuric groups were similar in age, race, sexual activity, and sexual preference. Eight (31%) of the 26 bacteriuric men were uncircumcised compared with 6 (12%) of the 52 nonbacteriuric men (P = .037; odds ratio, 3.4; 95% confidence interval, 1.0 to 11.2). Among 19 patients infected with gram-negative bacilli, 8 (42%) of 19 were uncircumcised vs 6 (12%) of 52 nonbacteriuric men (P = .004; odds ratio, 5.6; 95% confidence interval, 1.6 to 19.4). Escherichia coli was the most common urinary isolate (15 of 26 isolates), and the majority of E coli strains possessed urovirulence determinants, including mannose-resistant hemagglutination (10 of 14 isolates), F fimbriae (11 of 14 isolates), P fimbriae (6 of 14 isolates), hemolysin (10 of 14 isolates), and aerobactin (8 of 14 isolates). Although all 26 bacteriuric men had urethral cultures negative for Chlamydia trachomatis and Neisseria gonorrhoeae, Gram-stained urethral smears showed evidence of urethritis in 17 (68%) of 25 men. CONCLUSIONS: (1) Lack of circumcision increases the risk of UTI in young adult men. (2) The majority of these infections result from urovirulent strains of E coli. (3) Clinically, these infections often produce urethritis as well as UTI.

Adult↗
PubMed1992

Bordetella bronchiseptica pneumonia and bacteremia following bone marrow transplantation.

Bordetella bronchiseptica is a frequent cause of respiratory infections in animals but rarely causes disease in humans. We describe a patient with B. bronchiseptica pneumonia and bacteremia that developed following bone marrow transplantation. B. bronchiseptica infection persisted despite antimicrobial therapy and may have progressed because of the combined effects of the patient's underlying immunosuppression and the antimicrobial antagonism between doxycycline and ciprofloxacin.

Adult↗
PubMed1987

Protein kinase C-dependent and -independent pathways of proto-oncogene induction in human astrocytoma cells.

We compared the abilities of the muscarinic agonist carbachol, epidermal growth factor (EGF), and phorbol 12-myristate 13-acetate (PMA) to induce proto-oncogene mRNA accumulation and other cellular responses in normal and protein kinase C-deficient 1321-N1 human astrocytoma cells. PMA, carbachol, and EGF all stimulated rapid accumulation of mRNA for the proto-oncogenes c-fos and c-myc in the normal cells; in the protein kinase C-deficient cells, carbachol and EGF, but not PMA, retained this effect, which was not mimicked by the calcium ionophore A23187. Both carbachol and PMA activated protein kinase C in these cells, as evidenced by the stimulated phosphorylation of an acidic Mr 80,000 protein kinase C substrate protein with phosphoamino acid and peptide map identity. This response was mimicked by several other neurotransmitters in these cells, including epinephrine, histamine, oxotremorine, and serotonin, and was abolished in cells made protein kinase C-deficient by preincubation with high concentrations of PMA. Both PMA and carbachol promoted the phosphorylation of the ribosomal protein S6 and activated an S6 protein kinase in the normal but not in the protein kinase C-deficient cells. EGF, in contrast, did not appear to activate protein kinase C, but promoted the phosphorylation of S6 and activation of the S6 kinase in both normal and protein kinase C-deficient cells. We conclude that, in 1321-N1 cells, induction of c-fos and c-myc mRNA can occur through a protein kinase C-dependent pathway and one or more independent pathways, exemplified by the responses to carbachol and EGF in the protein kinase C-deficient cells.

Astrocytoma↗
PubMed1986

Protein phosphorylation and protein kinase activities in BC3H-1 myocytes. Differences between the effects of insulin and phorbol esters.

To determine whether insulin activates protein kinase C in BC3H-1 myocytes, we evaluated changes in protein phosphorylation, protein kinase activities, and the intracellular translocation of protein kinase C activity in response to insulin and phorbol esters. Phorbol 12-myristate 13-acetate (PMA), but not insulin, stimulated the phosphorylation of an acidic Mr 80,000 protein which has been shown to be an apparently specific marker for protein kinase C activation. In addition, PMA, but not insulin, stimulated the rapid association of protein kinase C activity with a cellular particulate fraction. In contrast to these differences, both insulin and PMA stimulated the phosphorylation of ribosomal protein S6 and activated a ribosomal protein S6 kinase in cell-free extracts from cells exposed to these agents. In cells exposed to high concentrations of PMA for 16 h, protein kinase C activity and immunoreactivity were abolished, without changes in cellular morphology. Under these conditions, insulin, but not PMA, stimulated phosphorylation of the ribosomal protein S6 in intact cells and activated the S6 kinase in cell-free extracts derived from insulin-treated intact cells. We conclude that: insulin does not appear to activate protein kinase C in BC3H-1 myocytes, at least as assessed by phosphorylation of the Mr 80,000 protein; both insulin and PMA activate an S6 protein kinase in these cells; and insulin can promote S6 phosphorylation and activate the S6 kinase normally in protein kinase C-deficient cells. Activation of the S6 kinase by insulin and PMA, although apparently proceeding through different mechanisms, may explain some of the similar biological actions of these compounds in BC3H-1 myocytes.

Animals↗