PubMed Health⌕ Search

Biomedical subjects

M B Goetz

Publications and source records attributed to M B Goetz.

At least 55 records · Page 3Linked to original sources
PubMed1992

Atypical roentgenographic manifestations of Pneumocystis carinii pneumonia.

Although Pneumocystis carinii pneumonia (PCP) usually presents with bilateral interstitial pulmonary infiltrates, many other roentgenographic presentations occur in human immunodeficiency virus-infected patients. To clarify the determinants of atypical presentations of PCP, we evaluated 65 English-language reports that related the roentgenographic manifestations of consecutive cases of PCP. The incidence of PCP-associated upper lobe disease, cysts, and spontaneous pneumothoraxes was increased in human immunodeficiency virus-infected patients receiving aerosolized pentamidine prophylaxis. Normal chest roentgenograms were more common and nodular lesions were less common in human immunodeficiency virus-infected patients than in uninfected patients. However, the roentgenographic manifestations of PCP could not be specifically predicted by a patient's underlying disease. Neither zidovudine therapy nor intravenous drug use apparently affected the roentgenographic presentation of PCP. Unusual pathologic responses to PCP, including granuloma formation, vascular invasion, and microscopic foci of calcification, were present in all patient groups.

HIV Infections↗
PubMed1991

Epidemiology of bacteremic urinary tract infections in chronically hospitalized elderly men.

We sought to determine the contribution of pathogen-specific factors to the pathogenesis of invasive urinary tract infections in chronically institutionalized elderly men with symptomatic bacteriuria. We found that Escherichia coli was the most invasive pathogen, being found in 46% of the bacteremic as opposed to 25% of the nonbacteremic, rigorously defined urinary tract infections (p less than 0.01). The predominance of E. coli in bacteremic urinary tract infections was observed regardless of whether indwelling urinary drainage devices were used. The finding that E. coli accounted for a greater proportion of bacteremic than nonbacteremic urinary tract infections indicates that bacteremia arising from the geriatric urinary tract is not simply a consequence of mechanical factors, such as urinary tract obstruction. Thus, further investigations are warranted to assess the specific contribution of previously defined E. coli virulence factors to the pathogenesis of urinary tract infections in such patients.

Aged↗
PubMed1991

Staphylococcal pyomyositis in patients infected by the human immunodeficiency virus.

PURPOSE: We describe the manifestations of spontaneous staphylococcal pyomyositis in patients infected by the human immunodeficiency virus (HIV). PATIENTS AND METHODS: We present the courses of five previously unreported patients infected by HIV who presented to our medical centers with spontaneous staphylococcal pyomyositis. Additionally, we review all previously reported cases of this entity in HIV-infected patients and discuss its possible pathogenesis and importance in the context of HIV infection. RESULTS: All patients presented with gradually developing fever and localized pain and swelling without accompanying leukocytosis. Often only scant evidence of local inflammation was found. None of our patients used intravenous drugs, had a history of trauma, had HIV- or zidovudine-related myositis, or had other conditions known to be associated with serious staphylococcal infections. Two patients studied had normal serum levels of all IgG subclasses. Elevated serum IgE, eosinophilic inflammatory infiltrates, or marked peripheral eosinophilia was observed in two patients. CONCLUSIONS: Staphylococcal pyomyositis in HIV-infected patients presents in an indolent fashion, which may delay appropriate diagnosis and treatment. Since staphylococcal pyomyositis is infrequently reported in the United States, the development of 14 such cases (five in this series and nine previously reported) among the first 140,000 cases of acquired immunodeficiency syndrome in this country implies that this patient population is predisposed to this infectious complication. The pathogenesis of this entity is uncertain, but it is notable that HIV-infected patients are commonly colonized by Staphylococcus aureus and that neutrophils from HIV-infected patients frequently manifest phagocytic, chemotactic, and oxidative defects, diminished expression of Fc tau RIII (CD16) and CR1, and impaired bactericidal activity against S. aureus.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Proliferation of HIV in lymphocyte--associated macrophages with cytopathic changes in AIDS erythroderma.

Latency of the Human Immunodeficiency Virus (HIV) has been demonstrated in both helper T-Lymphocytes and cells of the macrophage/monocyte series. Although mitogen-dependent amplification of HIV infection within lymphocytes and monocytes/macrophages has been demonstrated to occur in vitro, in vivo evidence of such a phenomenon has been lacking. We have performed electron microscopic and immunocytochemical evaluation of skin biopsies from a patient with the Acquired Immunodeficiency Syndrome (AIDS) with chronic erythroderma. These biopsies provided evidence of proliferation of HIV in macrophages interacting with activated lymphocytes (CD3+). These macrophages were undergoing morphologic changes characteristic of cytopathicity and contained numerous viral particles, many of which were actively budding from plasma membranes. Cutaneous macrophages which were not interacting with lymphocytes did not demonstrate cytopathicity or evidence of viral multiplication. These in vivo data substantiate the concept that activation of cells which harbour latent HIV promotes viral replication as well as subsequent cytopathicity.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Complications of corticosteroid therapy in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.

We retrospectively studied the acute toxicity of corticosteroid therapy in 23 episodes of PCP occurring in the setting of AIDS and determined the incidence of HIV-related complications following these and 16 other contemporaneous episodes of AIDS-related PCP treated with antimicrobials alone. The mean duration of corticosteroid therapy was 5.4 days and the mean total dose was 660 mg of methylprednisolone. Cryptococcus neoformans and Listeria monocytogenes infection each occurred once within one month of therapy in corticosteroid-treated patients; no other noteworthy acute corticosteroid toxicity was noted. Since all patients with imminently lethal PCP received corticosteroids, we could not assess the effect of these agents on acute mortality. After six months the rates of new AIDS-related diagnoses and of post-hospitalization mortality were equivalent in the two groups. We also have critically reviewed the available literature regarding this use of corticosteroids.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Priming of polymorphonuclear neutrophilic leukocyte oxidative activity by type 1 pili from Escherichia coli.

Preincubation of human polymorphonuclear leukocytes with free whole type 1 pili derived from Escherichia coli or with subunits of type 1 pili significantly augmented subsequent stimulation of cellular oxygen uptake by formyl-methionyl-leucyl-phenylalanine, concanavalin A, opsonized zymosan, or latex particles coated with whole type 1 pili. No such priming of leukocyte activation occurred if phorbol myristate acetate was used as a stimulant or if bovine serum albumin was substituted for the type 1 pili preparations. When free in solution, neither pili preparation directly stimulated cellular oxidative metabolism. Type 1 pili-mediated priming was not inhibited by polymyxin B, by mannose congeners, or by boiling the pili preparations but was prevented by trypsinization of the pili. This priming property indicates a further means by which type 1 pili may modulate the inflammatory response of the host and provides another tool that can be used to dissect the relationship between the structure and function of type 1 pili and to characterize leukocyte receptors for these pili.

Concanavalin A↗
PubMed1987

Stimulation of human polymorphonuclear leukocyte oxidative metabolism by type 1 pili from Escherichia coli.

We compared the degree to which Escherichia coli phase variants which do (T1P+ E. coli) or do not (T1P- E. coli) express type 1 pili (T1P) stimulate human polymorphonuclear leukocyte (PMN) oxidative activity. Unopsonized T1P+ E. coli stimulated the release of 0.20 to 0.24 nmol of H2O2 per 10(6) PMN per min and the consumption of 1.4 to 4.0 nmol of O2 per 10(6) PMN per min; no measurable PMN oxidative activity was stimulated by unopsonized T1P- E. coli. In the presence of serum opsonins, T1P+ E. coli stimulated the release of 1.12 to 1.16 nmol of H2O2 per 10(6) PMN per min and the consumption of 5.0 to 6.0 nmol of O2 per 10(6) PMN per min, whereas T1P- E. coli stimulated the release of 0.42 to 0.43 nmol of H2O2 per 10(6) PMN per min and the consumption of 0.6 to 2.0 nmol of O2 per 10(6) PMN per min. Although unaggregated T1P did not stimulate PMN, latex beads coated with T1P (T1P-latex) stimulated alpha-methylmannoside-inhibitable, opsonin-independent PMN oxidative activity. The activity stimulated by either T1P+ E. coli or T1P-latex was susceptible to inhibition by cytochalasin B. Latex particles coated with bovine serum albumin or mannose-resistant pili did not stimulate PMN. These data indicate that T1P+ E. coli stimulate PMN oxidative metabolism more effectively than do T1P- E. coli and that a similar PMN oxidative response follows cellular stimulation by either unopsonized T1P+ or opsonized T1P- E. coli. Furthermore, T1P-latex faithfully mimics the ability of T1P+ E. coli to stimulate PMN oxidative metabolism. Such particles may be useful in further analyses of cellular responses to T1P+ E. coli.

Concanavalin A↗
PubMed1986

Oxidative metabolism of circulating neutrophils in infantile (Philadelphia chromosome-negative) chronic myelogenous leukemia.

Mature polymorphonuclear neutrophilic leukocytes (PMNL) from a 2.5-year-old female with infantile chronic myelogenous leukemia (CML) were stimulated with phorbol myristate acetate or opsonized zymosan. The resulting enzymatic NADPH oxidation and the cellular O2- release and luminol-enhanced chemiluminescence were measured. The patient's PMNL responded normally in all respects. Thus, mature infantile CML PMNL undergo a normal respiratory burst following either soluble or particulate stimulation. Our review of the literature emphasizes the importance of studying a well-defined population of PMNL in patients with myelodysplasia.

Child, Preschool↗
PubMed1985

Combined ketoconazole and amphotericin B treatment of acute disseminated histoplasmosis in a renal allograft recipient.

We have reported the first case of successful treatment of disseminated histoplasmosis in a renal allograft recipient using a short course (14 days) of amphotericin B in combination with prolonged therapy (161 days) with ketoconazole. This regimen should decrease the risk of antibiotic induced nephrotoxicity, but it requires further study. Five days of treatment with ketoconazole alone was ineffective in our patient's infection. Our protocol might not be as efficacious in patients who are more profoundly immunocompromised, eg, bone marrow allograft recipients. Because relapse of histoplasmosis may occur as long as nine years after treatment, immunocompromised patients being treated with ketoconazole must have close long-term clinical follow-up.

Acute Disease↗