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T G Slama

Publications and source records attributed to T G Slama.

33 records · Page 2Linked to original sources
PubMed1983

Clinical and laboratory features of disseminated histoplasmosis during two large urban outbreaks.

Clinical and laboratory features have been reviewed in 66 episodes of disseminated histoplasmosis that occurred during two large urban outbreaks in Indianapolis. Immunosuppression, age greater than 54 years, and presence of other serious underlying illnesses predisposed to the disseminated form of the disease; only 21% of patients lacked one of these risk factors. Central nervous system findings, splenomegaly, hepatomegaly, and lymphopenia suggested disseminated disease but were present in only about one-third of patients. Miliary or diffuse pulmonary infiltrates also suggested dissemination and were noted in about one-third of patients, while mediastinal lymphadenopathy was present in only 17%. Histoplasmal serologic tests, positive in 90% of patients, provided useful diagnostic clues. The diagnosis could be confirmed by culture in 88% of patients, and special stains were positive in about two-thirds. Although 10% of patients recovered without treatment, 11 patients (17%) died because of failure to suspect the diagnosis and initiate therapy promptly. Amphotericin B was effective in all patients receiving at least 500 mg, but relapse occurred if the total dose was less than 30 mg/kg. Ketoconazole appeared effective in non-immunosuppressed patients but not in those with underlying immunosuppression; however, a controlled trial comparing ketoconazole and amphotericin B is required to establish the role of this new fungistatic oral agent.

Adolescent↗
PubMed1982

Toxic shock syndrome or toxic epidermal necrolysis? Case reports showing clinical similarity and histologic separation.

A case of toxic shock syndrome and a case of drug-induced toxic epidermal necrolysis with renal involvement are described. The two patients had similar early clinical manifestations and therefore posed a difficult differential diagnosis. Diagnostic distinction is important because therapy differs considerably. A skin biopsy in each case proved helpful in establishing the correct diagnosis, since there appears to be a different histologic pattern for each condition: superficial perivascular dermatitis for toxic shock syndrome and an interface dermatitis for toxic epidermal necrolysis.

Adult↗
PubMed1982

Risk factors for disseminated or fatal histoplasmosis. Analysis of a large urban outbreak.

An outbreak of histoplasmosis in Indianapolis involving 488 clinically recognized cases including 60 patients with disseminated or fatal infection permitted statistical analysis of risk factors. Being male, white, under 5 years of age, having chronic obstructive lung disease, and living near the presumed source of the outbreak were not risk factors for fatal or disseminated histoplasmosis. Age greater than 54 years and immunosuppression were the only risk factors for disseminated or fatal infection. Dissemination should be excluded in patients with histoplasmosis who are immunosuppressed or older than 54 years. Specific antifungal treatment is more likely to be required in those two groups rather than in patients without risk factors.

Adolescent↗
PubMed1982

The diagnostic laboratory tests for histoplasmosis: analysis of experience in a large urban outbreak.

Of 495 patients reported in a large urban histoplasmosis outbreak, we studied 276 whose serologic tests were done in a single laboratory. Serologic test results were positive in 96% of these patients (compared with less than 5% of controls from an endemic area), cultures were positive in 22%, and special stains in 19%. The immunodiffusion test results were negative in 13% of patients who had positive findings by complement fixation, and 1% had positive results only by immunodiffusion. The complement fixation test was almost twice as sensitive as the immunodiffusion test in patients with subclinical infection. The serologic response differed significantly among the clinical syndromes with higher titers in cavitary and lower titers in disseminated disease. Factors associated with titers of 1:64 or greater to both antigens were black race and immunocompetence. High mycelial titers were also associated with more intense exposure, and high yeast titers were associated with age less than 36 years. No prognostic significance could be proved for fourfold titer rises or falls or persistence of precipitins.

Adolescent↗
PubMed1981

Histoplasma capsulatum epididymitis.

We report 2 cases of epididymal histoplasmosis. In 1 patient an epididymal abscess was the sole manifestation of histoplasmosis and in the other an epididymal abscess occurred with paratracheal lymphadenopathy. Although uncommon histoplasmosis can cause symptomatic genitourinary tract disease and must be differentiated from tuberculosis, tumors and other fungal and bacterial infections.

Abscess↗
PubMed1981

A large urban outbreak of histoplasmosis: clinical features.

An outbreak of histoplasmosis estimated to involve more than 100,000 residents in Indianapolis, Indiana, occurred between September 1978 and August 1979. In the 435 cases evaluated, 52% of the patients were between 15 and 34 years old, and 63% were black. Fifteen patients died, and 46 progressive disseminated infection. Twenty-four patients had pericarditis, and 26 had rheumatologic syndromes. Unusual manifestations that occurred in 18 patients included esophageal and vocal cord ulcers, parotitis, adrenal insufficiency, uveitis, fibrosing mediastinitis, interstitial nephritis, intestinal lymphangiectasia, and epididymitis. The highest attack rate was in the central part of the city, which is a densely populated, disproportionately black section. The source of the outbreak has not been proved by positive culture results; two sites, however, were suspected on an epidemiologic basis.

Adolescent↗
PubMed1979

Comparative efficacy of prophylactic cephalothin and cefamandole for elective colon surgery: results of a prospective, randomized, double-blind study.

Thirty-four patients undergoing elective colon resection or anastomosis received either intravenous cephalothin or cefamandole prophylactically and were observed for evidence of intraabdominal or wound infection, or both, postoperatively. The infection rates were 31 and 33 per cent, respectively. Infections were caused predominantly by cephalosporin resistant aerobes and anaerobes. All four bacteremias were caused by members of the B. fragilis group. The overall infection rate (32 per cent) and the frequency of anaerobic bacteremia (12 per cent) observed in this study were much higher than previously reported after cephalosporin prophylaxis for colorectal surgery.

Adenoma↗
PubMedDate not supplied

Group A streptococcal fasciitis after submental tumescent liposuction.

Tumescent liposuction is a procedure with a good safety record. Local infection is rare but can result in devastating consequences. We report a rare case of group A streptococcal fasciitis complicating tumescent liposuction and highlight the importance of early diagnosis and treatment of this condition. A 62-year-old woman presented 8 days after submental liposuction and a platysmal plication procedure with signs and symptoms of cervical fasciitis. Microbiological analysis confirmed a group A streptococcal infection. By using early aggressive medical and surgical treatments, the disease was arrested before the onset of any necrotizing process. A high index of suspicion is required to make an early diagnosis of this potentially disfiguring and life-threatening infection.

Fasciitis↗
PubMedDate not supplied

Therapy of skin, soft tissue, and bone infections with cefoxitin sodium.

Twenty-seven patients with skin and soft tissue infections, including three with contiguous osteomyelitis, were given cefoxitin intravenously or intramuscularly; the infections of 25 (93%) were resolved with cefoxitin therapy. Etiologic agents included staphylococci, streptococci, Enterobacteriaceae, and anaerobes. Susceptible pathogens were inhibited by less than or equal to 8 micrograms of cefoxitin/ml. This level of drug was surpassed by mean peak serum concentrations eight- to 12-fold after intravenous infusions and two- to threefold after intramuscular injections and resulted in eradication of susceptible organisms from lesions during treatment. Intravenously administered cefoxitin was well tolerated, although eosinophilia, phlebitis, elevation of levels of hepatic enzymes, and a positive direct Coombs' test were observed. Intramuscular injections of cefoxitin in 0.5% lidocaine caused pain and induration and thus were poorly tolerated.

Abscess↗
PubMedDate not supplied

Detection of polysaccharide cell wall antigen of Neisseria gonorrhoeae in a rabbit model by counterimmunoelectrophoresis.

A rabbit chamber model was developed and inoculated with 10(9) colony-forming units (cfu) of viable Neisseria gonorrhoeae to determine whether the lipopolysaccharide-derived Gc2 polysaccharide cell wall antigens could be detected by counterimmunoelectrophoresis (CIE). Four hours after inoculation, a polymorphonuclear leukocyte response was noted in the chambers; this response was followed by progressive phagocytosis of the organisms and a fall in number of cfu/ml. All visible bacteria were intracellular, and chamber fluids were sterile 6 hr after inoculation. Use of sero specific antisera permitted detection by CIE of the Gc2 polysaccharide antigen in sera of all rabbits within 48 hr after inoculation of the chambers, whereas blood cultures remained sterile throughout the experiment. At 2-6 hr after inoculation, the Gc2 polysaccharide antigen was also detected as a single precipitin band in the chamber fluid of inoculated rabbits. At 24 hr the precipitin band was not observed; rather, a halo above the antigen well was noted. The halo was found to be a nonspecific complex containing the Gc2 polysaccharide antigen and no antibody. In the rabbit model studied, CIE was sufficiently sensitive to detect concentrations of the Gc2 polysaccharide antigen of greater than or equal to 0.97 microgram/ml in serum and chamber fluid.

Animals↗
PubMedDate not supplied

Falsely elevated aminoglycoside serum levels in jaundiced patients.

Two cases in which hyperbilirubinemia produced falsely elevated aminoglycoside concentrations, using the Emit assay, are described. Patients' sera were analyzed by both the Emit and a microbiologic assay. The first patient had a 26-percent greater tobramycin concentration with the Emit assay, as compared with the microbiologic assay, when the total bilirubin was 20.1 mg%. For the same patient, there was essentially no difference between the two assays when the total bilirubin was 4 mg%. The Emit concentrations in the other patient were 34-percent elevated with a total bilirubin of 9.7 mg%. Pharmacokinetic analysis also was performed on serum levels reported by each method. Calculated kinetic parameters and dosage regimens varied greatly. Patients with total bilirubin concentrations greater than 4 mg% may need to have aminoglycoside serum levels assayed by a method other than the Emit assay.

Aged↗
PubMedDate not supplied

PCP presenting as cavitary pneumonia: a case report.

As Pneumocystis carinii pneumonia cases increase, physicians must consider the various atypical radiographic presentations of the disease. The following case report illustrates one atypical presentation and the dramatic response to treatment.

Adult↗