Biomedical subjects
Publications and source records attributed to Janis E Blair.
Coccidioidal pericarditis, an uncommonly diagnosed entity, may evolve to a constrictive process. Constrictive coccidioidal pericarditis requires pericardiectomy and antifungal therapy. In the elderly, pericardiectomy may be complicated by coagulopathy and septic shock. Despite potential toxicity, use of antifungal therapy early postoperatively offers the best chance for survival.
Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States. Patients with end-stage liver disease (ESLD) have not been described as having a high rate of coccidioidal infection. We prospectively evaluated 290 patients with ESLD for liver transplantation and found that 6 of these patients (2.1%) had active coccidioidal infection at presentation. Of 184 patients listed for transplantation, 48 patients were observed for at least 1 year; among these 48 patients, new coccidioidal infection developed in 2 patients within the year, for a 1-year incidence of 4.2%. Conversely, the incidence of coccidioidal infection in Maricopa County, Arizona in that same period was 0.04%. Awareness is needed to identify the presence of coccidioidal infection, which may be masked by symptoms and findings of ESLD. Treatment may alleviate some of the symptoms of coccidioidomycosis originally attributed to the concomitant liver disease.
Women physicians have made great strides not only in gaining acceptance but also in excelling in the medical profession. A large minority of physicians today are women. Success in the dual roles of mother and physician really is possible, and the experience offers a uniquely rich and complex life. Our hope is that the practical suggestions offered here will prove useful to the next generation of women physicians and that each subsequent generation will become ever more successful in filling these roles.
BACKGROUND: Bacterial infection is a frequent, morbid, and mortal complication of liver transplantation. Selective bowel decontamination (SBD) has been reported to reduce the rate of bacterial infection after liver transplantation in uncontrolled trials, but benefits of this intervention have been less clear in controlled studies. METHODS: Eighty candidates for liver transplantation were randomly assigned in a double-blinded fashion to an SBD regimen consisting of gentamicin 80 mg+polymyxin E 100 mg+nystatin 2 million units (37 patients) or to nystatin alone (43 patients). Both treatments were administered orally in 10 ml (increasing to 20 ml, according to predefined criteria), four times daily, through day 21 after transplantation. Anal fecal swab cultures were performed on days 0, 4, 7, and 21. Rates of infection, death, and charges for medical care were assessed from day 0 through day 60. RESULTS: More than 85% of patients in both treatment groups began study treatment more than 3 days before transplantation. Rates of infection (32.4 vs. 27.9%), death (5.4 vs. 4.7%), or charges for medical care (median $194,000 vs. $163,000) were not reduced in patients assigned to SBD. On days 0, 4, 7, and 21, growth of aerobic gram-negative flora in fecal cultures of patients assigned to SBD was significantly less than that of patients taking nystatin alone; growth of aerobic gram-positive flora, anaerobes, and yeast was not significantly different. CONCLUSION: Routine use of SBD in patients undergoing liver transplantation is not associated with significant benefit.
Apophysomyces elegans is an environmental fungus related to other well-known agents of zygomycosis. We report a case of locally invasive A elegans soft tissue infection resulting from the application of a skin patch to test for snapdragon sensitivity. The infection was limited to skin and soft tissue, and treatment consisted of local debridement and liposomal amphotericin B. Outcome was successful.
Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States. This infection occurs at a rate of 1% to 8% in solid organ transplant recipients residing in the endemic area, and it has a high rate of disseminated infection and mortality. The risk of infection among transplant recipients from nonendemic areas visiting or moving to an endemic region is not known. We reviewed the clinical course of 41 liver transplant recipients who originally resided in and underwent liver transplantation in an area of low coccidioidal endemicity and who later relocated their follow-up care to our program, which is located in an endemic area. No patients received antifungal prophylaxis to prevent primary coccidioidomycosis. Among 37 patients with at least 1 year of follow-up care, the incidence of new coccidioidal infection was 2.7%. Coccidioidomycosis was identified in one patient and was manifested by fatigue, anemia, and pulmonary nodules. This patient survived with oral antifungal therapy. Coccidioidomycosis was not a frequent event in liver transplant recipients from areas of low endemicity who relocated to our highly endemic area.