bluuebunny/crossref_metadata_2025 huggingface dataset:
Enterococcus Faecalis Endocarditis Following Percutaneous Manipulation of a Biliary Tract Calculus and ERCP
Authors: Ronald Allan R , Pattullo Andrew LS
Published: March 2016

A case of Enterococcus faecalis endocarditis followed endoscopic retrograde cholangiopancreatography and percutaneous extraction of a biliary calculus is reported. The most likely cause of endocarditis, though unproven, is the latter procedure, as the bile is often infected during biliary tract obstruction, and bacteremia is frequent during percutaneous manipulations. Initial therapy with vancomycin was unsuccessful in clearing the bacteremia, possibly due to vancomycin tolerance of the isolate and lack of an aminoglycoside in the initial regimen. Cure was obtained when therapy with ampicillin and gentamicin was undertaken.
Epiglottitis in Canada: A Multiregional Review
Authors: Law Barbara J , Draper David , Mills Elaine L , Allard Manon , Nijssen-Jordan Cheri , Bortolossi Robert , MacDonald Noni E , Al-Twaim Abdulaziz A , Albritton William , Kasian Gordon , Rea Lottie , Cronk Sharon , Morris Robert
Published: March 2016

Epiglottitis is an acute, life threatening infection usually caused by Haemophilus influenzae type b. Although antibiotic therapy is an important part of management, the optimal route and duration is unknown. A multicentre retrospective review of 305 children with epiglottitis was carried out in order to relate antibiotic therapy to hospital course and outcome, as well as to examine regional variation in patient demographics, clinical presentation and course of disease. A standardized form was used to extract data from hospital records. Although management varied significantly among the six centres in terms of mean duration of intubation (46 to 81 h), intravenous antibiotic therapy (3.8 to 5.7 days) and hospital stay (5.3 to 8.4 days), there were no significant centre‐related differences in epidemiology, clinical course or outcome of epiglottitis. An extraepiglottic focus of infection was present in 15% of patients and included three with septic arthritis and one with meningitis. The duration of fever in hospital and maximum recorded temperature in hospital were significantly greater for children with extraepiglottic infection compared to those with epiglottitis alone. The data presented in this review suggest that most children with epiglottitis have an uncomplicated course and respond rapidly to antimicrobial therapy following airway securement. A short period of intravenous and oral antibiotic therapy is likely adequate for most children with epiglottitis. A well designed multicentre prospective trial is still needed to determine the optimal duration of antibiotic therapy.
Prostatic Abscess Caused by Streptococcus mutans
Authors: Nguyen Chau , Dascal Andre , Mendelson Jack
Published: March 2016

The first reported case of prostatic abscess caused by Streptococcus mutans isolated in pure culture is described. Urethral dilation for obstruction was unsuccessful, so suprapubic cystostomy was performed. Perineal aspiration under ultrasonic guidance resulted in 10 mL of pus containing pure Strep mutans. Diagnosis of prostatic abscess is difficult since the clinical manifestations are nonspecific.
Spectrum of Disease Caused by Rhodococcus equi in Human Immunodeficiency Virus Infection: Report of a Case and Review of the Literature
Authors: Willsie-Ediger Sandra K , Stanford James F , Salzman Gary A , Bamberger David M
Published: March 2016

Since the first report of Rhodococcus equi infection in an acquired immune deficiency syndrome patient in 1986, seven additional cases have been described. A patient is described in whom the diagnosis was delayed due to misidentification of the organism as an atypical mycobacterial species. The literature regarding R equi infection in persons infected with the human immunodeficiency virus is reviewed. The most common presentation is one of a chronic, indolent pulmonary infiltrative disease (78%). Fever (78%), cough (67%), and hemoptysis (44%) are frequently present. Coexistent opportunistic illnesses are common (67%). In the laboratory identification of this organism, it is important to communicate the clinical setting to the microbiologist and to recognize the potential for the organism to be overlooked as normal flora or a contaminant, or misidentified as an organism with similar phenotypic characteristics (Nocardia species or a rapidly growing mycobacterium). Based on experience in foals, therapy with erythromycin and rifampin is suggested.
Clinical Significance and Characterization of AZT‐Resistant Strains of HIV‐1
Authors: Wainberg Mark A , Rooke Ronald , Tremblay Michel , Li XuGuang , Parniak Michael A , Gao Qing , Yao Xiao-Jian , Tsoukas Chris , Montaner JSG , Fanning M , Ruedy J
Published: March 2016

A number of laboratories have now independently confirmed that zidovudine (AZT)‐resistant strains of human immunodeficiency virus type 1 (HIV‐1) may be isolated from patients undergoing prolonged therapy with this drug. In certain instances, such drug‐resistant viral isolates have been obtained from patients with clinical acquired immune deficiency syndrome (AIDS), while in others, isolation of drug‐resistant strains has been achieved in the case of HIV seropositive, asymptomatic subjects. Most of the evidence points to a series of mutations within the polymerase gene of HIV‐1, which encodes viral reverse transcriptase, as being responsible for development of the drug‐resistant phenotype. It further appears that over 50% of patients treated with AZT for periods longer than six months are likely to yield drug‐resistant strains of HIV‐1 in their circulation. Furthermore, the development of drug resistance soon after initiation of AZT therapy may potentially be correlated with the likelihood of AZT treatment failure. In several instances, cross resistance has been observed between AZT and other nucleosides being considered for potential therapy of HIV‐1‐associated disease.
Spontaneous Bacterial Peritonitis: Analysis of Treatment and Outcome
Authors: Victor Gary H , Opal Steven M
Published: March 2016

Spontaneous bacterial peritonitis occurred on 44 separate occasions in 43 patients during a five year period, including 27 culture positive and 17 probable cases of spontaneous bacterial peritonitis. Alcoholic liver disease was the underlying cause of 72% of cases. Of the 27 culture positive cases, Escherichia coli was the most common isolate (14 cases), followed by Klebsiella pneumoniae (three cases), group G streptococci (three cases), group B streptococci (two cases) and one case each of five other organisms. Bacteremia occurred in 50% of cases and was the same as the peritoneal isolate 88% of the time. The overall mortality rate was 65% (66% culture positive and 60% probable spontaneous bacterial peritonitis). The mean interval between onset of symptoms and death was 10.2±8.6 days in fatal cases. Spontaneous bacterial peritonitis was felt to be a contributing cause of mortality in 70% of fatal cases. Survivors were younger (44±20 years versus 59±13, P<0.05) and less likely to develop renal insufficiency than nonsurvivors (38% versus 73%, P<0.05). Patients who were treated with an aminoglycoside were more likely to develop renal failure compared to those treated with nonaminoglycoside regimens (P<0.05). There was no difference in mortality rate between culture positive and culture negative spontaneous bacterial peritonitis, total peritoneal leukocyte counts, Gram‐positive versus Gram‐negative organisms, presence of bacteremia, or serum albumin or bilirubin levels. The mortality rate for this disease remains unacceptably high, indicating a need for the development of new strategies in the prevention, diagnosis and management of this disease.
The Potential Role of Recombinant Hematopoietic Colony‐Stimulating Factors in Preventing Infections in the Immunocompromised Host
Authors: Rusthoven James
Published: March 2016

Hematopoietic colony‐stimulating factors coordinate the proliferation and maturation of bone marrow and peripheral blood cells during normal hematopoiesis. Most of these factors are now available as recombinant human colony‐stimulating factors, and preclinical and clinical testing is proceeding rapidly. Granulocyte and granulocyte/macrophage colony‐stimulating factors have been the most extensively studied to date. In human clinical trials, granulocyte colony‐stimulating factor improves neutrophil counts and function, reduces episodes of febrile neutropenia, improves neutrophil recovery after disease‐ or treatment‐induced myelosuppression, and reduces the number of serious infections in several neutropenic disease states. Granulocyte/macrophage colony‐stimulating factor has similar biological properties but may also improve eosinophil proliferation and function, and platelet cell recovery after myelotoxic bone marrow injury, Interleukin‐1 boosts the effects of granulocyte colony‐stimulating factor and granulocyte/macrophage colony‐stimulating factor, but also may promote the resolution of established infections in conjunction with antibiotics. The therapeutic realities and future therapeutic implications of these agents for the therapy of infections, cancer and hemopoietic disorders are discussed.
Epidemiology of Lyme Disease
Authors: White Dennis J
Published: March 2016

Investigation of the epidemiology of Lyme disease depends upon information generated from several sources. Human disease surveillance can be conducted by both passive and active means involving physicians, public health agencies and laboratories. Passive and active tick surveillance programs can document the extent of tick‐borne activity, identify the geographic range of potential vector species, and determine the relative risk of exposure to Lyme disease in specific areas. Standardized laboratory services can play an important role in providing data. Epidemiologists can gain a better understanding of Lyme disease through the collection of data from such programs. The interpretation of data and provision of information to the medical and general communities are important functions of public health agencies.
Bacterial Biofilms and Catheters: A Key to Understanding Bacterial Strategies in Catheter‐Associated Urinary Tract Infection
Authors: Nickel J Curtis , Costerton J William
Published: March 2016

Despite major technological improvements in catheter drainage systems, the indwelling Foley catheter remains the most common cause of nosocomial infection in medical practice. By approaching this common complicated urinary tract infection from the perspective of the biofilm strategy bacteria appear to use to overcome obstacles to produce bacteriuria, one appreciates a new understanding of these infections. An adherent biofilm of bacteria in their secretory products ascends the luminal and external surface of the catheter and drainage system from a contaminated drainage spigot or urethral meatus into the bladder. If the intraluminal route of bacterial ascent is delayed by strict sterile closed drainage or addition of internal modifications to the system, the extraluminal or urethral route assumes greater importance in the development of bacteriuria, but takes significantly longer. Bacterial growth within these thick coherent biofilms confers a large measure of relative resistance to antibiotics even though the individual bacterium remains sensitive, thus accounting for the failure of antibiotic therapy. With disruption of the protective mucous layer of the bladder by mechanical irritation, the bacteria colonizing the catheter can adhere to the bladder’s mucosal surface and cause infection. An appreciation of the role of bacterial biofilms in these infections should suggest future directions for research that may ultimately reduce the risk of catheter‐associated infection.
Nosocomial Legionnaires’ Disease: Clinical and Radiographic Patterns
Authors: Marrie Thomas J , Haldane David , Bezanson Gregory
Published: March 2016

From 1981 to 1991, 55 patients (33 males, 22 females, mean age 58.6 years) with nosocomial Legionnaires’ disease were studied. The mortality rate was 64%. One‐half of the patients developed nosocomial Legionnaires’ disease within three weeks of admission. A surprising clinical feature was the low rate of findings of consolidation on physical examination, despite the fact that 52% of patients had this finding on chest radiograph. More than one‐half of patients had pre‐existing lung disease, rendering a radiographic diagnosis of pneumonia due to Legionella pneumophila impossible in 16% of cases despite microbiological confirmation. Nineteen per cent of patients who had blood cultures done had a pathogen other than L pneumophila isolated, suggesting dual infection in at least some of the patients. When the clinical and radiographic findings were combined it was noted that 40% of patients had one of three patterns suggestive of nosocomial Legionnaires’ disease: rapidly progressive pneumonia, lobar opacity and multiple peripheral opacities. However, in 60% of patients there were no distinctive features.
In Vitro Activities of Sparfloxacin, Ceftriaxone, Penicillin, Tetracycline and Doxycycline against Chlamydia trachomatis and Neisseria gonhorrhoeae
Authors: Talbot Hazel , Romanowski Barbara
Published: March 2016

In vitro sparfloxacin was highly active against 223 penicillin‐susceptible isolates of Neisseria gonorrhoeae with a 90% minimal inhibitory concentration (MIC90) of 0.004 μg/mL. Resistant strains of N gonorrhoeae totalled 55; 32 were penicillinase‐producing and 23 chromosomally resistant. The MIC90 for these isolates was 0.004 μg/mL and 0.008 μg/mL, respectively. Chlamydia trachomatis was also very susceptible with an MIC50 of 0.063 μg/mL and a 50% minimal bactericidal concentration of 0.032 μg/mL for 11 isolates.
Blastomycosis in Quebec (1981–90): Report of 23 Cases and Review of Published Cases from Quebec
Authors: St-Germain G , Murray G , Duperval R
Published: March 2016

Twenty‐three cases of blastomycosis were reported in a survey conducted in the province of Quebec from 1981–90. Thirteen patients resided south of the St Lawrence River and the other 10, north. Two small geographical clusters were apparent in and around the cities of Sherbrooke and Quebec. The male to female ratio was 1.6:1 and the median age was 47 years (range 26 to 77). Lung involvement was observed in 19 cases and was the only site involved in 11. Cutaneous manifestations were reported in 11 cases while bone infection (three cases) and central nervous system (CNS) infections were also noted. Diagnosis was confirmed by culture in 21 cases and by histopathology in two cases. Of the 21 culture‐positive cases, 12 strains of Blastomyces dermatitidis were isolated from lungs, nine from skin, and one each from bone and brain. Serodiagnostic tests by immunodiffusion or complement fixation were positive for only one of the 10 patients known to have been tested. Ten patients were treated with amphotericin B, 11 with ketoconazole, one with fluconazole and eight underwent surgery. While amphotericin B was used in eight of the 10 earliest treated cases, ketoconazole was administered in 10 of the 13 more recent cases. Of the patients for whom follow‐up data have been obtained, 21 are reported cured (one of whom was not treated) and one patient died of another cause. This survey confirms that blastomycosis is a rare disease in this endemic area and that patterns of therapy are changing.
Molecular epidemiology of Candida albicans colonization and fungemia in very low birthweight infants
Authors: Robinson Joan L , Hartstein Alan I , Meuser Renate U , Morthland Virginia H , Dragoon Margaret E , Wenman Wanda M
Published: March 2016

Objective: This study investigated the relationship between colonization and fungemia.

Design: This was a prospective study involving surveillance cultures of the nares, base of umbilicus, point of entry of umbilical catheter and parenteral fluids. Blood cultures were done when sepsis was suspected. All Candida albicans isolates were typed using restriction enzyme analysis of DNA.

Setting: Patients were from the neonatal intensive care unit of a tertiary care hospital.

Population Studied: Twenty‐nine very low birthweight infants.

Main Results: Eleven babies were colonized with C albicans and five of these babies developed fungemia, including five of seven who were colonized at the point of entry of the umbilical catheter. Three different strains of C albicans caused fungemia. In four of the five patients, initial catheter entry site isolates were identical to the subsequent blood isolates. Occasionally, infants were colonized with more than one strain of C albicans.

Conclusions: Preceding colonization with C albicans and, in particular, colonization at the site of entry of umbilical vascular catheters are risk factors for subsequent development of C albicans fungemia. Fungemic and colonizing isolates are usually identical to one another by DNA typing.
Estimation of the Secondary Attack Rate for Delta Hepatitis Coinfection among Injection Drug Users
Authors: Poulin Christiane , Gyorkos Theresa , Joseph Lawrence
Published: March 2016

The secondary attack rate for delta hepatitis coinfection was estimated among a cluster of injection drug users (IDUs). The infections occurred during an epidemic of hepatitis B in a rural area of Nova Scotia in 1988 and 1989. Six IDUs formed a cluster of delta hepatitis coinfections, representing the first reported outbreak of delta hepatitis in Canada. Contact‐tracing was used to identify a cluster of 41 IDUs potentially exposed to delta hepatitis. The index case of delta hepatitis coinfection was presumed to have led to five secondary cases. The secondary attack rate was estimated to be 13.2% (95% confidence interval 0.044 to 0.281). The estimated secondary attack rate may be a useful predictor of disease due to delta hepatitis coinfection in similar IDU populations.
Influenza Surveillance in an Urban Area
Authors: Glezen W Paul
Published: March 2016

In Houston the yearly influenza epidemics have been defined virologically by community surveillance obtained by testing specimens submitted from patients with acute respiratory illnesses seen by sentinel physicians. Mortality attributed to influenza and pneumonia has increased regularly during the period of intense influenza virus activity, but the peak has lagged two weeks behind the peak of activity defined by the virological surveillance. Most of the deaths occurred in persons aged 65 years and older; the average annual rate has been 103.5 per 100,000 in that age group. Hospitalizations for pneumonia and other acute respiratory conditions also peaked during influenza epidemics; the highest rate occurred in the elderly, but children under five years of age also had high rates. Morbidity in the ambulatory setting was highest in children. The average visit rate for children under five years of age was 28%; the rate decreased to about 10% for persons aged 10 years and older. Improved coverage with more immunogenic vaccines is needed to protect the elderly. Young children would benefit from universal immunization with available live attenuated vaccines.
Direct immunofluorescence for the diagnosis of legionellosis
Authors: Haldane David JM , Peppard Ruth , Sumarah Robert K
Published: March 2016

Culture and direct immunofluorescent microscopy (DFA) results for Legionella pneumophila were reviewed over a two‐year period. In the first year, a positive result was defined as having at least one morphologically typical fluorescing organism. In the second year, a positive was defined as at least five typical fluorescing organisms. Despite these stricter criteria and other measures to reduce the possibility of reagent contamination, there was no statistically significant difference in the sensitivity or specificity of the DFA in the two years for sputa, deep specimens or overall. Of 37 sputum specimens from infected patients, 16 were positive on DFA. Thirty‐two of 38 positive patients were detected by sputum culture. DFA can provide rapid diagnostic information but cannot be used to rule out the diagnosis. Sputum is a useful specimen for the initial laboratory investigation of patients with legionellosis.
Prevalence of Sexually Transmitted Diseases in Juvenile Prostitutes and Street Youth
Authors: Rouget Antonietta Caffaro , Mah Jean K , Lang Reuben A , Joffres Michel R
Published: March 2016

Four groups of adolescents – 35 juvenile prostitutes, 36 street youth, 31 monogamous sexually active adolescents and 35 non‐sexually active adolescents – were studied between January 1, 1988 and December 31, 1988 for the presence of sexually transmitted diseases and other genital pathogens. The high prevalence of sexually transmitted diseases found in the juvenile prostitutes (Neisseria gonorrhoeae, 49%; Chlamydia trachomatis, 83%) is in contrast to other studies, which document much lower rates of infection. This could be due to the fact that there are few studies done on juvenile prostitutes as a well defined group. Despite high risk sexual behaviour, the consistent use of contraception was low. No contraceptives were used by 57% of the juvenile prostitutes and 85% of the street youth. None of the adolescents sought medical attention although 48% of the juvenile prostitutes and 53% of the street youth had genital symptoms. It appears that the present public health education and health care delivery do not reach this high risk population.
Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital
Authors: Nath Swapan K , Salama Suzette , Persaud Devia , Thornley James H , Smith Ian , Foster Gary , Rotstein Coleman
Published: March 2016

A case‐control study was undertaken to identify and quantify antimicrobial and nonantimicrobial drug risk factors associated with a sustained outbreak of Clostridium difficile diarrhea on two medical (teaching and nonteaching) units and an oncology unit. In total, 80 cases associated with an endemic clone of toxigenic C difficile were compared with controls. Eighty controls were selected from a group of 290 controls randomly chosen from the outbreak period. The controls were matched to cases according to age, admitting diagnosis and unit of admission. Seventy (88%) patients in the case group received at least one antibiotic before diarrhea, compared with 37 (46%) patients in the control group. Major risk factors implicated in the development of C difficile diarrhea in hospitalized patients were the following antimicrobial agents: ceftazidime (adjusted odds ratio [aor]=26.01, 95% ci 5.67 to 119.19, P=0.0001); cefuroxime (aor=5.17, ci 1.86 to 14.36, P=0.005); ciprofloxacin (aor=3.81, ci 1.05 to 13.79, P=0.04); and clindamycin (aor=15.16, ci 2.93 to 78.44, P=0.004). This is the first time that the use of ciprofloxacin has been linked to the development of C difficile diarrhea. Use of gastrointestinal drugs (ranitidine, famotidine, cimetidine, omeprazole and sucralfate) was also an added risk (aor=3.20, ci 1.39 to 7.34, P=0.01); however, antineoplastic therapy was not significant (P<0.53). Recognition of the specific high risk drugs may spur more restricted use of these agents, which may help in controlling C difficile diarrhea in hospitalized patients.
Mast Cells, Cytokines and Asthma
Authors: Redington Anthony E , Howarth Peter H
Published: March 2016

The appreciation that asthma is a chronic inflammatory
disorder of the airways has led to a reappraisal of the
importance of different cell populations within the bronchial
mucosa with respect to their role in the regulation of
the cellular events in this disease. While mast cell degranulation
has been implicated in the acute allergic bronchoconstrictor
response, activation of this cell population has not
been considered relevant to either the late phase inflammatory
cell influx within the airways following allergen bronchoprovocation
or to the mucosa! eosinophilia in chronic
clinical disease. As such, attention has focused on the T
lymphocyte as an orchestrator of these cellular events on
account of its ability to synthesize and release cytokines
relevant to the allergic process. It is now, however, realized
that many cell populations within the airways are able to
generate cytokines comparable with and complimentary to
those produced by T lymphocytes and that asthma cannot be
considered an inflammatory airway disorder dependent
upon activation of one single cell population. This review
details the current evidence that airway mast cells synthesize,
store and release cytokines relevant to allergic inflammation
and considers their potential involvement not only
in the cellular influx within the airways but also in the
fibrotic structural changes which are evident in chronic
disease.
Evaluation of Haemophilus influenzae Type B Conjugate Vaccine (Meningococcal Protein Conjugate) in Canadian Infants
Authors: Scheifele David W , Bjornson Gordean L , Meekison William G , Guasparini Roland , Mitchell Leslie A
Published: March 2016

Objective: To assess adverse effects and immune responses with a three‐dose series of Haemophilus influenzae type b meningococcal protein conjugate (PedvaxHIB or Hib.OMP) vaccine, including any immunological response alterations from concurrent administration with routine vaccines for infants.

Design: Randomized, controlled trial with treatment group crossover for dose 3.

Setting: Two public health units near Vancouver.

Participants: One hundred and ten healthy infants eight to 14 weeks old were enrolled; 105 completed the study (95%).

Interventions: All participants received two doses of diphtheria‐pertussis‐tetanus (dpt) vaccine (at two and four months of age) and one dose of measles‐mumps‐rubella (mmr) vaccine at 12 months. In each instance, Hib.OMP was given either concurrently in another limb or after a delay of two weeks (after dpt) or four weeks (after mmr).

Main Outcome Measures: Adverse effects, particularly fever and local erythema, were monitored by parents for 72 h after each dose of Hib.OMP vaccine. Five blood samples were taken at prescribed intervals to assess responses to each dose of Hib.OMP and to selected other vaccine antigens.

Main Results: Follow‐up was obtained after all 322 doses of Hib.OMP. Local adverse effects were infrequent and mild: 13% had redness, 17% tenderness. Systemic effects in those given Hib.OMP alone included fever in 8%, irritability in 29%. Anti‐polyribose‐ribitol phosphate (prp) responses to Hib.OMP were not impaired by coadministration with dpt or mmr vaccines, nor were tetanus or diphtheria antitoxin levels or rubella or measles response rates affected. After two doses of Hib.OMP, 92% were seropositive and 64% had greater than 1.0 μg/mL of anti‐prp. After three doses, 100% were seropositive and 82% exceeded 1.0 μg/mL.

Conclusion: Hib.OMP vaccine was well tolerated, immunogenic and compatible with vaccines routinely given to infants in Canada.
Art and Science: Where Numerology and Mathematics Touch the Lung
Authors: Tenney S Marsh
Published: March 2016

Mathematical analysis in the physical seiences has a long
history that reveals not only a rich harvest of fundamental
insights but also leads to a wonderment at the in trinsically
formal beauty in nature. Rigorous analysis or form and
function in the biological sciences has been a more recent
innovation. but introduction of′ the principles of similarity.
scaling, fractal geometry, harmony and proportion has
hroadened our perspective. The lung provides an apt example
to illustrate the usefulness of this kind or thinking.
Captopril‐Associated Cough Is Not due to Increased Airway Responsiveness
Authors: Blackie SP , Hilliam C , Porter R , Rangno R , Paré PD
Published: March 2016

BACKGROUND: Angiotensin‐converting enzyme (ACE) inhibitors
commonly cause cough. There is controversy as to
whether preexisting airway hyperresponsivencss predisposes
patients to ACE inhibitor‐induced cough and whether
ACE inhibitor therapy can cause airway hypcrresponsiveness.

OBJECTIVES: To lest the predictive value of baseline airway
responsiveness fur the development of cough induced
by ACE inhibitors, and whether patients who developed
cough during ACE inhibitor therapy showed an increase in
airway responsiveness.

METHODS: Baseline spiromctry and airway responsiveness
to methacholinc (expressed as the concentrat ion of
mcthacholine required to cause a 10% fall in forced expired
volume in 1 s [ FEV1 or PC10) were measured in 23 hypertensive
patients before and after 10 to l 2 weeks of treatment
with captopril at an initial daily dose of 50 mg.

RESULTS: During caplopril therapy seven (30%) patients
developed new cough, which resolved after discontinuation
of captopril. The base line PC10 was the same in coughers
and noncoughers and did not predict the development of
cough. During caplopril therapy there was a nonsignificant
decrease in the geometric mean PC10 for all patients from
15 mg/mL (range 0.8 to 62) to 13 mg/ml (range 0.7 to 62)
(P=0.08). These changes were not different in cougher, and
noncoughers. FEV1, forced vital capacity and total lung
capacity did not change during the study.

CONCLUSIONS: Cough caused by captopril is not predicted
by baseline airway responsiveness and is not associated
with increased airway res ponsiveness
Itraconazole: Precautions Regarding Drug Interactions and Bioavailability
Authors: Puttick Michael PE , Phillips Peter
Published: March 2016

Objective: To describe patients with fungal infections in whom drug interactions and bioavailability problems were associated with itraconazole treatment failure.

Design: Retrospective chart review.

Setting: Two tertiary care university‐affiliated teaching hospitals.

Population Studied: Itraconazole‐treated patients between 1990 and 1992.

Main Results: Four patients treated with itraconazole were identified in whom suboptimal serum itraconazole levels were associated with relapse of disseminated histoplasmosis, treatment failure of invasive aspergillosis or development of superficial mycoses. Low serum itraconazole levels were associated with concurrent therapy with rifampin or agents inhibiting gastric acid secretion, with administration of itraconazole capsule contents through a nasogastric tube or with the presence of aids.

Conclusions: It is recommended that serum itraconazole levels be measured in patients with potentially life‐threatening mycoses if coexistent factors may interfere with itraconazole therapy.
Airway Inflammation and the Pathogenesis of Asthma
Authors: O′Byrne Paul M
Published: March 2016

Airway inflammation has been recognized for more than
l00 years to be present in the airways of patients with severe
asthma. Much more recently, airway intlammation has been
identified to be central to the pathogenesis of all asthma.
The inflammation is of a characteristic type, with the presence
of activated eosinophils, mast cells and lymphocytes
in bronchoalveolar lavage fluid and airway biopsies from
patients with even mild asthma. Stimuli that are known to
worsen asthma, such as inhaled allergens, also increase the
numbers of mast cells and cosinophils in asthmatic airways.
In addition, treatment with inhaled corticoteroids ‐ the
most effective treatment for asthma ‐ improves symptoms
and reduces the numbers of eosinophil s, mast cells and
lymphocytes in the airways. The precise functions of the
cells in promoting inflammation and causing asthma symptoms
has not yet been fully elucidated. However, it is very
likely that eicosanoids, such as the cysteinyl leukotrienes,
are produced by eosinophils and mast cells and are a major
cause of bronchoconstriction in asthma. Also, these inflammatory
cells can produce proinflammatory cytokines,
such as granulocytc‐macrophage colony‐stimulating factor.
interleukin (IL) 3 and IL‐5, which may promote continuing
inflammation in the airways. Lastly, the persisting inflammatory
cell infiltrate and products re leased from these cells
arc very likely the cause or the airway structural changes
characteristic of asthma, such as epithelial damage, goblet
cell hyperplasia. smooth muscle thickening and deposition
of collagen below the basement membrane. These changes
have been suggested tn he the cause of airway hyperresponsiveness
in asthma. An improved understanding of the precise
mechanisms by which airway inflammation is initiated,
propagates and causes airway damage will hopefully allow
more precise treatment strategies to he developed for
asthma than currently exist.
Eradication of Methicillin‐Resistant Staphylococcus Aureus from the Lower Respiratory Tract of Patients with Cystic Fibrosis
Authors: Burdge David R , Nakielna EM , Noble MA
Published: March 2016

Two of 95 patients followed in an adult cystic fibrosis clinic consistently grew methicillin‐resistant Staphylococcus aureus (mrsa) on sputum culture. Sputum Gram stain consistently showed +4 polymorphonuclear leukocytes and +4 Gram‐positive cocci in clusters. Both patients were co‐infected with Pseudomonas aeruginosa and required multiple hospitalizations for treatment of pulmonary exacerbation, resulting in significant infection control concerns. Multiple courses of antibiotics, including ciprofloxacin and clindamycin regimens, failed to eliminate the mrsa. A combination of oral rifampin and clindamycin was successful in eradicating the organism from both patients. Over a 12‐month period following therapy, in both patients none of 13 sputums showed Gram‐positive cocci in clusters on Gram stain and none of 13 sputum cultures grew mrsa. Successful eradication of mrsa has greatly simplified infection control measures on subsequent hospitalizations, reducing costs and enhancing patient comfort.
Epidemiological Typing of Moraxella Catarrhalis by Pulsed Field Gel Electrophoresis
Authors: Davison Susan M , Low Donald E , Cruz Rene H , Beaulieu Danielle , Scriver Shelley R
Published: March 2016

Pulsed field gel electrophoresis (pfge) was used to compare 59 strains of Moraxella catarrhalis to evaluate pfge for the epidemiological typing of this organism. pfge‐generated patterns were compared with those obtained by small fragment restriction enzyme analysis (rea) and species‐specific probe hybridization. The strains used in the study were isolated from various geographic locations and included proven epidemiologically related strains. pfge yielded more unique patterns than dna-dna hybridization – 30 versus 18, respectively – but fewer than rea, which generated 45 unique patterns. Strains that demonstrated the same rea pattern or dna-dna hybridization pattern did not always demonstrate the same pfge pattern. For example, in 23 epidemiologically unrelated strains that shared six rea patterns, pfge differentiated the isolates into 12 patterns. Conversely, strains that demonstrated the same pfge pattern did not always demonstrate the same rea pattern or hybridization pattern. For example, in 42 strains that shared 13 pfge patterns, rea differentiated the isolates into 31 patterns and dna-dna hybridization differentiated them into 16 patterns. However, compared with rea, pfge yielded less complex patterns that were more easily comparable, and compared with dna-dna hybridization, pfge was technically easier.
Reproducibility of Protected Brush Catheter Specimen Cultures in Critically Ill Patients with Suspected Nosocomial Pneumonia
Authors: Fox George A , Leasa David J , Sibbald William J , McCormack David G
Published: March 2016

OBJECTIVE: To determine the reproducibility of two protected brush catheter (PBC) specimens obtained during the same bronchoscopy in critically ill patients with suspected ventilator associated pneumonia.

DESIGN: Prospective, observational study.

SETTING: Two university‐affiliated multidisciplinary intensive care un its with a combined total of 50 beds.

PATIENTS: A total of 75 (50 male. 25 female) patients with 84 episodes of suspected ventilator associated pneumonia were studied be tween January 1, 1991 and June 30, 1992. Age was 60.7±1.9 (mean ± SEM) years, and mean APACHE II score was 22.4±2.0. Twenty‐four patients were admitted from various medical services, 19 from surgical services including the operating room, 16 with central nervous system disease and 16 following multiple trauma. Twenty patients were transferred directly to the intensive care unit from peripheral hospitals.

INTERVENTIONS: All patients had lower respiratory tract secretions obtained for culture by both aspiration through the endotracheal n1be (tracheal aspirates) and flexible bronchoscopy, with separate samples obtained by two PBCs (PBC‐A and PBC‐8).

MAIN RESULTS: The overall proportion of agreement between the results of t he two PBC specimens was 0.928, with a calculated kappa statistic (κ) = 0.853 (P<0.01 versus κ=0.4, 95% CL 0.692, 1.014) indicating excellent agreement between the two specimens. Both PBC specimens had significant (ie, more than 103 colony‐forming units/mL) growth (positive/positive) in 33 cases, nonsignificant growth in 45 cases (negative/negative) and discordant results in six (positive/negative, n=3 or negative/positive, n=3 ). There was a significant relationship (P<0.05) between the concurrent use of antibiotics and a negative PBC result. However, after exclusion of patients on antibiotics, the overall proportion of agreement between the two PBCs was 0.94 with κ=0.875 (P<0.01 versus κ=0.4, 95% CL 0.721, 1.029), which also indicates excellent agreement between the two tests.

CONCLUSIONS: Although discordant results were observed in 7.2% cases, the overall reproducibility of the PBC results appears to be high. The significant relationship between concurrent antibiotic use and a negative PBC result is of concern clinically since many patients arc being treated with antibiotics al the time of bronchoscopy. Therefore, when the diagnosis of nosocomial pneumonia in critically ill patients is established, the PBC result should be considered only in association with all the other clinical data, particularly in patients receiving concurrent antibiotics.
Diaphragmatic Paralysis Following Cervical Herpes Zoster – A Rarely Recognized Association
Authors: Soparkar Gautam R
Published: March 2016

An 83‐year‐old woman was found to have a paralyzed hemidiaphragm less than three weeks after developing cervical herpes zoster. The diaphragm was radiographically normal the day before the skin rash appeared. The relatively short time frame and lack of evidence to indicate other etiologies suggests herpes zoster as the likely cause of the paralysis. Diaphragmatic paralysis following cervical herpes zoster is probably underrecognized and the association between the two conditions can be easily missed, especially if the interval between their detection is long.
Ozone: A Review of Recent Experimental, Clinical and Epidemiological Evidence, with Notes on Causation—Part 1
Authors: Bates David V
Published: March 2016

Part 1 of this review is concerned with theoretical issues of ozone dosimetry, animal and cellular studies that illustrate the mechanism of action of ozone on living tissues, and with clinical studies. Animal studies have indicated that there are long term effects from low level long term ozone exposure. Clinical studies involve controlled ozone exposures on human subjects, both normals and asthmatics. Exercise concomitant with the ozone exposure increases the effect of the gas. It is concluded that the induction of an inflammatory response in the airway, both in the nose and in the lung, is the striking and earliest feature of ozone exposure. Current unexplained observations include: the dissociation between the inflammatory and function test response; the mechanisms of ‘adaptation’ and of airway hyperresponsiveness; and the phenomena that underlie the effect of ozone on maximal athletic performance.
High Probability Ventilation‐Perfusion Scan in Primary Pulmonary Hypertension
Authors: Sharma Sat , Leslie William D , Lertzman Morley
Published: March 2016

The perfusion lung scan is a valuable noninvasive tool in the evaluation of patients with pulmonary arterial hypertension of undetermined cause and for the exclusion of occult large‐vessel pulmonary thromboembolism. Peripheral patchy defects have been reported in primary pulmonary hypertension (PPH) but there are no well documented reports of segmental or larger perfusion defects. A case of a 55‐year‐old male with severe pulmonary hypertension of unknown etiology who had persistent high probability perfusion scan patterns over a period of two years is reported. No evidence of thromboembolism was present on pulmonary angiography. A discussion of the case and a review of the literature on the role of lung scan in PPH are presented. Most patients with PPH have normal or low probability perfusion scans; high probability scans occur rarely.
Teleauscultation: Bringing You to the Bedside
Authors: Pasterkamp Hans , Sanchez Ignacio , Oh Yunes
Published: March 2016

A custom‐made device was used for the acquisition, digitization, compression, storage and telephone transmission of respiratory sounds and airflow data. Acoustical information from two patients at a small community in rural Manitoba was sent over a distance of 500 km via conventional telephone lines. Digital transmission left the respiratory sounds unaffected by telephone line noise. Data processing by computer at the receiving site provided more detail than would have been available on conventional auscultation. This new method for teleauscultation could be of value not only in remote areas but also for the surveillance of patients at home in urban settings.
Intra‐ and Interlaboratory Reproducibility of an ELISA Serological Test for Lyme Disease
Authors: Tammemagi Martin C , Frank John W , LeBlanc Michael , Artsob Harvey
Published: March 2016

Objectives: Lyme disease has been increasingly diagnosed throughout North America since the late 1970s. The clinical diagnosis and epidemiological monitoring of Lyme disease are aided by serological testing for the etiological agent, Borrelia burgdorferi. Numerous authorities have questioned the reproducibility of these serological tests. This study assessed the intra‐ and interlaboratory reproducibility of an elisa used to aid in the diagnosis of Lyme disease.

Methods: Twenty‐seven sera from cases and noncases were tested by three laboratories. Two of the laboratories repeated the tests once. These testings were part of the 1991 quality control assessment of provincial laboratories carried out by the Laboratory Centre for Disease Control (lcdc), Ottawa.

Results: The mean weighted kappa statistics were 0.87 for interlaboratory comparisons and 0.89 for intralaboratory comparisons.

Conclusions: Overall, the elisa assessed in this study demonstrated good to excellent intra‐ and interlaboratory reproducibility in the lcdc 1991 quality control assessment when the data were assessed in the categorical scale using the weighted kappa statistic. Generalization of these findings to clinical laboratory settings must be done with caution.
Cutaneous Corynebacterium Diphtheriae: A Traveller’s Disease?
Authors: Berih A
Published: March 2016

A Canadian soldier incurred a nonhealing traumatic skin ulcer while on duty in Somalia. The diagnosis of localized cutaneous diphtheria was confirmed by isolation of a toxigenic strain of Corynebacterium diphtheriae from the ulcer. The patient was placed in isolation and treated with erythromycin and penicillin for 10 days without antitoxin. He was released when two consecutive daily cultures were negative. Public health officials evaluated his wife, two children and close contacts for carriage, but no carriers or secondary cases were identified. Cutaneous diphtheria as a diagnostic and management patient problem and potential public health problem are discussed.
Laboratory Diagnosis of Chlamydia Pneumoniae Infections
Authors: Peeling Rosanna W
Published: March 2016

Chlamydia pneumoniae is an important cause of respiratory illness. There is a need for accurate and rapid laboratory diagnostic methods that will lead to improved patient care, appropriate use of antimicrobial therapy and a better understanding of the epidemiology of this emerging pathogen. Culture is highly specific but is technically demanding, expensive, has a long turnaround time and its sensitivity is highly dependent on transport conditions. Antigen detection tests such as enzyme immunoassay and direct fluorescent antibody assay, and molecular detection methods such as the polymerase chain reaction assay, may provide a rapid diagnosis without the requirement for stringent transport conditions. The results of these tests should be interpreted with caution until more thorough evaluation is available. Serology remains the method of choice. The limitations of different serological methods for the laboratory diagnosis of C pneumoniae are discussed.
Blastomycosis Presenting as Multiple Splenic Masses
Authors: Ijaz Tahir , El-Sayed Samy , Schroeder Garry , O’Connor Robert , Pintin-Quezada Julio , Greenberg Howard
Published: March 2016

Blastomyces dermatitidis is a fungus that causes a wide spectrum of disease in humans. The clinical and pathological entity of splenic abscess due to blastomycosis is extremely rare. A case of splenic blastomycosis is reported, and its cytopathological and radiological features are described.
Evaluation and Follow‐Up of Infectious Tuberculosis at the University of Ottawa
Authors: Memish Ziad A , Hickey Raymonde , Gemmill Ian
Published: March 2016

A case of active infectious pulmonary tuberculosis (tb) in a recent immigrant to Canada was identified at the University of Ottawa. The student was attending classes regularly and coughing for six months before the diagnosis of infectious pulmonary tb was made. Investigation carried out by the Ottawa‐Carleton Health Department identified 871 student contacts. Of the 871 contacts, 773 (89%) were available for testing and follow‐up. Initial skin testing with purified protein derivative (ppd) was positive in 149 contacts. Of the 602 contacts testing negative initially 399 (66%) returned for 12‐week retesting. Eleven skin test converters were identified. All 160 contacts with positive ppd had negative chest x‐ray and were given isoniazid prophylaxis for six months. The estimated cost of the process of contact tracing, testing, follow‐up and treatment was $34,036. Although pre‐immigration screening policies for tb do exist, additional pre‐ and postimmigration measures could help in the early detection of active tb and the prevention of its spread.
Ambient Air Quality and Human Health: Current Concepts—Part 1
Authors: Guidotti Tee L
Published: March 2016

There is a fundamental reevaluation of the association between air quality and human health taking place. This reevaluation is motivated by several recent developments: increasing interest in air quality as an environmental issue; interest in the unanswered questions regarding the epidemiology of asthma; and the reduced prevalence of the principal hazard to respiratory health, cigarette smoking,
the control of which invites interest in second‐order determinants of health. This article attempts to provide a framework for understanding air quality issues that pertain to human health. The objective is to provide the specialist in respiratory medicine with an overview that will assist in educating patients and in responding to their inquiries, and to equip the physician to respond to requests for assistance or interpretation when called upon to comment on public policy issues involving air pollution. The implications of setting air quality standards or objectives to meet arbitrary levels of risk of health effects are examined. The current state of the art does not support risk‐based air quality standards. A policy of continuous improvement is most protective of both human health and the environment.