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Biomedical subjects

S J Antony

Publications and source records attributed to S J Antony.

At least 19 recordsLinked to original sources
PubMed1999

Actinomyces and nocardia infections in immunocompromised and nonimmunocompromised patients.

A retrospective survey of nocardia and actinomyces infections in five local hospitals was conducted over a 3-year period in El Paso, Texas, a border city, in the southwestern United States. The medical records of 42 patients with suspected nocardiosis or actinomycosis were reviewed. One patient was diagnosed with actinomyces and 12 patients with nocardia. Microbiological data included morphologic characteristics, biochemical profile, and susceptibility testing. Predisposing factors included leukemia, renal insufficiency, renal transplant, and lymphoma. No predisposing factors were found in 67% (n = 8) of patients (including the patient with actinomycosis). Twenty-three percent (n = 3) of patients had disseminated disease without evidence of underlying disease or immunosuppression. The mortality and morbidity of these infections appeared to be low.

Actinomycosis↗
PubMed1998

Multidrug-resistant enterococci: the dawn of a new era in resistant pathogens.

Resistant enterococci, especially vancomycin-resistant enterococci, have rapidly become an important nosocomial pathogen. They are increasingly prevalent among hospitalized patients, patients with serious chronic illnesses, and immunosuppressed patients. Risk factors identified include previous antibiotics, exposure to contaminated equipment, and close proximity to infected patients. Treatment of multidrug-resistant pathogens has become increasingly difficult, with increased morbidity and mortality in these patients. Strict infection control measures remain the mainstay in the management of these infections.

Anti-Bacterial Agents↗
PubMed1997

Isoniazid hepatotoxicity in renal transplant recipients.

Tuberculosis occurs at higher rates in renal transplant recipients than in the general population. It would be desirable to use isoniazid prophylaxis in renal transplant recipients at risk for reactivation of tuberculosis; yet many transplant centers do not routinely employ INH prophylaxis because they perceive transplant recipients to be an enhanced risk of hepatotoxicity from isoniazid. Data on the risk of isoniazid in renal transplant patients receiving cyclosporine-based immunosuppression are limited. We retrospectively studied 83 renal transplant recipients (mean age 39.1 +/- 11.7 yr) who had received INH prophylaxis between 1985 and 1994. Eight patients had laboratory evidence of chronic hepatitis B or chronic hepatitis C infection. The mean duration of INH therapy was 344 +/- 163 d. The mean serum glutamate oxalacetic transferase (SGOT) at the start of INH therapy was 24.1 +/- 10.9 I.U., and 10% of patients had mildly elevated SGOTs. Mean peak SGOT during therapy was 36.4 +/- 15.3 I.U. (p < 0.001 compared to start (SGOT). In follow up, 31% of patients had an abnormal SGOT (> 40 I.U.); however, the elevations were small (the highest SGOT was 88.I.U.) and never necessitated discontinuation of INH. No patient had jaundice or other evidence of clinical hepatotoxicity. The 95% confidence interval for the observed frequency of clinical hepatitis was 0% to 4.3%. At the end of INH therapy the mean SGOT was 22.7 +/- 6.2 I.U. (p > 0.2, compared with start SGOT) and only one patient had an abnormal SGOT. In conclusion, it appears that the risk of renal transplant recipients developing serious hepatotoxicity with the administration of INH is low and not different from normal individuals.

Adult↗
PubMed1997

Q fever pneumonia.

Pneumonia is one of the principal manifestations of Q fever, a disease caused by Coxiella burnetii. This bacterium can replicate only within cells, yet it is capable of surviving in the environment because it can withstand drying and substantial temperature variations. Livestock, especially sheep, goats and cattle, are a major reservoir of C burnetii. The organism is transmitted to humans by direct contact with animal products, especially during parturition. Aerosols have transmitted infection over considerable distances. The illness is characterized by an influenza-like syndrome with patchy pulmonary infiltrates. The pneumonia may be accompanied by biochemical evidence of mild hepatitis. The diagnosis is established serologically. Tetracycline or doxycycline provide effective therapy.

Animals↗
PubMed1997

Multidrug-resistant Pneumococcus causing vertebral osteomyelitis.

Primary vertebral osteomyelitis in a rare presentation of pneumococcal infection especially in an asymptomatic patient with no primary focus of infection. This report describes a patient who presented with lower back pain in which the magnetic resonance imaging showed little evidence of L1 and L2 vertebral body destruction. Cultures from these vertebral bodies grew penicillin and third-generation resistant pneumococcus. The patient was treated successfully with 6 weeks of vancomycin and rifampin.

Anti-Bacterial Agents↗
PubMed1997

Use of fluconazole in the treatment of non-AIDS cryptococcal meningitis.

The treatment of non-acquired immunodeficiency syndrome (AIDS) cryptococcal meningitis has not been well defined as yet. The current recommendation is amphotericin B with or without flucytosine. However, due to the many side effects of these drugs, fluconazole is becoming an attractive alternative in patients who cannot tolerate amphotericin B and flucytosine. This case study demonstrates the successful use of fluconazole in a patient with underlying diabetes mellitus and cryptococcal meningitis.

Aged↗
PubMed1996

Lactobacillus bacteremia: description of the clinical course in adult patients without endocarditis.

Lactobacillus bacteremia in the absence of endocarditis is a rare entity, and the clinical relevance of such bacteremia remains unclear. The clinical courses of lactobacillus bacteremia without endocarditis in 43 previously described patients and 12 new patients were reviewed. Bacteremia with Lactobacillus alone occurred in 34 (62%) of the patients, and 12 (22%) of the patients had bacteremia with other organisms, including Lactobacillus. Lactobacillus was isolated from another site in 18 (33%) of these patients. Intravenous catheter infections were not noted in these patients. Underlying conditions included cancer (6 patients), organ transplantation (9), diabetes mellitus (4), and recent surgery (12). Fever occurred in all patients, and eight (15%) of the patients experienced a sepsis syndrome. The mortality rate was 14%; however, only three deaths were attributed soley to lactobacillus sepsis. Lactobacillus bacteremia is an uncommon condition that usually occurs in patients with severe underlying illnesses and is frequently seen as a part of a polymicrobial infection. Blood cultures positive for Lactobacillus represent true infection and not contamination. Although resistance to commonly used antibiotics is common, the mortality rate associated with this bacteremia appears to be low.

Adult↗
PubMed1996

Nontropical pyomyositis in patients with AIDS.

Nontropical pyomyositis in persons with acquired immunodeficiency syndrome (AIDS) is an unusual entity with only a few cases having been described in the United States. Staphylococcus aureus is the most common organism implicated. The infection usually presents in a subacute indolent fashion with minimal inflammation. Fever and leukocytosis may be absent, and blood cultures are frequently negative. The diagnosis usually can be established by a combination of clinical features, computed tomography or ultrasound, and prompt examination of material obtained by aspiration or debridement. This article describes two cases of S aureus pyomyositis in patients with AIDS and reviews the literature relevant to this infection.

AIDS-Related Opportunistic Infections↗
PubMed1995

Leg cramps: differential diagnosis and management.

Leg cramps are a common problem, especially in the elderly. The differential diagnosis is extensive and includes the following conditions: true cramps, such as those related to heat, hemodialysis and electrolyte disturbances, as well as idiopathic cramps (the most common type); contractures occurring in conditions such as metabolic myopathies and thyroid disease; tetany, which is usually related to electrolyte disturbances, and dystonias, such as occupational cramps and those related to antipsychotic medications. Other leg problems that are not cramps, such as restless legs syndrome and periodic leg movements, also must be distinguished. The etiology of idiopathic leg cramps is not clear. Treatments for leg cramps include stretching exercises, quinine sulfate and vitamin E, but no treatment is conclusively effective. Nonetheless, in many patients relief of symptoms is achieved with one or more of these treatments.

Diagnosis, Differential↗
PubMed1995

Increased bactericidal activity as documented by serum bactericidal titers for a triple combination of cell wall active agents against gentamicin-resistant enterococci.

Infections caused by entercocci have become increasingly difficult to treat because these bacteria are becoming increasingly resistant to commonly used antibiotics such as ampicillin, gentamicin and vancomycin. A consensus for an optimal therapy of enterococcal infections caused by resistant isolates has not yet been determined. We present a patient with prolonged enterococcal sepsis in whom a combination of ampicillin, vancomycin and imipenem was ultimately successful in suppressing enterococcal bacteremia. The enhanced activity of this triple combination was documented by the results of serial serum bactericidal titers.

Adult↗
PubMed1995

Tuberculous pericarditis in an HIV-infected patient.

Persons co-infected with mycobacterium tuberculosis (MTB) and HIV are at increased risk for developing active tuberculosis. While extrapulmonary tuberculosis is particularly common in patients with AIDS, tuberculous pericarditis is a very uncommon complication of AIDS in the United States. We present a case of tuberculosis involving the pericardium and review the current literature on this topic.

AIDS-Related Opportunistic Infections↗
PubMed1995

Dermatitis artefacta revisited.

Self-induced factitial dermatitis, or dermatitis artefacta, is a rare and difficult condition to treat. We present an unusual case of factitious dermatitis with its subsequent severe complications. The clinical features, radiographic findings, histopathologic features, and treatment options are reviewed.

Abscess↗
PubMed1995

Clinical differences between pulmonary and extrapulmonary tuberculosis: a 5-year retrospective study.

This article describes the clinical, epidemiologic, laboratory, and treatment characteristics of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in Eastern North Carolina, a primarily rural area. The database was obtained for 1988-1992 from the University Medical Center of Eastern North Carolina-Pitt County and East Carolina University School of Medicine (the tertiary care referral center for this region). One hundred thirty-eight culture-positive patients were enrolled in the study; 56% were PTB and 44% were EPTB. African-American males constituted 59% of the population. Sixty-nine percent of the patient base were uninsured. There was a bimodal age distribution of < 40 and > 60 years of age. Factors associated with PTB (reported as odds ratios) were white males (2.5), diabetes mellitus (5.4), and cancer (5.1). Factors associated with EPTB (reported as odds ratios) were African-American females, positive human immunodeficiency virus (HIV) serology (8.7), low hematocrit (32.6), and elevated alkaline phosphatase (199). This study emphasizes that in the latest resurgence of tuberculosis, impoverished rural areas, which have been ignored in earlier and present control efforts, are important reservoirs of disease.

Adult↗
PubMed1995

Primary cutaneous Cryptococcus in nonimmunocompromised patients.

Cutaneous cryptococcosis in the nonimmunocompromised host is a rare entity and, when it does occur, presents with protean manifestations making a clinical diagnosis difficult. The diagnosis is made by a combination of a high degree of suspicion, clinical features, and histopathologic examination of the skin biopsy. Antifungals should be used early in the disease; however, the class of antifungal, dose, and duration of therapy is controversial at this time.

Aged↗