Prolonged incubation in brucellosis.
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Biomedical subjects
Publications and source records attributed to E J Young.
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Fever patterns were studied prospectively in 200 consecutive patients referred for infectious disease consultation and retrospectively in 204 patients with selected infectious or noninfectious diseases. Most patients had remittent or intermittent fever, which, when due to infection, usually followed diurnal variation. Hectic fever occurred less commonly but was observed in patients with all categories of infectious or noninfectious diseases. Although hectic fevers were seen more frequently in patients who had documented bacteremia, there were many nonbacteremic subjects who had this pattern and others without this pattern who had bacteremia. Sustained fever nearly always occurred in patients with Gram-negative pneumonia or CNS damage, although some patients with these diseases had other patterns as well. Our data suggest that, with the possible exception of sustained fever in Gram-negative pneumonia or CNS damage, the fever pattern is not likely to be helpful diagnostically.
A middle-aged woman developed malabsorption and severe protein-calorie malnutrition after a near-total gastrectomy for a perforated gastric ulcer. A transbronchial lung biopsy showed pulmonary infection with Torulopsis glabrata. Improvement in the patient's nutritional status was followed by clearing of the pneumonia without the need for antifungal chemotherapy.
By using mice infected with strains of Brucella abortus and Brucella melitensis we examined the histological responses to infection, the relationship of histology to persistence of organisms, and the relation of persistence of organisms to the acquisition of acquired cellular resistance (ACR). Infection with B. abortus resulted in well-formed granulomas in the livers, which persisted for more than 30 days. In contrast, infection with B. melitensis produced microabscesses in the livers which resolved before 30 days. The clearance of organisms from the tissues was also different. A total of 30 days after infection, large numbers of viable bacteria were recovered from the tissues of B. abortus-infected mice whereas bacteria were no longer recoverable from B. melitensis-infected animals. ACR to Listeria monocytogenes, another intracellular pathogen, persisted for more than 30 days in B. abortus-infected mice but waned rapidly in B. melitensis-infected animals. This disappearance of ACR due to B. melitensis paralleled the clearance of bacteria from the tissues.
Two distinctly different and stable forms of Staphylococcus aureus were isolated from the blood of each of two patients with staphylococcal sepsis. In each case, one form was hemolytic and the other nonhemolytic, although both had the same biochemical reactions, phage types, and antibiotic susceptibilities, and both were virulent for mice. Variant forms of S. aureus may be selected in vivo by host factors and may be responsible for causing and/or perpetuating infection.
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Acute bilateral suppurative parotitis developed in two patients with documented cirrhosis of the liver while they were in the hospital. Gram's stain and culture of purulent material obtained from the orifice of Stensen's duct disclosed Haemophilus influenzae as the sole isolate. Both patients were treated successfully with local care and antibiotics. To our knowledge, with one possible exception, infection of the parotid gland due to this organism has not been described previously.
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The availability of effective antimicrobial agents has greatly decreased the need for surgical intervention in patients who have a pyogenic lung abscess. We describe 3 patients with lung abscesses caused by gram-negative bacteria who failed to respond to medical treatment and who were believed to be unable to withstand lobectomy. Percutaneous insertion of a drainage tube directly into the abscess brought about a dramatic clinical response, with prompt closure of the cavity. This procedure provides an alternative to thoracotomy and lobectomy in treating lung abscesses that fail to respond to medical therapy.
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A 47-year-old man had multiple pyogenic liver abscesses from which the anaerobic bacteria Fusobacterium nucleatum and Peptostreptococcus were isolated. The clinical course, diagnostic evaluation, and appearance of the lesions at surgery suggested metastatic tumor. Histologically, the lesions consisted of necrotic liver tissue surrounded by zones of acute and chronic inflammation and fibrous connective tissue closely resembling the lesions of hepatic necrobacillosis attributable to F necrophorum. Treatment with high doses of penicillin was curative.
Thirteen patients severely infected with herpesvirus were treated with intravenous adenine arabinoside (ara-A), and two patients received placebo therapy. Blastogenic and cytotoxic responses specific for the virus infecting each patient were determined before, during, and after treatment. Blastogenic responses to three mitogens (phytohemagglutinin, pokeweed, and concanavalin-A) were examined, as were titers of viral antibody. In vitro responses during and after treatment with ara-A were unchanged or often enhanced as compared with values before treatment. Newborn infants, presumably infected at or shortly before birth, did not demonstrate cellular immune reactivity to the infecting virus until after four days of life. In this series of patients, prognosis appeared to be in part determined by the cellular immune competence of the host at the time of infection.
Seven young to middle-aged patients with Haemophilus parainfluenzae endocarditis are reported. Three patients had underlying heart disease and three patients had recent events predisposing for endocarditis. The clinical presentation was subacute or acute and new pathologic murmurs were uncommon. Diagnosis was prolonged because of difficulties in isolating the organism. Routine subculturing of blood cultures to chocolate agar with incubation in CO2 is recommended. A prominent complication, occurring in six patients, was major arterial occlusion secondary to emboli. Antibiotic control of infection was difficult and best achieved by the concomitant administration of ampicillin and gentamicin. Killing curves proved useful in assessing antibiotic efficacy. There were two medical failures and one death in the series. It appears H. parainfluenzae endocarditis is characterized by distinctive clinical features, difficult in vitro isolation of the organism, and the necessity for combination antibiotic therapy.