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| Scand J Infect Dis, 1976, 8(4), 255 - 61 Infections in splenectomized patients . A study of 131 patients; Edwards LD et al.; A retrospective study on infections was done on 131 patients (predominately adults) undergoing splenectomy with a median follow-up to 11 months . 43 patients died, and 23 of them were infected . Three succumbed primarily from their infection; in 9 the infection was a contributing factor; and 11 died primarily from their underlying disease with an associated infection . 64 patients had lymphoreticular malignancies, 53 had a nonmalignant condition and 14 had carcinomas . Infection rates were 42%, 42%, and 21% respectively . Bacteremia rates (all in adults) were were 5%, 4%, and 7% respectively . Over four-fifths of the infections were hospital acquired . 12 of 14 community onset infections occurred in patients with lymphoreticular malignancies. J Neurosurg, 1976 Jan, 44(1), 105 - 8 Mycotic aneurysms of the internal carotid artery . Case report; Shibuya S et al.; The authors report a case with two mycotic aneurysms in the cavernous portion of the internal carotid artery, presumably secondary to a transient bacteremia from pneumonia . The strikingly rapid development of the aneurysms was demonstrated by angiography . Painful total ophthalmoplegia and extophthalmos were the main clinical features. J Chir (Paris), 1975 Dec, 110(6), 551 - 66 {Energy and protein needs of surgical patients}; Tremolieres J; Energy and protein requirements following operation, are those levels which permit the best possible use of fatty and protein body reserves, without the resistance to trauma becoming diminished . The fatty reserves in a 70 kg man, correspond to 72 000 calories and require, to be used without danger of acidosis, 100 or, preferably, 200 g of glucose daily . Energy expenditure may be about 1 200 calories, thus much less than one would think . Fat does not have the antiketosis effects, nor the nitrogen sparing effects of glucose and their interest in raising calory intake has not been demonstrated . There is a level of nitrogen intake of about 20 to 30 g of protein, below which, nitrogen balance becomes rapidly negative and one then has to increase considerably the protein intake to 80 or 90 g to restore nitrogen balance . 200 g of carbohydrate, then 20 to 30 g of amino-acid, provide a calory intake of 900, easily administrable by the parenteral route, without the danger of bacteremia with more hypertonic solutions in infected operated patients . Higher calory intakes are only indicated in multiple trauma and burns. Cancer, 1975 Dec, 36(6), 1950 - 8 High dose cyclophosphamide therapy in solid tumors . Therapeutic, toxic, and immunosuppressive effects; Mullins GM et al.; Cyclophosphamide (CY) in a total dose of 120 mg/kg was given over 2 days on one to three occasions to 12 patients with a variety of nonlymphoid solid tumors . Two of 10 patients with measurable disease had a partial response . One had embryonal rhabdomyosarcoma and the other had ovarian carcinoma . In the 20 treatment courses, the mean leukocyte count was less than 1,000/mm for 7 days . Thrombocytopenia was variable with a mean nadir of 87,000/mm on day 12 . There were four instances of local infection, one of bacteremia, and 11 of fever of undetermined origin . Weight gain of 2 or more kg occurred after 12, and EKG changes compatible with cardiotoxicity after six courses of CY . Serial skin testing with recall antigens revealed a frequent transient loss, and in three patients a later overall gain, in responsiveness . All patients were immunized with Vi antigen before CY, and with Vi and sheep red blood cells (SRBC) after CY . Specific immune tolerance to Vi, with a satisfactory response to SRBC, was found in six of 12 patients . Patients' responses to the lymphocytes of 2 ABO compatible normal subjects were measured in mixed lymphocyte culture (MLC) before and after CY . Patients were given 500 ml of whole blood from one of the subjects prior to CY . Following CY, the patients' responses to the blood donors' cells were not significantly lower than their responses to non-donor cells . Thus, tolerance to HL-A antigens was not demonstrable in MLC . Three patients had an increase from subnormal to normal reactivity to non-donor cells in MLC. JAMA, 1975 Nov 17, 234(7), 718 - 21 Hemoglobinopathy with prolonged bactermia . A report of two cases; Finley RA; Prolonged Escherichia coli bacteremia occurred as a complication of pyelonephritis in two patients with abnormal hemoglobins (SC and SS), despite "appropriate" antibiotic therapy . Careful investigation in each case failed to account for the persistent sepsis . Pyogenic arthritis ultimately developed in both patients. Am J Med Sci, 1975 Nov-Dec, 270(3), 427 - 40 Acute bacterial meningitis: an analysis of factors influencing prognosis; Hodges GR et al.; Three-hundred and forty-nine cases of acute bacterial meningitis treated during a 25-year period (1949 through 1973) were reviewed to determine the prognostic significance of initial historical, physical and laboratory findings . A poor prognosis was associated with age greater than or equal to 40 years (p less than 0.01), presence of predisposing illness (p less than 0.01), associated illness (p less than 0.01), absence of nuchal ridity (p less than 0.05), and derangement of cerebral function (p less than 0.01) . The effects of predisposing illness and moderate cerebral dysfunction were dependent upon age . In contrast, the effects of associated illness, mild or severe cerebral dysfunction, and absent nuchal rigidity were independent of age . Laboratory studies associated with a poor prognosis included an elevated cerebrospinal fluid (CSF) protein (p less than 0.05), a positive CSF smear (p less than 0.05), or culture (p less than 0.01), or bacteremia (p less than 0.01).No prognostic significance could be attributed to race (p greater than 0.05), sex (p greater than 0.05), prior antibiotic therapy (p greater than 0.05), duration of illness before institution of adequate therapy (p greater than 0.05), CSF leukocyte count (p greater than 0.05), frequency of polymorphonuclear leukocytes in CSF (p greater than 0.05), CSF sugar less than or equal to 40 mg/100 ml (p greater than 0.05), or a CSF sugar-simultaneous blood sugar ratio less than or equal to 0.40 (p greater than 0.05). Am J Dis Child, 1975 Nov, 129(11), 1283 - 4 Pneumococcal bacteremia associated with gingival lesions in infants; Burech DL et al.; Five infants with fever, leukocytosis, and a cystic lesion superimposed on a swollen gingiva had pneumococcal bacteremia . Lesions were so characteristic that a presumptive diagnosis of pneumococcal bacteremia was made in the last three patients before confirmation by blood cultures . Infants who initially have these symptoms should be considered at risk for pneumococcal bacteremia. Am J Clin Pathol, 1975 Nov, 64(5), 694 - 9 Rapid detection of bacteremia by an early subculture technic; Todd JK et al.; Routine blood cultures in a pediatric hospital were subcultured after 4 to 14 hours of incubation (average 8 hours) . Eighty-five per cent of all significant, positive blood cultures were detected within 24 hours of initial incubation . Contaminant organisms rarely grew on early subculture plates . Compared with the traditional 24-hour or 48-hour stain and subculture technics, the 4--14-hour (early) subculture method allows more rapid detection, identification, and sensitivity testing of most bacteria isolated from clinically significant positive blood cultures. Am J Med, 1975 Sep, 59(3), 424 - 6 Brucella canis . A cause of undulant fever; Blankenship RM et al.; Brucella canis, recognized in 1967 as a cause of canine abortion, is an uncommonly recognized human pathogen . Our patient, a 48 year old man, probably acquired his infection by contact with an infected dog . His clinical course was characterized by intermittent fever and bacteremia over a 4 month interval . His course, which expands the clinical spectrum of human infections due to Br . canis, is discussed in the context of the other reported instances of community and laboratory acquired cases. Gastroenterology, 1975 Jul, 69(1), 240 - 3 Hepatic portal vein gas without bowel infarction or necrosis; Tedesco FJ et al.; Spontaneously developing intrahepatic portal vein gas is usually associated with necrotic bowel, bacteremia, or both . Very few patients with this radiographic sign survive . A postoperative patient with severe abdominal pain and distention was found to have hepatic portal vein gas . At exploration two intraperitoneal abscesses were found and drained . The bowel was unremarkable . The patient had an uncomplicated postoperative course . Abscesses have not been associated with the development of intrahepatic portal vein gas . It is rare for this "diagnostic sign" not to be associated with necrotic bowel and a very bad prognosis. G Batteriol Virol Immunol, 1975 Jul-Dec, 68(7-12), 174 - 8 Endotoxemia detected by Limulus assay in severe malnourished children . Plasma effects on leucocyte migration: preliminary investigations; Jirillo E et al.; The Authors have examined 10 cases of severe malnourished children (7 cases of kwashiorkor, 2 cases of marasmus, 1 case of marasmic kwashiorkor) . Experiments were carried in order to detect endotoxemia by means of Limulus test, bacteremia with blood cultures and possible effects of plasma on leucocyte migration by Leucocytes Migration Agarose Test (LMAT) . The relationship between severe malnutrition, endotoxemia and leucocytes migration has been discussed. Obstet Gynecol, 1975 Jun, 45(6), 603 - 8 The fever index: A technic for evaluating the clinical response to bacteremia; Ledger WJ et al.; The fever index, quantitative measure of the total amount of fever in degree hours, was determined in obstetric-gynecologic patients with bacteremia . Comparison of the mean fever index between those women with hospital-or community-acquired infections, those patients monitored or not monitored during labor, or by grouping of single organisms recovered by culture revealed no significant differences . Bacteremia patients over the age of 40 had significantly more fever than those under the age of 40 . Patients with postpartum with postpartum bacteremia following cesarean section had a mean fever index significantly greater than women who had vaginal delivery . The implications of these findings are discussed. Clin Pediatr (Phila), 1975 Jun, 14(6), 562 - 5 Bacteremia in pediatric patients following dental manipulations; Faigel HC et al.; A recent study has claimed that children who do not have gingivitis do not have bacteremia following dental manipulations and that these children do not require antibiotic prophylaxis . Postoperative blood cultures from 53 children and adolescents with and without gingivitis drawn within ten minutes of elevation of the gums, extraction of teeth, and extensive gingivectomies were sterile in all cases . The collection and laboratory methods and media were carefully evaluated and found satisfactory . However, the time interval between the dental procedure and the collection of the blood is believed to have been too short for reliable results and that the abandonment of the antibiotic prophylaxis in children is unwarranted. J Pediatr Surg, 1975 Jun, 10(3), 367 - 73 Surgical management of infantile ulcerative enteritis; Miller RC; Infantile transmural ulcerative enteritis is a disorder of early infancy characterized by feeding difficulties, intermittent and progressive diarrhea, cachexia, anemia, abdominal distention, and small-bowel dilation which may progress to intestinal obstruction . The pathologic process, of unknown etiology, involves a transmural enteritis with deep undermining mucosal ulceration, not unlike that seen in Crohn's disease, except that granulomas are usually not present . The early stages of the diseases may be reversible if the bowel is simply placed at rest by use of intravenous nutrition . In the later stages of the illness, there is progressive mechanical and functional intestinal obstruction due to inflammatory constriction of the distal small bowel and lack of effective peristalsis through the inflammed segments . The terminal stages are characterized by marked abdominal distention, complete obstruction, septicemia, and death . It is during the period of abdominal distention due to progressive intestinal obstruction that surgical intervention is of benefit . A cutaneous enterostomy proximal to the involved segments of small intestine serves to decompress the bowel, to minimize bacteremia, and to allow the distal inflamed intestine to heal . Total intravenous nutrition is mandatory for a period of several weeks until there is healing of the distal small bowel and closure of the enterostomy . In all surviving infants, bowel function has returned to normal and there have been no long-term sequelae or recurrences. Am J Pathol, 1975 Jun, 79(3), 509 - 22 Lymphoid cell necrosis, thymic atrophy, and growth retardation in newborn mice inoculated with murine cytomegalovirus; Schwartz JN et al.; During studies on the effect of murine cytomegalovirus on the developing retina, virus was inoculated into the eyes of newborn Swiss mice, and the animals were sacrificed at various times thereafter . Controls consisted of mice inoculated with ultraviolet-inactivated murine cytomegalovirus and uninjected mice . Marked lymphoid cell necrosis, thymic atrophy, pronounced growth retardation, bacteremia, and death occurred in the animals inoculated with live virus . this virus-induced injury resulted in a marked depletion of lymphocytes in the subcapsular and cortical areas of the thymus as well as in the spleen, lymph nodes, and Peyer's patches . Areas of necrosis with viral inclusions were present at the site of inoculation and in various other organs including the spleen and bone marrow . Since growth retardation has been associated with thymic atrophy due to other causes, the observed abnormal physical development in the present study was interpreted as a sequel to the thymic injury . An implication of this study is that some human infants with concomitant immune deficiency and viral infection may have a primary viral disease with resultant secondary lymphoid tissue alterations, rather than a thymic disorder with a subsequent viral infection. J Pediatr, 1975 May, 86(5), 759 - 65 Risk of infection associated with umbilical vein catheterization . A prospective study in 75 newborn infants; Anagnostakis D et al.; To determine the risk of infection created by catheterization of the umbilical vein per se, 75 jaundiced, but otherwise healthy, newborn infants subjected to exchange transfusion were studied . Twenty-three were given antibiotics because of premature rupture of membranes . Fifty-three percent of the umbilici were contaminated before the insertion of the catheter, even after a very careful cleansing procedure . Sixty-two percent of the catheters were colonized upon removal . Bacteria were isolated from 44.9% of blood specimens drawn via the catheter at the onset of ET, but only in 14% of blood specimens drawn in the same way at the end of the procedure . Seven newborn infants (10%) were found to be bacteremic 4-6 after ET; four of these infants were not treated and were able to eliminate the bacteremia . Systemic antibiotic therapy did not reduce the overall prevalence of colonization of cord and catheter of positive blood cultures pre- and postexchanges transfusion or the rate of bacteremia. Am J Dis Child, 1975 May, 129(5), 590 - 2 Lumbar punctures and meningitis; Fischer GW et al.; Four patients, with an additional seven from the literature, had meningitis following a lumbar puncture (LP) that disclosed normal cerebrospinal fluid (CSF) . Animal studies demonstrate that perforation of the meninges in the presence of bacteremia enhances the development of meningitis . Simultaneous blood culture should be obtained with all LPs . Regardless of the results of the initial LP, a second CSF examination is recommended in any patient whose clinical condition is deteriorating . If the initial blood culture is positive, a second LP should be strongly considered in all newborn and very young infants. Cornell Vet, 1975 Apr, 65(2), 221 - 7 Duration of Brucella ovis infection in ewes; Muhammed SI et al.; Twenty Romney Marsh ewes, some 5 to 40 days pregnant, were inoculated with a strain of Brucella ovis onto the scarified mucous membrane of the vagina . Establish of infection was ascertained by recovery of the organisms from blood; supramammary and inguinal lymph nodes; the vagina, after initial disappearance of the organism from this organ; and the complement fixation tests . The bacteremia was transitory or intermittent, but organisms could not be recovered from blood, or any other tissue examined, after 98 days of infection . Abortions or placentitis were not observed . It is recommended that in countries where sheep breeding is aseasonal a sexual rest of infected ewes for at least 4 months must be part of any program for the control and eradication of ram epididymitis. J Rheumatol, 1975 Mar, 2(1), 83 - 90 Spectrum of gonococcal arthritis: evidence for sequential stages and clinical subgroups; Gelfand SG et al.; In a series of 84 patients with gonococcal (GC) arthritis, 41 were documented as follows: 17 had positive blood culture or typical skin rash (Hematogenous Group); four had positive joint culture plus hematogenous manifestations (Transition Group); and 20 had positive joint culture without positive blood culture or skin rash (Joint Localization Group) . The hematogenous group, especially patients with proved gonococcemia, presented significantly earlier after onset of symptoms than patients with joint localization alone, suggesting sequential stages of disease . Patients with verified bacteremia were significantly more toxic than those with rash or culture-proved joint infection alone . Nine of the joint localization patients had a monoarthritis with minimal systemic manifestations . The remaining 11 had a polyarthritis and were significantly more toxic . A concept of sequential stages and clinical subgroups of GC arthritis is proposed which may improve patient classification and differential diagnosis. J Rheumatol, 1975 Mar, 2(1), 7 - 13 Arthropathy, skin and bone lesions in pancreatic disease; Gibson TJ et al.; A patient with a history of alcoholism and pancreatic calcification, developed subcutaneous fat necrosis and an arthropathy, associated with a pancreatic pseudocyst and accompanied by an elevation of serum lipase and amylase . The illness was complicated by bacteremia and destructive bone lesions . A clinical distinction between osteomyelitis and medullary fat necrosis proved difficult . Infection of bone was demonstrated at one site but did not exclude medullary fat necrosis elsewhere. Folia Microbiol (Praha), 1975, 20(6), 513 - 6 Attempt to enhance resistance to infection in 6-mercaptopurine treated mice by lysozyme administration and immunization with Escherichia coli O86 antigen; Prixova J; Long-term immunosuppressive therapy of mice with 6-mercaptopurine (6-MP) for 2 and/or 3 weeks results in partial lethality, decrease of total leukocyte count, of serum lysozyme level and in bacteremia . The adverse effect of 6-MP treatment could not be prevented by lysozyme administration; immunization with Escherichia coli O86 antigen further increased the lethality of 6-MP in mice . The results stress the potential danger of immunization with bacterial antigens during immunosuppressive therapy. Obstet Gynecol, 1972 May, 39(5), 673 - 8 Fever and bacteremia associated with hypertonic saline abortion; Steinberg CR et al.; PIP: A retrospective analysis of 302 patients from July 1 to Dec . 15, 1970 and a prospective study of 43 patients from mid-Dec . 1970 to mid-Jan . 1971 who underwent hypertonic saline abortion at the New York Hospital-Cornell Medical Center showed that nearly 20% of the patients underwent a febrile episode . Only 6 of the 67 patients with fever had positive blood cultures . An additional 15 patients had positive vaginal, cervical, placental or uterine cultures . No obvious explanation for the fever was found in 57% of the febrile patients . The fever is usually associated with forceful uterine contractions though other subclinical entities may be responsible . Prophylactic antibiotics are not required .
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