Rapid relapse of cryptococcal meningitis after termination of maintenance fluconazole in AIDS.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to L A Haglund.
Explore the source record for details and available documents.
Relapse of Streptococcus pneumoniae bacteremia after appropriate therapy is thought to be rare, even in immunocompromised patients. We describe three immunodeficient patients who experienced repeated episodes of pneumococcal bacteremia within 8 weeks after receiving appropriate therapy. Serotyping and DNA fingerprinting of respective isolates strongly suggested that each patient's bacteremic relapse was caused by the same pneumococcal strain. Relapsing and recurrent infections with an identical pneumococcal strain, especially in immunodeficient individuals, may be more common than is generally appreciated.
Recent clinical enterococcal isolates from the Oklahoma City Department of Veterans Affairs Medical Center were screened for high-level aminoglycoside resistance, vancomycin resistance, beta-lactamase production, and hemolysin production. Twenty-nine of 53 (55%) enterococcal isolates had high-level resistance to gentamicin, kanamycin, or streptomycin; 27 of these isolates were from the blood and 16 (59%) showed high-level gentamicin resistance. Twenty-one percent of 259 enterococcal isolates from blood, urine, stool, and other sources were hemolytic. Of thirteen blood isolates tested for both high-level gentamicin resistance and hemolysin production, 6 (46%) showed both characteristics. Vancomycin-resistant or beta-lactamase-producing isolates were not found. Nineteen of 21 charts from patients with premortem enterococcal blood isolates were reviewed, and no correlation was found between appropriate antibiotic treatment for high-level gentamicin-resistant or susceptible enterococcal bacteremia and outcome. Enterococci with multiple high-level aminoglycoside resistance, but not vancomycin resistance or beta-lactamase production, are common at this referral medical center. Clinical microbiology laboratories in Oklahoma should routinely screen enterococcal isolates causing potentially serious infections (eg, from blood or cerebral spinal fluid) for high-level aminoglycoside resistance.
Two hundred seventy-two patients infected with human immunodeficiency virus (HIV) have received care from the members of the adult infectious disease section at the University of Oklahoma Health Sciences Center. The majority of these patients met the diagnostic criteria for acquired immunodeficiency syndrome. This group of patients was characterized by relatively few parenteral drug abusers, a high incidence of disseminated histoplasmosis, and an unexpectedly low frequency of toxoplasmosis. The prevalence of risk behaviors and endemic disease may be responsible for these particular case distributions.