Meningococcemia diagnosed by peripheral blood smear.
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Biomedical subjects
Publications and source records attributed to T A Cardella.
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Relative toxicities of methicillin and nafcillin were compared in 70 patients with serious infections caused by Staphylococcus aureus. Of the 29 patients treated with nafcillin, four had fever, rash, and leukopenia and 1 had absolute neutropenia. Of the 41 patients treated with methicillin, 16 experienced 27 reactions. In addition to fever and skin rash, neutropenia and urinary tract abnormalities were common. Methicillin and nafcillin are equally effective in treating S aureus infections, but methicillin was significantly and more frequently associated with adverse drug reaction that was nafcillin.
Twenty-six strains of Staphylococcus aureus obtained from patients with endocarditis were studied for the production of alpha- and/or beta-ribitol teichoic acid (TA), using highly specific anti-TA antibodies prepared in rabbits. A counterimmunoelectrophoretic assay was used. Beta-TA was the predominant residue produced by all strains; alpha-TA was found in all strains, but in smaller amounts and with much strain-to-strain variations. Antibodies in patients' sera were found against beta-TA in higher titers and for longer periods than were anti-alpha-TA antibodies. Antibodies against one or both TA residues were present in all but one of 26 patients.
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Forty patients had staphylococcal endocarditis and a history of parenteral drug abuse. Clinical and microbiologic features of their cases were evaluated. None of our patients were known to have had preexisting valvular disease. The tricuspid valve lesions and their pulmonary complications were the predominant findings. Systemic complications in the form of meningitis, glomerulonephritis, empyema, arthritis, and nosocomial Gram-negative septicemia occurred in 33% of our patients. Of interest was the high incidence of reactions to therapy especially with methicillin sodium, which occurred in 30% of patients. Correlation of phage type and group with the antibiotic sensitivities of individual staphylococci showed that group 3 and phage types 6, 42E, 54, and 75 were much more resistant to penicillin than other groups and types. The clinical outcome did not relate to phage type and group or to antibiotic sensitivity of the organism.
An adult drug abuser with endocarditis due to a group II Staphylococcus aureus developed the staphylococcal scalded skin syndrome (SSSS). Studies of the patient's immune function found cell-mediated immunity (CMI) to be essentially normal; thus, previous suggestions that deficient CMI is required in adults who develop SSSS seem unfounded. Pathogenesis, diagnosis, and therapy of SSSS and its differentiation from drug-induced hypersensitivity reaction are discussed in detail.