PubMed Health⌕ Search

Biomedical subjects

R B Laing

Publications and source records attributed to R B Laing.

At least 37 records · Page 2Linked to original sources
PubMed1997

Antimicrobial treatment of fish tank granuloma.

Three patients with fish tank granuloma of the hand and forearm are reported. Each patient was treated with antimicrobial regimes which have rarely or never been previously used in this condition. Two patients responded well to treatment, one who received ciprofloxacin plus clarithromycin and another who was given clarithromycin plus ethambutol. The third patient received six different antimicrobial regimes before responding to a combination of rifabutin and ciprofloxacin. Our experience suggests that there now exist a number of effective alternatives to antimicrobials which have been traditionally used in the treatment of cutaneous Mycobacterium marinum infection.

Adult↗
PubMed1996

An audit of the clinical features and use of antimicrobials in adult diarrhoea.

We reviewed the case records of 128 adult patients hospitalized with diarrhoea. A relevant stool pathogen was isolated from 45, a diagnosis of culture-negative or non-specific gastroenteritis (NSGE) was made in 40 and the remaining 43 patients had no enteric infection. A history of fever or bloody stools was more common in those with culture-positive gastroenteritis than it was in those with NSGE or other diarrhoeal illness. The mean duration of diarrhoea prior to admission was significantly shorter in those with all forms of gastroenteritis than it was in the remainder. Epirical treatment with ciprofloxacin was commenced in 46% of all cases of gastroenteritis, of which 51% were found to have a relevant pathogen on stool culture. Patients with NSGE were just as likely to be treated with ciprofloxacin as those who were subsequently found to have culture-positive gastroenteritis. A history of abdominal tenderness or bloody stools did not discriminate for treatment with empirical ciprofloxacin in any patient group. Patients with positive stool cultures were more likely to be given ciprofloxacin if they were febrile but the same was not true for the other patients. In the patients reviewed, a significantly higher proportion of those with culture-positive diarrhoea presented with a history of fever or bloody stools. Despite this, the empirical use of ciprofloxacin in suspected infective gastroenteritis appeared to be only partially guided by the clinical features.

Adult↗
PubMed1996

Community-acquired toxigenic Clostridium difficile diarrhoea in the normoxaemic elderly who have received no antimicrobials: soft evidence for ischaemic colitis?

We report three examples of community-acquired toxigenic Clostridium difficile diarrhoea in elderly patients who had neither received antimicrobial therapy nor been institutionalised. These cases stimulated interest in the non-antimicrobial changes which might predispose the host to C. difficile-related disease and raised the spectre of bowel ischaemia as a possible aetiological factor.

Aged↗
PubMed1996

Clinical features, outcome and survival from cerebral toxoplasmosis in Edinburgh AIDS patients.

Nineteen cases of cerebral toxoplasmosis (CTOX) are reported from a group of Edinburgh AIDS patients. All patients were severely immunodeficient at the time of presentation with CD4 count < 50 cells/mm3. Thirteen patients had suffered a previous AIDS-defining illness. In Edinburgh, CTOX has developed in 48% of patients who are seropositive for toxoplasma and have a CD4 count < 50 cells/mm3. It is estimated that at least half of the toxoplasma seropositive patients will develop CTOX if they survive for 21 months after reaching a time in their illness when the CD4 count = 50 cells/mm3. The incidence of CTOX in toxoplasma-seronegative patients with a CD4 count < 50 cells/mm3 is 1.3%. All patients showed improvement on treatment and there was no correlation between clinical or radiological features and patient survival. Those patients unable to tolerate first choice anti-toxoplasma therapy had a significantly shorter survival than the remainder but there was no single therapeutic regimen which conferred a survival advantage. Eighteen patients had died at the time of study and the median survival following diagnosis of cerebral toxoplasmosis was 10 months (range 3-38 months). Postmortem examination of the brain was available in 8, 4 of whom had concomitant cerebral lymphoma. The survival from AIDS or CD4 count = 50 cells/mm3 did not differ significantly between those with treated CTOX and a control group who had no toxoplasma infection, suggesting that treatment is reasonably effective. CTOX is a disease associated with severe HIV-related immunodeficiency and, in those with a CD4 count < 50 cells/mm3, occurs more than 35 times as frequently in toxoplasma-seropositive than toxoplasma-seronegative patients. Treatment is effective but the outcome of treated disease cannot be predicted from presenting clinical or radiological features. Concomitant space-occupying cerebral pathology is evident in 50% of post-mortem examinations.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Stridor in patients with HIV infection.

The immunodeficiency which results from HIV infection is associated with a range of opportunistic infections and tumors which may present with the symptoms of upper airways disease. This paper presents three cases of stridor from different causes in patients with HIV infection, all of whom recovered following treatment. The management of this problem requires consideration of the likely aetiology which, in those with advanced immunodeficiency, includes bacterial and fungal laryngitis and epiglottitis as well as rapidly growing laryngeal tumours. Recommendations for the treatment of those with HIV infection who present with severe or rapid-onset stridor should include a combination of aggressive airway intervention and broad-spectrum antibacterial and antifungal agents. Laryngeal biopsy for histology and culture is particularly important for those patients who fail to respond to the aforementioned treatment.

AIDS-Related Opportunistic Infections↗
PubMed1995

Disseminated disease due to Mycobacterium avium complex in AIDS.

We retrospectively analysed 46 cases of disseminated infection with Mycobacterium avium complex (MAC) within a cohort of 702 HIV-infected patients in Edinburgh. Clinical features were compared with case-matched controls (AIDS cases without disseminated MAC), and survival and progression times were controlled for confounding variables that influence survival. Disseminated MAC was diagnosed antemortem in 18% of AIDS patients, and was the AIDS-defining diagnosis in 6% of all AIDS cases. Concomitant colonization of respiratory and gastrointestinal tracts was common (61% and 48%, respectively). In 58% of cases, CD4+ counts were < 10 cells/mm3 (median 6 cells/mm3). Weight loss, anaemia, leucopenia, and elevated liver transaminases and alkaline phosphatase were significantly more common among cases than controls. Therapy was given in 74%, and not tolerated in 32%. Following AIDS diagnosis, disseminated MAC incidence was 14% at one year, 25% at 2 years and 36% at 3 years. Median survival after disseminated MAC diagnosis was 6 months, with shorter survival in untreated cases. However, overall survival from AIDS diagnosis was not significantly different between patients who did or did not develop disseminated MAC. Disseminated MAC contributes significantly to AIDS morbidity, and its incidence increases with prolonged AIDS survival. Although survival following diagnosis is short, the development of disseminated MAC in AIDS probably does not affect overall survival. In cohorts with a low incidence, an alternative to prophylaxis might be surveillance and early diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1993

Salmonella enteritidis urinary infection associated with polycystic renal disease.

Extraintestinal infection from non-typhoidal Salmonellae is uncommon and infection in the urine is particularly rare. We report a patient with polycystic renal disease and diabetes mellitus who developed a urinary infection due to Salmonella enteritidis following presumed enteric infection. Isotope white cell scanning demonstrated active infection in the left kidney.

Ciprofloxacin↗