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Biomedical subjects

E D Everett

Publications and source records attributed to E D Everett.

At least 19 recordsLinked to original sources

Mucocutaneous lymph node syndrome (Kawasaki disease) in adults.

Mucocutaneous lymph node syndrome has been reported to occur only in children. Three adults aged 16 to 27 years had findings compatible with this illness. Patients with fever, polymorphous skin eruption, congested conjunctiva, reddened palms and soles, red lips and oral mucous membrane, and soft-tissue swelling of the peripheral extremities and who experience membranous desquamation of fingers and toes should be suspected of having mucocutaneous lymph node syndrome. No laboratory test is currently available for confirmation of the diagnosis.

Adolescent

Gastrointestinal histoplasmosis.

Histoplasma capsulatum involves some part of the gastrointestinal tract in 75% of patients with disseminated disease, but clinically obvious gastrointestinal involvement is infrequent. Symptoms include crampy abdominal pain, diarrhea, nasopharyngeal ulcers, and rectal ulcers. Granulomatous constrictive lesions may simulate either carcinoma anywhere in the gut or less commonly Crohn's disease. We describe a patient and discuss gastrointestinal histoplasmosis.

Colonic Diseases

Haemophilus influenzae infections in adults: report of nine cases and a review of the literature.

Haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with Streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. In vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic.

Adolescent

Infectious mononucleosis with severe neutropenia and opsonic antineutrophil activity.

Severe granulocytopenia is an uncommon complication of infectious mononucleosis, only 18 cases having been reported previously. Our review and experience with this case would indicate that (1) severe granulocytopenia is usually diagnosed at about the third or fourth week of illness, (2) bone marrow examination most commonly reveals lack of mature neutrophil precursors in the myelocytic series, (3) the duration of usually short, lasting about a week, and (4) most patients recover without treatment. The laboratory findings in our case suggests that the neutropenia may be antibody mediated.

Adolescent

Antibiotic susceptibilities of human isolates of Pasteurella multocida.

Seventeen human strains of Pasteurella multocida, biochemically similar to, if not identical with, isolates of animal origins, were tested for susceptibility to 16 antimicrobial agents utilizing a microtiter broth dilution technique. Ten of these isolates were also tested against 11 antibiotics by disk diffusion. The most active drugs with respect to the median minimal inhibitory concentration (micrograms per milliliter) were tetracycline (0.09), penicillin G (0.78), ampicillin (0.78), carbenicillin (1.56), cephalothin (1.56), and chloramphenicol (1.56). With the exception of tetracycline, the median minimal inhibitory concentration and minimal bactericidal concentration values were equal or differed by no more than a factor of two. The semisynthetic penicillins clindamycin, erythromycin, and aminoglycosides had relatively low activities, suggesting that these agents would be poor choices for the treatment of P. multocida infections.

Anti-Bacterial Agents

Amebic liver abscess. Report of a case presenting with nonreactive serologic tests for Entamoeba histolytica.

We present a patient with an acute amebic liver abscess with nonreactive serologic tests. Motile hematophagous trophozoites of Entamoeba histolytica were seen microscopically in scrapings from the wall of the abscess. Postoperative serologies revealed rapidly rising then falling titers by SAFA and IHA antibody assays. Serologic tests for amebiasis may be reative in greater than 95% of patients with invasive amebiasis. Nevertheless, a reactive serologic test should not be relied upon exclusively to establish the diagnosis. Sequential serologic testing and surgical intervention to obtain material for microscopic examination, gram stain and bacteriologic culture are warranted in patients with hepatic abscess and nonreactive serologic tests for antibodies to E. histolytica.

Adult

All pustular nodules are not bacterial.

A case of lymphocutaneous sporotrichosis was thought to represent bacterial pyoderma. Lack of recognition led to excessive costs and a delay in the institution of specific therapy. The differential and an approach to diagnosis of pus-containing nodules are discussed.

Adult

Infections caused by Rhodochrous.

Organisms conforming to "rhodochrous taxon" were isolated from three immunocompromised patients, suggesting a pathogenic role for the organisms. The organisms are partially acid-fast, gram-positive catalase positive rods which form orange or red colonies aerobically in three or four days on Sabouraud, Mueller-Hinton and Middlebrook 7H-10 agars. They are differenitated from Nocardia by morphology and ability to degrade ethylene glycol in 7H-10 media. Two of these clinical isolates and a reference strain were injected intraperitoneally into guinea pigs, half of which received methylprednisolone intramuscularly beginning three days prior to inoculation. Steroid-treated animals exhibited clinical illness, diffuse peritonitis and recovery of inoculated organisms whereas one of three nonsteroid-treated animals exhibited a localized abscess without recovery of organisms. This study suggests that rhodochrous may be pathogenic under conditions of immune compromise.

Aged

Group B streptococcal osteomyelitis in adults.

Osteomyelitis due to group B Streptococcus occurred in two adult male patients. Both patients responded to parenteral penicillin G. A review of the literature verifies that group B Streptococcus has been an exceedingly rare cause of osteomyelitis in adults.

Humans

Haemophilus influenzae pneumonia in adults.

Thirty cases of Haemophilus influenzae pneumonia with clinical and laboratory features have previously been recorded in adults. During the past three years, we have examined 18 patients in whom this diagnosis was established by transtracheal aspirate or blood culture. Our study suggests that H influenzae, both typable and nontypable strains, is a more frequent cause of pneumonia in adults than previously appreciated. We found no clinical values that distinguished H influenzae pneumonia from other bacterial pneumonias. A properly performed Gram's stain of a transtracheal aspirate specimen is classical in its appearance and facilitates instritution of appropriate initial treatment. The emergence of both typable and nontypable organisms resistant to ampicillin makes it important that organisms be isolated from reliable samples for sensitivity testing. With appropriate therapy, the prognosis for patients with H influenzae pneumonia appears to be good.

Adolescent

Postoperative hemorrhage associated with carbenicillin administration. Report of two cases and review of the literature.

Two patients receiving preoperative carbenicillin manifested platelet dysfunction and severe wound hemorrhage. Platelet transfusions appeared beneficial. Investigations indicate that hemostatic abnormalities, especially platelet aggregation defects, may be produced by carbenicillin. Extreme caution and awareness of possible hemorrhage are advised when carbenicillin is used preoperatively.

Adolescent