John P. Utz

Infection, antibody response and gamma globulin components in multiple myeloma and macroglobulinemia

Abstract Frequency of infection and antibody response to antigen administration were investigated in patients with multiple myeloma and macroglobulinemia. The patients were divided as follows on the basis of the specific proteins present: (1) γ 1 -macroglobulins; (2) 6.6 S γ-myeloma proteins; (3) β 2A -myeloma proteins; or (4) Bence Jones proteins. Infections were more frequent in patients with macroglobulinemia or multiple myeloma than in the total Clinical Center population. Infections in the group with macroglobulinemia were less frequent, however, than in those with multiple myeloma. In the group with multiple myeloma, patients with γ-myeloma proteins, β 2A -myeloma proteins or Bence Jones proteins were equally susceptible to infection. Antibody response to antigen administration was impaired in all patients, and impaired antibody response was related significantly to susceptibility to infection. Serum levels of the normal gamma globulin components—the 6.6 S γ-globulins, β 2A -globulins and γ 1M -globulins—were found to be reduced in most of the serum from patients with myeloma and macroglobulinemia in which they could be quantitatively measured. Impaired antibody response and low levels of normal gamma globulin components indicate that reduction of normal plasma cell function is a prominent feature in multiple myeloma and macroglobulinemia. This impairment of normal cell function, however, does not relate to the type or quantity of globulin synthesized but appears to reflect some other feature of plasmacytic and lymphocytic malignancy.

Aspergillus species endocarditis: The new face of a not so rare disease

Abstract Aspergillus flavus endocarditis developed in a 13 year old girl after mitral valve replacement. Thirty-nine other cases of Aspergillus species endocarditis were found in the medical literature. Twenty-nine of these infections occurred in postcardiac surgery patients. Fever was the most common presenting manifestation (35 patients). Cardiac murmurs were present in 25. Lesions were in the left side of the heart in 38 (95 per cent), and there were major arterial emboli in 33 (83 per cent). The diagnosis was made antemortem in only nine patients. The diagnostic specimen in eight of these was an embolus. Aspergillus sp. were cultured from the blood of only three (8 per cent). Two (5 per cent) patients survived; in both infected prostheses were replaced, and one received antifungal chemotherapy. Aspergillus sp. endocarditis should be suspected in any postcardiac surgery patient presenting with endocarditis and emboli whose blood yields no organisms in culture. Careful surveillance and control of fungal contamination of the surgical environment is urged. Cultures of arterial blood should be obtained, and both solid and liquid microbiological media utilized. Early valve replacement and chemotherapy with both amphotericin B and flucytosine are recommended.

The Improved Prognosis of Cryptococcal Meningitis with Amphotericin B Therapy

Excerpt Cryptococcal meningitis is the most frequent cause of mycotic meningitis in man, accounting for about 10 per cent of the 300 to 400 fatal mycoses reported annually in the United States (1)....

Fever, Infection and Host Resistance in Acute Leukemia*

Abstract 1.1. Fever and infection were studied with comprehensive bacterial, fungal and viral technics in thirty-six consecutive patients with acute leukemia. 2.2. As a group, these patients were febrile for almost one-half of the total 2,614 patient days. Only two patients had no febrile episodes during the period of observation. Of the ninety-two febrile episodes recorded, fifty-nine appeared to be related to infection. In the remaining thirty-three febrile episodes, bacterial, viral or fungal infection could not be incriminated as a cause for fever. 3.3. Age and type of leukemia did not influence the frequency of febrile episodes. However, more febrile episodes related to proved or presumptive infection developed in adults than in children. 4.4. The most common clinical illnesses associated with the proved infections were pharyngitis, pyelonephritis and septicemia. On occasion, relatively avirulent bacteria were capable of causing serious clinical infection. The most frequently encountered organisms were E. coli, M. pyogenes var. aureus, coagulase-positive, and Ps. aeruginosa. Infections due to Ps. aeruginosa were the most difficult to treat. 5.5. Survival after infection was common, in the absence of bacteremia, if intensive and appropriate antimicrobial therapy was employed. Nevertheless, infection remained a leading cause of death in those patients who died during the study. 6.6. The majority of the presumptive infections were related to infections of the respiratory tract. 7.7. In the initial evaluation of the febrile leukemic patient it is to be emphasized that a negative physical examination does not exclude infection as a cause for fever in a patient with acute leukemia. 8.8. Of the fourteen fevers of undetermined origin which persisted after two weeks of antibiotic therapy, eight eventually terminated in serious bacterial infection. Appropriate management for persistent fever of undetermined origin requires continual reappraisal to insure that a superimposed infection, masked by preceding unexplained fever, has been detected.

RELATIONSHIP OF THE GRIESS NITRITE TEST TO BACTERIAL CULTURE IN THE DIAGNOSIS OF URINARY TRACT INFECTION

Excerpt Interest has been renewed periodically in the Griess nitrite reaction as a means of detecting bacterial infection in urine.1-4Although it was originally employed as a test of bacterial cont...

Factors Influencing the Cure of Salmonella Carriers

Excerpt Typhoid Mary is known to physicians and lay public as well. Although the medical journal (1) estimate of 53 cases and 3 deaths attributable to her is far below the 1,300 victims claimed in ...

The current status of chemotherapy of systemic fungal disease.

Excerpt Thirty years ago this June, Fleming1first reported the antibacterial action of cultures of Penicillium, thus in one sense inaugurating the Antibiotic Era. During this period many antibiotic...

Clinical and Laboratory Studies of Mumps II. Detection and Duration of Excretion of Virus in Urine

Summary 1. Specimens of urine from mumps patients were concentrated by ultra-centrifugation prior to tissue culture inoculation. This concentration resulted in 3 times as many mumps virus isolations as simultaneously tested portions of the same urine prepared by simple dilution. 2. All isolations were made in primary monkey kidney cell cultures; only 2 were made also in simultaneously inoculated HeLa cultures and none were made in HeLa cultures only. 3. Mumps virus was recovered from the urine of each of 13 patients within the first 14 days after onset of salivary gland pain or swelling. Virus was isolated from urine as early as the first and as late as the 14th day of illness. No testing was done beyond the 20th day.

General Side Effects

Excerpt The undesirable effects of the administration of the commercially available, colloidal (solubilized) form of amphotericin B may be divided into the idiosyncratic reactions, that is, those t...

Oral Administration of Solubilized Amphotericin B.

THE intravenous administration of the solubilized preparation of amphotericin B has proved to be an effective means of treating systemic fungal infections in man.1 , 2 This route of administration,...