Biomedical subjects
Publications and source records attributed to Larry M Baddour.
Cutaneous inoculation blastomycosis is a rare illness. We report a case of cutaneous inoculation blastomycosis in a patient who was inoculated after being struck by a projectile while performing yard work. We also review cases of cutaneous inoculation blastomycosis described elsewhere, to improve characterization of the syndrome.
Illicit drug use is frequently complicated by sinopulmonary illnesses. These complications fall into two major categories: (1) direct effects of drug exposure, and (2) indirect effects caused by HIV-induced immunosuppression. This article reviews the more common sinopulmonary syndromes associated with illicit drug use.
Penicillin resistance among Eastern Tennessee isolates of Streptococcus pneumoniae has been increasing since the early 1990s. To maintain active surveillance of the prevalence of penicillin resistance among pneumococci isolated at our institution, antibiotic susceptibility testing was performed for 95 consecutive isolates and results were compared with those of strains examined 2 years earlier. The prevalence of penicillin resistance among local pneumococcal isolates may have stabilized in recent years.
Antibiotic resistance among viridans streptococci has increased with Streptococcus mitis being more resistant than other viridans species. In a case presented in this report, it is possible that antibiotic resistance contributed to an apparent failure of endocarditis prophylaxis. The patient had undergone periodontal surgery on 2 separate occasions and in both instances was administered 2 g of amoxicillin orally 1 hour before each procedure. He subsequently developed a subacute illness and had multiple blood cultures drawn that grew S. mitis with a minimum inhibitory concentration of 1.0 microg/mL for penicillin. Transesophageal echocardiogram provided further evidence of infective endocarditis with vegetations seen on the anterior leaflet of the mitral valve. Combination therapy with high-dose intravenous aqueous crystalline penicillin G and gentamicin sulfate for 4 weeks was curative. Clindamycin, rather than amoxicillin, has since been used as dental prophylaxis for subsequent procedures.
One hundred fifty-two cases of fungal endocarditis (FE) were identified in the English-language literature between January 1, 1995, and June 30, 2000. Although the median age of patients (44 years) was relatively young, injection drug use was identified as a risk factor in only 4.1% of cases. Other factors, including underlying cardiac abnormalities (47.3%), prosthetic valves (44.6%), and central venous catheters (30.4%), were more commonly identified as predisposing conditions and reflect the changing epidemiology of the syndrome. Unfortunately, mortality remains unacceptably high, particularly for patients with Aspergillus-related FE. Novel therapies are needed to improve patient outcomes.