A new Ehrlichia strain, designated as Ehrlichia chaffeensis, Sapulpa strain, was isolated from a patient from Oklahoma with severe ehrlichiosis. Isolation of the ehrlichial pathogen was achieved by inoculating patient blood onto HEL cells and DH82 cells. Antigenic properties of the new isolate were characterized with monoclonal antibodies, homologous patient serum, and polyclonal rabbit serum by Western immunoblotting. The results showed antigenic differences and protein size variation of Sapulpa strain compared with the other 2 strains of E. chaffeensis. Sequencing of the 16S rRNA gene showed 100% identity to that of E. chaffeensis, strain 91HE17. Polymerase chain reaction and sequencing of DNA homologous to the 120-kDa protein gene of E. chaffeensis, Arkansas strain, showed that this gene of Sapulpa strain was smaller than that of Arkansas strain and contained a repeat region with three tandem repeat units.
Intermittent intravenous cyclophosphamide therapy has been shown to be effective in the management of lupus nephritis. There have been no reports of malignancies associated with such treatment regimens. We describe a patient who developed acute nonlymphocytic leukemia after receiving a total dose of 4 gm of cyclophosphamide over a 1-year period.A variety of therapeutic regimens designed to control or halt the progression of lupus nephritis have been studied over the last 2 decades. The results have often been difficult to interpret because of the small numbers of patients studied under some protocols and because of the inclusion of heterogenous histologic groups. In 1986, Austin and associates at the National Institutes of Health (1) reported the results of longterm, randomized, therapeutic trials involving 107 patients with active lupus nephritis. Their findings showed that renal function was better preserved in patients whose treatment regimen had included cytotoxic drugs than in patients treated with oral prednisone alone. Statistical analysis of their data demonstrated a significant difference only for the drug regimen that combined intravenous cyclophosphamide with low-dose prednisone. Of great importance was the absence of hemorrhagic cystitis and cancer, and the fact that there was not a disproportionate number of major infections in the patients (1). Recently, we used the cyclophosphamide and prednisone protocol, as outlined by Austin et al (l), to treat a patient with progressive lupus nephritis. After 1 year on this regimen, she developed acute nonlymphocytic leukemia.Case report. The patient, a 67-year-old woman, was seen at our institution in December 1979. She had symmetric polyarthritis involving her hands, feet, and ankles. Aspirin treatment produced no benefit. Her hematocrit value was 29%, and she had a white blood cell (WBC) count of 3,300/mm3. A urinalysis showed 2 + protein, 30 red blood cells (RBC) per high power field (HPF), 5-10 granular casts per HPF, and a rare RBC cast. The serum creatinine level was 2.7 mg/dl, and the blood urea nitrogen value was 39 mg/dl. Antinuclear antibody was present at a titer of 1:320, with a speckled pattern.A percutaneous renal biopsy was subsequently performed, and it revealed focal proliferative and sclerosing glomerulonephritis. A diagnosis of systemic lupus erythematosus was made, and over the ensuing 7 years, she was maintained on a regimen of nonsteroidal antiinflammatory agents and varying doses of oral prednisone daily. Her arthritis and cytopenias improved, and her renal function remained stable.In August 1986, the patient's serum creatinine level abruptly rose to 4.6 mg/dl, and the Westergren erythrocyte sedimentation rate increased to 100 mm/ hour. Urinalysis showed numerous RBCs, many granular casts, and 3+ protein. Creatinine clearance was 31 mllminute, and 24-hour protein excretion was 2.5 gm. Percutaneous renal biopsy at that time demonstrated a range of changes, from a membranouspattern glomerulonephritis to complete glomerulosclerosis. Predni...
Josamycin, a new macrolide antibiotic, was compared with ampicillin, erythromycin, and clindamycin in vitro against 25 isolates each of pneumococci, enterococci, Staphylococcus aureus, S. epidermidis, and nonenterococcal hemolytic streptococci and against 25 anaerobes including 10 Bacteroides fragilis. Minimal inhibitory concentration and minimal bactericidal concentration data were obtained for the aerobic organisms, using serial twofold tube dilutions in Mueller-Hinton broth. Minimal inhibitory concentrations were determined for the anaerobes by the agar dilution technique. Josamycin was comparable to erythromycin and clindamycin in activity against the pneumococci, streptococci, and staphylococci and was more active than clindamycin against enterococci. It was somewhat less active than ampicillin against enterococci and S. epidermidis and showed its greatest in vitro activity against anaerobes, being comparable to clindamycin.
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