Biomedical subjects
Publications and source records attributed to W L Sutker.
We report a case of brucellosis in a young Mexican man who had weight loss, fever, and nausea. Physical examination revealed hepatosplenomegaly, and examination of the blood showed pancytopenia. This case illustrates the need for a high index of suspicion when patients living in the southern United States have these symptoms.
Although persistent infection of animals by members of the genus Ehrlichia is well known and may be associated with subsequent severe or fatal illness, persistent infection of humans with Ehrlichia chaffeensis has not been reported. Herein we report a typical case of serologically documented acute ehrlichiosis; despite therapy with tetracycline and chloramphenicol, the patient's condition progressively worsened and he suffered multiple secondary infections and gastrointestinal hemorrhage. He died 68 days after his initial hospitalization. Retrospective immunohistologic examination of both acute-phase bone marrow specimens (obtained day 12 of illness) and postmortem liver tissue specimens (obtained day 68 after onset of disease) revealed E. chaffeensis morulae in mononuclear cells, presumably macrophages and monocytes. Findings of this case provide the first definitive evidence that E. chaffeensis is capable of establishing persistent human infection and suggest a role for this obligate intracellular bacterium in the induction of immune compromise associated with a fatal outcome.
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For unknown reasons, manifestations of even heavy opportunistic infection in AIDS patients may be chronic and subtle. We have presented the second fully reported case of an AIDS patient with symptomatic Pneumocystis carinii pneumonia in whom the usual screening tests of blood gases and chest roentgenography were normal to all observers. Diffusing capacity for carbon monoxide can be an early and sensitive indication of PCP.
Fusobacterium necrophorum septicemia developed in five patients after an oropharyngeal infection. Four patients had sore throat or neck pain, and two had findings of jugular vein septic thrombophlebitis. Metastatic abscesses, including embolic pneumonia, empyema, septic arthritis, and osteomyelitis, also occurred. Four patients recovered and one died. Proper treatment requires recognition of the oropharyngeal source of the septicemia and its differentiation from endocarditis. Antibiotic therapy should be prolonged, and metastatic abscesses drained.
We compared infection rates in 12 patients with hairy cell leukemia (a malignant neoplasm for which the cell of origin remains controversial) with rates in 15 patients with chronic lymphocytic leukemia (a known B-lymphocyte neoplasm) recently treated at four Dallas hospitals. We found a significantly higher over-all rate of infections in the patients with hairy cell leukemia (P = 0.004 BY Gehan's variation on the generalized Wilcoxon test). This increased rate was primarily due to a significantly higher rate of infections normally controlled by the cell-mediated immune system (P = 0.005). Despite these findings, five of six patients with hairy cell leukemia who were skin-tested exhibited intact delayed type hypersensitivity, and each of the three patients examined serologically produced antibodies normally in response to recent infections. A review of the case records of 173 previously described patients with hairy cell leukemia, demonstrated a similar predilection of patients with this disease for infections normally controlled by cell-mediated immunity. In this regard, they were similar to previously described patients with Hodgkin's disease. Both over-all infection rates and rates of fatal infection were highest in patients with hairy cell leukemia who received chemotherapy as their sole form of treatment and lowest in those who underwent splenectomy as their only form of antitumor therapy.
Clinical data on 25 patients with granulomatous synovitis and bursitis observed from 1970 through 1977 are reviewed. The lesions occurred about the extremities, the wrists and hands being involved most often. With three exceptions, the patients had no significant underlying disease. The lesions were chronic and often followed minor trauma. Many patients had had prior surgery, steriod injections, or both. At the time of surgery for the synovitis, the gross appearance proved to be relatively characteristic, and microscopic examination revealed granulomatous inflammation. Mycobacteria were found in 20 patients. In 15 of these cases, mycobacteria were isolated in cultures; in an additional five cases, acid-fast bacilli were seen in the excised tissue but cultures were negative. The species isolated were Mycobacterium tuberculosis (four cases), Mycobacterium kansaii (six), Mycobacterium marinum (one), Mycobacterium gordonae (one), Mycobacterium avium-intracellulare (two), and Mycobacterium chelonei (one). The clinical results after therapy that combined surgery and antimicrobial agents were generally favorable. It is stressed that surgical specimens should be sent for appropriate cultures as well as for histologic study.