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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Review Clinical Trial
Role of aerobic gram-negative bacilli in endometritis after cesarean section.
Endometritis is considered to be a polymicrobial infection, involving aerobes, anaerobes, and genital mycoplasmas. Aerobic gram-negative rods make up 7%-25% of all genital isolates, but findings from studies in which special collection techniques were used suggest that many of these may be contaminants from the lower genital tract. Bacteremia occurs in 4%-30% of patients with endometritis, and aerobic gram-negative rods account for approximately 25% of blood isolates. ⋯ Klebsiella pneumoniae and Proteus mirabilis rank next, followed by Enterobacter species. Pseudomonas species account for fewer than 0.6% of genital isolates. Overall, aerobic gram-negative rods are causally involved in 10%-20% of cases of endometritis following cesarean section.
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Recent developments that influence patterns of antibiotic prescription for obstetric-gynecologic patients include a better understanding of the multibacterial dimensions of pelvic infections, the introduction of new antibiotics, and the pressures for cost-containment in medical care. Prophylaxis has become established as effective for prevention of infection following vaginal hysterectomy and cesarean section, but its success in abdominal hysterectomy has been less uniform. For patients with pelvic infections, the poorest clinical response occurs in those whose infection is well established before initiation of therapy. ⋯ Both metronidazole and clindamycin meet these criteria. Controlled studies of infections seen early in the clinical course are few. The initial selection of agents effective against gram-negative anaerobes seems important in the treatment of endomyometritis following cesarean section, whereas curettage seems the most significant therapy for infections following abortion.
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The meaning of eradication, which is an irreversible conclusion, is considered primarily to distinguish it from elimination, which is reversible from outside the area. Poliomyelitis and measles are at present the diseases for which conditions most favor an attempt to produce eradication. Poliomyelitis has now reached a frequency in the developing world as high as it was in the prevaccine era of the United States. ⋯ Following determined efforts to achieve immunization of at least 95% of the population, the United States is now nearing the state of complete freedom from the transmission of measles virus. The use of diploid cells for making vaccine has enabled the virus to be given as an aerosol to babies less than six months of age and would be of particular value in developing countries. The high transmissibility of measles makes a severe demand for vaccine, but so long as the uptake of vaccine reaches at least 90%, the successful elimination of measles is extremely probable.