Pathologic quiz case. Chronic pneumonia after gastrectomy. Pathologic diagnosis: chronic aspiration lipoid pneumonia with Mycobacterium abscessus.
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Chronic Disease↗
Biomedical subjects
W J Buesching
Publications and source records attributed to W J Buesching.
Novel screening method for urine cultures using a filter paper dilution system.
We have developed a novel method for urine culture for office practice based on the use of filter paper as a solid-phase dilution device. Filtration dilutes and spreads the inoculum onto a solid culture surface. Experiments were conducted to determine the optimum inoculum size, microbial permeability through filter papers, and ability to exclude vaginal epithelial cells. The filter paper dilution system was compared to the standard streak method to detect bacteriuria in specimens submitted to the diagnostic laboratory. The sensitivity and specificity of the filter paper dilution system for detection of high-count (>/=10(4) CFU/ml) gram-negative bacteriuria in 487 urine specimens were 98.2 and 97.4%, respectively. The sensitivity and specificity for gram-positive bacteriuria in 404 urine specimens were 91.2 and 99.2%, respectively. Low-count gram-negative bacteriuria (<10(4) CFU/ml) was detected by the filter paper dilution system in five of nine specimens (55.6%). In addition, the filter paper dilution system was able to detect gram-negative bacteria in 12 of 41 (29.3%) mixed cultures. Lactobacillus and Gardnerella organisms in urine specimens were excluded by the filter paper dilution system. Only three of eight Candida sp. isolates were detected at counts of >/=10(4) CFU/ml. The system has good storage properties and can be inoculated at the point of source without the need for refrigeration or preservatives. It should be a useful screening method for office practice, where members of the family Enterobacteriaceae and staphylococci cause most infections. Standard culture methods are preferred for hospital diagnostic microbiology laboratories, where there is a need to detect yeasts and fastidious microorganisms and to isolate individual colonies from mixed cultures.
Bacteriuria↗
Isolation of fluconazole-resistant Candida albicans from human immunodeficiency virus-negative patients never treated with azoles.
Isolation of fluconazole-resistant strains of Candida species from human immunodeficiency virus (HIV)-infected patients after repeated or continuous courses of treatment has been reported with increasing frequency. During 1991-1992, MICs of fluconazole for 139 Candida albicans isolates from our institution were bimodally distributed: 102 strains were susceptible (MICs, < or = 4 micrograms/mL) and 37 were resistant (MICs, > or = 8 micrograms/mL). There was incomplete cross-resistance between fluconazole and ketoconazole or miconazole, and there was no cross-resistance between azoles and amphotericin B or flucytosine. Twenty of the 37 fluconazole-resistant strains were isolated from 17 HIV-negative patients, some with systemic infections, who had never been treated with azoles. There were no differences in characteristics or risk factors for those patients as compared with those for an equal number of HIV-negative patients from whom fluconazole-susceptible strains were isolated. Among patients with systemic infection, 6 (50%) of 12 with infection caused by fluconazole-resistant strains survived and 11 (69%) of 16 with infection caused by fluconazole-susceptible strains survived (P = .54). Survival was not found to be related to treatment regimen, but the number of patients was small. The emergence of fluconazole-resistant C. albicans among HIV-negative patients never exposed to azoles is of concern.
Adolescent↗
Inability of cytomegalovirus infection of cultured endothelial cells to induce HLA class II antigen expression.
Cytomegalovirus infection in the renal allograft recipient has been associated with the initiation of acute rejection. The mechanism of this induction is unknown. It may be related to renal tubular epithelial and endothelial expression of HLA class II antigens or a CMV immediate-early antigen that exhibits immunologic crossreactivity with HLA DR. In this study the ability of CMV to both infect and subsequently induce class II antigen expression on cultured human umbilical-vein endothelial cells (HUVEs), in the absence of cytokines, particularly gamma interferon, was tested. Individual HUVE cell lines were first proven to express HLA class II antigens in the presence of 10, 100, and 200 units of recombinant IFN-gamma as early as 24 hr postincubation by an immunohistochemical technique and by flow cytometry. These cell lines were successfully infected with CMV strains AD169 and CMV3 as determined by the presence of early and late viral antigens and CMV DNA. The degree of infection was dose and incubation-time dependent. Infection of HUVEs with these CMV strains and a nonattenuated clinical isolate failed to induce HLA DR, DP, or DQw1 expression in the absence of IFN-gamma. These findings support the hypothesis that endothelial cells in vivo may serve as reservoirs of CMV infection. They do not support the hypothesis that CMV produces an immediate-early antigen that has immunologic cross-reactivity with HLA DR. Furthermore, there is no support for the hypothesis that CMV independently induces HLA class II antigens in the absence of IFN-gamma.
Cells, Cultured↗
Infectious hazards in the clinical laboratory: a program to protect laboratory personnel.
The increasing risk of exposure to blood-borne pathogens in the health care setting makes the development of effective infection control programs in the laboratory workplace critical. Central to such programs is the concept of universal precautions. The program described here relates the level of protection or precaution to the potential danger for infection, given the laboratory workstation and task which is to be performed. Four Levels of Protection are described. Implementation of this program requires that each workstation and procedure in each laboratory section be reviewed by the laboratory director and supervisory personnel for risk of exposure. Implementation additionally requires that provisions be made for both the initial and continuing education of laboratory employees. Laboratory directors and supervisors should also monitor the program to ensure compliance. There will certainly be situations unique to individual institutions or laboratory settings that may require precautions or policies over and above those described by universal precautions. Laboratory policies will not gain acceptance if they are developed and implemented without the advice and cooperation of the hospital medical staff. Employee acceptance of infection control policies will be greater if actual development and implementation actively involves the laboratory personnel who will practice them. The program described here is but one approach to the problem. Employers and laboratory directors must understand that it is their responsibility to develop a program that provides appropriate safeguards for workers who may be exposed to infectious agents in the laboratory workplace and to ensure that employees are properly trained and educated in the proper use and application of those safeguards.
Acquired Immunodeficiency Syndrome↗
Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission.
Sixty-eight sexually active and 52 virginal asymptomatic adolescent girls were evaluated for bacterial vaginosis and various laboratory indicators of bacterial vaginosis in a 3-month observational noninterventive study. Sixteen of 120 (13%) subjects had bacterial vaginosis during the study. There was no significant difference in the prevalence of bacterial vaginosis or in the prevalence of isolation of Gardnerella vaginalis between the sexually active and virginal groups. Only a few cases of bacterial vaginosis (one of eight), wet mount clue cells (four of 11), sniff tests (two of eight), and abnormal vaginal fluid succinate/lactate ratios (none of 6) persisted for 3 months in the absence of therapy. These results are discussed in light of several recent reports that suggest using the isolation of G. vaginalis or the diagnosis of bacterial vaginosis as evidence of sexual abuse in children. It is concluded that bacterial vaginosis should not be considered an exclusively sexually transmitted disease. The presence of the condition is neither proof of sexual activity nor warrants male sexual partner therapy. In addition, therapy seems unwarranted for the incidental finding of bacterial vaginosis in the patient without symptoms.
Adolescent↗
In vitro activity of systemic antifungal agents against Malassezia furfur.
The activity of four antifungal agents against 15 systemic (blood and vascular catheter) and 10 superficial (skin) Malassezia furfur isolates was evaluated. MIC ranges were similar for the two groups of organisms: amphotericin B, 0.3 to 2.5 micrograms/ml; flucytosine, greater than 100 micrograms/ml; miconazole, 0.4 to 1.5 micrograms/ml; and ketoconazole, 0.025 to 0.4 micrograms/ml.
Antifungal Agents↗
Sexually transmissible infectious agents in sexually active and virginal asymptomatic adolescent girls.
Sixty-eight sexually active and 52 virginal adolescent girls were evaluated for six sexually transmissible infectious agents: Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, Trichomonas vaginalis, and Neisseria gonorrhoeae. There were significant differences between sexually active and virginal girls with respect to the prevalence of isolation of U urealyticum (75% v 33%, P less than .005), M hominis (27% v 10%, P less than .05), and C trachomatis (19% v 2%, P less than .025) but not for G vaginalis (34% v 17%, P = .09). N gonorrhoeae and T vaginalis were isolated exclusively from sexually active girls, but their low prevalence (6% and 9%, respectively) made the difference statistically insignificant (P = .2 and .06, respectively). Race, current v previous sexual activity, multiple sexual partners, oral contraceptive use, and concurrent isolation of another organism did not identify those at increased risk for chlamydial isolation. Such girls were significantly more likely to have inflammatory Papanicolaou smears (36% v 10%, P less than .05) and excessive WBC in their vaginal secretions (50% v 19%, P = .05). The data support the contention that C trachomatis, N gonorrhoeae, and T vaginalis are organisms that are predominantly acquired via sexual routes. Significant nonsexual modes of transmission are supported by the data for the genital mycoplasmas and G vaginalis. Finally, a history of sexual activity in an adolescent female warrants specific diagnostic testing for Chlamydia.
Adolescent↗
Filamentous Histoplasma capsulatum endocarditis involving mitral and aortic valve porcine bioprostheses.
We report a case of histoplasmosis capsulati endocarditis simultaneously infecting a mitral and aortic porcine bioprostheses. Histologically, the fungus demonstrated a diversity of morphologies, ranging from typical, intracellular, 2- to 5-micron yeast cells, to septate and branching hyphae, to bizarre hyphae with vesicular swellings. Cultures obtained from both valves were positive in four days. The combination of unexpected histologic appearance and rapid growth in culture may pose problems in diagnosis.
Aortic Valve↗
The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women.
The natural course of signs and laboratory test findings indicative of bacterial vaginosis was followed in an observational noninterventive 6-month longitudinal study of 270 asymptomatic women. Only the minority of positive Gardnerella vaginalis cultures (5 of 33), wet mount clue cells (5 of 14), sniff tests (3 of 11), Papanicolaou smear clue cells (0 of 5), and discharge consistent with bacterial vaginosis (11 of 49) persisted in the absence of therapy. While these four laboratory parameters as well as chromatographic succinate/lactate ratios (performed only on the final visit) were abnormal significantly more often in patients with abnormal discharge than in those with normal discharge (p = 0.006, p less than 0.0001, p less than 0.0001, p = 0.0003, and p = 0.002, respectively), all were insensitive predictors of abnormal discharge with sensitivities ranging between 10.6% and 20.2% and abnormal test predictive values between 30.6% and 65.2%. We conclude that G. vaginalis represents indigenous flora in some normal women and that therapy is unwarranted for the incidental finding of a positive laboratory indicator of bacterial vaginosis in the patient without symptoms.
Adolescent↗
Mycobacterium fortuitum infection of a Hickman catheter site.
A patient with histiocytic lymphoma who developed a Hickman catheter exist site infection due to Mycobacterium fortuitum is described. Due to the risk of dissemination in immunosuppressed patients and the resistance to antibiotic therapy, rapid-growing mycobacteria should be considered when gram-positive bacilli are associated with infections in patients with these catheters.
Adult↗
Evaluation of the Anaerobe-Tek system for identification of anaerobic bacteria.
The Anaerobe-Tek system of Flow Laboratories, Inc. (McLean, Va.), is a new bacterial identification system which uses Gram morphology, sporulation, and reactions from 15 agar-based biochemical tests to generate a six-digit code number for identification of anaerobic bacteria. Supplemental tests are recommended when necessary to complete species identification. Individual test and identification performance of this system was evaluated by testing 216 anaerobic bacteria representing 31 species and one Centers for Disease Control unnamed group in parallel with a routine clinical laboratory identification system. Most of the tests in the Anaerobe-Tek system performed well; 85% of the organisms were correctly identified. The 32 (15%) failures in identification were due to omission from the identification code data base (38%), false-negative indole reactions (22%), and other incorrect biochemical reactions (40%). The replacement of the recommended indole test with an extraction method using the inoculum broth and an expansion of the data base of the system could raise the correct identification for this organism population to over 90% with no change in the test materials.
Anaerobiosis↗
Enhanced primary isolation of Legionella pneumophila from clinical specimens by low-pH treatment.
During the 12-month study period, 919 clinical specimens were submitted to the laboratory for culture of Legionella pneumophila. All specimens were plated onto nonselective and semiselective media both directly and after treatment with a KCl-HCl solution, pH 2.2. Of the 51 specimens (5.5%) positive for L. pneumophila and Legionella-like organisms, 20 were recovered by acid pretreatment only, 5 were recovered by direct plating only, and 26 were recovered by both acid pretreatment and direct inoculation. These data demonstrated that acid pretreatment substantially improved the recovery of L. pneumophila and Legionella-like organisms from the clinical specimens examined.
Bacteriological Techniques↗
Pulmonary clearance of blood-borne bacteria.
Clearance of blood-borne bacteria has been attributed primarily to a fixed macrophages in the liver and spleen. Although many important nonrespiratory functions of the lung have been reported, a major role for this organ in the clearance of circulating bacteria has not been described. To investigate mechanisms of sepsis induced lung dysfunction and pneumonia, we measured lung clearance, tissue accumulation and morphologic effect of blood-borne. Pseudomonas aeruginosa in pigs. Single pass pulmonary clearance of 60 to 80 per cent occurred over a wide range of infusion concentrations. Tissue concentrations of viable, hematogenously delivered bacteria were greatest in the lungs and exceeded inflowing blood concentrations in the lungs, liver and spleen but were less than inflowing blood concentrations in the heart, kidney and skeletal muscle. Electron microscopy showed phagocytosis of bacteria predominantly by mononuclear cells located within small pulmonary vessels. Viable test organisms were recovered from the upper airways of pigs receiving high dose bacterial infusions but not from pigs in the control group. In this experimental model, an important nonrespiratory function of the lungs is clearance of blood-borne bacteria. If lungs in humans have a similar capacity, retention of circulating organisms may be one mechanism of sepsis induced pulmonary failure.
Animals↗
Effect of laminar air flow and clean-room dress on contamination rates of intravenous admixtures.
The effect of laminar air flow conditions and clean-room dress on the microbial contamination rates of intravenous admixtures was investigated. Intravenous admixtures were prepared by one investigator using aseptic technique under four environmental conditions: laminar air flow conditions with clean-room dress; laminar air flow without clean-room dress; clean table top with clean-room dress; and clean table top without clean-room dress. In each environmental condition, 350 admixtures were compounded. Negative-control samples (n = 150) were also tested, as were 10 positive-control samples. Samples were tested in each of two growth media and incubated at 35 degrees C for 14 days or until growth occurred. The incidence of contamination of admixtures compounded in laminar air flow conditions was significantly less than the contamination of those compounded on a clean table top (p less than 0.05) regardless of the operator's dress. The incidence of contamination of admixtures compounded while wearing clean-room dress was not significantly different from those prepared while not wearing clean-room dress regardless of the environment in which the admixture was prepared. The overall low level of contamination [0.79% (11/1400)] was inconclusive regarding the effect of dress on the incidence of contamination when admixtures were prepared under LAF conditions. It is concluded that, when one adheres to aseptic technique, the environment in which admixtures are compounded is the most important variable affecting the microbial contamination rate.
Drug Compounding↗
Evaluation of the modified Micro-ID system for identification of Enterobacteriaceae.
Micro-ID is a system designed to identify the Enterobacteriaceae by utilizing reagent-impregnated disks for 15 biochemical tests. Since its initial evaluations, the system has undergone modification in formulation and in its computer data base. In a dual-center evaluation, 306 isolates of Enterobacteriaceae were tested: 145 common and typical isolates at the Mayo Clinic and 161 unusual or atypical isolates at the Center for Disease Control. Each laboratory also exchanged 50 cultures to test the system's reproducibility. Micro-ID correctly identified 142 (98%) of the common clinical isolates and 123 (76%) of the unusual or atypical organisms. However, in this latter group, three species tested were not in the system's data base. When these organisms were deleted from the analysis, 138 of 146 (95%) of the unusual or atypical isolates were correctly identified. Analysis of the 100 isolates identified in duplicate revealed 93% reproducibility of genus and species identification and 62% reproducibility of octal code numbers. Of the 31 strains with the same identification but different code numbers, 74% differed in only one biochemical test.
Bacteriological Techniques↗
Evaluation of the modified API 20C system for identification of clinically important yeasts.
The modified API 20C system (Analytab Products, Inc.) containing 19 carbohydrate assimilation tests was used to identify stock cultures of clinical isolates and routine clinical isolates from the Mayo Clinic mycology laboratory. The system provided correct identifications for 96% of the 505 organisms tested. The API 20C represents a commercial system useful for the identification of yeasts from clinical specimens. Although reliable, it is not a complete system and must be used in conjunction with microscopic morphological features for definitive identification. Since the system requires 72 h for identification, it is not designed for the rapid presumptive identification of such organisms as Cryptococcus neoformans; other biochemical tests must be used for this purpose.
Diagnosis, Differential↗