Reviews of infectious diseases
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From 1895 to 1915 Theobald Smith served as Professor of Comparative Pathology in the Harvard Medical School in Boston and concurrently as Director of the Massachusetts State Antitoxin and Vaccine Laboratory. On the verge of his departure for a new post at the Rockefeller Institute in Princeton, New Jersey, Smith's colleagues sponsored an elaborate dinner in his honor. ⋯ This previously unpublished card is reproduced in the present paper, and a digest of the work represented by each sketch is provided. Collectively these summaries are evidence of the remarkable range of Smith's accomplishments, and they serve as a remainder of why Smith is universally regarded as the premier American microbiologist of his day.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sulbactam/ampicillin vs. chloramphenicol/ampicillin for the treatment of meningitis in infants and children.
Eighty-one patients ages one month to 14 years with meningitis were randomized to receive either sulbactam (50 mg/kg per day) and ampicillin (400 mg/kg per day; 41 patients) or chloramphenicol and ampicillin (40 patients). The groups were comparable in terms of sex and degree of illness; however, more patients treated with chloramphenicol/ampicillin than patients treated with sulbactam/ampicillin were younger than 12 months of age (78% vs. 56%). Pathogens were isolated from the cerebrospinal fluid (CSF) of 65 (80%) of the 81 patients. ⋯ Twelve percent in the sulbactam/ampicillin group and 18% in the chloramphenicol/ampicillin group had neurologic sequelae. No clinically significant reactions or toxicities were noted. Sulbactam/ampicillin was as effective as chloramphenicol/ampicillin in the treatment of meningitis.
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The unusually high mortality associated with Pseudomonas aeruginosa pneumonia has provided an incentive for the development of immunologic strategies for preventing or treating this infection. A guinea pig model of experimental P. aeruginosa pneumonia was employed to determine prophylactic efficacy of active immunization with a detoxified lipopolysaccharide vaccine; efficacy of passive immune therapy utilizing a new hyperimmune immunoglobulin G preparation enriched for antibodies to P. aeruginosa immunotypes 1, 2, 4, and 6; and efficacy of active and passive immunization against the mucoid exopolysaccharide antigen associated with mucoid strains of P. aeruginosa. Each of these immunologic methods provided an element of protection against P. aeruginosa pneumonia.
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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.