[Experiments with the antigenicity of inactivated smallpox vaccines].
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Animals↗
Biomedical subjects
E Vanek
Publications and source records attributed to E Vanek.
Mucormycosis in the immunocompromised host.
We are presenting two typical case histories of mucormycosis in patients with acute leukaemia which illustrate some of the important features of this infection in compromised hosts. In such patients, mucormycosis is mostly pulmonary or widely disseminated and often has a rapidly fatal course. A microbiological diagnosis from blood or sputum is difficult to establish. Mucormycosis or other fungal infections should be suspected in compromised patients with infections which do not respond to adequate antibiotic therapy.
Acute Disease↗
The penetration of antibiotics into human pancreas.
In order to analyse the penetration of two antibiotics (mezlocillin and metronidazole) which cover the spectrum of microorganisms involved in pancreatic infection, we determined their concentration in pancreatic tissue, juice and cyst fluid in 16 patients undergoing pancreatic surgery. In addition, the external pancreatic fistula fluid of one patient was analysed for antibiotic concentration and bacterial counts during a seven-day treatment with mezlocillin, metronidazole and netilmicin (i.v.). Antibiotic concentrations were determined by HPLC between 16 and 210 (median 74) min after i.v. administration of 4 g mezlocillin and 500 mg metronidazole, respectively. The median concentration of mezlocillin was 23.2 (range: 3.1-37.4) mg/kg, 15.9 (range: 4.2-55.0) mg/l and 9.9 (range: 5.2-14.8) mg/l in pancreatic tissue, juice and cyst fluid, respectively. The median concentration of metronidazole was 5.1 (range: 1.8-13.0) mg/kg, 8.5 (range: 3.6-16.2) mg/l and 1.2 (0.9-1.4) mg/l in pancreatic tissue, juice and cyst fluid, respectively. From the fistula patient, seven different bacteria were cultured (five aerobic and two anaerobic isolates); their concentration in fistula fluid ranged from 10(5) to 10(7) CFU/ml. The bacteria sensitive for mezlocillin and metronidazole disappeared after four days of i.v. treatment, whereas the two isolates sensitive for netilmicin showed continuous growth seven days after i.v. treatment. The peak concentrations for mezlocillin, metronidazole and netilmicin in the fistula fluid were 6.8 mg/l, 5.6 mg/l and less than 0.1 mg/l, respectively.
Adenocarcinoma↗
Ofloxacin for prevention of bacterial infections in granulocytopenic patients.
We studied the potential value of oral ofloxacin (200 mg twice daily) for selective decontamination and infection prevention in 40 granulocytopenic patients with acute leukemia, blast crisis of chronic myelogenous leukemia, hairy cell leukemia or severe aplastic anemia. The quality of selective decontamination was acceptable with rapid elimination of Enterobacteriaceae from the alimentary tract, only a slight decrease in concentrations of anaerobes in faeces, and a small number of newly acquired transient (twelve isolates in seven patients) or colonizing (six strains with 28 isolates in four patients) aerobic gram-negative rods and Staphylococcus aureus (one isolate) recovered from 672 surveillance cultures from faeces, oral washings and urine. Two of three patients colonized with ofloxacin-resistant Pseudomonas aeruginosa strains developed Pseudomonas infections. A total of twelve acquired infections was observed. Six were microbiologically documented infections, all caused by ofloxacin-resistant bacteria (two P. aeruginosa, two Staphylococcus epidermidis, one Aerococcus viridans, one Micrococcus sp.). Tolerance was acceptable with no serious side effects observed. Mean drug concentrations in serum and saliva were comparable to those determined in healthy volunteers and were found to be higher in saliva than in serum. We conclude that ofloxacin may be studied as an effective alternative to trimethoprim-sulfamethoxazole for selective decontamination and infection prevention in severely granulocytopenic patients. Careful monitoring of colonizing Pseudomonas spp. with decreased ofloxacin sensitivity, however, seems necessary.
Adult↗
Low prevalence of intestinal cryptosporidiosis among immunocompetent and immunocompromised patients with and without diarrhoea in southern Germany.
1160 stool specimens, from 160 severely immunocompromised patients, from 70 adults and 180 children with acute diarrhoea and from 60 controls without diarrhoea and without evidence of immunocompromising underlying disorders, were examined for Cryptosporidium excretion. Only two children (1.1%) (one with previous contact to a straying cat and to lambs, the other without known risk) had documented intestinal cryptosporidiosis, whereas none of the symptomatic adults, immunocompromised patients or controls were found to be positive for Cryptosporidium fecal excretion. Other potential protozoal enteric pathogens among immunocompromised patients were only found in seven of 25 patients with HIV infection. We conclude that sporadic intestinal cryptosporidiosis in Southern Germany is a rare disease in humans even of younger age, but should be included in the differential diagnosis of diarrhoea in immunocompetent and immunocompromised patients.
Acquired Immunodeficiency Syndrome↗