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R A Durlach

Publications and source records attributed to R A Durlach.

8 recordsLinked to original sources
PubMed2003

Toxoplasmic lymphadenitis--clinical and serologic profile.

OBJECTIVE: To study the serologic profile of several types of test for toxoplasmosis, in order to contribute to the interpretation of antibody kinetics. METHODS: The clinical and serologic features of 120 cases of lymphadenopathy with known time of clinical onset were studied during 18 months postinfection. Antibody kinetics was determined by Sabin-Feldman dye test, complement fixation with light antigen, IgM immunofluorescent antibody test, and IgM immunosorbent agglutination assay (IgM-ISAGA). Cell-mediated immunity was evaluated by the toxoplasmin skin test. RESULTS: Seventy-five female patients aged 11-54 years (median 27 years) and 45 male patients aged 3-59 years (median 17 years) were studied, 85% of whom were under 30 years of age. Cervical lymph nodes were involved throughout, generally on both sides, with more than one affected ganglion group in 88%. The predominant symptom was asthenia (69%), which persisted in some cases for several months. A negative Sabin-Feldman dye test in a lymphadenopathy with more than three weeks' evolution excludes a toxoplasma etiology. A positive Sabin-Feldman dye test with negative IgM-ISAGA almost invariably excludes recent infection. The Sabin-Feldman dye test was positive in 94% of patients with titers higher than 1 : 16 000 within the first three months. The IgM-ISAGA yielded 98% of positive results, of which 94% were high titers. Titers >/= 1 : 160 in the IgM immunofluorescent antibody test and complement fixation were found to be highly indicative of recent infection, since 87% and 91%, respectively, were found within the first three months. A negative skin test plus positive serology values indicates recent infection. CONCLUSION: Our results indicate that estimation of time of infection on the basis of serologic results is improved by the simultaneous application of several tests, and correlates closely with the presence of clinical lymphadenitis.

Adolescent↗
PubMed1995

[Bacterial sacroileitis. Clinical findinds and clinical course in 9 cases].

Since septic sacroileitis is one of the less frequent localizations among joint infections, we decided to review 9 cases in a retrospective study of 5 females and 4 males, aged between 22 and 60 years old. None had a clinically predisposing condition. The initiating factor was gynecologic-obstetric in 4 women, the irruption of the skin barrier in 3 cases and finally in one case the infection reached the joint through the psoas muscle. Fever and lumbar pain were present in all cases and allowed diagnostic orientation. Radiologic and centellographic alterations were useful for clinical confirmation. An articular biopsypunction was performed in 4 cases, while in the other 5 cases the clinical and radiologic features and the bacteriologic positivity in the blood cultures were enough criteria for diagnosis. The bacteriologic findings were Staphylococcus aureus (4 cases), Streptococcus group A beta hemolítico (1 case), Staphylococcus coagulase negative (1 case), Streptococcus agalactiae (1 case), Proteus mirabilis (2 cases). Eight out of 9 patients were treated with a B-lactamic and aminoglycoside association. One patient received her treatment per os, with quinolones. Six patients recovered, 2 died and one needed to be sent to another hospital.

Adult↗
PubMed1994

[Staghorn renal lithiasis treated with shock waves. Bacteriologic aspects].

Struvite renal stones are caused by infection of the urine with bacteria that synthesize the enzyme urease. Ammonium is released by the breakdown of urea by urease, the urine becomes highly alkaline, and magnesium ammonium phosphate (struvite) and carbonate apatite crystallize. Incorporation of the infecting bacteria within the developing stone, results in a focus of infection that is resistant to conventional antimicrobial therapy, and which is manifested clinically by repeated urinary tract infection caused by persistent bacteriuria. Extracorporeal shock wave lithotripsy (ESWL) currently is accepted as the election treatment for most renal calculi. This trial examines the bacteriologic aspects pre and post-ESWL. Eighty adult patients, 47 females and 33 males, without clinical signs of urinary tract infections (UTI) were submitted to urine cultures pre and post-ESWL. The first 50 patients underwent during and post-ESWL, 150 blood cultures, which all proved to be negative, confirming very low risk of generalized sepsis. No patient presented fever, chills or rigors pre or postprocedures. With respect to urine cultures 43 patients (52.5%) had a pre-ESWL UTI, in comparison to 49 (60%) who had a UTI post-ESWL. The distribution of organisms pre and post-ESWL was as follows: Proteus mirabilis (22/22), Escherichia coli (11/11), Pseudomonas aeruginosa (4/5), Klebsiella pneumoniae (2/2), Enterobacter cloacae (0/1), Alcaligenes odorans (1/2) Enterococcus faecalis (1/3), Staphylococcus saprophyticus (1/2) and Candida albicans (1/1). In this study 6 patients presented bacteriuria post-ESWL probably due to bacteria from inside the calculi. According to these results, the risk of bacteremia seems to be very low. In 60% of staghorn renal stones we could demonstrate a bacterial infection.

Adult↗
PubMed1994

[Kaposi's sarcoma in young adults without evidence of HIV infection].

Besides the AIDS-related form of Kaposi sarcoma (KS) there are few well-known aggressive types of this disease. These non-epidemic invasive variants of KS have been recognized in young black males of equatorial Africa and in renal transplant recipients after iatrogenic immunosuppression. We report on two white patients without known risk factors who presented an invasive clinical form of KS with negative serology for HIV infection. Patient 1: 46 year-old white male of Italian origin without known risk factors. He consulted in September 1990 because of a nephrotic syndrome associated with membranoproliferative glomerulonephritis. On physical examination he presented a violaceous nodule in one toe of the right foot. He received prednisolone with amelioration of the renal disorder, but consulted again some months later because of fever, marked weight loss, generalized enlargement of superficial lymph nodes, autoimmune hemolytic anemia and polyclonal hypergammaglobulinemia. ELISA tests, Western-blot and HIV-antigen investigations were repeatedly negative. CD4 and CD8 counts were 450 and 365 per microlitre respectively. A lymph node biopsy demonstrated KS associated to Castleman's disease. KS was also diagnosed in the skin biopsy. The hemolytic anemia was treated with prednisolone without success and KS cutaneous lesions extended to both legs and ulcerated even after a short course of bleomycin and radiotherapy. The patient died nine months later. Patient 2: 38 year-old white male of German origin, with a history of alcoholism. He was admitted to the hospital because of septic shock associated with hepatic failure. On physical examination he presented ascites, liver and spleen enlargement, and a big subcutaneous nodule on the knee covered with normal skin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗