Biomedical subjects
Publications and source records attributed to S W Chapman.
A single case of thoracic actinomycosis presenting with spinal cord compression is described. The authors review the etiology, pathology, presentation and management of thoracic and vertebral actinomycosis.
Eosinophilia is an unusual paraneoplastic manifestation. The authors describe for the first time the association of eosinophilia and metastatic medullary carcinoma of the thyroid. The eosinophil count normalized during remission after chemotherapy but increased at time of relapse. The patient's serum enhanced eosinophilic differentiation of human multipotential hemopoietic precursors but was inhibitory to in vitro growth of murine myelopoietic precursors. The number of multipotential colonies which could be cultured in vitro was lower in the patient's peripheral blood than in normal controls. The authors conclude that a tumor-related circulating factor caused eosinophilia by inducing eosinophilic differentiation and inhibiting myeloid differentiation. Such a mechanism of paraneoplastic eosinophilia has not been previously described.
Mucormycosis is an opportunistic invasive infection caused by fungi of the order Mucorales. Rhizopus, Absidia, and Mucor are the most commonly encountered genera. Disease is characterized by vascular invasion, thrombosis, and tissue necrosis. Rhinocerebral disease is the most common manifestation but pulmonary, cutaneous, gastrointestinal, and widely disseminated forms have been reported. Pulmonary and disseminated disease are usually seen in neutropenic patients with leukemia or lymphoma. Both present as fever and unexplained pulmonary infiltrates unresponsive to antibacterials and corticosteroids. Disease is usually fulminant and has a high mortality rate. Diagnosis is most commonly made at autopsy. A single case of disseminated disease is reported that is unusual in its subacute course and its occurrence in an otherwise healthy non-neutropenic diabetic male.
Upon review of the English literature and the patients at our hospital, we identified 94 renal transplant recipients with nocardiosis. These patients were further evaluated and compared to nonrenal transplant patients with nocardiosis. We found that these patients were similar in presentation, course, and therapeutic outcome to non-transplant patients. Survival was related to underlying disease, site of infection, rapidity with which the diagnosis was made and, especially, the inclusion of a sulfa compound in the antimicrobial regimen. Transplant centers with high rates of Nocardia infection should consider trimethoprim/sulfamethoxazole prophylaxis for at least the first year after transplantation.
Edwardsiella tarda, a member of the family Enterobacteriaceae, has recently become recognized as pathogenic, especially in patients with an underlying illness. In the present report, a patient had sickle cell hemoglobinopathy and E tarda bacteremia. Other cases of serious infection with Edwardsiella are reported in the literature. Edwardsiella infection may present as bacteremia, enteric fever, gastroenteritis, localized infection, and an asymptomatic carrier state. On the basis of this review, bacteremia with E tarda often has been associated with septic shock and has a high mortality, but this may be related to the usual presence of a serious underlying illness in these patients.
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The ability of Clonorchis sinensis to cause severe hepatobiliary disease is illustrated by the case we have reported, in which biliary obstruction and hepatic fibrosis resulted from the pathologic process associated with chronic clonorchiasis. Immunodiagnostic tests are currently limited, and diagnosis, as illustrated by our case, relies on identification of the fluke, usually as the adult or egg stage in clinical specimens. Praziquantel has revolutionized therapy of this disease, but surgical drainage may be necessary to relieve biliary obstruction. Physicians caring for emigrants or travelers from the Clonorchis endemic belt need to be aware of the manifestations of clonorchiasis to enhance diagnosis and therapy.
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A patient with an ill defined density in the left upper lobe underwent transthoracic needle aspiration. A diagnosis of Blastomyces dermatitidis was made from the aspiration. The patient later returned with a cutaneous ulcer at the site of needle aspiration. B dermatitidis was subsequently recovered from the skin lesion.
The present study provides the first systematic evaluation of strategies for increasing handwashing of hospital staff. Nursing staff on two intensive care units (ICUs) were observed over a 3-month period. After baseline observations, two interventions were implemented on the experimental unit: changing to an emollient handwashing agent, and providing feedback to staff about the frequency of handwashing. Feedback focused on the previous day's handwashing following completed patient contacts, interrupted patient contacts, and critical procedures. No increase in handwashing was observed following introduction of the emollient soap. However, when feedback was provided on the experimental ICU, handwashing following completed patient contacts (the major dependent measure) increased to 92%, and was significantly higher than handwashing on the control unit. Follow-up observations suggested that compliance on the experimental unit appeared to return to baseline levels.
We have reported a case documenting the difficulties encountered in diagnosing and treating patients with brucellosis caused by Brucella canis, including the nonspecific clinical presentation, low level of intermittent bacteremias, the slow-growing, fastidious nature of the organism, and the lack of antigenic cross-reactivity with the antigens usually used in routine Brucella serology. Further, the predominant southeastern United States epidemiology of this organism and the importance of exposure to dogs are also demonstrated by this report. It is important that physicians caring for patients in this region of the country be aware of the epidemiologic, serologic, and microbiologic pitfalls encountered in diagnosing B canis infections.
A 77-year-old patient is described who developed pemphigus vulgaris temporally with the administration of cefadroxil. The disease improved when the drug was discontinued but was exacerbated with the administration of ampicillin. This may be the first case of possible cefadroxil-induced and only the second case of ampicillin-induced pemphigus vulgaris reported. The pathophysiology, diagnosis, and treatment of pemphigus vulgaris is briefly described. Drug-induced pemphigus is reviewed. By far the most incriminated drug has been penicillamine. It is postulated that the sulfhydryl group of penicillamine alters the intercellular cement substance into an antigenic structure with subsequent antibody formation. The chemical similarity between penicillamine, the penicillins, and the cephalosporins is alluded to and the potential for cross-sensitivity between the penicillins and cephalosporins is emphasized. Although the pemphigus vulgaris could have occurred by chance, it seems probable that it was drug-induced.
A sequential separation protocol is described which reproducibly yields biologically active populations of B cells, T cells and monocytes from human peripheral and umbilical cord blood. The purification protocol employed T lymphocyte rosetting with unmodified sheep red blood cells, monocyte adherence to microexudate-coated flasks and anti-immunoglobulin panning of B cells. Population purity was determined by cytofluorographic light scatter analysis, expression of cell surface markers, esterase activity and mitogen responsiveness. The sequential protocol reproducibly yielded viable and functionally active cell populations of greater than 95% purity from a single starting population of mononuclear cells.
We evaluated the effects of 6 supplements often used in human lymphocyte cultures, including fetal calf serum, autologous human serum, pooled human AB serum, hypogammaglobulinemic human serum, bovine serum albumin and human serum albumin. Lymphocyte proliferation of unstimulated and mitogen activated peripheral blood mononuclear cells was measured by [3H]thymidine incorporation. The response of cells stimulated with the T-cell mitogen phytohemagglutinin-P were significantly lower when cultured in bovine serum albumin supplemented media, but were otherwise not supplement dependent. In contrast, responses of cells stimulated with the B-cell mitogens Cowan I strain of S. aureus and antisera against the mu or delta chain of human immunoglobulin were significantly effected by supplement. Cultures containing fetal calf serum and bovine serum albumin had high background responses without a proportional rise in cellular proliferation when B-lymphocyte-specific mitogens were utilized. Autologous human serum and pooled human AB serum contained immunoglobulin which interacted with each of the B cell mitogens, thus limiting their usefulness as in vitro supplements. Cells grown in human serum albumin supplemented media had minimal background and high stimulated responses to B-cell mitogens. These results indicate that human serum albumin is an optimal supplement for in vitro human lymphocyte proliferative assays since it supports high stimulated cell responses with low background activity, is devoid of immunoglobulin and had minimal variability among lots.
Because an increased incidence of nosocomial bacteremia due to gentamicin-resistant organisms occurred in our hospital, amikacin was substituted for gentamicin as the primary empiric aminoglycoside. Prospective surveillance of aminoglycoside use and of bacterial resistance to aminoglycosides was done before and after the substitution. We compared the baseline period when gentamicin was the primary aminoglycoside with the subsequent period when amikacin accounted for 81% of aminoglycoside used. During the two periods the patient population did not differ with regard to indications for aminoglycoside therapy. Among the gram-negative organisms isolated, rates of amikacin resistance during the baseline (1.1%) and usage (1.05%) periods were not significantly different (p greater than 0.6). Resistance to gentamicin and tobramycin during the period of amikacin use showed a statistically significant decrease (p greater than 0.001) due to decreased resistance to gentamicin of Providencia, Serratia, indole-positive Proteus, and decreased resistance to tobramycin of Pseudomonas aeruginosa. Unrestricted use of amikacin does not necessarily lead to increase in amikacin resistance but may lead to a decrease in resistance to gentamicin and tobramycin among gram-negative organisms.
We recently reported a method for long-term in vitro culture of human monocytes with maintenance of functional and morphological homogeneity. We have now used microexudate-coated flasks to improve both the plating efficiency and the purity of these cultures. The technique is based on pregrowth of BHK cells that presumably produce large amounts of fibronectin, thus coating the flask with this substance, for which monocytes have receptors. We have further characterized the monocytes obtained with this culture technique by scanning electron microscopy (SEM), transmission electron microscopy (TEM), cytochemistry, surface markers, lectin receptors, and phagocytic functions. All these methods show the cultured cells to consist of a pure, functionally and morphologically homogeneous population of nontransformed monocytes.
Hairy-cell leukemia has been associated with a number of disorders of the immune system. At least 13 cases of vasculitis and hairy-cell leukemia have been reported. However, the occurrence of cryoglobulinemia and hairy-cell leukemia is rare. We report a case of a patient with the unusual combination of hairy-cell leukemia, vasculitis, and cryoglobulinemia. This case illustrates that hairy-cell leukemia should now be included in the differential diagnosis of patients with the appearance of vasculitis and cryoglobulinemia. The association presents a therapeutic challenge and emphasizes the need for individualized treatment in such patients.
The incidence and etiology of infections in 210 acute leukemics at the University of Mississippi Medical Center between 1962 and 1978 were reviewed. Infections episodes occurred 269 times in 148 patients. In 193 infections, potential pathogens were cultured. Infection was a contributing cause of death in 89 patients. E. Coli, S. aureus, K. pneumoniae, and P. aeruginosa accounted for 58% of the isolates. No unusual patterns of antimicrobial resistance were observed. The outcome of the infections was related to the absence or resolution of neutropenia. Among 48 patients febrile on first admission, four cases of gram-negative pneumonia, two cases of fungal pneumonia, and two cases of pseudomonas cellulitis were diagnosed. We conclude that the etiology of infections was similar to that of cancer centers; multidrug-resistant gram-negative organisms were not prevalent; absence or resolution of neutropenia indicates a good prognosis for outcome of infection; and untreated acute leukemics may acquire opportunistic infections.