Reviews of infectious diseases
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The results of culture and histopathologic examination of 419 lymph node biopsy specimens obtained from 414 patients in 1978-1983 were correlated with clinical histories. The clinical diagnosis was lymphadenopathy of unknown etiology in 113 cases, sarcoidosis in 93, malignant lymphoma in 86, metastatic carcinoma in 17, histoplasmosis in 18, tuberculosis in 13, and other miscellaneous conditions in 79. All but two clinically significant microbial isolates from lymph nodes were either mycobacteria or fungi: the only exceptions were staphylococcal isolates from two children with lymphadenitis. ⋯ Of 33 lymph nodes that were culture-positive, two had histologic evidence of lymphoid hyperplasia, and the remainder included granulomatous and/or acute inflammatory lesions. With one exception, lymph node cultures in immunocompetent patients were positive only when there was a granuloma and/or an acute inflammatory lesion in the tissue. On the basis of these findings, it was concluded that lymph nodes from immunocompetent patients should be cultured only when a granuloma and/or an acute inflammatory lesion are detected and that the cultures can be limited to mycobacteria and fungi.
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Invasive pulmonary aspergillosis occurs predominantly in individuals who are neutropenic or who have severe defects in cell-mediated immunity. The isolation of Aspergillus from respiratory secretions of normal hosts usually signifies tracheobronchial colonization, not disease. ⋯ Two of 10 nonimmunocompromised, nonleukopenic individuals who had pulmonary infiltrates and whose sputum yielded Aspergillus had invasive pulmonary aspergillosis, whereas two of five individuals who had pulmonary infiltrates and whose bronchial washings grew Aspergillus had invasive disease. These findings indicate that invasive pulmonary aspergillosis should be considered when Aspergillus is isolated from the respiratory secretions of anyone who has pneumonia, regardless of host defense status.
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Comparative Study
Bacteremia in narcotic addicts at the Detroit Medical Center. II. Infectious endocarditis: a prospective comparative study.
For one year all narcotic addicts admitted to the Detroit Medical Center with infectious endocarditis (74 cases) were compared with a control group of bacteremic addicts who had other infections (106 cases). Endocarditis was caused by Staphylococcus aureus (60.8% of cases), streptococci (16.2%), Pseudomonas aeruginosa (13.5%), mixed bacteria (8.1%), and Corynebacterium JK (1.4%). S. aureus endocarditis most frequently involved the tricuspid valve; streptococci infected left-sided valves significantly more often than other organisms (P = .001). ⋯ Polymicrobial bacteremia in the nonendocarditis group was associated with markedly increased morbidity. Mild hyponatremia occurred in 41% of all patients and was also associated with significantly increased morbidity. Analysis of the two groups disclosed similarities and differences with implications for the pathophysiology and treatment of addicts with bacteremic infection.
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Travelers' diarrhea in Asia has been studied among Peace Corps volunteers in Thailand, Japanese travelers, foreign residents in Bangladesh, guests in hotels, and members of various tour groups. Rates of diarrheal attack of greater than 50% during four- to six-week sojourns were reported for these groups. Among travelers with diarrhea, the most commonly isolated pathogen was enterotoxigenic Escherichia coli (20%-34%), followed by Salmonella (11%-15%), Shigella (4%-7%), Campylobacter (2%-5%), and Vibrio parahaemolyticus (1%-13%). ⋯ Among Japanese travelers, Salmonella was more commonly acquired in the Far East; Shigella and Campylobacter, in the Indian subcontinent; and V. parahaemolyticus, in Southeast Asia. Aeromonas hydrophila and Plesiomonas shigelloides were commonly isolated from ill travelers in Thailand but less frequently from other travelers. Protozoa and Vibrio species other than V. parahaemolyticus were isolated in less than 5% of episodes.