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M K Sachs

Publications and source records attributed to M K Sachs.

10 recordsLinked to original sources
PubMed1992

Lymphocutaneous Nocardia brasiliensis infection acquired from a cat scratch: case report and review.

Nocardia brasiliensis is a bacterium that is most commonly found in the soil. Traumatic inoculation of N. brasiliensis into the skin is the most typical mode of acquisition of infection due to this organism. To the best of my knowledge, I report the first case of lymphocutaneous N. brasiliensis disease from a penetrating cat scratch of the skin, thereby establishing cats as vehicles for the transmission of this infection. Treatment with penicillin produced a rapid resolution of all signs and symptoms of infection. The efficacy of penicillin against the N. brasiliensis isolate recovered from this patient was highly unusual. In general, penicillin has limited therapeutic value since these organisms elaborate beta-lactamase. Sulfonamides remain the drugs of choice for the treatment of these infections. These soil-borne organisms are most likely carried on the claws of cats and may establish infection after percutaneous inoculation. A high index of suspicion for N. brasiliensis soft-tissue infection is required since a delayed or missed diagnosis may be associated with progressive local disease and/or widespread disseminated infection.

Adult↗
PubMed1992

Antiretroviral chemotherapy of human immunodeficiency virus infections other than with azidothymidine.

The intense research effort to develop molecules with the ability to inhibit the replication of human immunodeficiency virus type 1 was greatly facilitated by the elucidation of the viral life cycle. This information engendered the production of novel antiretroviral agents that inhibit human immunodeficiency virus type 1 at different points in its replicative cycle. The nucleoside analogue 3'-azido-2',3'-dideoxythymidine (azidothymidine) inhibits reverse transcriptase, and it was the first compound tested in patients with the acquired immunodeficiency syndrome. Considerable knowledge of the activity and toxicity of this class of drugs has accumulated. Less well-characterized compounds inhibit human immunodeficiency virus type 1 binding and absorption to target cells, prevent the expression of viral genetic material critical for the construction of new infectious viral progeny, and inhibit the posttranslational modification of viral polypeptides. In additional, biologic response, modifiers act to restore immune function by a number of diverse mechanisms. The ultimate goal is the discovery of compounds capable of inducing a complete and permanent remission of infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Failure of dithiothreitol and pronase to reveal a false-positive cryptococcal antigen determination in cerebrospinal fluid.

A patient with squamous cell carcinoma of the lung and a serum rheumatoid factor (RF) of 1:1,280 had a positive cerebrospinal fluid (CSF) latex agglutination test (LAT) for cryptococcal antigen, in culture-negative, India-ink-negative CSF. Pretreatment of the sample of CSF with 2-mercaptoethanol (2-ME) ablated the antigen titer and established the presence of a false-positive LAT, whereas CSF pretreated with dithiothreitol (DTT) and pronase continued to yield a false-positive result. The differing ability of pronase, DTT, and 2-ME to eliminate interfering substances from CSF has not been previously described. Moreover, because RF is unlikely to cross the blood-brain barrier, the authors postulated that malignant disease was responsible for the patient's false-positive LAT in CSF. Hence, the authors report the case to emphasize that false-positive LAT results in CSF are unlikely to be produced by RF and to underscore the benefit of using enzymatic and sulfhydryl-reducing agents when the validity of the initial test results are in doubt. Such a procedure will optimize the chances of accurately identifying false-positive LAT results in CSF.

Aged↗
PubMed1991

Cutaneous cellulitis.

Cellulitis has long been postulated to be the result of antecedent bacterial invasion with subsequent bacterial proliferation. Nonetheless, the difficulty in isolating putative pathogens from cellulitic skin has served to cast doubt on this hypothesis. In this regard, the skin is provided with a unique set of lymphoid and reticular cells with the capacity to secrete lymphokines and cytokines. These substances rapidly reduce the number of viable bacteria from infection by enhancing the infiltration of skin by circulating macrophages and neutrophils. The warmth and erythema associated with cellulitis are most likely produced both by a small number of residual bacteria and by fragmented bacterial remnants, and amplified by the lymphokines that are secreted in response to antigenic challenge. Anti-inflammatory agents may play a significant role in enhancing the resolution of infection by reducing the production of soluble mediators by these intra-epidermal immunocompetent cells.

Bacteria↗
PubMed1990

The optimum use of needle aspiration in the bacteriologic diagnosis of cellulitis in adults.

Twenty-five adult inpatients with cellulitis were prospectively studied to determine if distinctive predisposing factors, characteristic clinical findings, or specific laboratory features were predictive of isolating a pathogen from needle aspiration cultures of the leading edges of their lesions. In the univariate analysis, age, underlying disease, temperature, and white blood cell count at admission to the hospital correlated with a positive needle aspiration culture. A series of logistic regressions were performed to determine if each of these variables was independently associated with a positive needle aspiration culture. The final model demonstrated that underlying disease and body temperature were independent predictors of obtaining a positive needle aspiration culture. Consequently, the addition of white blood cell count and age failed to enhance the model's predictability. For most patients this procedure will not be helpful [corrected] in establishing a bacteriologic diagnosis. On the basis of these results, the needle aspiration technique will most likely yield pathogens in patients with underlying disease that predisposes to the acquisition of cellulitis. These patients may also fail to mount a febrile response to infection.

Adult↗
PubMed1989

Intestinal infections in patients with AIDS.

A broad spectrum of gastrointestinal pathogens can cause diarrhea in patients with acquired immunodeficiency syndrome (AIDS). A systematic approach utilizing symptomatology and the appropriate diagnostic tests will maximize the clinician's chance of identifying the specific pathogens. Enteric infections in AIDS patients are often incurable and require prolonged therapy and chronic suppression. Experimental agents show promise of decreasing the morbidity and mortality attendant on diarrhea in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Antiretroviral therapy.

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Acquired Immunodeficiency Syndrome↗