Biomedical subjects
Publications and source records attributed to R J Faville.
Isoniazid (INH) is the cause of one of the most common serious drug overdoses and can cause severe metabolic acidosis. We report a case of INH overdose that is most notable because the patient survived without apparent sequelae after experiencing an extremely low pH level (6.49). This is the lowest reported pH level with patient survival. Toxicity and pharmacology of INH and various aspects of metabolic acidosis are discussed.
A case of childhood intervertebral diskitis caused by Kingella kingae is presented. In a review of the literature, the authors found 33 reported cases of infection caused by species of the Kingella genus, of which 29 were due to K. kingae. Of the 33 cases, 42% represented bacterial endocarditis and 48% bone and joint infection. Of the 16 bone and joint infections, 11 represented septic arthritis, 3 osteomyelitis, and 2 intervertebral diskitis, the latter finding making the authors' case of K. kingae intervertebral diskitis the third to be reported. A review of the bacteriologic findings in cases of childhood intervertebral diskitis indicates a prominent role for fastidious microorganisms and the need for careful attention to specimen procurement and microbiologic processing.
Two children with persistent bacteremia and endocarditis due to Staphylococcus aureus failed to respond to vancomycin therapy, even though serum levels greatly exceeded the inhibitory concentrations. The Staphylococcus from one patient was resistant to methicillin; the other patient had a penicillin hypersensitivity. There was a wide disparity between the minimum inhibitory and the minimum bactericidal concentrations of vancomycin. Striking clinical and laboratory evidence of improvement was demonstrated with the addition of rifampin therapy.
Ten severely burned (greater than 50% BSA) pediatric and young adult patients developed 19 episodes of clinical sepsis of four or more days duration. During eight of the 19 septic episodes the patients received granulocyte transfusions (median, four; range, two to seven). Risk variables, types and prevalence of infections, mainly Pseudomonas aeruginosa and antibiotic regimens were similar for all the septic episodes studied. All eight episodes (100%) resolved in the transfused group while eight of 11 (72%) episodes resolved in the nontransfused group. Patients survived four episodes of ecthyma gangrenosum when granulocyte transfusions were used and the single episode in which they were not used was fatal. Granulocyte transfusions may be helpful in severely burned patients with sepsis.