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Biomedical subjects

S Krajden

Publications and source records attributed to S Krajden.

At least 19 recordsLinked to original sources
PubMed2004

Subcutaneous phaeohyphomycosis caused by Lasiodiplodia theobromae and successfully treated surgically.

While visiting Jamaica, a 50-year-old woman stumbled on an outdoor wooden staircase and sustained an injury to the right leg. The wound was cleaned topically and the patient was given antibacterial therapy. Five weeks later, in Canada, she presented with an ulcer at the injury site. An excisional biopsy showed copious broad, septate, melanized fungal filaments penetrating into tissue. Culture yielded a nonsporulating melanized mycelium. The isolate was strongly inhibited by cycloheximide and benomyl but grew at 37 degrees C. After 16 weeks cultivation on modified Leonian's agar at 25 degrees C, it developed pycnidia characteristic of Lasiodiplodia theobromae, a common tropical phytopathogen mainly known previously as a rare agent of keratitis and onychomycosis in humans. The patient was not given antifungal chemotherapy, and the ulcer, which had been broadly excised in the biopsy procedure, ultimately resolved after treatment with saline compresses. The six-month follow-up showed no sign of infection. This case, interpreted in light of previously reported cases, shows that on rare occasions L. theobromae is able to act as an agent of subcutaneous phaeohyphomycosis and that, when this occurs, debridement alone may be sufficient to eradicate it.

Antifungal Agents↗
PubMed2000

Novel cases of blastomycosis acquired in Toronto, Ontario.

Blastomycosis a potentially fatal fungal disease, is well known from defined areas of endemicity in Ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern Ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent "inoculation blastomycosis" connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. Physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.

Adult↗
PubMed1996

Evaluation of Roche Amplicor PCR assay for Mycobacterium tuberculosis.

The Roche Amplicor Mycobacterium tuberculosis PCR test (RMtb-PCR) was compared with mycobacterial culture, with the BACTEC 460 system and inoculation on Lowenstein-Jensen media. Results were interpreted with an adjusted "gold standard" incorporating clinical diagnosis. A total of 1,480 clinical specimens from 1,155 patients, including tissues and fluids, as well as 141 specimens which demonstrated a positive growth index on the BACTEC 460 system were assessed. The sensitivity, specificity, and positive and negative predictive values of RMtb-PCR compared with the adjusted gold standard for clinical specimens were 79, 99, 93, and 98%, respectively. In smear-positive specimens, the sensitivity of RMtb-PCR was 98% versus 53% for smear-negative specimens. When RMtb-PCR was performed two times per week, PCR results were available an average of 21 days before the culture results. For specimens demonstrating a positive growth index on the BACTEC 460 system, RMtb-PCR had a sensitivity and specificity of 98 and 100%, respectively. This study demonstrates the value of a commercial nucleic acid amplification kit for rapid diagnosis of M. tuberculosis, particularly in smear-positive specimens or BACTEC culture-positive specimens.

Bacteriological Techniques↗
PubMed1995

Application of the API YeastIdent system in determining the enzymatic profiles of Nocardia asteroides isolates.

Glucose represses production of ammonium in many clinical isolates of Nocardia asteroides growing on bromcresolpurple casein glucose agar. Strains exhibiting this property are designated as group A, while group B represents isolates showing a high degree of proteolytic activity and a resulting rapid increase in pH. Twenty isolates of N. asteroides were characterized as group A or B. Enzymatic profiles obtained using the API YeastIdent system showed significant enzymatic variation between 12 group B and 8 group A isolates. Proteolytic enzymes which most varied in activity between groups were glycine aminopeptidase, histidine aminopeptidase and leucyl glycine aminopeptidase. As some of the N. asteroides isolates were isolated from asymptomatic patients, it is of interest to consider the possibility of one group being of low virulence while the other is more strongly associated with infection.

Bacterial Typing Techniques↗
PubMed1993

Piperacillin versus cefazolin given perioperatively to high-risk patients who undergo open cholecystectomy: a double-blind, randomized trial.

OBJECTIVE: To study the efficacy, microbiologic features and toxicity of prophylactic cefazolin versus prophylactic piperacillin in high-risk patients who undergo open cholecystectomy. DESIGN: Double-blind randomized trial with follow-up for 6 weeks postoperatively. SETTING: An 850-bed community hospital, located in a major Canadian city. Patients admitted to hospital who satisfied published criteria for being at high-risk for infection after open cholecystectomy were entered into the protocol, and those who satisfied the criteria and provided consent were entered into the study. Eighty-one patients were randomly assigned by computer to receive either piperacillin or cefazolin as the prophylactic agent. INTERVENTIONS: Open cholecystectomy. MAIN OUTCOME: Provides detailed information on the organisms found in the biliary tree in patients with acute cholecystitis, assesses the in-vitro activity of cefazolin versus piperacillin against the isolated organisms, expecting that piperacillin would be much more active against isolated anaerobes and gram-negative bacteria. RESULTS: Bactobilia was documented in 42% of patients in the cefazolin group and 29% of patients in the piperacillin group. Piperacillin was active in vitro against 94% of all isolates versus 56% for cefazolin (p < 0.005, McNemar's test). Adverse effects and toxicities in both the piperacillin and cefazolin group were low and were not serious. CONCLUSIONS: Both piperacillin and cefazolin are safe and effective prophylactic antimicrobials for high-risk patients who undergo open cholecystectomy. However, piperacillin had a much wider spectrum of in-vitro activity against the isolated pathogens, especially Enterococcus sp., Enterobacter cloacae and the anaerobes.

Adult↗
PubMed1993

An unusual nosocomial infection: nasotracheal myiasis.

A number of fly maggots were found emerging from the nose and tracheostomy site of an 82-year-old woman who had been in a coma for two months in an acute care hospital in a large Canadian city. This case history indicates that the infestation was hospital-acquired and although undoubtedly an extremely rare occurrence, at least in Canada, points out the risk of myiasis in the unconscious, debilitated patient.

Aged↗
PubMed1991

Normally saprobic cryptococci isolated from Cryptococcus neoformans infections.

We report two cases in which Cryptococcus laurentii was isolated from surgically resected pulmonary lesions but the cryptococcal cells is tissue reacted positively with a specific fluorescent antibody (FA) conjugate for Cryptococcus neoformans. Both patients had no apparent host defense defects. In both cases, multiple cryptococcal isolates were obtained from tissue, and yeastlike cells consistent with C. neoformans were seen in direct histology. The isolates were identified by assimilation patterns and standard procedures including phenoloxidase reactions. Since C. laurentii was consistently isolated by using stringent procedures, it was considered unlikely that the fungus represented surgical or laboratory contamination. Its presence may be the result of dual infection not detected by FA, but other possible explanations exist. The results show the value of the FA test in diagnostic mycology and call into question previous reports of cryptococci other than C. neoformans as agents of infection.

Adult↗
PubMed1991

Microorganisms in the Stomach During Vertical Banded Gastroplasty.

Vertical banded gastroplasty involves the cutting of a stapled window against an Ewald tube Passed perorally, and creation of a vertical staple-line partition. The channel at the window is banded by a polypropylene mesh collar. A study of the gastric rings removed at this operation found that the bacterial colonization rate was 46.8%, so that the potential for infection of the collar exists. The actual significance of this finding is unknown.

Journal Article↗
PubMed1990

An autochthonous phaeohyphomycotic nail infection in Canada caused by Hendersonula toruloidea.

A case of an autochthonous toenail infection caused by Hendersonula toruloidea is presented. H. toruloidea was characterized by thick, branching septate brown-walled hyphae of a non-dermatophyte in microscopic tissue mounts in 25% Na0H with 5% glycerol. Cultures grew out on Littman's agar and Sabouraud peptone glucose agar plus chloramphenicol, but only if cycloheximide was not present. In vitro, the H. toruloidea isolate was characterized by copious 1-to 2-celled hyaline to dark-brown arthroconidia deriving from the fragmentation of aerial hyphae. It is likely that more infections due to H. toruloidea will be diagnosed if cycloheximide-free media are routinely used in the isolation of organisms from suspected dermatophyte infections.

Aged↗
PubMed1989

Potted plants in hospitals as reservoirs of pathogenic fungi.

The soils of five potted plants cultivated within a hospital were investigated for the presence of fungal opportunistic pathogens of humans. A total of 16 potentially pathogenic species were isolated, including Aspergillus fumigatus at up to 53.5 colony-forming units (CFU) per gram dry soil and Scedosporium apiospermum (Pseudallescheria boydii) at up to 97.0 CFU/g. Other common species included Phialophora verrucosa and Fusarium solani. Scedosporium inflatum, a recently described emerging pathogen, is reported for the first time from an environmental source. The results of this study, in combination with previous case reports linking mycoses to potted plants and available information on the establishment and dispersal of fungal opportunistic pathogens in indoor habitats, indicate that indoor plant soils constitute a serious mycotic hazard to the immunosuppressed patient.

Aspergillus↗
PubMed1989

Onychomycosis, tinea pedis and tinea manuum caused by non-dermatophytic filamentous fungi.

Over 4000 cases of fungal nail, sole and palm infection recorded during a three-year study period were investigated to determine the prevalence and significance of etiologic agents other than dermatophytes and yeasts. Littman's oxgall agar, which permitted isolation of cycloheximide-sensitive species but restricted overgrowth by fast growing contaminants, was used to promote isolation of these disease agents. Non-dermatophytic filamentous fungi made up 2.3% of the confirmed etiologic agents obtained overall, and constituted 3.3% of the agents obtained from nail infections. The most common species were Scopulariopsis brevicaulis, Hendersonula toruloidea, and Aspergillus sydowii. Scytalidium hyalinum was recorded for the first time from Canada, and an instance of nail infection by Gymnascella dankaliensis was recorded. Only H. toruloidea and Sc. hyalinum caused palm and sole infections.

Foot Dermatoses↗
PubMed1989

Evidence for the occurrence of the same strain of Campylobacter pylori in the stomach and dental plaque.

Restriction endonuclease analysis with HindIII, HaeIII, and BglII endonucleases of DNA extracted from each of eight colonies of Campylobacter pylori subcultured from a stomach biopsy and from each of eight colonies subcultured from dental plaque of the same patient indicated that at least three strains were present in the dental plaque but only one strain was present in the biopsy. One of the dental strains had restriction patterns indistinguishable from those of the biopsy isolate, providing evidence that both sites were infected with the same strain of C. pylori.

Biopsy↗
PubMed1989

Examination of human stomach biopsies, saliva, and dental plaque for Campylobacter pylori.

To examine possible sources of Campylobacter pylori and to determine the routes by which it is transmitted to the human stomach, samples of dental plaque and saliva from 71 patients undergoing endoscopy in addition to stomach biopsies were collected and cultured on selective noninhibitory Skirrow medium. A total of 29 (40.8%) of the stomach biopsies yielded C. pylori. None of the saliva samples and only one of the dental plaque samples was found positive for C. pylori, and thus neither saliva nor dental plaque could be implicated as a significant reservoir of this organism.

Biopsy↗
PubMed1988

An outbreak of Trichophyton tonsurans dermatophytosis in a chronic care institution for the elderly.

A nosocomial outbreak of dermatophytosis caused by Trichophyton tonsurans var. sulfureum subvar. perforans is reported in a nursing home for the elderly. The outbreak affected six residents and persisted for nine months despite remedial medical and sanitary measures. In a survey designed to determine the potential role of fomites in disease transmission, 129 environmental sites were sampled. A high proportion (22.3%) of the samples yielded T. tonsurans, including samples from beds, floors, and washroom facilities. Methods for the control of dermatophyte outbreaks in chronic care institutions are discussed.

Adult↗
PubMed1988

Tinea corporis caused by Microsporum canis: report of a nosocomial outbreak.

In an unusual nosocomial outbreak, 13 staff and 11 patients in an acute and chronic health care facility were infected with the zoophilic dermatophyte, Microsporum canis. The dermatophyte was apparently introduced into the facility by a single infected patient. Likely modes of subsequent disease transmission include person-to-person contact, handling of contaminated laundry, and use of a shared razor. Infection control measures for managing such outbreaks are discussed.

Adult↗
PubMed1987

Expanded clinical spectrum of infections caused by Proteus penneri.

Strains of Proteus penneri from seven abdominal wounds (after bowel resection), five urine samples, and eight other sites were isolated in mixed cultures. Seven urine isolates were in pure cultures. All infections were nosocomially acquired, indicating that complete identification of P. penneri in the clinical laboratory is warranted.

Aged↗