PubMed HealthSearch

Biomedical subjects

M K Maier

Publications and source records attributed to M K Maier.

10 recordsLinked to original sources

Long-term follow-up after leptospirosis.

Human leptospirosis is an infectious disease that is a substantial problem in the Third World, but it can occur in developed countries as well. Survivors of the acute disease are considered to recover without sequelae, though little literature exists on long-term follow-up among these patients. Eleven patients, at an average of 22 years after acute leptospirosis, were reevaluated for possible delayed sequelae. Results showed that liver and renal disease had resolved, but headache and ophthalmic sequelae persisted. Even though the number of patients involved in this study is small, it appears that the eyes, particularly the anterior chambers, may be the site of continuing morbidity after acute human leptospirosis. The pathogenesis for persistent headache is not known.

Acute Disease

Relapse of rickettsial Mediterranean spotted fever and murine typhus after treatment with chloramphenicol.

In the years 1975-1984, 132 patients with rickettsial Mediterranean spotted fever and murine typhus were treated with chloramphenicol or tetracycline. Among the 24 patients who received chloramphenicol ten relapsed and one failed to respond at all. None of the 108 recipients of tetracycline suffered a relapse. It appears that tetracycline should serve as first-line therapy in several rickettsial diseases.

Chloramphenicol

Hairy cell leukemia with an autoimmune syndrome, paraproteinemia, and cryoglobulinemia.

We have described an 82-year-old man with HCL who had autoimmune manifestations, paraproteinemia, and cryoglobulinemia. Chemotherapy resulted in a dramatic response, with a decrease in the tumor mass, a reduction in the clinical and serologic features of the autoimmune syndrome, and disappearance of the cryoglobulin, but without a significant change in the serum level of paraprotein.

Aged

Delayed neurologic display in murine typhus. Report of two cases.

Two cases of murine typhus with prolonged neurologic manifestations appearing after the febrile stage of the illness are described. One patient had behavioral and memory disturbances for almost 18 months after defervescence, which terminated gradually without specific therapy. The second patient had similar manifestations over a period of weeks that rapidly resolved after tetracycline therapy. Such phenomena were not previously described in the literature, as far as we know, although similar manifestations were noted in Rocky Mountain spotted fever.

Adult

Newer beta-lactam antibiotics in the treatment of experimental Staphylococcus aureus endocarditis.

Antistaphylococcal activity of three beta-lactam antibiotics, i.e. cefmenoxime, cefotaxime and latamoxef (moxalactam) was compared with that of nafcillin by studying cure rates of aortic valvular endocarditis caused by one of three clinical isolates of Staphylococcus aureus in New Zealand white male rabbits. The animals were randomly allocated to a control and four antibiotic treatment groups. Each animal except the controls received 60 mg/kg of one antibiotic intramuscularly twice daily for two weeks, beginning 24 h after induction of endocarditis. The aortic valve was sterilized in 11 of 15 (73%) animals treated with cefmenoxime, nine of 13 (69%) treated with cefotaxime, 11 of 13 (85%) treated with latamoxef and 12 of 15 (80%) treated with nafcillin. All nine animals in the control group developed aortic valvular vegetations with an average of 2.4 X 10(9) cfu/g. The differences in sterility rates resulting from treatment with the four antibiotics were not statistically significant (P greater than 0.70).

Animals

In vitro activity of cefmenoxime, cefotaxime, latamoxef, cefazolin, nafcillin and vancomycin against 53 endocarditis and bacteremic strains of Staphylococcus aureus.

Antistaphylococcal activity of newer beta-lactam antibiotics, cefmenoxime, cefotaxime and latamoxef was compared with that of the more conventional antistaphylococcal agents, nafcillin, cefazolin and vancomycin. 53 strains of Staphylococcus aureus, 40 from patients with endocarditis and 13 from patients with bacteremia from other causes were tested in vitro against each antibiotic using agar dilution methods. Minimal concentration of antibiotic to inhibit 90% of strains tested was 2 micrograms/ml for cefmenoxime and cefotaxime, 8 micrograms/ml for latamoxef and only 0.5 microgram/ml for nafcillin, cefazolin and vancomycin. The newer beta-lactam antibiotics may not be preferred to nafcillin, cefazolin or vancomycin in the treatment of serious staphylococcal infections.

Anti-Bacterial Agents

Neonatal craniotabes.

Craniotabes is a frequent, benign physical finding in newborn infants. Resolution occurs spontaneously by two to three months of age. If the history and physical examination are otherwise normal, no further investigation is necessary or desirable. Craniotabes may be related to pressure due to early engagement of the fetal head or to subtle abnormalities of maternal calcium and vitamin D metabolism.

Female

Nontyphoid salmonellosis in renal transplant recipients: report of five cases and review of the literature.

Five cases of nontyphoid salmonella infection among renal transplant recipients are reported, and 32 cases from the literature are reviewed. Contrary to the nontyphoid salmonella infection in normal hosts, such infection in renal transplant recipients manifested as bacteremia (62%) and in extraintestinal foci (35%). Asymptomatic bacteriuria, at times prolonged, was common, whereas gastrointestinal symptoms were noted in only 19%. The course of infection may be prolonged, with relapse occurring in 43.2% and death in 5.4%. Extraintestinal manifestations were located at very unusual sites, such as testes, maxillary sinus, axillary vein thrombus, and hemodialysis fistula. Because relapses were so frequent, the suggestion is made that every effort be made to find silent foci of infection after clinical recovery and to eradicate such foci with prolonged antibiotic therapy and with surgical measures, if necessary. Stool and urine should be screened for nontyphoid Salmonella before and after transplantation.

Adult

Nontyphoid salmonellosis in patients with total hip replacement: report of four cases and review of the literature.

Five episodes of nontyphoid salmonella infection following total hip replacement in four patients were studied. In three patients the infection occurred in the immediate postoperative period while prophylactic antibiotics were being administered. The fourth patient had bilateral total hip replacements five years apart with two nontyphoid salmonella infections, one immediately after the first operation (during antibiotic prophylaxis) and the second four years after the second operation. In addition to local infection, clinical manifestations included fever (all patients), diarrhea (three patients), deep prosthetic infection (two patients), and shock with disseminated intravascular coagulation and acute renal failure (one patient). In addition to antibiotic therapy, removal of the prosthesis was necessary for cure in three patients. All patients recovered. Hematogenous spread was thought likely in all cases. Four of five salmonella isolates were resistant to ampicillin and chloramphenicol. A review of the English-language literature yielded information on five additional cases of nontyhpoid salmonella infection after total hip replacement in four patients.

Adult