A Case of Cephalic Tetanus in an Elderly Patient with Trismus.

We report a case of a 77-year-old woman who presented to the Emergency Room with a three-day history of oral lesions and jaw tightness. Her physical examination was remarkable for the presence of trismus and white ulcers on the visible portion of the tongue. CT head and neck was unremarkable, and she was discharged with empiric treatment for oral candidiasis.

Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection in a patient with advanced HIV infection.

We describe a patient with advanced HIV infection and Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with Toxoplasma gondii coinfection. A multidisciplinary effort and state-of-the-art diagnostic techniques were required for diagnosis. Our patient is the first reported case of an HIV-infected person with dual Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection.

Lactococcus garvieae endocarditis: report of a case and review of the literature.

Bacterial endocarditis due to Lactococcus garvieae is extremely unusual, and may actually be underreported due to its morphologic and biochemical similarities with enterococci. Only three cases have been reported in the medical literature, and all involved prosthetic valves. We report a case of native valve bacterial endocarditis caused by L.

Performance on the internal medicine second-year residency in-training examination predicts the outcome of the ABIM certifying examination.

For 223 residents from eight teaching hospitals, the results of the second-year in-training examination and the first-sitting certifying examination of the American Board of Internal Medicine were highly correlated. The results of the in-training examination can serve residents as an important measure of their preparedness for certification and can be useful in identifying the need for more intensive self-study strategies during the subsequent one and a half years.

Subcutaneous nodules as a dermatologic manifestation of bacteremia due to Pseudomonas aeruginosa.

Sepsis due to Pseudomonas aeruginosa continues to be an important source of morbidity and mortality in hospitalized patients. Early recognition of this condition is of paramount importance in choosing specific therapy at the earliest possible moment. We present three cases in which P aeruginosa bacteremia was manifested by subcutaneous nodules.

Tension fecal pneumothorax in a postpartum patient.

A 20-year-old woman developed severe shortness of breath 4 h after a cesarean section. Chest roentgenogram showed a pleural effusion and tension pneumothorax; insertion of a chest tube drained liquid stool. At surgery she was found to have a left diaphragmatic defect with herniation, strangulation, and perforation of the transverse colon into the pleural cavity.

Chronic osteomyelitis due to Clostridium clostridiiforme.

We have reported a case of chronic osteomyelitis due to an unusual anaerobic organism, Clostridium clostridiiforme, a gram-positive rod that often stains gram-negative and that is frequently resistant to such drugs as cefoxitin and clindamycin. Clostridia other than those similar to C perfringens are generally not considered invasive pathogens, but our case and several similar ones show that they can be.

Native valve endocarditis due to Pseudallescheria boydii in a patient with AIDS: case report and review.

A 53-year-old man with AIDS developed mitral valve endocarditis due to infection with the fungus Pseudallescheria boydii. A limited number of cases of prosthetic valve endocarditis caused by this organism have been described. We report a unique case of pseudallescheria infection of a native valve and describe this disease in a patient with AIDS.

Eosinophilic pleural effusion in cutaneous myiasis.

We have reported the case of a 54-year-old man with recurrent painful migratory subcutaneous nodules associated with marked blood eosinophilia and an eosinophilic pleural effusion. The entire syndrome was subsequently determined to be due to cutaneous myiasis caused by the larvae of Hypoderma lineatum, the cattle botfly. Infestation by this or other dipterous fly larvae should be among the parasitic diseases considered in the differential diagnosis of any patient with similar symptoms.

Changing prescribing patterns: a program of physician education.

A drug utilization review identified significant inappropriate use of second-generation cephalosporins at a 700-bed community teaching hospital. As a result, an educational program designed to modify physician prescribing patterns was developed as a cost-containment measure. Educational guidelines listing indications and contraindications for cefamandole and cefoxitin and comparing their costs with those of first-generation cephalosporins were placed in patient records, and physician use of these agents was reviewed before, during, and after the intervention.

Infective endocarditis caused by Neisseria flavescens.

Neisseria flavescens is a rare cause of human disease. This is the first reported case of endocarditis caused by N. flavescens.

Viral meningitis.

Viral meningitis is part of the aseptic meningitis syndrome but must be distinguished from bacterial meningitis on the basis of a careful examination of the CSF and sound clinical judgment. Enteroviruses probably account for the bulk of cases of aseptic meningitis that occur in the United States and which are reported to the Centers for Disease Control each year. The seasonal pattern in the incidence of aseptic meningitis is largely due to the seasonal variation of enteroviral infections.

Effect of atropine on tracheal mucociliary clearance and bacterial counts.

The purpose of this study was to determine if atropine, which has been shown to alter mucosal function, prolongs the persistence of inhaled bacteria in the trachea. In conscious sheep, bacterial counts in the trachea were determined by quantitative sterile brush cultures obtained before and serially after a controlled inhalation challenge with an aerosolized solution containing P. hemolytica (10(8) CFU X ml-1).

An investigation of enterococcal bacteremia.

Records of all 34 patients with positive blood cultures for enterococcus at Mount Sinai Medical Center of Greater Miami in 1981 were reviewed. Twenty-four true bacteremias were identified from sources including the pelvis/abdomen (9), urinary tract (6), wounds (2), IV catheter (2), contaminated needle (1), endocarditis (1), and primary bacteremia (3). Sixteen of the 24 true bacteremias were hospital acquired, and these infections accounted for 7 of 9 (78%) fatal outcomes.

Management of infected cerebellar stimulation systems.

Over a 7-year period (February 1974 through February 1981), 318 patients underwent the implantation of cerebellar stimulation systems for the reduction of spasticity (98%) or epilepsy (2%). A total of 518 procedures were carried out to implant and maintain the equipment during this period. Fourteen patients developed infections in the tissue around their implanted systems, which represented 4.

Chemoprophylaxis with cefoxitin and cephalothin in orthopedic surgery: a comparison.

Forty-eight patients who underwent elective hip or knee surgery were randomly divided into two groups. A total of 22 patients received a single 1-g preoperative bolus of cefoxitin, and 26 patients received a single 1-g preoperative dose of cephalothin. At various time intervals, serum and bone samples were taken during the operative procedure.

Excretion of cefamandole, cefazolin, and cephalothin into T-tube bile.

The biliary tract excretion of cefamandole, cefazolin, and cephalothin was measured in eight patients with T-tubes inserted into their common ducts after ductal exploration for biliary tract stones. Each patient received 1.0 g intravenously of each cephalosporin on 3 separate days; T-tube bile and serum were collected at selected time intervals thereafter.

Bilateral deep brachial vein thrombophlebitis due to vibrio fetus.

A patient had bilateral deep brachial vein thrombophlebitis in which Vibrio fetus was recovered from six blood cultures of the six drawn. Fever and phlebitis continued with treatment with intravenous doses of heparin and oxacillin but rapidly improved with treatment change of oxacillin to clindamycin. In vitro antibiotic disk susceptibility testing confirmed resistance to oxacillin and susceptibility to clindamycin.

Effect of sodium cyanate upon the function of normal human polymorphonuclaer leukocytes.

Sodium cyanate, a drug that prevents sickling of hemoglobin S by virtue of its irreversible carbamylation of the N-terminal amino group of valine, was studied for its effect upon the function of normal human polymorphonuclear luekocytes. In concentrations of 500 and 100 mug/ml, sodium cyanate was found to inhibit killing by neutrophils of Staphylococcus epidermidis and Eschierichia coli but not of Streptococcus faecalis. Viability of cells and phagocytosis were not affected by cyanate; however, production of [14-C] carbon dioxide from [1-14-C] glucose and the iodination of 125-I during phagocytosis were significantly impaired.

Biliary tract excretion of cefazolin, cephalothin, and cephaloridine in the presence of biliary tract disease.

The biliary tract excretion of three cephalosporins, cefazolin, cephaloridine, and cephalothin, was compared in patients with biliary tract disease. In the absence of obstruction, mean antibiotic levels in bile from gall bladder and common duct in patients undergoing cholecystectomy were highest for cefazolin (17 and 31 mug/ml, respectively) than either cephaloridine (7 and 9 mug/ml) or cephalothin (1 and 4 mug/ml). Biliary tract levels generally paralleled serum levels.

Correlation of increased metabolic activity, resistance to infection, enhanced phagocytosis, and inhibition of bacterial growth by macrophages from Listeria- and BCG-infected mice.

Macrophages from mice infected with facultative intracellular organisms such as Listeria monocytogenes and BCG have been shown to resist infection by antigenically unrelated intracellular bacterial parasites. This study compares phagocytosis, bacterial growth inhibition, and oxidation of glucose by macrophages from normal mice, mice infected with listeria or BCG, or mice immunized with killed listeria in incomplete Freund's adjuvant. Macrophages from listeria- and BCG-infected mice ingested more listeria; 67 and 57%, respectively, had three or more cell-associated bacteria versus 22% of controls (P < 0.