Rapid Resolution Of Infection Research Articles

Evisceration with Primary Implant Placement in Patients with Endophthalmitis

To assess the feasibility of evisceration with primary implant placement in patients with endophthalmitis. Pilot retrospective study. Sixty-seven patients with endophthalmitis. A retrospective study was conducted to review the files of 67 patients with endophthalmitis who underwent evisceration with primary implant placement over an 8-year period. These patients' files were reviewed to evaluate the following: persistent infection and inflammation, spread of infection to contiguous or remote sites, implant exposure or extrusion, and successful fitting of the prosthesis. Quiescence of the infection, complete healing of the socket, and long-term retention of the implant. Sixty-three patients successfully retained their primary implant with rapid resolution of infection and inflammation. In 1 patient, attempts at implant placement were abandoned during surgery because of marked scleral necrosis. Delayed implant extrusion was noted in 2 patients, 10 and 12 days after surgery, respectively. In 1 diabetic patient, an orbital abscess developed that was evacuated with implant exchange. In a fourth patient, marked conjunctival prolapse developed in the early postoperative period with eventual obliteration of the inferior fornix. The patient declined further management. Minor complications included a central conjunctival dehiscence or necrosis (n = 2) and a pyogenic granuloma that was excised (n = 1). All minor complications healed without sequelae. Overall, 12 % of patients experienced complications (n = 8). Based on the low overall complication rate in the present study (12%), the ease of evisceration, the convenience of a single procedure, the rapid resolution of infection, and the successful retention of the implant in most of our patients, it is plausible to offer evisceration with primary implant placement to patients with recalcitrant endophthalmitis or panophthalmitis. This would avoid a secondary surgical intervention in most patients, as opposed to delayed secondary implantation, in which case 100% of the patients would require, at least theoretically, another intervention.

Long-term outcomes of school-based treatment for control of urinary schistosomiasis: a review of experience in Coast Province, Kenya

Urinary schistosomiasis remains a significant burden for Africa and the Middle East. The success of population-based control programs will depend on their impact, over many years, on Schistosoma haematobium reinfection and associated disease. In a multi-year (1984-1992) control program in Kenya, we examined risk for S. haematobium reinfection and late disease during and after annual school-based treatment. In this setting, long-term risk of new infection was independently associated with location, age, hematuria, and incomplete treatment, but not with sex or frequency of water contact. Thus, very local environmental features and age-related factors played an important role in S. haematobium transmission, such that population-based control programs should optimally tailor their efforts to local conditions on a village-by-village basis. In 2001-2002, the late benefits of earlier participation in school-based antischistosomal therapy were estimated in a cohort of formerly-treated adult residents compared to never-treated adults from the same villages. Among age-matched subjects, current infection prevalence was lower among those who had received remote therapy. In addition, prevalence of bladder abnormality was lower in the treated group, who were free of severe bladder disease. Treatment of affected adults resulted in rapid resolution of infection and any detectable bladder abnormalities. We conclude that continued treatment into adulthood, as well as efforts at long-term prevention of infection (transmission control) are necessary to achieve optimal morbidity control in affected communities.

Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis (SBP) is frequently associated with renal failure. This study assessed if systemic and hepatic hemodynamics are also affected by this condition. Standard laboratory tests, tumor necrosis factor alpha (TNF-alpha) in plasma and ascitic fluid, plasma renin activity (PRA) and norepinephrine (NE), and systemic and hepatic hemodynamics were determined in 23 patients with SBP at diagnosis and after resolution of infection. Eight patients developed renal failure during treatment. At diagnosis of infection, patients developing renal failure showed significantly higher values of TNF-alpha, blood urea nitrogen (BUN), PRA and NE, peripheral vascular resistance, and hepatic venous pressure gradient (HVPG) and lower cardiac output than patients not developing renal failure. During treatment, a significant reduction in cardiac output and arterial pressure and increase in PRA and NE, HVPG, and Child-Pugh score were observed in the first group but not in the second. Peripheral vascular resistance remained unmodified in both groups. Changes in PRA and NE correlated inversely with changes in arterial pressure and directly with changes in BUN, Child-Pugh score, and HVPG. Five patients in the renal failure group developed encephalopathy, and 6 died. In the group without renal failure, none of the patients developed encephalopathy or expired. In conclusion, patients with SBP frequently develop a rapidly progressive impairment in systemic hemodynamics, leading to severe renal and hepatic failure, aggravation of portal hypertension, encephalopathy, and death. This occurs despite rapid resolution of infection and is associated with an extremely poor prognosis.

The effect of experimental infectious mastitis on leukocyte subpopulations and cytokine production in non-lactating ewes.

The interactions between leukocytes and cytokines during the acute response to intramammary infections in the dry mammary gland of sheep were studied. Dry ewes were experimentally infected in one udder half with either Staphylococcus aureus or Escherichia coli, or infused with saline as control. Udder secretion samples, blood samples and udder tissue samples were collected before and 4, 8 and 24 h after infections/infusions. Total and differential leukocyte counts were calculated in both blood and mammary secretions, and flow cytometry was used to detect the presence of CD4+, CD8+, WC1+, IL-2R+, CD18+ or L-selectin + lymphocytes, CD18+ or L-selectin + neutrophils, and CD14+ leukocytes. Moreover, the concentrations of interleukin-1 beta (IL-1 beta), interleukin-8 (IL-8) and granulocyte-macrophage colony stimulating factor (GM-CSF) in udder secretions were measured using ELISA, and RT-PCR was used to detect the presence of corresponding cytokine mRNA in udder tissue biopsies. The results suggest an association between the concentrations of IL-1 beta, IL-8 and the intensity of neutrophil infiltration of the infected gland. Immunologically relevant changes in proportions of lymphocyte subpopulations might also occur in the acute phase of the inflammatory reaction of the udder. Greater cellular and cytokine responses to E. coli infection may have contributed to the milder clinical picture and more rapid resolution of infection than that seen for S. aureus. Enhancing the production of pro-inflammatory cytokines may improve defence against bacterial mastitis.

Listeria monocytogenes Keratitis

We treated a farmer who had Listeria monocytogenes bacterial keratitis. Therapy with topical antibiotics was unsuccessful; it was necessary to treat the patient with topical and systemic penicillin and gentamicin. To elucidate the pathogenesis of this infection, we developed a rabbit model. Using the patient's strain of L. monocytogenes, we determined that the severity of the rabbit infection was dose-related. If we used an inoculum of more than 10(7) organisms, many of the features of the human Listeria keratitis were mimicked. We also found that treatment with either penicillin or gentamicin did not control the infection as well as using both antibiotics simultaneously, a combination which resulted in relatively rapid resolution of infection and no corneal scarring. The human and animal data indicate that L. monocytogenes can be a virulent corneal pathogen. Listeria corneal infections must be treated aggressively with both penicillin and gentamicin to prevent permanent visual loss.

Sternal Dehiscence: Pericostal Guy Wires Equals Sternal Stability

Our five-year clinical experience with 11 patients treated with pericostal guy wires has uniformly established sternal stability, primary bone healing, and rapid resolution of infection. The stable anterior chest wall helps abolish cardiopulmonary complications (i.e., progressive pulmonary insufficiency, atelectasis, and low cardiac output) commonly associated with sternal dehiscence.

Cutaneous leishmaniasis in mice: disease patterns in reconstituted nude mice of several genotypes infected with Leishmania tropica.

BALB/c mice differ from CBA/H, (CBA/H x BALB/c)F1 and C57BL/6 mice in being highly susceptible to infection with a particular isolate of the intramacrophage protozoan parasite, Leishmania tropica. This is true over a wide range of challenge doses of promastigotes administered intradermally although, at low doses, male BALB/c are able to restrict the rate at which cutaneous lesions increase in size. Resistance to infection in highly susceptible hypothymic nude (nu/nu) mice of CBA/H and C57BL/6 genotypes can be achieved readily with as few as 10(6) syngeneic lymphoid cells. In CBA/H.nu/nu mice, Lyl+2- cells in low dose cellular inocula appear to be involved in restoring resistance (i.e. rapid resolution of infection). Surprisingly, a proportion of BALB/c.nu/nu mice injected with syngeneic lymphoid cells are resistant and thus differ from intact BALB/c mice or non-reconstituted BALB/c.nu/nu mice. In keeping with a high efficacy of limited numbers of T cells following minimal reconstitution, the majority of nude mice implanted subcutaneously with allogeneic, irradiated, neonatal thymus grafts are resistant to L. tropica infection. Genetic features of the nude mouse, such as defect in skin, may contribute to the extraordinary potency of T cell reconstitutive manipulations. Evidence was obtained that BALB/c.nu/nu skin on BALB/c.nu/+ recipients did not support the development of lesions as readily as normal skin sites.