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Abstracts of papers in this issue
Acute histoplasmosfs
Gram-positive
cocci
Necplastic
disease
Cancer
Netilmicin
Ticarcillin Infection
Gentamicin
Continued
A randomized trial of ticarcillin plus gentamicin (group l), ticarcillin plus amikacin (group 2) and ticarcillin plus netilmicin (group 3) as empiric antibiotic therapy in patients with granule cytopenia and cancer was performad at the Baltimore Cancer Research Center. The response rate for all infections was 97 per cent in group 1.9 1 per cent in group 2 and 95 per cent in group 3. Patients with bacteremias showed improvement in 93 per cent (group 1). 78 per cent (group 2) and 82 per cent (group 3) of the cases. All failures were among patients with gram-negative ~cksnsrnias. Both antibiotic susceptibitii of the bacteremic organism and mulocyte recovery correlated with patient improvement. Nephrotoxicity and ototoxicity were rare and were not significantly different in the three groups. Therefore, ticarcillin plus gentamicin. ticarcillin plus arntkacin and ticarcillin plus netilmicln appear to be equally efficacious and minimally toxic in this patient population. Excellent over-all results can be expected with these combinations provided the etiologic agent is susceptible.
Love W, Schimpft SC, Hahn DM, Young VM. Standiford HC, Bender JF. Fortner CL, Wiernik PH: Randomized Trial of Empiric Antibiotic Therapy with Ticarcillin in combination with gentamicin, amikacin or netilmicin in febrile patients with granulocytopenia and cancer. Am J Med 66: 603-610. 1979.
Amikacln
Granulocytopenia
disease with fever, malaise and cough, chest pain, or weight loss (Xi pounds), which developed subsequent to the activities. Chest roentgenograms revealed abnormalities in 67 per cent of those with acute pulmonary disease. Illness began an average of 14 days after exposure, and three subjects required hospiilizetlon. The diseese developed in two dogs that ware also present at the activities.
lmmunodeflciency
Bone marrow transplantation Slcca syndrome
Scleroderma
on page A63
In six long-term survivors of allogeneic bone marrow transplantation chronic graft-versushost disease (GVHD), characterized by scleroderma-like skin Involvement, developed. Sicca syndrome, limitation of joint movement and interstitial pneumonitis occurred in a majority of patients. Infectious complications, especially DNA viral infections, were frequent. A spectrum of immune abnormalbii was observed, including hypergernmagtobulinemia, circulating immune complexes, lympbocytotoxic antibodies and autoantibodii to autolosous end donor lymphocytes. In one patient, a skin graft from the marrow donor remained healthy despite progressive involvernent in recipient skin, whereas unrelated skin grafts were rejected normally. Chronic GVFUI appears to be a syndrome of disordered immune regulation with prominent features of immunodeficiency and autoimmunity.
Graze PR, Gale RP: Chronic graft versus host disease: a syndrome of disordered immunity. Am J Med 66: 61 l-620, 1979.
Autoimmunity
Graft versus host disease
Fifty-seven bacteremias occurring over four and a half years in patients with a wide variety of malignancies were due to Streptococcus pneurnoniae (14 cases), other streptococci (17 cases), and S~@Y~~C~CCUS aureus (26 cases). There was an identifiable mucocutaneous portal of entry in 95 per Cent, fever in 81 per Cent and granulocytopenia in 18 per cent of the cases at onset. Poor OutCOffte was assoqiated with a prebacteremic performance status of 3 or 4 other than optima) antimicrobial therapy, granulocytopenia at onset and infection due to S. pneumoniae. Over-all immediate mortality was 23 per cent, and an additional 39 per cent of patients died from other causes within one month of the bacteremia.
Bacteremia
An outbreak of acute histoplasmosis occurred among 42 people who gathered for two days in May 1977 to cut and clear a fallen oak tree near Nashville, Tennessee. lmmunodiffusion and complement fixation antibodies to the yeast and myceltal antigens of Histoplasma capsulatum were measured in serum from the participants and communtty controls. Thirty-two (76 per cent) of the participants had serologic evidence of infection. Twenty (48 per cent) bad acute pulmonary
Chest pain
Kilton LJ, Fossieck BE Jr., Cohen MH, Parker RH: Bacteremia due to gram-positive cocci in patients with neoplastic disease. Am J Med 66: 595-601, 1979.
Epldemlology lmmunodlffusion tests
Serologic findings
Ward JI, Weeks M. Alien D, Hutcheson RH Jr., Anderson R, Fraser DW, Kaufman L, Ajello L, Spickard A: Acute histoplasmosis: clinical, epidemiologic and serologic findings of an outbreak associated with exposure to a fallen tree. Am J Med 66: 567-595, 1979.
Complement fixation tests
Gram-positive
cocci
Necplastic
disease
Cancer
Netilmicin
Ticarcillin Infection
Gentamicin
Continued
A randomized trial of ticarcillin plus gentamicin (group l), ticarcillin plus amikacin (group 2) and ticarcillin plus netilmicin (group 3) as empiric antibiotic therapy in patients with granule cytopenia and cancer was performad at the Baltimore Cancer Research Center. The response rate for all infections was 97 per cent in group 1.9 1 per cent in group 2 and 95 per cent in group 3. Patients with bacteremias showed improvement in 93 per cent (group 1). 78 per cent (group 2) and 82 per cent (group 3) of the cases. All failures were among patients with gram-negative ~cksnsrnias. Both antibiotic susceptibitii of the bacteremic organism and mulocyte recovery correlated with patient improvement. Nephrotoxicity and ototoxicity were rare and were not significantly different in the three groups. Therefore, ticarcillin plus gentamicin. ticarcillin plus arntkacin and ticarcillin plus netilmicln appear to be equally efficacious and minimally toxic in this patient population. Excellent over-all results can be expected with these combinations provided the etiologic agent is susceptible.
Love W, Schimpft SC, Hahn DM, Young VM. Standiford HC, Bender JF. Fortner CL, Wiernik PH: Randomized Trial of Empiric Antibiotic Therapy with Ticarcillin in combination with gentamicin, amikacin or netilmicin in febrile patients with granulocytopenia and cancer. Am J Med 66: 603-610. 1979.
Amikacln
Granulocytopenia
disease with fever, malaise and cough, chest pain, or weight loss (Xi pounds), which developed subsequent to the activities. Chest roentgenograms revealed abnormalities in 67 per cent of those with acute pulmonary disease. Illness began an average of 14 days after exposure, and three subjects required hospiilizetlon. The diseese developed in two dogs that ware also present at the activities.
lmmunodeflciency
Bone marrow transplantation Slcca syndrome
Scleroderma
on page A63
In six long-term survivors of allogeneic bone marrow transplantation chronic graft-versushost disease (GVHD), characterized by scleroderma-like skin Involvement, developed. Sicca syndrome, limitation of joint movement and interstitial pneumonitis occurred in a majority of patients. Infectious complications, especially DNA viral infections, were frequent. A spectrum of immune abnormalbii was observed, including hypergernmagtobulinemia, circulating immune complexes, lympbocytotoxic antibodies and autoantibodii to autolosous end donor lymphocytes. In one patient, a skin graft from the marrow donor remained healthy despite progressive involvernent in recipient skin, whereas unrelated skin grafts were rejected normally. Chronic GVFUI appears to be a syndrome of disordered immune regulation with prominent features of immunodeficiency and autoimmunity.
Graze PR, Gale RP: Chronic graft versus host disease: a syndrome of disordered immunity. Am J Med 66: 61 l-620, 1979.
Autoimmunity
Graft versus host disease
Fifty-seven bacteremias occurring over four and a half years in patients with a wide variety of malignancies were due to Streptococcus pneurnoniae (14 cases), other streptococci (17 cases), and S~@Y~~C~CCUS aureus (26 cases). There was an identifiable mucocutaneous portal of entry in 95 per Cent, fever in 81 per Cent and granulocytopenia in 18 per cent of the cases at onset. Poor OutCOffte was assoqiated with a prebacteremic performance status of 3 or 4 other than optima) antimicrobial therapy, granulocytopenia at onset and infection due to S. pneumoniae. Over-all immediate mortality was 23 per cent, and an additional 39 per cent of patients died from other causes within one month of the bacteremia.
Bacteremia
An outbreak of acute histoplasmosis occurred among 42 people who gathered for two days in May 1977 to cut and clear a fallen oak tree near Nashville, Tennessee. lmmunodiffusion and complement fixation antibodies to the yeast and myceltal antigens of Histoplasma capsulatum were measured in serum from the participants and communtty controls. Thirty-two (76 per cent) of the participants had serologic evidence of infection. Twenty (48 per cent) bad acute pulmonary
Chest pain
Kilton LJ, Fossieck BE Jr., Cohen MH, Parker RH: Bacteremia due to gram-positive cocci in patients with neoplastic disease. Am J Med 66: 595-601, 1979.
Epldemlology lmmunodlffusion tests
Serologic findings
Ward JI, Weeks M. Alien D, Hutcheson RH Jr., Anderson R, Fraser DW, Kaufman L, Ajello L, Spickard A: Acute histoplasmosis: clinical, epidemiologic and serologic findings of an outbreak associated with exposure to a fallen tree. Am J Med 66: 567-595, 1979.
Complement fixation tests