A 64-year-old female with diffuse coronary artery disease underwent open heart surgery for coronary artery bypass grafts. She had an unstable postoperative course; she had cardiac rhythm disturbances, blood gas derangement, and required a tracheostomy for ventilation. Fourteen days postoperatively she seemed to improve and was permitted out of bed. That evening, however, she developed respiratory distress and her color became poor. Initial tracheal suctioning failed to effect improvement; additional suctioning was carried out. Within minutes, she had a cardiopulmonary arrest. Resuscitation was instituted. After one-half hour of external massage, and I.V. bicarbonate and epinephrine, the electrocardiogram indicated that her asystole had reverted to a slow idioventricular
Human granulocytic ehrlichiosis (HGE), a potentially fatal tick-borne disease, was first described in the upper Midwest in 1994. Following reports of suspected cases of ehrlichiosis from New York physicians, descriptive and case-control studies were conducted to characterize the epidemiology and risk factors for HGE in New York residents.
Methods
Descriptive data were gathered from surveillance and laboratory reports and hospital records. A confirmed case was defined as either (1) a 4-fold change in total antibody titer toEhrlichia equiby indirect immunofluorescence or (2) a polymerase chain reaction assay positive forEhrlichia phagocytophila/E equigroup DNA. A probable case was defined as an acute febrile illness and either (1) a singleE equititer greater than or equal to 80 or (2) morulae on a peripheral blood smear. The case-control study included patients with confirmed HGE 18 years of age or older with the onset of disease in 1995 and 2 to 3 neighborhood-matched controls.
Results
During 1994 and 1995, the New York State Department of Health, Albany, received reports of 241 residents who were tested for HGE; 30 met the confirmed case definition and 34 met the probable case definition. The median age of patients was 46 years (age range, 9-90 years), 35 (55%) were male, and 25 (45%) were hospitalized. Fever, headache, malaise, and myalgia were the most frequently reported symptoms. Fifty-six (88%) of the 64 patients resided in areas in which Lyme disease is hyperendemic. In the case-control analysis, cases were more likely than controls to have sustained a tick bite during 1995 (matched odds ratio, 5.0; 95% confidence interval, 0.9-49.8). Cases and controls did not differ by occupational exposure to ticks, underlying chronic diseases, or measures taken to prevent tick bites.
Conclusions
This study, which, to our knowledge, is the first population-based study of HGE, demonstrates the recent recognition of HGE in the state of New York. Control measures should be integrated with those for Lyme disease and should focus on minimizing contact with ticks and obtaining early treatment for infection.
Letters and Corrections1 June 1985Trimethoprim-Sulfamethoxazole in Listeria monocytogenes MeningitisGERMAINE JACQUETTE, M.D., PENELOPE H. DENNEHY, M.D.GERMAINE JACQUETTE, M.D.Search for more papers by this author, PENELOPE H. DENNEHY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-102-6-866_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In their review of the use of trimethoprim-sulfamethoxazole in the treatment of bacterial meningitis, Levitz and Quintiliani (1) conclude that it may play a major role in treatment of resistant gram-negative and Staphylococcus aureus meningitides. They also cite two reports of successful use of the drug in Listeria monocytogenes meningitis. We report our experience and note additional cases in the literature indicating that trimethoprim-sulfamethoxazole should be considered in the treatment of Listeria meningitis in appropriate situations.A 73-year-old man with a history of resected renal cell Carcinoma, prostatectomy, recurrent urinary tract infections, and mild renal insufficiency was...References1. LEVITZQUINTILIANI RR. Trimethoprim-sulfamethoxazole for bacterial meningitis. Ann Intern Med. 1984;100:881-90. LinkGoogle Scholar2. IWARSONLIDIN-JAMSONSVENSSON SGR. Listeria meningitis in the non-compromised host. Infection. 1977;5:204-6. CrossrefMedlineGoogle Scholar3. SCHEERHIRSCHMAN MS. Oral and ambulatory therapy of Listeria bacteremia and meningitis with trimethoprim-sulfamethoxazole. Mt Sinai Med J. 1982;49:411-4. MedlineGoogle Scholar4. LARSSONCRONBERGWINBLAD SSS. Clinical aspects of 64 cases of juvenile and adult listeriosis in Sweden. Acta Med Scand. 1978;204:503-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByListeria Rhomboencephalitis in an Immunocompetent HostListeria monocytogenes encephalitis mimicking west nile encephalitisAcute Bacterial Meningitis in Adults: A 12-Year ReviewCentral Nervous System Infection with Listeria monocytogenes : 33 Yearsʼ Experience at a General Hospital and Review of 776 Episodes from the LiteratureMeningites bacteriennes non tuberculeuses du sujet age de plus de 60 ansCentral Nervous System Infections in the Compromised HostTraitement des méningo-encéphalites à Listeria monocytogenes de l'adulte par le cotrimoxazole en monothérapie 1 June 1985Volume 102, Issue 6Page: 866-867KeywordsBacterial meningitisDrugsMeningitisProstatectomyRenal cell carcinomaStaphylococcus aureus Issue Published: 1 June 1985 PDF DownloadLoading ...
