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Biomedical subjects

J E Milder

Publications and source records attributed to J E Milder.

14 recordsLinked to original sources
PubMed1992

Clinical, social and ethical aspects of HIV-1 infections in an Arab Gulf State.

Clinical, social and ethical aspects of HIV-1 infection as occurring in the Arab Gulf State of Qatar are presented. Up until November 1989, 50 patients were reported with HIV infection. In more than 75% of cases, the disease was acquired via transfusion of imported blood; 52% have developed AIDS and 65% of these have died. In response to the problem, the Ministry of Health has established a National AIDS Committee whose major function has been to educate both the medical profession and lay public about the disease and on ways to prevent its spread. Furthermore, the Committee has also taken on the role of patient advocate and has been instrumental in resolving many HIV-related difficulties in the community at large. Specialized HIV clinics have also been set up, with both Qatari and expatriate patients being enrolled in treatment programmes. No expatriate patient has been deported due to infection with HIV. Although many social and ethical issues remain unresolved, it appears that a rational and humane public health policy has been adopted in Qatar with respect to the AIDS threat.

AIDS Serodiagnosis↗
PubMed1983

Legionella micdadei (Pittsburgh pneumonia agent). Two infections with unusual clinical features.

We describe herein the clinical features, diagnosis, and successful treatment of two patients with Legionella micdadei pneumonia, the Pittsburgh pneumonia agent. The rapid pulmonary cavitation and relapse of symptoms after a course of therapy in a renal transplant recipient, and the prolonged illness with hemorrhagic pleural fluid, splenomegaly, and multiple-organ dysfunction in a nonimmunocompromised host, illustrate the clinical spectrum of infections with this organism.

Adult↗
PubMed1982

Concurrent legionnaires' disease and active pulmonary tuberculosis.

A 68-yr-old man was admitted to the hospital with severe Legionnaires' disease, which was serologically confirmed by a 6-fold increase in antibody titers to Legionella pneumophila, serogroup 1. The patient improved dramatically with intravenously administered erythromycin therapy but was discharged from the hospital with residual debility and pulmonary complaints later recognized as being caused by active pulmonary tuberculosis. The diagnostic and therapeutic confusion engendered by the concurrence of these pulmonary infections is discussed.

Aged↗
PubMed1982

Epidemiologic features of Strongyloides stercoralis infection in an endemic area of the United States.

The epidemiologic features of Strongyloides stercoralis infection in Kentucky were studied by an analysis of clinical cases at the University of Kentucky Medical Center (UKMC); by an analysis of parasitologic records of the Kentucky Bureau for Health Services (KBHS); and by a prospective stool survey of school children in Clay County, located in southeastern Kentucky, an area of the state previously found to be highly endemic for intestinal parasites. S. stercoralis was the most common parasitic infection diagnosed at UKMC. The patients were predominantly white male adults who were over 50 years old, had an associated chronic or debilitating medical illness, were of low socioeconomic background, and resided in southeastern Kentucky. S. stercoralis was a common parasitic infection at KBHS ad the patients showed a similar geographic distribution. Of 561 Clay County children surveyed, 23.7% harbored one or more intestinal parasite pathogens and 3.0% had S. stercoralis. Thus, S. stercoralis remains highly endemic in Kentucky and may cause disease even in geriatric patients.

Adolescent↗
PubMed1981

Clinical features of Strongyloides stercoralis infection in an endemic area of the United States.

Infection with Strongyloides stercoralis, the most common intestinal parasite at our hospital, was encountered in 56 patients over a 3-yr period. The majority of the patients were male adults over 50 years old who had a chronic debilitating associated illness; about half the patients were immunocompromised. Strongyloidiasis was usually a chronic relapsing illness of mild to moderate severity characterized by gastrointestinal complaints (diarrhea, pain, tenderness, nausea, vomiting) and peripheral eosinophilia. Hypoalbuminemia also occurred. Stool examination for larvae was an effective method of diagnosing the parasite, and treatment with thiabendazole was usually successful. The frequent occurrence of S. stercoralis in geriatric patients with other medical problems and the delays in making the diagnosis suggest that the clinical spectrum of strongyloidiasis is greater than generally appreciated by the medical profession. Increased awareness of S. stercoralis is important to prevent the hyperinfection syndrome, which was estimated to occur in 1.5-2.5% of our patients.

Adolescent↗
PubMed1980

Growth characteristics and pathogenesis of experimental Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia was produced in two groups of rats by the administration of corticosteroids, a low-protein (8%) diet, and tetracycline in the drinking water. A third group not on corticosteroids or a low-protein diet served as controls. Members of the first group were sacrificed weekly for 8 weeks, and lungs were examined. A highly significant correlation was found between the histopathological assessment of the intensity of P. carinii infection and the number of cysts counted in enzyme-digested lungs. P. carinii progressively filled alveoli, and cyst counts increased from less than or equal to 10(4) to 10(9) cysts/g of lung at peak intensity of infection at 7 to 8 weeks. The second group of rats was placed on a regular diet and tapering doses of corticosteroids after week 4, and they were sacrificed at varying intervals for up to 21 weeks. P. carinii was not cleared from the lungs until after week 13 (more than 6 weeks after discontinuation of all steroids). Histologically, there was an increased prominence of alveolar macrophages and the progressive development of interstitial mononuclear cell infiltrate and fibrosis. Thus, P. carinii grows grows slowly in vivo and interacts with specific host cells. The resulting changes may be important in the pathogenesis of the infection and in the clearance of the organism from the lung after immunocompetence has been restored.

Animals↗
PubMed1980

Comparison of histological and immunological techniques for detection of Pneumocystis carinii in rat bronchial lavage fluid.

We compared histological and immunological techniques in the early diagnosis of Pneumocystis carinii pneumonia in bronchial lavage fluid of steroid-treated rats. The rats were sacrificed weekly and lavage fluids were: (i) examined with cresyl echt violet and Giemsa stains; (ii) examined for P. carinii antigens by indirect fluorescent-antibody, counterimmunoelectrophoresis, and double-diffusion techniques, using high-titer spectific antisera to P. carinii raised in rabbits. P. carinii was detected in lavage fluid by cresyl echt violet at 2 weeks of steroids and persisted even with steroid tapering; the intensity of the infection in lavage fluid closely paralleled that in the lungs. P. carinii was not detected in lavage by Giemsa stain until 4 weeks and disappeared from the fluids with steroid tapering. P. carinii was detected by indirect fluorescent antibody as early as 1 week of steroids, and the results correlated well with those of cresyl echt violet. P. carinii antigens were not detected in lavage fluids or serum by counterimmunoelectrophoresis or double-diffusion techniques. Although precipitin lines sometimes occurred, they were nonspecific. In this model, cresyl echt violet and indirect fluorescent antibody were the preferred techniques for the early diagnosis of P. carinii infection in bronchial lavage fluid.

Animals↗
PubMed1979

Presumed respiratory syncytial virus pneumonia in an adolescent compromised host.

A 15-year-old boy with nephrotic syndrome, renal insufficiency, and cutaneous anergy had severe pneumonia with pleural effusion. There was serologic evidence of respiratory syncytial virus infection, and extensive microbiologic, histologic, and serologic studies failed to identify any other etiologic agent. Respiratory syncytial virus as a possible cause of severe pneumonia in immunocompromised hosts has not been previously reported.

Adolescent↗
PubMed1979

Treatment of Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole and pentamidine: efficacy and toxicity.

A 39-year-old man with Pneumocystis carinii pneumonia responded poorly to oral trimethoprim-sulfamethoxazole (TMP-SMX) therapy, despite excellent serum concentrations of the drug. He developed severe thrombocytopenia when pentamidine was added to the regimen. This case illustrates problems of drug efficacy and toxicity in the treatment of P carinii pneumonia and suggests caution in the use of TMP-SMX and pentamidine in combination.

Adult↗
PubMed1977

Pasteurella multocida pneumonia and bacteremia.

A 76-year-old man with chronic obstructive pulmonary disease who developed P multocida pneumonia and bacteremia has been described. The infection was treated with antibiotics, and the patient recovered. Pasteurella multocida is known to infect many species of animals. The instances of human infection due to this organism are frequently associated with exposure to animals. Pulmonary infection occurs principally in patients with underlying chronic bronchopulmonary disease.

Aged↗