Robert C. Aber

Cryptosporidiosis in hospital personnel: evidence for person-to-person transmission

An intern responsible for the care of a patient with chronic cryptosporidiosis developed acute diarrhea and serologic evidence of cryptosporidium infection. Sera from 26 hospital personnel exposed to the patient and 18 personnel with no exposure were examined with an indirect immunofluorescent antibody procedure for the presence of antibodies to Cryptosporidium. Eight (31%) exposed personnel--5 nurses, 2 house officers, and 1 student--had positive antibody titers (1:10 or more). The frequency of positivity in the nurse-housestaff-student group (8 of 18, 45%) was significantly greater (p less than 0.05) than that in the attending physicians and respiratory therapists (0 of 8). The former group had significantly more exposure to the patients feces than did the latter group (p less than 0.01). Three of eighteen control personnel (17%) had positive cryptosporidium antibody titers. These findings suggest that Cryptosporidium may be transmitted from person to person in the hospital environment and that serologic evidence of infection is common among hospital personnel.

Antimicrobial Susceptibility of Flavobacteria

Antimicrobial susceptibility patterns of 28 clinical isolates of Flavobacterium sp. were determined by standard disk diffusion technique and by antimicrobial dilution in agar. Rifampin, clindamycin, trimethoprim-sulfamethoxazole, cefoxitin, and vancomycin are among the antimicrobial agents which may be clinically useful to treat infections caused by flavobacteria. All 28 isolates were resistant to erythromycin with minimal inhibitory concentrations of 32 μg/ml or more. Currently recommended interpretive zones of inhibition by disk diffusion did not reliably predict antimicrobial susceptibility of the 28 flavobacteria isolates when compared with the agar dilution technique, and, therefore, a more direct measurement of minimal inhibitory or bactericidal concentration is recommended.

Chronic Osteomyelitis caused by Staphylococcus Aureus: Controlled Clinical Trial of Nafcillin Therapy and Nafcillin-Rifampin Therapy

A controlled trial of treatment of chronic osteomyelitis caused by Staphylococcus aureus compared nafcillin alone with nafcillin plus rifampin for a six-week period. Treatment was well tolerated, the only adverse effect being mild neutropenia in four of 18 patients; no toxicity was observed from rifampin. Eight of ten patients in the combined treatment group had a favorable clinical response (with follow-up of two to four years) as compared to four of eight in the nafcillin group (P=.2). Despite the failure to show a statistically significant advantage of rifampin plus nafcillin, we conclude that the combination, along with appropriate surgery, should be considered for patients with chronic staphylococcal osteomyelitis.

Factors that influence doctors' participation in clinical research.

Background  Although clinical investigators are regarded as an endangered species, no systematic investigation of the factors that influence doctor participation in clinical research has previously been performed.

Dermatitis from cashew nuts

Between April 4 and May 10, 1982, fifty-four individuals developed a poison ivy-like dermatitis 1 to 8 days after eating imported cashew nuts. The patients had a very pruritic, erythematous, maculopapular eruption that was accentuated in the flexural areas of the body. Three had blistering of the mouth and four had rectal itching. Nineteen volunteers (eleven ill and eight well) were patch-tested with 2.5 micrograms of poison ivy urushiol and an acetone extract of cashew nut shells. Patch testing did not predict illness since positive tests to both materials occurred in those who had been ill as well as in those who had been well. Absence of cashew nut shells from two thirds of the bags probably accounted for the lack of correlation between patch testing and illness. All nine who reacted to the cashew extract also reacted to poison ivy urushiol. The three who were not sensitive to poison ivy had no reaction to cashew extract. Mass spectrometry of the cashew shell extract suggested the presence of cardol , one of the allergens in cashew shell oil.

Staphylococcus epidermidis Bacteremia Associated With Vascular Catheters: An Important Cause of Febrile Morbidity in Hospitalized Patients

Seventeen episodes of persistent Staphylococcus epidermidis bacteremia (one to nine days) occurred in 16 patients with vascular catheters during a 26-month period. Cases were statistically more likely to have a longer hospitalization (54 v 7.6 days, p less than .0005), longer duration of antibiotic therapy (22 v 2.5 days, p = .002), presence of a central venous pressure (CVP) catheter (14 v 2, p less than 3 X 10(-8), and presence of an arterial catheter (4 v 1, p = 0.037) than randomly selected hospitalized patients matched for age, sex, and date of admission. However, when cases were compared with similarly matched non-bacteremic patients having CVP catheters, these characteristics were not significantly different in the two groups. Furthermore, exposure to total parenteral nutrition (TPN) and duration of TPN were not significantly different between cases and controls. Hence, the presence of a CVP catheter appeared to be the major risk factor for S. epidermidis bacteremia. In 16 episodes, patients had temperature greater than 38.6 degrees C without another identifiable cause, and the average white cell count for the case group was 19,400/mm.3 Seven patients also had diaphoresis, confusion, hypotension, or oliguria. Temperatures returned to normal in 13 within 24 hours after catheter removal, and all patients were afebrile and symptom-free within 72 hours. Thus, vascular catheter-associated S. epidermidis bacteremia was an important case of febrile morbidity in these patients.

Vertebral disc space infection and osteomyelitis due to Candida albicans in a patient with acute myelomonocytic leukemia.

A 67‐year old man with acute myelomonocytic leukemia had Candida albicans fungemia during induction chemotherapy. Bilateral pulmonary infiltrates and hepatic granulomata containing yeast forms and septate hyphae developed, but cultures of the hepatic tissue failed to grow a fungus. Although his pulmonary and liver disease improved following appropriate therapy, vertebral osteomyelitis due to Candida albicans developed approximately 12–15 weeks after the original fungemia. The fungal osteomyelitis was successfully treated with amphotericin B and 5‐fluorocytosine. This case illustrates the need for early diagnosis and aggressive treatment of fungal infections in patients with leukemia.

Osteomyelitis caused by Veillonella

Veillonella parvula and alcalescens are anaerobic gram-negative cocci that, when isolated from anaerobic cultures of clinical specimens, are usually regarded as commensal organisms. Occasionally they play a pathogenic role and require antibiotic therapy. Limited clinical experience and in vitro susceptibility studies suggest that penicillin G is the drug of choice for these organisms and that cephalosporins, clindamycin, chloramphenicol, and metronidazole may be acceptable therapeutic alternatives. Presented herein is a case report of a Veillonella infection, a discussion of the importance of these organisms when they occur in a clinical infection, and a discussion of the appropriate antibiotic therapy.

Transfusion‐associated Yersinia enterocolitica

Yersinia enterocolitica is an emerging enteric pathogen associated with a wide spectrum of clinical and immunologic manifestations.’ There has been a rather dramatic increase in the frequency of isolation of this organism from both clinical and nonclinical specimens over the past two decades. I n several countries (Netherlands, Belgium, Canada, and Australia), Y. enterocolitica has surpassed Skigella and rivals Salnionella and Carnpylobacter as a cause of acute bacterial gastroenteritis. Y. enterocolitica is a facultatively anaerobic, gramnegative coccoid bacillus that is motile at 25°C but nonmotile at 37”C.2 Although the organisms multiply most rapidly at higher temperatures (25-37”C), they continue to do so at lower temperatures (e.g., 4°C) as well. Hence, their detection can be “enhanced” by incubating specimens at lower temperature^.^ Colonies of Y. enterocolitica grow slowly (48 hours) on routine enteric media and do not ferment lactose on media containing bile Salk2 Typical strains give positive reactions in Christensen’s urea agar. Strains previously termed “atypical Y. enterocolitica ” or ‘Y. enterocolitica-like organisms” have now been classified as separate species (Y. intermedia, Y. kristensenii, and Y. frederiksenii). Y. enterocolitica can be characterized by biochemical testing (five biotypes), serotyping (39 0 and 19 H antigens), bacteriophage susceptibility patterns, and plasmid analysis.’ In the United States, outbreaks of Y. enterocolitica illness have usually been caused by serotype 0:8, and sporadic cases have been caused by many different serotypes, whereas, in Europe and Scandinavia, most infections have been caused by serotypes 0:3 and 0:9, and outbreaks are rare. Interestingly, serotype 0:3 has previously been isolated in Canada but only recently so in the United States. Y. enterocolifica has been isolated from humans in many countries of the world but seems to be found most frequently in cooler climates.’ Many animate reservoirs have been identified, including birds, frogs, fish, flies, fleas, snails, crabs, oysters, and an array of mammals. Animal products including raw milk, whipped cream, Editorials

Effects of a limited nap on night sleep in older subjects.

The night sleep of sixteen 50-60-year-old women, which had been preceded by either afternoon naps or no-nap control periods, was assessed by polygraphic and subjective measures. There were 2 nap and 2 non-nap nights. The naps were limited to a 1-hr opportunity. The measures of all subjects, good nappers (more than 20-min sleep on both nap occasions), and subjects with 50-min or more nap time, were separately analyzed. The null hypothesis of a nap effect could not be rejected. Within limits, naps may be recommended to offset the common night-time awakenings in older persons.