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Fever in parenteral drug user [keywords]
- [Fever and suppurative lymphadenitis in a parenteral drug user infected with the human immunodeficiency virus]. [Case Reports, Journal Article]
- Enferm Infecc Microbiol Clin 2001 Dec; 19(10):495-6.
- Management of pyelonephritis and upper urinary tract infections. [Journal Article, Research Support, U.S. Gov't, P.H.S., Review]
- Urol Clin North Am 1999 Nov; 26(4):753-63.
The most frequent cause of upper urinary tract infection remains E. coli. Other organisms are found in complicated infections associated with diabetes mellitus, instrumentation, stone, and immunosuppression. The pathogenesis of acute pyelonephritis is reviewed herein, with an emphasis on the virulence factors responsible for its initiation, including urothelial adhesion by P-fimbriae of E. coli and other common factors including hemolysin and aerobactin. Renal damage does not always ensue following such infection. It is seen when toxic oxygen radicals are released during the ischemic episode and the respiratory burst of phagocytosis is marked and prolonged. These events occur when effective antibacterial treatment is delayed when the diagnosis is not made early or when socioeconomic factors prevent treatment. The scarring of chronic pyelonephritis leads to the loss of renal tissue and function and may progress to end-stage renal disease. With effective antibacterial therapy, the immune response by both T and B lymphocytes leads to antibodies that assist in bacterial eradication. Therapy must be both rapid and effective. In many instances, antibacterial agents may be used as outpatient therapy. If the Gram stain shows only gram-negative organisms and if the infection is community acquired, oral outpatient therapy with trimethoprim/sulfamethoxazole or a fluoroquinolone may suffice if the patient has no nausea. When the patient is septic, hospitalization and treatment with parenteral antibiotics are needed. Both ceftriaxone and gentamycin are cost-effective parenteral therapy because only once-daily dosing is needed. If gram-positive organisms are found, an enterococcus should be suspected, and a beta-lactam penicillin such as piperacillin or a third-generation cephalosporin such as ceftriaxone is indicated. If penicillin allergy exists, vancomycin should be used. If the patient does not improve rapidly, diagnostic studies including ultrasound and CT will assist in the diagnosis of obstruction, abscess, or emphysematous pyelonephritis. Most of these complications are now rapidly treated percutaneously, with surgical therapy following as needed. Complicated infections, such as those occurring in patients with anatomic abnormalities, stone, or immunosuppression, are often caused by organisms other than E. coli, and long-term antibacterial therapy often leads to fungal infections such as candidiasis. A recrudescence of tuberculosis is occurring, often with resistance to antituberculous drugs. The increased incidence has been associated with the immunosuppression of AIDS but is also occurring in intravenous drug users, perhaps because of poor nutrition but also owing to noncompliance with treatment. The symptoms of renal tuberculosis are usually limited to fever, frequency, urgency, and dysuria. Hematuria with sterile pyuria is the usual laboratory finding. The young urologist should remember this renal disease in the differential diagnosis of hematuria, because medical therapy can provide a cure.
- Prevalence of GBV-C/hepatitis G virus RNA and E2 antibody among subjects infected with human immunodeficiency virus type 1 after parenteral or sexual exposure. [Journal Article]
- J Med Virol 1999 Aug; 58(4):373-7.
GB virus C (GBV-C) or hepatitis G virus (HGV) is transmitted by the parenteral route but the importance of sexual transmission needs to be ascertained. GBV-C/HGV infections were investigated using RNA and E2-antibody detection methods in 80 subjects infected by the human immunodeficiency virus type 1 (HIV-1) divided into 4 groups of 20 individuals each according to their main risk factor for HIV-1 infection: blood product recipients (group 1), intravenous drug users (group 2), homosexuals (group 3), or heterosexual exposure (group 4). The overall prevalence of GBV-C/HGV infection was 66.3%. No significant difference was observed in GBV-C/ HGV prevalence among the four groups: 75, 75, 55, and 60% in groups 1, 2, 3, and 4, respectively. Hepatitis C virus (HCV) antibodies, used as a control for parenteral exposure, were found in 70% and 90% of the subjects in groups 1 and 2 versus only 15% and 20% of the subjects in groups 3 and 4, respectively (P< .001). Similarly, coinfections with GBV-C/HGV and HCV were significantly associated with the parenteral route (P <.001). These data emphasized the usefulness of combining the detection of RNA and the E2 antibody to determine the actual prevalence of GBV-C/HGV infection. The high prevalence of the GBV-C/HGV markers among the HIV-1-infected subjects, especially those with sexual exposure, provides additional evidence that this route of transmission plays a key role in the epidemiology of GBV-C/HGV. The potential influence of GBV-C/HGV infection on the course of HIV-1 disease needs further evaluation.
- The febrile parenteral drug user: a prospective study in 121 patients. [Comparative Study, Journal Article]
- Am J Med 1993 Mar; 94(3):274-80.
To determine the most efficient approach to the diagnosis of infective endocarditis (IE) in febrile parenteral drug users (PDUs) and evaluate possible effects of human immunodeficiency virus (HIV) infections or acquired immunodeficiency syndrome (AIDS) on susceptibility to IE and final outcome.A prospective study of appropriate patients admitted on 149 random sampling days during a 14-month period and review of past experience with IE, HIV, and AIDS admissions to hospital.An urban university hospital.Prospectively, 121 febrile PDUs plus an additional 16 found to have IE on nonsampling days during the study period. Retrospectively, all PDUs with IE from 1985 to 1991 and all patients with HIV infections with or without AIDS from July 1990 through December 1991.Physical examination, hemograms, urinalysis, blood cultures (plus other body fluids when indicated), echocardiography, laboratory testing for HIV status.Five categories of patients were identified: I. Infective endocarditis (n = 16); II. Other infections with bacteremia (n = 21); III. Bacteremia with unidentified source of infection (n = 14); IV. Infections without bacteremia (n = 52); V. Fever of unknown origin (n = 18). Physical findings and standard laboratory testing did not differentiate Group I from any of the other diagnostic categories. Adding additional IE cases from nonstudy days brought the total to 32. Vegetations were found on echocardiography in 94%; blood cultures, available in 30 of 32 instances, were all positive. HIV or AIDS status was not found to alter susceptibility to IE or influence mortality. While hospital admissions for HIV and especially AIDS have continued to increase among PDUs, the number of cases of IE has decreased since 1988 to 1989.Based on the high incidence of blood culture positivity and the sensitivity of echocardiography in detecting vegetations in IE, a simple algorithm has been developed for the initial diagnostic management of febrile PDUs admitted with the possible diagnosis of IE. HIV infection, with or without full-blown AIDS, does not appear to affect the incidence or outcome of IE among these patients. Current practices among PDUs may be effecting a decline in IE but not HIV infections.
- Vertebral osteomyelitis in intravenous drug abusers: report of three cases and review of the literature. [Case Reports, Journal Article, Review]
- Rev Infect Dis 1980 Mar-Apr; 2(2):196-206.
Three cases of vertebral osteomyelitis in intravenous drug abusers are described, and 64 cases in the literature are reviewed. The patients were almost exclusively heroin users from the United States, were predominantly male, and were frequently of black or Hispanic ethnic background. Symptoms were present for less than threemonths in 81% of patients. On admission to the hospital, fever was seen in 42%, transient neurologic deficits in 15%, elevated erythrocyte sedimentation rate in 91%, and leukocytosis in 35%. Twenty-two percent of patients with initially normal X rays had spinal abnormalities detected by tomography and technetium bone scan. A strikingly high incidence (27%) of cervical spine involvement was found. Gram-negative aerobic bacilli accounted for 82% of infections, and Pseudomonas species comprised 66% of the total. Ninety-two percent of the patients responded to parenteral antibiotic therapy administered for four weeks or longer. Patients experiencing relapses responded to a second course of therapy. The prognosis for intravenous drug abusers with vertebral osteomyelitis appeared to be good with appropriate therapy, and no deaths or permanent neurologic sequelae were seen.
- Rheumatoid factor in acute bacterial endocarditis. [Journal Article, Research Support, U.S. Gov't, P.H.S.]
- Arthritis Rheum 1976 Sep-Oct; 19(5):887-90.
Sera from 55 parenteral drug abusers with endocarditis due to Staphylococcus aureus were assayed for the presence and titer of rheumatoid factor. Thirteen (24%) of the 55 patients with endocarditis had sera positive for rheumatoid factor at one point or another in their courses; only 2 (7%) of 30 noninfected drug users were found to be positive. It appeared that more severe cases, as evidenced by duration of fever after initiation of antibiotic therapy, were more likely to develop rheumatoid factor.