Bacterial and Fungal Infections

Daar, Eric S.; Meyer, Richard D.

doi:10.1016/s0025-7125(16)30376-5

Cited by 42 publications

(2 citation statements)

References 203 publications

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“…Of the many infections associated with HIV disease, invasive fungal infections are relatively common and the presence of a central venous catheter. Routine blood cultures were performed by directly inoculatand are usually considered in the initial diagnostic workup for febrile patients with õ200 CD4 / T lymphocytes/mm 3 [3]. ing 5 -10 mL of whole blood into BACTEC culture bottles (Becton Dickinson, Sparks, MD) at the bedside and subseFungal blood cultures are labor intensive and expensive and represent only one of many tests that can result in the diagnosis quently analyzing them with use of the BACTEC 860 System (Becton Dickinson).…”

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“…Candida species and C. neoformans are the most frequently identified fungi causing the pandemic mycoses observed in Despite the fact that the premortem diagnosis of invasive fungal infection was made for all the patients, and all patients, except patients with HIV disease [3]. In contrast, the possibility of / 9c40$$de21 11-07-97 11:12:16 cida UC: CID endemic mycoses such as those due to C. immitis and H. capsuhas been shown to be superior to the BACTEC fungal system for culturing H. capsulatum.…”

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Utility of Fungal Blood Cultures for Patients with AIDS

Mess

Daar

1997

CLIN INFECT DIS

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This study was designed to define the clinical utility of fungal blood cultures for human immunodeficiency virus type 1 -infected individuals. A retrospective chart review was performed for all patients admitted to an inpatient AIDS unit who had evidence of an invasive fungal infection. During a 25-month period, 1,162 fungal blood cultures were performed for 322 patients. These cultures, along with bacterial blood cultures, resulted in the isolation of fungi from 26 patients; 15 of these isolates were considered true pathogens. Routine blood cultures were positive for the fungal isolates in all 15 cases: Candida species and Candida glabrata (6 cases), Cryptococcus neoformans (7), Coccidioides immitis (1), and Histoplasma capsulatum (1). All invasive fungal infections were diagnosed by other means before fungal blood cultures were reported as positive. The results of this study suggest that the routine performance of such cultures in clinical practice should be reevaluated.Patients with advanced HIV-1 infection present with an excourse, results of all bacterial and fungal blood cultures, symptoms and neutrophil count at the time of the positive culture, tended spectrum of infectious complications, including those due to a host of bacterial, mycobacterial, viral, parasitic, and pertinent serological findings, fungal cultures of specimens other than blood, the most recent CD4 / T lymphocyte count, fungal pathogens [1,2]. Of the many infections associated with HIV disease, invasive fungal infections are relatively common and the presence of a central venous catheter. Routine blood cultures were performed by directly inoculatand are usually considered in the initial diagnostic workup for febrile patients with õ200 CD4 / T lymphocytes/mm 3 [3]. ing 5 -10 mL of whole blood into BACTEC culture bottles (Becton Dickinson, Sparks, MD) at the bedside and subseFungal blood cultures are labor intensive and expensive and represent only one of many tests that can result in the diagnosis quently analyzing them with use of the BACTEC 860 System (Becton Dickinson). These cultures were held for 5 days before of invasive fungal infection. Thus, to determine the clinical utility of fungal blood cultures for this patient population, we being reported as negative. Fungal blood cultures were performed with use of a lysis centrifugation system where 10 mL reviewed the results of these cultures for all HIV-1-infected patients admitted to an inpatient AIDS unit at our institution.of whole blood was directly aspirated into a Dupont isolator tube (Wampole Laboratories, Cranbury, NJ) and inoculated onto plates with Sabouraud brain-heart infusion agar and inhibPatients and Methods itory mold agar. Fungal blood cultures were held for 21 days before being reported as negative. Positive fungal cultures were This study was a retrospective analysis of patients admitted to a 22-bed inpatient AIDS unit at Cedars-Sinai Medical Center considered to be contaminants if there was only a single positive culture of an unusual pathogen (unlike Cryptococcus n...

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Utility of Fungal Blood Cultures for Patients with AIDS

Mess

Daar

1997

CLIN INFECT DIS

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An Unusual Case of Neonatal Brain Abscess Following Klebsiella pneumoniae Septicemia

et al. 2001

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A case of solitary brain abscess in a term neonate caused by Kiebsiella pneumoniae is described. K. pneumoniae, although a common cause of neonatal septicemia, is rarely implicated as an etiological agent for cerebral abscess in this age-group. The interest of this case lies in the rarity of the causative organism and atypical features. In the absence of predisposing factors in the neonate, we suspect that the infection was transmitted vertically from the mother before or at the time of delivery since there was evidence of asymtomatic urinary tract infection in the antenatal period.

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The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2

Guss

1994

The Journal of Emergency Medicine

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Human immunodeficiency virus (HIV) affects all organ systems. Infection of the heart can manifest with evidence of myocarditis, pericarditis, or cardiomyopathy. The most common gastrointestinal symptom is diarrhea, which can result from infection with a variety of bacterial, fungal, or protozoal organisms. In about 15% of cases, no pathogen is recognized and the diarrhea syndrome is termed AIDS enteropathy. Any portion of the alimentary tract can be affected as well as the liver, gallbladder, and pancreas. Cryptosporidium, a previously infrequent cause of human illness, has emerged as an important pathogen in the HIV-infected patient and is responsible for chronic diarrhea, cholecystitis, and biliary tract obstruction. Evidence of neurologic involvement is present in more than 80% of patients at the time of autopsy. Cryptococcal meningitis, toxoplasma encephalitis, and neurosyphilis are the most often encountered central nervous system infections. While all three are responsive to therapy, treatment must be prolonged or persist for the duration of the patient's life to avoid recurrence. Peripheral nervous system manifestations include myelopathy, myopathy, and a variety of peripheral neuropathies. Retinal infection with cytomegalovirus (CMV) and toxoplasma can lead to irreversible loss of vision. Cotton wool spots are a common benign physical finding that must be differentiated from the early signs of CMV or toxoplasma infection. Management of the HIV-infected patient, while most often conducted by specialists in Internal Medicine or Infectious Diseases, is often an issue for the emergency physician. Many of the commonly afforded therapies are reviewed. Part 1 of this two-part series discussed the pathophysiology and clinical expression, epidemiology, laboratory testing, and the general clinical manifestations of AIDS, as well as dermatologic, pulmonary, and cardiac symptoms. Part 2 discusses the gastrointestinal, neurologic, and ocular symptoms, as well as the treatment and management of the AIDS patient.

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Bacterial and Fungal Infections

Cited by 42 publications

References 203 publications

Utility of Fungal Blood Cultures for Patients with AIDS

Utility of Fungal Blood Cultures for Patients with AIDS

An Unusual Case of Neonatal Brain Abscess Following Klebsiella pneumoniae Septicemia

The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2

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