Advertisement

Superinfection: Another look

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections.
      Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, should reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gold E
        Infections associated with immunologic deficiency diseases.
        Med Clin North Am. 1974; 58: 649-659
        • Feigin R.D.
        • Shearer W.T.
        Opportunistic infection in children.
        J Pediatr. 1975; 87: 507-514
        • Feigin R.D.
        • Shearer W.T.
        Opportunistic infection in children.
        J Pediatr. 1975; 87: 677-694
        • Feigin R.D.
        • Shearer W.T.
        Opportunistic infection in children.
        J Pediatr. 1975; 87: 852-866
        • Anderson R.J.
        • Schafer L.A.
        • Olin D.B.
        • Eickhoff T.C.
        Infectious risk factors in the immunosuppressed host.
        Am J Med. 1973; 54: 453-460
        • Williams D.M.
        • Krick J.A.
        • Remington J.S.
        Pulmonary infection in the compromised host.
        Am Rev Respir Dis. 1976; 114: 359-394
        • Davies S.F.
        • Khan M.
        • Sarosi G.A.
        Disseminated histoplasmosis in immunologically suppressed patients: occurrence in a non-endemic area.
        Am J Med. 1978; 64: 94-100
        • Seeliger H.P.R.
        Listeriosis.
        in: Hafner, New York1961: 122-123
        • Johnston R.B.
        Stroud RM: Complement and host defense against infection.
        J Pediatr. 1978; 90: 169-179
        • Brooks G.F.
        • Israel K.S.
        • Patersen B.H.
        Bactericidal and opsonic activity against Neisseria gonorrhoeae in sera from patients with disseminated gonococcal infection.
        J Infec Dis. 1976; 134: 450-462
        • Schoolnik G.K.
        • Buchanan T.M.
        • Holmes K.K.
        Gonococci causing disseminated gonococcal infection are resistant to the bactericidal action of normal human sera.
        J Clin Invest. 1976; 58: 1163-1173
        • Barrett-Connor E.
        Bacterial infection and sickle cell anemia.
        Medicine (Baltimore). 1971; 50: 97-112
        • Winklestein J.A.
        • Drachmann R.H.
        Deficiency of pneumococcal serum opsonizing activity in sickle cell disease.
        N Engt J Med. 1968; 279: 459-466
        • Johnston R.B.
        • Newman S.L.
        • Struth A.G.
        An abnormality of the alternate pathway of complement activation in sickle cell disease.
        N Engl J Med. 1973; 288: 803-808
        • Koethe S.M.
        • Casper T.J.
        • Rodey G.E.
        Alternative pathway activity in sera from patients with sickle cell disease.
        Clin Exp Immunol. 1976; 23: 56-60
        • Wilson W.A.
        • Thomas E.J.
        • Sissons J.G.P.
        Complement activation in asymptomatic patients with sickle cell anemia.
        Clin Exp Immunol. 1979; 36: 130-139
        • Haud W.L.
        • King N.L.
        Serum opsonization of Salmonella in sickle cell anemia.
        Am J Med. 1978; 64: 388-395
        • Brayton R.G.
        • Stokes P.E.
        • Schwartz M.S.
        Louria DB. Effect of alcohol and various diseases on leukocyte mobilization, phagocytosis, and intracellular bacterial killing.
        N Engl J Med. 1970; 282: 123-128
        • Moiwat A.G.
        • Baum J
        Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus.
        N Engl J Med. 1971; 284: 621-627
        • Bagdade J.D.
        • Nielson K
        • Rott R.K.
        • Bulger R.
        Host defense in diabetes mellitus: the feckless phagocyte during poor control and ketoacidosis.
        Diabetes. 1970; 19: 364
        • Bagdade J.D.
        Infection in diabetes: predisposing factors.
        Postgrad Med. 1976; 59: 160-164
        • Miller M.E.
        • Baker L
        Leukocyte function in juvenile diabetes mellitus: humoral and cellular aspects.
        J Pediatr. 1972; 81: 979-982
        • Bagdade J.D.
        • Root R.K.
        • Bulger R.J.
        Impaired leukocyte function in patients with poorly controlled diabetes.
        Diabetes. 1974; 23: 9-15
        • Lewis J.L.
        • Rabinovich S.
        The wide spectrum of cryptococcal infections.
        Am J Med. 1972; 53: 315-322
        • Wheat L.J.
        Infection and diabetes mellitus.
        Diabetic Care. 1980; 3: 187-197
        • Diamond R.D.
        • Krzesicki R.
        • Epstein B
        • Jao W
        Damage to hyphal forms of fungi by human leukocytes in vitro.
        Am J Pathol. 1978; 91: 313-323
        • Warshawksy A.B.
        • Keiller D
        • Gittes R.F.
        Bilateral renal aspergillosis.
        J Urol. 1975; 113: 8-11
        • Zaky D.A.
        • Bentley D.W.
        • Lowy K.
        • Betts R.F.
        • Douglas Jr, R.G.
        Malignant external otitis: A severe form of otitis in diabetic patients.
        Am J Med. 1976; 61: 298-302
        • Giuliano A
        • Lewis F
        • Hadley K
        • Blaisdel F.W.
        Bacteriology of necrotizing fasciitis.
        Am J Surg. 1977; 134: 52-56
        • Kauffman C.A.
        • Tan J.S.
        Torulopsis glabrata renal infection.
        Am J Med. 1974; 57: 217-224
        • Rabson A.R.
        • Hallett A.F.
        • Koornhof H.J.
        Generalized Yersinia enterocolitica infection.
        J Infect Dis. 1975; 131: 447-451
        • Merkow L
        • Pardo M
        • Epstein S.M.
        • Verney E
        • Sidransky H
        Lysosomal stability during phagocytosis of Aspergillus flavus spores by alveolar macrophages of cortisone-treated mice.
        Science. 1968; 160: 79-81
        • Butler W.T.
        • Alling D.W.
        • Spickard A
        • Utz J.P.
        Diagnostic and prognostic value of clinical and laboratory findings in cryptococcal meningitis: a followup study of 40 patients.
        N Engl J Med. 1964; 270: 59-67
        • Dickerman J.D.
        Bacterial infection and the asplenic host: a review.
        J Trauma. 1976; 16: 662-668
        • Eraklis A.J.
        • Kevy S.V.
        • Diamond L.K.
        • Gross R.K.
        Hazard of overwhelming infection after splenectomy in childhood.
        N Engl J Med. 1969; 276: 1225-1229
        • Gopal V
        • Bisuo A.L.
        Fulminant pneumococcal infections in normal asplenic hosts.
        Arch Intern Med. 1977; 137: 1526-1530
        • Winkelstein J.A.
        Splenectomy and infection.
        Arch Intern Med. 1977; 137: 1516-1517
        • Singer D.B.
        Postsplenectomy sepsis.
        in: Rosenberg H.S. Bolande R.P. Perspectives in pediatric pathology. Yearbook Medical, Chicago1973: 285
        • Horan M
        • Colebatch J.H.
        Relation between splenectomy and subsequent infection.
        Arch Dis Child. 1962; 37: 398-414
        • Erickson W.D.
        • Burgert Jr, E.O.
        • Lynn H.B.
        The hazard of infection following splenectomy in children.
        Am J Dis Chiild. 1968; 116: 1-12
        • Carlisle H.N.
        • Saslow S
        Properidin levels in splenectomized persons.
        in: 3rd ed. Proc Soc Exp Biol Med. 102. 1959: 150-154
        • Constantopoulos A
        • Najjar V.A.
        • Wish J.B.
        • Necheler T.H.
        • Stolbach L.L.
        Defective phagocytosis due to tuiftsin deficiency in splenectomized subjects.
        Am J Dis Child. 1973; 125: 663-665
        • Giannella R.A.
        • Broitman S.A.
        • Zamcheck N
        Influence of gastric acidity on bacterial and parasitic enteric infection.
        Ann Intern Med. 1973; 78: 271-276
        • Steiger Z
        • Nichel W.O.
        • Shannon G
        • Nedwicki E.G.
        • Higgins R.F.
        Pulmonary tuberculosis after gastric resection.
        Am J Surg. 1976; 131: 668-671
        • Bruce R.M.
        • Wise L
        Tuberculosis after jejunoileal bypass for obesity.
        Ann Intern Med. 1977; 87: 574-576
        • Collin J
        • Collin C
        • Constable F.L.
        • Johnston I.D.A.
        Infusion thrombophlebitis and infection with various cannulas.
        Lancet. 1975; II: 150-152
        • Buchholz D.H.
        • Young V.M.
        • Fridman N.R.
        • Reilly J.A.
        • Mardiney M.R.
        Bacterial proliferation in platelet products stored at room temperature: transfusion-induced Enterobacter sepsis.
        N Engl J Med. 1971; 285: 429-433
        • Rhame F.S.
        • Root R.K.
        • MacLowry J.D.
        • Dadisman T.A.
        • Bennett J.V.
        Salmonella septicemia from platelet transfusions: study of an outbreak traced to a hematogenous carrier of Salmonella choleraesuis.
        Ann Intern Med. 1973; 78: 633-641
        • Ryan J.A.
        • Abel R.M.
        • Abbott W.M.
        • et al.
        Catheter complications in total parenteral nutrition.
        N Engl J Med. 1974; 290: 757-761
        • Maki D.G.
        • Goldmnan D.A.
        • Rhame F.S.
        Infection control in intravenous therapy.
        Ann Intern Med. 1973; 79: 867-887
        • Ferguson R.L.
        • Rosett W
        • Hodges G.R.
        Complications with heparin lock needles: a prospective evaluation.
        Ann Intern Med. 1976; 85: 583-586
        • Stamm W.E.
        • Colella J.J.
        • Anderson R.L.
        • Dixon R.E.
        Indwelling arterial catheters as a source of nosocomial bacteremia: An outbreak caused by Flavobacterium species.
        N Engl J Med. 1975; 292: 1099-1102
        • Ralston A.J.
        • Harlow G.R.
        • Jones D.M.
        • Davis P.
        Infections of Scribner and Brescia arteriovenous shunts.
        Br Med J. 1971; 3: 408-409
        • Roxe D.M.
        • Argy Jr, W.P.
        • Frost B
        • Kerwin J
        • Schreiner G
        Complications of peritoneal dialysis.
        South Med J. 1976; 69: 584-587
      1. Morbid Mortal Weekly Rep. 1978; 27: 307-309
        • Horwitz M.A.
        • Bennett J.V.
        Nursery outbreak of peritonitis with pneumoperitoneum probably caused by thermometerinduced rectal perforation.
        Am J Epidemiol. 1976; 104: 632-644
        • Chmel H.
        • Armstrong D
        Salmonella Oslo: a focal outbreak.
        Am J Med. 1976; 60: 203-208
        • Schoenbaum S.C.
        • Gardner P
        • Schillito J
        • Shillito J
        Infections of cerebrospinal fluid shunts: epidemiology' clinical manifestations and therapy.
        J Infect Dis. 1975; 131: 543-552
        • Myers M.M.
        • Schoenbaum S.C.
        Shunt fluid aspiration: an adjunct in the diagnosis of cerebrospinal fluid shunt infections.
        Am J Dis Child. 1975; 129: 220-222
        • McBride M.E.
        • Duncan C
        • Bodey G.P.
        • McBride C.M.
        Microbial skin flora of selected cancer patients and hospital personnel.
        J Clin Microbiol. 1976; 3: 14-20
        • Anyanwu N.E.
        • Yacoub M
        Miliary tuberculosis following homograft valve replacement.
        Thorax. 1976; 31: 101-106
        • Louria D.B.
        • Kaminski T
        The effects of four antimicrobial drug regimens on sputum superinfection in hospitalized patients.
        Am Rev Resp Dis. 1962; 85: 649-665
        • Tillotson J.R.
        • Finland M
        Bacterial colonization and clinical superinfection of the respiratory tract complicating antibiotic treatment of pneumonia.
        J Infect Disc. 1969; 119: 597
        • Fass R.J.
        Treatment of mixed bacterial infections with clindamycin and gentamicin.
        J Infect Dis. 1977; 135: 574-579
        • Bartlett J.G.
        Antibiotic-associated colitis.
        Clin Gastroenterol. 1979; 8: 783-801
        • Louria D.B.
        • Fallon N
        • Browne H.G.
        The influence of cortisone on experimental fungus infection in mice.
        J Clin Invest. 1960; 39: 1435-1449
        • Berthrong M
        The macrophage tubercle bacillus relationship and resistance to tuberculosis.
        Ann NY Acad Sci. 1968; 154: 157-166
        • Armstrong D
        Infectious complications in cancer patients treated with chemical immunosuppressive agents.
        Transplant Proc. 1973; 5: 1245-1248
        • Igra-Siegman Y
        • Kapila R
        • Sen P
        • Kaminsky ZC
        • Louria DB
        Syndrome of hyperinfection with Strongyloides stercoralis: Report of two cases and review of 101 previously described cases.
        Rev Infect Dis. 1981; 3: 397-407
        • Shulman ST
        • Barlett J
        • Clyde WA
        • Ayoub EM
        The unusual severity of Mycoplasma pneumonia in children with sickle cell disease.
        N Engl J Med. 1972; 287: 164-167
        • Foy HM
        • Ochs H
        • Davis SD
        • Kenny GE
        • Knu RR
        Infections in patients with immunodeficiency syndrome: report of 4 cases.
        J Infect Dis. 1977; 127: 388-393
        • Solanki DL
        • Berdoff RL
        Severe Mycoplasma pneumonia with pleural effusions in a patient with sickle cell hemoglobin C (SC) disease.
        Am J Med. 1979; 66: 707-710
        • Onal E
        • Lopata M
        • Lourenco RV
        Disseminated pulmonary blastomycosis in an immunosuppressed patient.
        Am Rev Resp Dis. 1976; 113: 83-86
        • Deresinski SC
        • Stevens DA
        Coccidioidomycosis in compromised hosts.
        Medicine (Baltimore). 1974; 54: 377-395
        • Kauffman CA
        • Israel KS
        • Smith JW
        • White AC
        • Schwarz J
        • Brooks GF
        Histoplasmosis in immunosuppressed patients.
        Am J Med. 1978; 64: 923-932
        • Baker EJ
        • Hawkins JA
        • Waskow EA
        Surgery for coccidioidomycosis in 52 diabetic patients with special reference to related immunologic factors.
        J Thorac Cardiovasc Surg. 1978; 75: 680-687
        • Goodwin Jr, RA
        • Shapiro JL
        • Thurman GH
        • Thurman SS
        • Des-Prez RM
        Disseminated histoplasmosis: Clinical and pathological correlations.
        Medicine (Baltimore). 1980; 59: 1-33
        • Raskin J
        • Remington JS
        Toxoplasmosis in the compromised host.
        Ann Intern Med. 1976; 84: 193-199
        • Burke BA
        • Good RA
        Pneumocystis carinii infection.
        Medicine (Baltimore). 1973; 52: 23-51
        • Singer C
        • Armstrong D
        • Rosen PP
        Pneumocystis carinii pneumonia: a cluster of 11 cases.
        Ann Intern Med. 1975; 82: 72
        • Ruebush TK
        • Cassady PB
        • Marsh HJ
        • et al.
        Human babesiosis on Nahtucket Island' clinical features.
        Ann Intern Med. 1977; 86: 6-9
        • Tapper ML
        • Armstrong D
        Malaria complicating neoplastic disease.
        Arch Intern Med. 1976; 136: 807-810
        • Louria DB
        • Blumenfeld HL
        • Ellis JT
        • Kilbourne ED
        • Rogers DE
        Studies on influenza in the pandemic of 1957–1958. II. Pulmonary complications of influenza.
        J Clin Invest. 1959; 38: 213-265
        • Mackowiak PA
        • Jones SR
        • Martin RM
        • Smith JW
        Oropharyngeal colonization of chronic alcoholics by gram-negative bacilli and other potential pathogens (abstr).
        Clin Res. 1976; 24: 349A
        • Tillotson JR
        • Lerner AM
        Characteristics of pneumonias caused by Escherichia coli.
        N Engl J Med. 1967; 227: 115-122
        • Rudin ML
        • Michael JR
        • Huxley EJ
        Community acquired Acinetobacter pneumonia.
        Am J Med. 1979; 67: 39-43
        • Lomax CW
        • Harbert Jr, GM
        • Thornton Jr, WN
        Actinomycosis of the female genital track.
        Obstet Gynecol. 1976; 48: 341-346
        • Gottlieb MS
        • Schroff R
        • Schanker HM
        • et al.
        Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency.
        N Engl J Med. 1981; 305: 1425-1431
        • Masur H
        • Michelis MA
        • Greene JB
        • et al.
        An outbreak of community-acquired Pneumocystis carinii pneumonia' initial manifestation of cellular immune dysfunction.
        N Engl J Med. 1981; 305: 1431-1438
        • Siegal FP
        • Lopez C
        • Hammer GS
        • et al.
        Severe acquired immunodeficiency in male homosexuals' manifested by chronic perianal ulcerative herpes simplex lesions.
        N Engl J Med. 1981; 305: 1439-1444
      2. Lancet. 1981; II (Editorial:): 1325-1326
        • Goldstein E
        • Lippert W
        • Warshauer D
        Pulmonary alveolar macrophage Defender against bacterial infection of the lung.
        J Clin Invest. 1974; 54: 519-528
        • Scrimshaw NS
        • Guzman MA
        • Flores M
        • Gordon JE
        Nutrition and infection: field study in Guatemalan villages.
        Arch Environ Health. 1968; 16: 233-234
        • Sander LA
        • Young EJ
        • Musher DM
        • Clarridge JE
        Torulopsis glabrata pneumonia in a malnourished woman.
        South Med J. 1979; 72: 1477-1479