David Huminer

Primary hyperparathyroidism in children

We present here a series of seven children with primary hyperparathyroidism caused by parathyroid adenoma. Chief cells were the primary element in six patients and water-clear cells in one patient. A brief review of the literature on primary hyperparathyroidism in children is included. Emphasis is placed on the clinical characteristics of this rare disease in children.

Five-year prospective study of bacteraemic urinary tract infection in a single institution

In order to determine the epidemiology, microbiology, and outcome of bacteraemia originating in the urinary tract in hospitalised patients, a prospective study was conducted in a large general hospital in Israel. Data from all patients with bacteraemia were collected prospectively, and a subgroup of patients with bacteraemia secondary to urinary tract infection was analysed. There were 702 episodes of bacteraemia secondary to urinary tract infection during a five-year period (33.9% of all episodes of bacteraemia). The mean age of the patients was 76 years, and the male: female ratio was 0.9∶1.0. The most common pathogens wereEscherichia coli (52%),Klebsiella spp. (14%), andProteus spp. (9%).Pseudomonas spp. were isolated from 8% of all patients, from 19% of those who had received antibiotics, and from 15% of males.Enterococcus spp. were isolated from 4% of males but from no females. Five percent of the episodes were polymicrobial, and 16% of the infections were hospital acquired. On logistic multivariate regression analysis, predictors of mortality were: hospitalisation in a medical department, hospital-acquired infection, inappropriate empiric antibiotic treatment, presence of decubitus ulcer(s), respiratory or renal failure, and elevated urea and decreased albumin levels.

Lymphoma presenting with adrenal insufficiency: Adrenal enlargement on computed tomographic scanning as a clue to diagnosis

A 73-year-old woman who presented with primary adrenal insufficiency and enlarged adrenal glands on computed tomographic scanning was ultimately found to have a large-cell lymphoma that had initially involved the adrenals and the stomach. A search of the English language medical literature revealed only seven other cases of lymphoma presenting with hypoadrenalism, none of which involved the stomach. As in this case, in most of those cases adrenal enlargement was documented on computed tomographic scanning. Despite its rare occurrence, lymphoma should be searched for in patients presenting with Addisons disease and enlarged adrenal glands.

Home intravenous antibiotic therapy for patients with infective endocarditis.

Abstract Although home intravenous antibiotic therapy (HIAT) is increasingly being used for various infectious diseases, outpatient treatment of infective endocarditis (IE) is still uncommon. Recently, the American Heart Association recommended outpatient treatment of endocarditis only for infections with streptococci that are highly susceptible to penicillin. Herein, the experience with HIAT in patients with IE due to a diversity of pathogens is presented. During a 3-year period, 37 patients with IE who were in a stable condition and were cooperative were enrolled in a service for HIAT after completion of diagnostic procedures. Of the 37 patients, 21 were male; mean age was 64.3 years (range 20–87 years); in most cases (26/37), IE involved a native valve. Causative organisms were Streptococcus spp. (20), Staphylococcus spp. (10), Enterococcus spp. (2), Enterobacter spp. (1), and Erysipelothrix rhusiopathiae (1), while three were unknown. The most common antibiotics used were ceftriaxone and vancomycin. Almost three-quarters of the intravenous lines were peripheral. The mean duration of HIAT was 26.2±8.5 days, with 92% of the patients cured by it. Most complications were minor. Six patients were rehospitalised and two of them required valve replacement. In half of the rehospitalised patients, the complication was unrelated to HIAT. Surprisingly, almost all of the complications necessitating rehospitalisation occurred in patients with streptococcal IE and most involved native valves. HIAT may be suitable for IE due to a diversity of pathogens and involving prosthetic as well as native heart valves, provided there are proper patient and antibiotic selections, good follow-up, and vigilant monitoring of complications.

Family outbreaks of psittacosis in Israel

Eight family outbreaks of clinical or subclinical psittacosis in Israel after exposure to infected birds were studied. Throat cultures for Chlamydia psittaci and serological tests for Chlamydia species, including strain TWAR, were obtained from 37 people. Cloacal smears and cultures of internal organs for C psittaci were taken from 9 dead birds. 62% of the people studied had symptoms, and 67% of the birds that died had previously been sick. Evidence for acute C psittaci infection was found in 81% of patients (30/37). Diagnosis was established in 22 by isolation of the causal organism from throat cultures and in 8 by positive IgM serology (reciprocal titre greater than or equal to 8) with evidence of acute seroconversion or clinical findings compatible with the disease, or both. No serological evidence for acute TWAR infection was found. All birds studied had microbiological evidence of C psittaci infection, and most had abnormal findings on necropsy.

Mycoplasma and Chlamydia in Adenoids and Tonsils of Children Undergoing Adenoidectomy or Tonsillectomy

The prevalence of mycoplasmal and chlamydial infection was assessed in 83 children undergoing adenoidectomy, tonsillectomy, or both procedures for recurrent adenotonsillitis or obstructive symptoms. Throat smears (surface specimens) and minced adenoids and tonsils (core specimens) were cultured for Mycoplasma spp and for Chlamydia spp. Isolation rates in adenoidal specimens were as follows: Mycoplasma hominis, surface 7.1%, core 2.9%; and Ureaplasma urealyticum, surface 1.4%, core 2.9%. Mycoplasma hominis was also found in tonsillar specimens: surface 14.3%, core 20%. Chlamydia trachomatis was isolated only from a single core adenoidal specimen. The rate of mycoplasma isolation was significantly higher in children with recurrent adenotonsillitis (34.5%) than in those with obstructive symptoms (3.7%). Our findings document colonization of genital mycoplasmas in adenoids and tonsils of children with recurrent adenotonsillitis. Further studies are needed to evaluate the possible pathogenetic role of these microorganisms in adenotonsillar infection.

Hyperamylasemia in Ethiopian Immigrants to Israel

Excerpt To the editor: In 1985 we examined 13 newly arrived Ethiopian immigrants to Israel who were very ill on arrival. These patients came from a tropical area and most were affected by famine an...

AIDS IN THE PRE-AIDS ERA

A search of the medical literature published since 1950 disclosed 19 cases of probable AIDS reported before the start of the current epidemic. These cases retrospectively met the Centers for Disease Controls surveillance definition of the syndrome and had a clinical course suggestive of AIDS. The reports originated from North America, Western Europe, Africa, and the Middle East. The mean age of patients was 37 years, and the ratio of male to female patients was 1.7:1. Sixteen patients had opportunistic infection(s) without Kaposis sarcoma. The remainder had disseminated Kaposis sarcoma. The commonest opportunistic infection was Pneumocystis carinii pneumonia. Two patients were reported to be homosexual. Three others had been living in Africa, and one patient was born in Haiti. In two instances concurrent or subsequent opportunistic infection occurred in family members. All patients died 1 month to 6 years after the initial manifestation of disease. In view of the historical data, unrecognized cases of AIDS appear to have occurred sporadically in the pre-AIDS era.