Biomedical subjects
Publications and source records attributed to F J Schafer.
A number of recent articles have reviewed the problem of hypoprothrombinemia and bleeding associated with antibiotic therapy. We report three cases in which bleeding is believed to be related to a prolonged prothrombin time secondary to cefoperazone therapy. Reports of coagulopathies such as these are increasing in number and call attention to the need to monitor the prothrombin time during cefoperazone therapy.
Legionella micdadei (Pittsburgh pneumonia agent) pneumonia was diagnosed in three patients by transtracheal aspiration and in a fourth patient by percutaneous lung aspiration on two occasions. The organism was identified by direct fluorescent antibody staining and by culture in each case. Diagnosis by aspiration of the respiratory tract was rapid, specific, and safe. This allowed early institution of specific antimicrobial therapy in a group of severely ill, immunocompromised patients. These techniques should be considered whenever the diagnosis of L micdadei pneumonia is likely.
Optimal treatment of Legionella micdadei pneumonia has not been established, although in vitro studies have shown the pathogen to be sensitive to erythromycin. At our institution, L. micdadei pneumonia was diagnosed in six patients over a one and one-half year period. All patients were immunocompromised and had a typical clinical syndrome; in four of six, diagnosis was made by isolation of the pathogen. All patients received erythromycin (2 to 4 g daily) for 12 to 27 days, and five of six recovered completely. One patient improved initially but died four weeks later from Serratia marcescens pneumonia and septicemia. Although L. micdadei may cause life-threatening pneumonia in immunocompromised hosts, prompt diagnosis and institution of erythromycin therapy can result in a favorable outcome.
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