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Janis E Blair

Publications and source records attributed to Janis E Blair.

At least 19 recordsLinked to original sources
PubMed2006

Coccidioidomycosis in liver transplantation.

Coccidioidomycosis is an endemic fungal infection in the southwestern United States. It causes morbidity and mortality among solid organ transplant recipients who reside in or visit the endemic area or who receive organs from donors infected with the fungus. This paper reviews current literature addressing these infections in liver transplantation programs, including risk factors, clinical manifestations in persons with cirrhosis or who have had a liver transplantation, prophylaxis, treatment, and outcomes.

Adult↗
PubMed2006

Viral and fungal infections after liver transplantation--part II.

Viral and fungal infections in liver transplant recipients are important to recognize and treat early because of their association with substantial morbidity and mortality. Some viruses, such as cytomegalovirus and human herpesvirus 6, have immunomodulatory properties and can facilitate other infections, including fungal infections. Cytomegalovirus has long been recognized as an important virus in transplantation, but in the past decade other viruses have also received attention in the medical literature because of their association with particular clinical syndromes. Although human herpesvirus 6 has been associated with fever, rash, and encephalitis, a direct cause-and-effect relationship is still lacking. Human herpesvirus 8 has been found to be the cause of Kaposi sarcoma. Molecular techniques (e.g., pp65 antigenemia and polymerase chain reaction) that have been introduced for routine diagnosis of viruses have facilitated the diagnosis of asymptomatic viral infections and the institution of preemptive therapy. Nonetheless, the diagnosis of invasive fungal infections in liver transplant recipients is often delayed and thus associated with high mortality. Despite the use of new antifungal agents in clinical practice and the reduced incidence of fungal infections because of antifungal prophylaxis regimens, mortality has not decreased. Future patient outcomes may improve with early identification of patients who have risk factors for invasive fungal infections and with the development of new molecular diagnostic techniques for early detection.

Adult↗
PubMed2006

Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts.

Serologic studies are an important diagnostic tool in the clinical evaluation and follow-up of persons with coccidioidomycosis. Numerous types of serologic tests are available, including immunodiffusion, enzyme immunoassay, and complement fixation. We conducted a retrospective review of the results of 1,797 serologic tests spanning 12 months from the onset of coccidioidomycosis in 298 immunocompetent and 62 immunosuppressed persons with symptomatic infection. Using the onset of symptoms as a reference point, we plotted the positive or negative serologic results over time for both groups. Compared with the immunocompetent group, immunosuppressed persons had lower rates of seropositivity for every type of test during the first year after onset of symptoms for coccidioidomycosis, although many results did not achieve statistical significance. Combining the results of these tests increased the sensitivity of the serologic evaluation in immunocompromised patients. Immunosuppressed persons have the ability to mount a serologic response to coccidioidomycosis, but in some circumstances, multiple methods may be required to improve detection.

Aged↗
PubMed2006

Coccidioidomycosis in patients with diabetes mellitus.

PURPOSE: The study reviewed the interrelationships of diabetes mellitus and coccidioidomycosis. SUBJECTS AND METHODS: We conducted a retrospective review of the medical records of immunocompetent patients with coccidioidomycosis who were treated at our academic medical institution between January 1, 1999, and October 31, 2003, to compare those with and without diabetes mellitus and to determine whether glycemia correlates with the course of illness. RESULTS: Of 329 immunocompetent patients with coccidioidomycosis, 44 had diabetes (4 type 1 and 40 type 2) and were divided into 2 groups: those with serum glucose concentrations of less than 12.2 mmol/L (220 mg/dL) and those with glucose concentrations of greater than or equal to 12.2 mmol/L (220 mg/dL). Persons with diabetes in either glucose group were more likely than those without diabetes to have cavitary lung disease (relative risk, 2.94; P<.001) and relapsed infection. However, only the diabetes group with serum glucose concentrations greater than or equal to 12.2 mmol/L (220 mg/dL) were more likely to have disseminated infection (relative risk, 2.8; P=.05) and to require treatment (relative risk, 9.85; P=.005), but their infection was less likely to resolve (relative risk, 0.24; P=.002). CONCLUSION: Because glycemia strongly correlated with clinical characteristics of coccidioidomycosis in this cohort, we recommend routine measurement of serum glucose in persons with coccidioidomycosis to identify patients with an increased risk of complicated infection. Future studies should evaluate the efficacy of tight glycemic control on the outcome of coccidioidal infection.

Adult↗
PubMed2006

Hormonal contraception update.

Unintended pregnancy continues to be a serious public health issue in the United States. Of the 3 million unplanned pregnancies per year, 60% occur in women using some form of contraception. Educating and helping women choose a contraceptive agent that best suits their needs will improve compliance and contraceptive efficacy. A multitude of new contraceptive agents are now available. We review new hormonal contraceptive options and discuss newer oral agents, extended-cycle contraception, and innovative delivery methods.

Contraception↗
PubMed2006

Prevention of migraine in women throughout the life span.

Migraine is a common disorder in women. The 1-year prevalence of migraine is 18% in women compared with 6% in men. Migraine most commonly occurs during the reproductive years, affecting 27% of women 30 to 49 years of age. The predominance of this disorder and its social, functional, and economic consequences make migraine an important issue in women's health. The hormonal milieu has a substantial effect on migraine in women. An understanding of these hormonal influences in the various stages of life in females is essential to the management and prevention of migraines. This article reviews migraine prevention strategies with an emphasis on specific therapies for each stage of a woman's life.

Disease Progression↗
PubMed2005

Coccidioidomycosis.

Explore the source record for details and available documents.

Coccidioidomycosis↗
PubMed2005

Successful treatment with voriconazole of fungal cerebral abscess due to Cladophialophora bantiana.

We report the first successfully treated case of Cladophialophora bantiana cerebral abscess with the relatively new antifungal agent voriconazole. Infection with this organism is often fatal. A 64-year-old man presented to our institution with progressive neurologic symptoms due to a brain abscess. A stereotactic brain biopsy confirmed the pathogen as C. bantiana. We discuss the successful treatment of this patient, and review the pharmacological actions of voriconazole and the literature on the treatment of this organism. Previously considered a rare cause of cerebral abscess, C. bantiana fungal infections have become more common in recent years. Aggressive and continuous treatment with voriconazole may offer an improved chance of survival in these patients.

Antifungal Agents↗
PubMed2005

Coccidioidomycosis in patients with hematologic malignancies.

BACKGROUND: An endemic fungal infection of the desert southwestern United States, coccidioidomycosis is generally a self-limited illness in healthy persons. Immunosuppressed persons who contract coccidioidomycosis, however, are at increased risk for disseminated infection. METHODS: We conducted a retrospective review of patients with coccidioidomycosis and hematologic malignancy or bone marrow disease. RESULTS: Fifty-five patients were identified. The most common underlying malignancies were non-Hodgkin lymphoma and chronic lymphocytic leukemia. Extrathoracic (or disseminated) infection was observed in 12 patients (22%). Fifteen patients (27%) died with active coccidioidomycosis. Treatment of the hematologic disease with corticosteroids or antineoplastic chemotherapy increased the risk of death. CONCLUSION: To date, this is the largest case series of patients with hematologic malignancy and coccidioidomycosis. In persons with hematologic malignancy, coccidioidomycosis can be a severe illness with a high risk for disseminated infection and death.

Adrenal Cortex Hormones↗
PubMed2005

Colonization of personal digital assistants used in a health care setting.

BACKGROUND: The use of personal digital assistants (PDAs) by health care workers is increasing. Increasing rates of infection in our institution led to the question of whether PDAs were colonized with pathogenic organisms. METHODS: Specimens for culture were obtained from PDAs used at our institution, and surveys were distributed to the users to determine factors predisposing to colonization. RESULTS: Forty percent of PDAs had growth on culture. The most common organism detected on 27 of 82 PDAs was coagulase-negative Staphylococcus (82%). No isolates of methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci were detected. Colonization was more common on PDAs that had undergone previous cleaning. No other predisposing factors to colonization were found. CONCLUSIONS: PDAs are frequently colonized with typical skin organisms and less commonly with pathogenic organisms. Whether PDAs used in the health care setting serve as vectors for nosocomial infection is not determined.

Bacteria↗
PubMed2005

Coccidioidomycosis in hematopoietic stem cell transplant recipients.

Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States that can cause devastating disseminated infection in immunocompromised persons. Clinical coccidioidomycosis, which is caused by Coccidioides species, has been well characterized in patients who have had solid organ transplants, but it has rarely been described in patients who have received a hematopoietic stem cell transplant (HSCT). We report the experience of 121 consecutive HSCT recipients at a single tertiary care institution in an endemic area. One patient had fatal disseminated coccidioidomycosis after receiving an allogeneic transplant, and 2 patients had pulmonary infection before successful autologous HSCT; 1 of these 2 had a reactivation of coccidioidal infection after HSCT but was treated and survived. Coccidioidomycosis was not commonly identified in HSCT recipients, even in the endemic area. A prospective evaluation is required to address the optimal use of coccidioidal serologic tests, antifungal protocols, and secondary prophylaxis in these patients.

Adult↗
PubMed2005

Coccidioidomycosis of the eyelid.

A 77-year-old woman presented with an ulcerated nodule on her right lower eyelid that was unresponsive to broad-spectrum antibiotics or incision and drainage. Coccidioidomycosis was suspected because of previous serologic testing and concurrent indurated cutaneous nodules. Although skin biopsies were not diagnostic, cultures from the eyelid were positive for Coccidioides immitis. The patient was initially treated with oral fluconazole, with resolution of the eyelid and skin lesions. She ultimately completed a 6-month course of oral azole therapy, and at 18-month follow-up she was symptom free. Few cases of granulomatous coccidioidomycosis of the eyelids have been reported. The clinical features of this infection are not specific, and the diagnosis is often difficult. Presentation can mimic bacterial infection or malignant neoplasm, leading to delayed or inappropriate treatment. We describe an unusual ulcerative lesion of the eyelid that led to a diagnosis of disseminated coccidioidomycosis.

Aged↗
PubMed2005

Coccidioidomycosis of the male genital tract.

PURPOSE: Symptomatic genital tract infection is a rare manifestation of disseminated coccidioidomycosis. We characterized the clinical presentation, diagnosis, management and outcome in male patients with genitourinary coccidioidomycosis. MATERIALS AND METHODS: We reviewed all cases of genital tract coccidioidomycosis involving testes, epididymis or prostate at our institution between 1990 and 2000, and searched the medical literature for all reports since the first reported case in 1943. RESULTS: A total of 30 male patients with a median age of 58 years who had coccidioidomycosis of the genital tract were identified, including 6 at our institution. Four patients (13%) had a simultaneous pulmonary infection and 63% (19) had a remote history of primary pulmonary coccidioidomycosis. The most commonly involved genital tract sites were the epididymis in 18 cases, prostate in 14 and testes in 6. Patients with prostatitis presented with urinary obstruction, prostatic enlargement, tenderness and palpable nodules. Most patients with epididymal infection presented with scrotal swelling, tenderness and induration. All 30 patients (100%) had histopathological evidence of granulomatous inflammation with fungal spherules. Urine fungal cultures were positive in 19 cases (63%). A total of 12 patients received combined medical and surgical treatment, and 18 underwent surgical excision only. Most immunocompetent patients with isolated genital coccidioidomycosis did well with surgical resection alone. Six deaths occurred in patients with multifocal, extragenital, disseminated disease. CONCLUSIONS: Male genitourinary coccidioidomycosis is rare but it should be considered in the differential diagnosis of patients with exposure to the endemic area who present with prostatitis or epididymitis.

Aged↗
PubMed2005

Health care maintenance in female adolescents.

The assessment and care of female adolescents by primary care physicians can be facilitated with increased knowledge about this stage of development, the health care risks faced by these patients, and the resources available to aid in their care. With a focus on preventive health maintenance, this concise review addresses these areas as well as how to build relationships with female adolescent patients, conduct age-appropriate interviews and tests, and maintain patient confidentiality.

Adolescent↗
PubMed2004

Evaluation of fever in the international traveler. Unwanted 'souvenir' can have many causes.

As international travel becomes more common, primary care physicians will be increasingly involved in the treatment of patients who return home with febrile illnesses. The initial laboratory evaluation is critical. This approach to diagnosis involves taking a thorough history, asking specific questions about the patient's travel itinerary and activities, and giving a careful and complete physical examination. Malaria is the most common cause of febrile illness in travelers returning from endemic areas, and prompt evaluation is essential to initiating timely treatment. Various resources are available to assist in this evaluation.

Communicable Diseases↗
PubMed2004

Endocarditis caused by Coccidioides species.

Endocarditis caused by Coccidioides species has been reported rarely. Herein, we report 2 such cases and summarize 4 published reports. Coccidioidal endocarditis was found in patients who had prolonged or disseminated infection. Vegetations were identified on mitral or aortic valves or valvular rings, and embolic phenomena were observed. Diagnosis was hindered by uniformly negative results from blood cultures. The patients had a wide range of serologic titers for Coccidioides species (1:1-1:2048). The infection was fatal in 4 of the 6 patients whose cases we reviewed. We conclude that coccidioidal endocarditis is an uncommon manifestation of Coccidioides infection that connotes a poor prognosis.

Adult↗