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Biomedical subjects

E Mylonakis

Publications and source records attributed to E Mylonakis.

49 records · Page 3Linked to original sources
PubMed1998

Central nervous system infection with Listeria monocytogenes. 33 years' experience at a general hospital and review of 776 episodes from the literature.

We reviewed 776 previously reported and 44 new cases of CNS listeriosis outside of pregnancy and the neonatal period, and evaluated the epidemiologic, diagnostic, and therapeutic characteristics of this infection. Among patients with Listeria meningitis/meningoencephalitis, hematologic malignancy and kidney transplantation were the leading predisposing factors, but 36% of patients had no underlying diseases recognized. The infection occurred throughout life, with a higher incidence before the age of 3 and after the age of 45-50 years. Fever, altered sensorium, and headache were the most common symptoms, but 42% of patients had no meningeal signs on admission. Compared with patients with acute meningitis due to other bacterial pathogens, patients with Listeria infection had a significantly lower incidence of meningeal signs, and the CSF profile was significantly less likely to have a high WBC count or a high protein concentration. Gram stain of CSF was negative in two-thirds of cases of CNS listeriosis. One-third of patients had focal neurologic findings, and approximately one-fourth developed seizures over their course. Mortality was 26% overall, and was higher among patients with seizures and those older than 65 years of age. Relapse occurred in 7% of episodes. Ampicillin for a minimum of 15-21 days (with an aminoglycoside for at least the first 7-10 days) remains the treatment of choice. Cerebritis/abscess due to L. monocytogenes, without meningeal involvement, is less common but may be diagnosed by blood cultures and CNS imaging, or by stereotactic biopsy. Longer antibiotic therapy (at least 5-6 weeks) is needed in the presence of localized CNS involvement.

Brain Abscess↗
PubMed1998

Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases.

Aspergillosis is an infrequent but commonly fatal infection among HIV-infected individuals. We review 342 cases of pulmonary Aspergillus infection that have been reported among HIV-infected patients, with a focus on invasive disease. Invasive pulmonary aspergillosis usually occurs among patients with <50 CD4 cells/mm3. Major predisposing conditions include neutropenia and steroid treatment. Fever, cough, and dyspnea are each present in >60% of the cases. BAL is often suggestive, but biopsy specimens are necessary for definite diagnosis. Amphotericin B is the mainstay of treatment and mortality is > 80%. Avoiding neutropenia and judicious use of steroids may be helpful in prevention. Aggressive diagnostic approach, early initiation of treatment, adequate dosing of antifungals, and close follow-up may improve the currently dismal prognosis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Enterohemorrhagic Escherichia coli O157:H7--an emerging pathogen.

Enterohemorrhagic Escherichia coli O157:H7 has become an important public health problem in recent years, causing more than 20,000 cases of infection and up to 250 deaths per year in the United States. Transmission of infection is most commonly linked to consumption of undercooked ground beef, contaminated drinking water or unpasteurized milk. Patients with this infection most often present with an acute onset of diarrhea and abdominal cramping that progresses over days to bloody stools. The most serious complications of E. coli O157:H7 infection include hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura. Hemolytic-uremic syndrome occurs most often in children less than five years of age and the elderly, while thrombotic thrombocytopenic purpura occurs only in adults. Detection of E. coli O157:H7 requires specific testing that is not performed in routine stool cultures. All patients with documented infection require close observation for the development of possible complications. Use of antibiotics and antimotility agents may worsen the course of the infection and should be avoided.

Diagnosis, Differential↗
PubMed1997

Invasive Aspergillus sinusitis in patients with human immunodeficiency virus infection. Report of 2 cases and review.

Aspergillus sinusitis is an uncommon complication of advanced human immunodeficiency virus (HIV) infection. We describe 2 patients with AIDS who developed histologically proven invasive Aspergillus sinusitis. We also review the findings of 14 histologically documented and 5 probable cases of invasive Aspergillus sinusitis. The literature on the prevalence, predisposing factors, diagnosis, treatment, and prognosis of the infection is reviewed. Major risk factors for the disease are advanced AIDS, chronic sinusitis or otitis, neutropenia, use of corticosteroids and prolonged use of broad spectrum antibiotics. The most common presenting symptoms are nonspecific and include fever, local pain, and swelling. Despite the newer diagnostic and therapeutic approaches discussed herein, the infection is usually fatal in HIV-infected patients. Early diagnosis and aggressive treatment remain the only available means to improve the currently dismal prognosis of Aspergillus sinusitis.

Abscess↗
PubMed1997

Efficacy of deoxycholate amphotericin B and unilamellar liposomal amphotericin B in prophylaxis of experimental Aspergillus fumigatus endocarditis.

OBJECTIVE: To evaluate and compare in vivo the protective efficacy of unilamellar liposomal amphotericin B (L-AmB) with that of deoxycholate amphotericin B (D-AmB) in experimental endocarditis. MATERIAL AND METHODS: In the rabbit model of experimental Aspergillus fumigatus endocarditis, two doses of each antifungal agent (1.5 mg/kg each) were administered intravenously at 4 hours and at 30 minutes before challenge with an inoculum of A. fumigatus. Three days later, the animals were sacrificed, and the aortic vegetations were analyzed. RESULTS: All 19 animals that did not receive chemoprophylaxis acquired endocarditis. In contrast, endocarditis developed in 2 of 10 animals pretreated with D-AmB (P < 0.01) and 3 of 8 animals pretreated with L-AmB (P < 0.01). Both D-AmB and L-AmB prevented the development of endocarditis due to A. fumigatus and decreased the concentration of fungi in the aortic vegetations by more than 1 log10. CONCLUSION: In the rabbit experimental model of Aspergillus endocarditis, D-AmB and L-AmB were equally effective in reducing the incidence of the infection and the tissue burden of fungi.

Amphotericin B↗
PubMedDate not supplied

Report of a false-positive HIV test result and the potential use of additional tests in establishing HIV serostatus.

Considering the lifelong implications of a positive human immunodeficiency virus (HIV) test result, physicians should be aware of the limitations of tests for HIV. A 43-year-old man had a reactive enzyme-linked immunosorbent assay and an indeterminate result on Western blot analysis. The results of subsequent enzyme-linked immunosorbent assay and Western blot tests were interpreted as positive, and the patient was informed that he had HIV infection. Persistently undetectable plasma HIV-1 RNA, combined with normal physical examination findings, CD4(+) cell count, and CD4/CD8 ratio, prompted further testing, which revealed that the patient was not infected with HIV. False-positive HIV test results are uncommon, but they can occur. In the appropriate clinical setting, follow-up and the use of other laboratory tests, such as determination of plasma viral load, may help identify such cases.

AIDS Serodiagnosis↗
PubMedDate not supplied

Atrial fibrillation and tumor emboli as manifestations of metastatic leiomyosarcoma to the heart and lung.

Leiomyosarcoma is a malignant tumor of the smooth muscle that rarely occurs in the gastrointestinal tract. High-grade leiomyosarcomas of the rectosigmoid usually metastasize to the liver and lungs. Although it is unusual, metastases to the heart have been reported. When this occurs, the metastatic tumor usually seeds in the right atrium and pulmonary artery. We report on and discuss a patient who had atrial fibrillation, peripheral emboli, and thrombocytopenia resulting from a low-grade rectosigmoid leiomyosarcoma metastatic to the pulmonary vein and left atrium. Atrial fibrillation is not a common manifestation of malignant neoplasms that have spread to the heart. Surgical removal of the tumor terminated the arrhythmia and thrombocytopenia.

Atrial Fibrillation↗
PubMedDate not supplied

Pulmonary invasive aspergillosis in patients infected with the human immunodeficiency virus: report of two cases.

Patients infected with the human immunodeficiency virus (HIV) have an increased frequency of invasive aspergillosis. We report two cases of invasive pulmonary aspergillosis in patients infected with HIV. Patients had less than 10 CD4 (helper cell) cells/mm3 (2/2), presented with fever (2/2), dyspnea (1/2), and abnormal chest radiograph (2/2). Diagnosis was established by transbronchial biopsy (1/2) and autopsy (1/2). Patients died in spite of treatment with intravenous deoxycholate amphotericin B. Prognosis of invasive pulmonary aspergillosis among patients infected with HIV remains dismal, even with aggressive antifungal treatment.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Thrombosis of mitral valve prosthesis presenting as abdominal pain.

A 67-year-old woman presented with abdominal pain, anemia, and leukocytosis. Five years previously, the patient had undergone mitral valve replacement with a St. Jude bileaflet mechanical prosthesis. After her admission, echocardiography confirmed an immobile leaflet of the prosthetic valve. At urgent surgery, thrombosis and pannus, obstructing the disc, were found, and the mechanical valve was replaced with a bioprosthesis. The incidence of mitral valve thrombosis is low, ranging from 0.1% to 5.7% per patient per year. Patients who receive inadequate anticoagulation, particularly with valve prostheses in the mitral position, have an increased risk for thrombus or pannus formation. Presentation varies, from symptoms of congestive heart failure or systemic embolization, to fever or no symptoms. New or worsening symptoms in a patient with a prosthetic heart valve should raise concerns about prosthetic dysfunction. Aggressive investigation and, if indicated, urgent or emergency surgery for treatment can be lifesaving.

Abdominal Pain↗