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Biomedical subjects

L B Guze

Publications and source records attributed to L B Guze.

At least 91 records · Page 5Linked to original sources
PubMed1977

Anorectal gonococcal infection.

Anorectal gonococcal infection is common in women and homosexual men. In women with uncomplicated gonorrhea, the mean prevalence rate of anorectal involvement is 44%, with lone involvement of the anorectum in 4%. Among homosexual men with gonorrhea, anorectal infection occurs in 45%, although more than 90% of all male patients with anorectal gonorrhea admit to homosexual rectal intercourse. This infection is usually asymptomatic but occasionally presents with acute or chronic symptoms that mimic other causes of proctitis. Whereas currently recommended regimens for uncomplicated gonorrhea appear effective for anorectal gonorrhea in women, results in men have not been adequately evaluated. Available data showed failure rates from 7% to 35%; however, only one study used a currently accepted regimen. Further controlled studies in male patients with anorectal gonorrhea are clearly needed to establish optimal therapeutic regimens. Diligent contact tracing of all male homose.xual cases appears to be the only effective means of control at present.

Anti-Bacterial Agents↗
PubMed1977

Therapeutic regimens for anorectal gonococcal infection in males.

Anorectal gonococcal infection is particularly prevalent in women and homosexual men. Although the currently recommended Public Health Service therapeutic regimens for uncomplicated gonorrhea appear to be effective also for anorectal gonorrhea in women, their efficacy for anorectal infection in men has not been adequately evaluated. We report a case of gonococcal proctitis in a homosexual man that did not respond to therapy with ampicillin plus probenecid and tetracycline, but subsequently responded to spectinomycin therapy. Currently available therapeutic regimens for anorectal gonococcal infection in males are reviewed.

Adult↗
PubMed1977

Infectious mononucleosis and mononucleosis syndromes.

Infectious mononucleosis (IM) and cytomegalovirus (CMV) mononucleosis are caused by a primary infection with related viruses, Epstein-Barr virus (EBV) and CMV. Despite the similarity of clinical manifestations, basic differences exist: (1) The heterophil antibody (HA) response is absent in CMV mononucleosis, whereas it is present in IM. (2) In IM atypical lymphocytosis reflects proliferation of B cells early and of T cells later in the disease course; in CMV mononucleosis the situation appears complex. (3) In blood, EBV is restricted to B lymphocytes, whereas CMV is found in polymorphonuclear and mononuclear leukocytes. (4) Complications of CMV mononucleosis such as hepatitis and pneumonitis may be due to virus cytopathic effect in target organs. Prominent tonsillopharyngitis with adenopathy, and visceral complications of IM are related to lymphoproliferation which is self-limited except in males with a rare familial defect in defense against EBV. Immune complex-mediated pathology may occur in both diseases. (5) CMV is frequently transmitted to a fetus in utero or to an infant during or after birth, and this occasionally leads to severe cytomegalic inclusion disease; vertical transmission of EBV appears to be exceptional. (6) Secondary EBV infections are associated with certain malignancies whereas such an association has not been recognized in the case of CMV. Toxoplasma gondii is another cause of HA-negative mononucleosis. Its complications in the heart, in skeletal muscle and in the central nervous system are related to direct invasion by the parasite. Cellular immunity plays an important role in defense against all three agents.

Cytomegalovirus Infections↗
PubMed1977

Serum gentamicin assay by high-performance liquid chromatography.

We describe a high-performance liquid chromatographic method for the quantitative determination of gentamicin in serum. The antibiotic was separated from serum by passage through a silicic acid column, derivatized with o-phthalaldehyde, and eluted with ethanol. The derivatized gentamicin was then separated into all three of its major components by reversed-phase chromatography and quantified by fluorometry. Concentrations in serum as low as 0.5 mg of gentamicin per liter could be accurately determined. A standard curve showed a linear response for serum containing gentamicin at concentrations ranging from 0 to 20 mg/liter. Tobramycin, amikacin, ampicillin, penicillin G, methicillin, carbenicillin, chloramphenicol, clindamycin, and cephalothin did not interfere with the gentamicin assay. Comparison with an accepted microbiological assay yielded a correlation coefficient of 0.99. This chemical assay is rapid (less than 30 min), sensitive, accurate, specific, and appears to be applicable to other aminoglycosides.

Bacillus subtilis↗
PubMed1977

Sternoarticualr pyoarthrosis due to gram-negative bacilli. Report of eight cases.

Of eight patients with Gram-negative bacillary sternoarticular pyoarthrosis, seven were long-term intravenous heroin abusers. Clinical onset was insidious and a long delay (one month or more) in seeking hospitalization was usually noted. Anterior chest discomfort and painful, restricted homolateral shoulder motion were the chief complaints. Fever and monoarticular arthritis were universally present, Open synovial biopsy examination was frequently required for etiologic diagnosis. Pseudomonas aeruginosa was the most common pathogen isolated. Roentgenographic evidence of associated osteomyelitis was usually seen, but tomography was often necessary to delineate this lesion. Intraoperatively, associated osteomyelitis of the clavicular head and/or sternum was present in all eight cases and a perisynovial and/or retrosternal abscess was found in five patients. Early surgical exploration and prolonged antimicrobial therapy yielded excellent results.

Acinetobacter Infections↗
PubMed1976

Circulating immune complexes in infective endocarditis.

To examine further the role of immune-complex deposition in infective endocarditis, we studied 29 patients with infective endocarditis for presence of complement-containing circulating immune complexes. Ninety-seven per cent (28 of 29) had serum levels of immune complexes greater than 12 mug per milliliter. Mean levels in these patients were significantly higher than in patients with sepsis without endocarditis or in normal controls (P less than 0.05). Circulating immune-complex levels were correlated with longer duration of illness (P less than 0.025), extravalvular manifestations of endocarditis (P less than 0.025) and hypocomplementemia (P less than 0.05). Patients with right-sided endocarditis had significantly higher circulating immune-complex levels than patients with left-sided involvement (P less than 0.025). In general, levels fell to zero with successful antimicrobial or surgical therapy. This drop was concurrent with disappearance of extravalvular signs, blood cultures becoming sterile, and rise in serum complement levels. These findings support the concept that immune complexes may be important in the pathogenesis of infective endocarditis.

Anti-Bacterial Agents↗
PubMed1976

Clindamycin plus gentamicin as expectant therapy for presumed mixed infections.

The prevalence of obligate anaerobes was studied prospectively in 60 patients with severe sepsis of intra-abdominal, soft tissue, female genital or oropulmonary origin. In addition, the efficacy of clindamycin (for anaerobes) plus gentamicin (for aerobic bacteria, especially coliforms) as initial empiric therapy in these patients was evaluated. Among 54 patients with cultural proof of infection, anaerobic pathogens were recovered from 52%. Nineteen patients had bacteremia; Bacteroides fragilis and Klebsiella pneumoniae were the most prevalent pathogens, being isolated in five patients each. Infection was eradicated in 56 of the 60 patients (93%). Mortality related to sepsis was 7% in the entire group, 16% in patients with bacteremia and 2% in patients without bacteremia. Eighty-five percent of aerobic isolates tested were susceptible in vitro to either gentamicin or clindamycin; 97% of anaerobic isolates were inhibited by 5 mug/ml of clindamycin.

Adult↗
PubMed1976

Group D enterococcal meningitis. Clinical and therapeutic considerations with report of three cases and review of the literature.

Three patients with meningitis due to the Lancefield group D enterococci are described and the pertinent literature is reviewed. Anatomic central nervous system (CNS) defects, prior neurologic or neurosurgical interventions, group D enterococcal endocarditis, and urinary tract infection appear to be important predisposing factors. Of note is the frequent lack of cellular response in the spinal fluid to enterococci. The mortality of this infection is high (33%) and is probably dictated as much by the underlying disorder as the infection itself. The therapeutic importance of careful separation of group D streptococcal isolates into enterococci and nonenterococci, especially in instances of CNS infections, is emphasized. We discuss the appropriate antimicrobial therapy for enterococcal meningitis.

Adult↗
PubMed1976

Serious infections in adults due to group B streptococci. Clinical and serotypic characterization.

Serious infections in adults due to group B streptococci have been infrequently reported. We describe 24 such patients. Bacteremic pyelonephritis, pneumonitis and endometritis were the most common clinical syndromes observed. Group B streptococci infections tended to occur in patients with underlying illnesses, particularly genitourinary disorders and diabetes mellitus. Mortality was surprisingly low (8 per cent). Type III was the serotype most commonly isolated, and there was no significant correlation of different serotypes with specific organ-system involvement. Group B streptococcal isolates from these patients were uniformly sensitive to penicillin, ampicillin, cephalothin, chloramphenicol, erythromycin and clindamycin; all were highly resistant to kanamycin. Eighty-seven per cent were resistant to tetracycline. Although consistently sensitive to penicillin, the minimal inhibitory concentrations were significantly higher for group B than group A streptococci (p less than 0.0005).

Adolescent↗
PubMed1976

Sepsis associated with decubitus ulcers.

Among 21 patients with sepsis attributed solely to decubitus ulcers, bacteremia was documented in 16 (76 per cent)9 Bacteremia involved obligate anaerobes in eight patients (50 per cent) and was polymicrobial in eight patients (50 per cent). Twelve of 17 patients who received antibiotics had persistent bacteremia; in five patients, bacteremia was terminated only after surgical debridement. Ten of these 21 patients died, eight despite appropirate antibiotics. Among 14 patients who underwent surgical debridement, only four patients died. Surgical debridement and antibiotics effective against aerobic as well as anaerobic bacteria are both important in the treatment of this serious complication.

Adult↗
PubMed1976

Candida peritonitis. Report of 22 cases and review of the English literature.

Thirty-one patients with Candida isolated from peritoneal fluid were examined. Twenty-two were considered to have Candida peritonitis. The data on these 22 patients, plus 12 additional patients described in the literature, were reviewed. This infection was observed as a complication of peritoneal dialysis, gastrointestinal surgery or perforation of an abdominal viscus. Recent antibiotic administration seemed to be an important predisposing factor. The disease usually remained localized intra-abdominally, although disseminated candidiasis was also noted in three cases. Clinically significant infection could be differentiated from peritoneal contamination with Candida by the presence and persistence of fever, peritoneal signs, peripheral leukocytosis, positive peritoneal cultures for Candida, abnormal films of the abdomen and purulent ascitic fluid. Surgical interventions and removal of infected peritoneal fluid were the cornerstones of therapy. Short-term, low-dose systemic and/or intraperitoneally administered amphotericin B appeared promising in the treatment of unremitting infection. Mortality in treated patients was low and was comparable to that in patients with bacterial peritonitis.

Adult↗
PubMed1976

Arthritis in mice due to infection with Mycoplasma pulmonis. II. Serological and histological features.

Histological and serological data were obtained from a group of 160 mice given intravenous inoculations of 3.5 X 10(7) colony-forming units of Mycoplasma pulmonis and studied for 46 weeks. The basic pathology was that of an initial acute inflammatory response within the joint and periarticular tissues, slowly changing to a chronic inflammatory response seen predominantly in subsynovial areas with marked synovial proliferation. Occasional lymphoid follicles and plasma cells were seen in the subsynovial spaces. Titers of antibody to M. pulmonis were determined by both metabolic inhibition and indirect hemagglutination techniques. By the metabolic inhibition method, titers were highest between two and 22 weeks, and by indirect hemagglutination between four and 42 weeks. Antibodies to synovial antigens were present between nine and 26 weeks as determined by indirect hemagglunination. Serologic cross-reactions were found between M. pulmonis and normal mouse synovium in sera from infected mice and, by indirect hemagglutination, metabolic inhibition, and immunodiffusion techniques, in sera of rabbits or mice immunized with either M. pulmonis or mouse synovium.

Animals↗
PubMed1976

Klebsiella L-forms: effect of growth as L-form on virulence of reverted Klebsiella pneumoniae.

A strain of Klebsiella pneumoniae virulent for mice was serially passaged in vitro as a penicillin-induced L-form. Periodically, the L-form was reverted to the bacterial form by removal of penicillin, and the revertant was tested for virulence. Virulence was gradually reduced, and after 109 passages the revertant was totally avirulent. Virulence was not restored by 40 passages of the revertant through mouse peritoneum. The revertant grew less vigorously and did not infect mice when inoculated subcutaneously; in contrast, the parental form was found in all tissues examined. After phagocytosis in vitro or in vivo, the revertant survived but did not increase in numbers, whereas the parental form did increase in numbers. The revertant had a much smaller capsule than did the parental form. Immunization with the live revertant resulted in type-specific protection against infection with the parental form.

Animals↗
PubMed1976

Candida meningitis. Report of seven cases and review of the english literature.

Seven patients with Candida meningitis are reported. These 7, plus 21 previously cited cases, were reviewed. This infection arose by two distinct mechanisms: hematogenous dissemination and direct inoculation. Recent antibiotic therapy, corticosteroid administration and severe underlying diseases were important predisposing factors. Fever, meningismus, elevated CSF pressures and localizing neurologic signs were commonly noted. Organisms were seen on gram-stain of CSF in only 43% of cases. Mortality rate in patients receiving inadequate or no antifungal therapy was high (greater than 90%), while those patients given appropriate antifungal drugs, especially intravenous amphotericin B, had a significantly lower mortality rate (38%). Several factors associated with poor prognosis were delineated in this study: diagnostic interval after symptomatic onset longer than two weeks, CSF glucose levels below 35 mg/100 ml and presence of intracranial hypertension and focal neurologic deficits.

Amphotericin B↗
PubMed1976

Susceptibility of Acinetobacter calcoaceticus var. anitratus (Herellea vaginicola) to minocycline.

The in vitro activity of minocycline against Acinetobacter calcoaceticus var. anitratus (Herellea vaginicola) was examined. All strains of A. anitratus were inhibited by minocycline at concentrations of 0.4 mug/ml or less. The strains studied were considerably more susceptible to minocycline than tetracycline. No difference between the susceptibility to minocycline and tetracycline was seen with Escherichia coli, Klebsiella pneumoniae, Enterobacter and Proteus sp. A regression line of the log minimal inhibitory concentration (MIC) values and the diameter of the zone of inhibition, determined by the Kirby-Bauer technique, showed good linear correlation for minocycline. Comparison of the disk diffusion results and MICs indicated that an inhibitory zone size of 19 mm produced by a 30-mug minocycline disk was equivalent to a MIC of 3.1 mug/ml, a serum concentration achieved by oral administration of the drug. When the zone of inhibition was greater than 19 mm, however, there was poor correlation with the MIC for Enterobacteriaceae.

Acinetobacter↗